Chapter 16 General Principles of Managing MSDs Flashcards Preview

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Flashcards in Chapter 16 General Principles of Managing MSDs Deck (17)
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Communication vs. Speech

Focus on overall communication rather than just speech, i.e. gestures, AAC when patients cannot regain 100% of their normal speech


Management Goals (3)

>Restore lost function
>Promote use of residual function
>Reduce need for lost function


Management Goals: Restore lost function

Dependent on the type and severity of MSD
i.e. degenerative diseases will not be able to restore lost function whereas UUMN probably can


Management Goals: Promote use of residual function

Learn to compensate by using:
>prosthetic devices
>pacing strategies
>Modifying physical environment


Management Goals: Reduce need for lost function

Must adjust to the reality of the lost function
>Change of occupation and other roles that depend on speech


Factors influencing management (6)

>Medical Dx and prognosis
>Disability and societal limitations
>Environmental and communication disorders
>Motivation and needs
>Associated problems
>Health care system


Factors influencing management: Medical Dx and prognosis

>Will the disease get worse?
>Can patient make progress?


Factors influencing management: Disability and societal limitations

>Does the MSD limit the patient and how much?
>Is there benefit from working on it?


Factors influencing management: Environmental and communication disorders

Are there supportive people in their environment to communicate with the patient


Factors influencing management: Motivation and needs

If the person is not motivated don't waste the time unless counseling can change patients motivation


Factors influencing management: Associated problems

Other cognitive deficits may interfere with managing MSD


Factors influencing management: Health care system

Is there funding for quality care?


Approaches to Management (3)

>Medical intervention
>Prosthetic management
>Behavioral management


Approaches to Management: Medical intervention

>Pharmacological management (L-Dopa for Parkinson's)
>Surgeries (pharyngeal flap, remove tumors)


Approaches to Management: Prosthetic management

>Palatal lift
>Pacing board, DAF
>Voice amplifier
>Light pointers, switches


Approaches to Management: Behavioral management

Speaker oriented approaches
>Oral motor exercises
>Slow rate and over articulate
Communication oriented approaches
>Give patient a hierarchy of strategies (if you're not understand do _____ and ____)
>Change environment to reduce miscommunication and increase comprehension (turn of tv, move to quiet place)


Guidelines for Behavioral Management

>Start as soon as allowable
>Baseline data to establish goals and measure changes (even for degenerative dx)
>Increase physiological support of subsystems and start from the bottom up (respiratory to articulatory)
>Consideration of compensatory strategies: Compensation requires consciousness of speech and may make speech effortful
>Practice is essential, Drill is necessary, Give proper instruction, Discover what works, Give appropriate feedback, Make it relevant to speech, and begin with the most advance skill