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 >AAC >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
