Chapter 17 Managing Dysarthrias Flashcards Preview

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Flashcards in Chapter 17 Managing Dysarthrias Deck (28)
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1
Q

Typically speech demands on respiration are:

A

not great, even individuals with significant respiratory problems may have adequate respiratory support for speech

2
Q

Improving phonation, resonation, and articulation generally promotes:

A

Efficient use of the airstream

3
Q

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

A

They have adequate respiratory support for speech and can produce consistent subglottal airpressure

4
Q

Pushing, pulling, or bearing down during speech and non speech tasks helps

A

Increase respiratory drive for speech

5
Q

Abdominal binders, expiratory board/paddle and pushing on the abdomen are all examples of

A

Prosthetic assistance for respiration

6
Q

Behavioral Compensation for Respiration

A

> 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

7
Q

Medical treatment for improving phonation

A

> 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)

8
Q

Vocal intensity controller and amplification systems are used as prosthetics for:

A

Phonation

9
Q

Behavoiral Management of Phonation

A

Effort closure strategies help strengthen vocal fold adduction:
>push/pull/lift techniques
>coughing in controlled manner
LSVT for Parkinson’s patients

10
Q

Surgical management for Resonance

A

> Pharyngeal flap
Injection into pharyngeal wall to improve VP closure
“would this pt be a candidate for Teflon injection?”

11
Q

Prosthetic management for Resonance

A

> Palatal lift prosthesis (need teeth)

>Wearing nose clip

12
Q

Behavioral management for Resonance

A

> Slowing rate and over articulate (hypernasality)

>Using a mirror for visual feedback

13
Q

Prosthetic management for Articulation

A

Bite block to help jaw control and keep jaw from opening

14
Q

Only use strength training to improve articulation if there is:

A

Weakness (do not use for ALS or MG)

15
Q

Recommend minimum sets, reps, and frequency of articulatory exercises:

A

5 sets of 10 reps 3-5 times a day

16
Q

Articulatory exercises

A

> 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

17
Q

Prosthetic management of Rate

A

> DAF
Pacing board
Letter alphabet board

18
Q

Non-prosthetic rate management

A

> Finger tapping each syllable (note: ataxic imprecise, Parkinson’s accelerate)
Visual feedback from oscilloscope
.Rhythmic cueing

19
Q

Chunking utterances into natural syntactic units, contrastive stress drills, and LSVT are all ways to improve:

A

Prosody and Naturalness

20
Q

Treatment for Flaccid dysarthria

A

> 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

21
Q

Treatment for Spastic dysarthria

A

> Work on relaxation exercises (hyperadduction treatment)
Medications (Ellaville) for pseudobalbar affect
Modify behavior for individual behaviors that trigger pseudobalbar affect

22
Q

Treatment for Ataxic dysarthria

A

Focus on behavioral management to improve incoordination
>emphasizing rate
>loudness
>pitch control

23
Q

Treatment for Hypokinetic Dysarthria

A

> 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)

24
Q

Treatment for Hyperkinetic dysarthria

A

> Mainly surgical and pharmacological tx to treat abnormal movements
SLPs can teach compensatory techniques such as holding a pipe in the mouth

25
Q

Treatment for UUMN

A

May work on specific articulation problems or on tongue strengthening

26
Q

Communication Oriented Treatment: Speaker strategies

A
>Prepare listener
>Tell listener how communication will happen
>Identify topic
>Increasing redundancy may help
>Simplify content
>Use gestures
>Monitor listener comprehension
>Use alphabet board
27
Q

Communication Oriented Strategies: Listener strategies

A

> Maintain eye contact
Work at comprehending
Modify environment

28
Q

Communication Oriented Strategies: Interaction strategies

A

> 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