Typically speech demands on respiration are:
not great, even individuals with significant respiratory problems may have adequate respiratory support for speech
Improving phonation, resonation, and articulation generally promotes:
Efficient use of the airstream
If the patient is able to maintian a stream of bubbles for 5 seconds in a glass of water at a depth of 5cm than
They have adequate respiratory support for speech and can produce consistent subglottal airpressure
Pushing, pulling, or bearing down during speech and non speech tasks helps
Increase respiratory drive for speech
Abdominal binders, expiratory board/paddle and pushing on the abdomen are all examples of
Prosthetic assistance for respiration
Behavioral Compensation for Respiration
> Practice inhaling more deeply
Practice exhaling more forcefully
Controlled breathing letting air out slowly
Use shorter phrases per breath group
Use biofeedback machines with visual feedback
Correct maladaptive breathing
Medical treatment for improving phonation
> Laryngeal surgery
Implants in paralyzed VF for medial approximation
Arytenoid adduction surgery (removing arytenoid cartilage)
Recurrent nerve resection prevents hyperadduction (SD and laryngeal spasms)
Fat, Collagen, Teflon, Botox injections (wait 1 full year to assess nerve regeneration)
Vocal intensity controller and amplification systems are used as prosthetics for:
Phonation
Behavoiral Management of Phonation
Effort closure strategies help strengthen vocal fold adduction:
>push/pull/lift techniques
>coughing in controlled manner
LSVT for Parkinson’s patients
Surgical management for Resonance
> Pharyngeal flap
Injection into pharyngeal wall to improve VP closure
“would this pt be a candidate for Teflon injection?”
Prosthetic management for Resonance
> Palatal lift prosthesis (need teeth)
>Wearing nose clip
Behavioral management for Resonance
> Slowing rate and over articulate (hypernasality)
>Using a mirror for visual feedback
Prosthetic management for Articulation
Bite block to help jaw control and keep jaw from opening
Only use strength training to improve articulation if there is:
Weakness (do not use for ALS or MG)
Recommend minimum sets, reps, and frequency of articulatory exercises:
5 sets of 10 reps 3-5 times a day
Articulatory exercises
> Steady, continuous, prolonged stretches
Slow movement of articulators beyong normal ROM
Exaggerate consonants to improve imprecisions
Compensate with tongue blade instead of tip
Tradition artic approach, placement, minimal pairs, phonetic derivations
intelligibility drills
Prosthetic management of Rate
> DAF
Pacing board
Letter alphabet board
Non-prosthetic rate management
> Finger tapping each syllable (note: ataxic imprecise, Parkinson’s accelerate)
Visual feedback from oscilloscope
.Rhythmic cueing
Chunking utterances into natural syntactic units, contrastive stress drills, and LSVT are all ways to improve:
Prosody and Naturalness
Treatment for Flaccid dysarthria
> Work on increasing strenghth (unless there is no LMN innervation or if the patient has a progressive disease like ALS)
Push, pull (respiratory weakness)
Effortful closure tx or injections (VF weakness)
VP strengthening or prosthesis (resonance problems
For MG limit length of time for speaking
Treatment for Spastic dysarthria
> Work on relaxation exercises (hyperadduction treatment)
Medications (Ellaville) for pseudobalbar affect
Modify behavior for individual behaviors that trigger pseudobalbar affect
Treatment for Ataxic dysarthria
Focus on behavioral management to improve incoordination
>emphasizing rate
>loudness
>pitch control
Treatment for Hypokinetic Dysarthria
> LSVT 4 times a week for one month focusing on respiratory and phonatory effort
Medications L-Dopa, Sinemet may improve speech
Work on rate and overarticulation
Surgery (Pallidotomy, thalalmotomy and Deep Brain Stimulation DBS)
Treatment for Hyperkinetic dysarthria
> Mainly surgical and pharmacological tx to treat abnormal movements
SLPs can teach compensatory techniques such as holding a pipe in the mouth
Treatment for UUMN
May work on specific articulation problems or on tongue strengthening
Communication Oriented Treatment: Speaker strategies
>Prepare listener >Tell listener how communication will happen >Identify topic >Increasing redundancy may help >Simplify content >Use gestures >Monitor listener comprehension >Use alphabet board
Communication Oriented Strategies: Listener strategies
> Maintain eye contact
Work at comprehending
Modify environment
Communication Oriented Strategies: Interaction strategies
> Don’t communicate important things when fatigued or stressed
Select conducive speaking environment
Maintain eye contact (everyone)
Identify breakdowns and establish means of feedback
Repair breakdowns by rephrasing, spelling, synonyms
