Chapter 17 Managing Dysarthrias Flashcards Preview

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Flashcards in Chapter 17 Managing Dysarthrias Deck (28)
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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:



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

>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
>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