L8: Treatment of Spastic Dysarthria

Question 1

what two things should be focused on for treatment of resp impairment in SD?

Answer 1

improving vital capacity and lung volumes during speech

improving abdominal contributions to speech breathing

Question 2

murdoch et al - based on a speech study of 18 spastics recommends any therapy program for resp impairment that…

Answer 2

inc the depth of inspiration

inc the range and force of abdominal movements

Question 3

what are 3 behavioural resp treatment methods for SD?

Answer 3

accent method

inspiratory checking

breathing-for-speech treatment program

Question 4

what is accent method? what is the rationale?

Answer 4

a method of treatment for hyper functional voice

rationale = to normalize vocal fold vibratory patterns, inc the efficiency and flexibility of vocalization, reduce excessive muscular tension, and inc pulmonary output

Question 5

what does the accent method involve?

Answer 5

extensive use of rhythmic vocal play, a variety of pitch and loudness patterns produced at diff rates and guided by external drum beats or rhythmic body movements

also focuses on the abdominal muscles - pts learn to monitor and enhance their activity during vocal exercises

Question 6

shimizu et al found that the accent method post treatment…

Answer 6

inc phonation time, more consistent syllable durations and inc speech intelligibility

Question 7

koschkee found that the accent method…

Answer 7

improvements in resp function, vocal shimmer, and pitch range

Question 8

what is the rationale for inspiratory checking?

Answer 8

inc depth of inhalation, inc the length and control of exhalations

Question 9

what are patients instructed to do during inspiratory checking?

Answer 9

instructed to take a deep breath and try to let the air out v slowly

requires insp muscle activity to check or slow the exhalation rate

try w speech and non speech tasks

Question 10

netsell and hixon found that with inspiratory checking 3/6 SDs showed

Answer 10

improvements in speech breathing

Question 11

what is the goal of breathing-for-speech program?

Answer 11

to achieve relaxed, coordinated breathing for nonspeech and speech activities

11 one hour sessions

Question 12

what are patients instructed to do during breathing-for-speech treatment?

Answer 12

nonspeech slow/moderately paced abdominal and rib cage expansion during insp and relaxed exp w/o excessive tension

speech breathing tasks had same target to reduce overflow and tension during speech tasks

Question 13

what are the results from breathing-for-speech treatment?

Answer 13

one case spastic TBI, lung volumes during speech, breath group length and syllables per breath near normal values post tx

Question 14

what can be used instrumentally for resp impairments in SD?

Answer 14

Airflow transducer/respirometer to provide feedback about depth of inhalations

respitrace to provide feedback displays of ribcage and abdomen movements

Question 15

what are 2 instrumental considerations for resp impairments in SD?

Answer 15

attempts to inc insp volume/abdominal effort may inc spasticity in the resp sys and in other systems

may need to assess and identify insp levels that are a prob and make sure the pt stays below these

Question 16

what are 2 prosthetics that can be used for SD w resp impairments?

Answer 16

abdominal binding

abdominal paddle

weak recommendation tho!

Question 17

what are the 3 behavioural treatment methods for laryngeal impairments in SD?

Answer 17

breathy phonation

self-monitoring

prosodic exercises

Question 18

how does breathy phonation work for laryngeal impairments in SD?

Answer 18

breathy onsets and breathy sighs

yawning and chewing methods may inc spasticity due to excessive movements

raising the chin may facilitate breathiness

Question 19

how does self-monitoring work for laryngeal impairments in SD?

Answer 19

teach pt to recognize diffs in the sounds of harshness and breathiness, strained and relaxed voice

Question 20

how does prosodic exercises work for laryngeal impairments in SD?

Answer 20

to enhance pitch and loudness variation

Question 21

what are the two prosodic exercises for laryngeal impairments in SD?

Answer 21

contrastive stress drills (ex. bob bit tod, who bit tod?, BOB bit tod)

pitch contour exercises (questions, exclamations, declaratives… variety of emotional states and levels of intensity)

Question 22

what are the 3 instrumental techniques for laryngeal impairment in SD?

Answer 22

EMG Feedback

Intensity feedback

pitch (F0) feedback

voice quality feedback

Question 23

how is EMG feedback for laryngeal impairment used for SD?

Answer 23

to reduce laryngeal muscle activity

surface EMG electrode records external laryngeal muscle activity from the sternohyoid muscle

feedback for pt on screen - pt tries to relax muscle to reduce EMG activity

Question 24

how is intensity feedback for laryngeal impairment used for SD?

Answer 24

oscilloscope or visipitch to provide visual display of intensity

to facilitate gentle breathy vocal onsets

to enhance contrastive stress drills

Question 25

how is pitch (F0) feedback for laryngeal impairment used for SD?

Answer 25

visipitch to provide visual display of pitch and enhance prosodic contour exercise or to practice expanding pitch range

Question 26

how is voice quality feedback for laryngeal impairment used for SD?

Answer 26

the CSL version of visipitch provides real time feedback about jitter and shimmer may be useful for feedback about vocal harshness

Question 27

what are the 3 prosthetic/surgical/pharmaceuticals for laryngeal impairment in SD?

Answer 27

tranquilizers for spasticitu anti-depressant botulinum toxin injections

Question 28

how do tranquilizers help with laryngeal impairment in SD?

Answer 28

reported to reduce limb spasticity but limitted data on speech some reported reduced strain one pt - improved intell

Question 29

how do antidepressants help with laryngeal impairment in SD? (2 types)

Answer 29

elavil --> reported to dramatically reduce pseudobulbar laughing and crying nuedexta --> MS/ALS pts = only about half as many laughing and crying episodes as those who took the placebo

Question 30

how do botulinum toxin injections help with laryngeal impairment in SD?

Answer 30

used extensively w Spasmodic dysphonia injected into thyroarytenoid muscle = causes partial paralysis for 3-6m reduces tension and abnormal movements but also weakens the muscle

Question 31

what evidence do they have for palatal lift in palatopharyngeal issues in SD?

Answer 31

9/10 SDs marked or moderate improvement in hypernasality 5/5 marked/moderate improvement at 1 yr post op concern when patient has a very spastic or hyper reflexive palate may need to examine effectiveness of gradual inc in lift length Improved hypernasality in 84% of ALS patients

Question 32

_____ more likely to have better outcome w palatal lifts than spastic Ds

Answer 32

flaccid Ds

Question 33

what is the goal of behavioural interventions for oral articulation issues in SD?

Answer 33

to improve articulatory precision w/o inc tension/spasticity in oral articulators or other subsystems

Question 34

what are the 3 proposed behavioural methods for oral articulation in SD?

Answer 34

rate reduction procedures louder more forceful speech intelligibility drills w familiar listener

Question 35

how can rate reduction procedures be used for oral articulation issues in SD?

Answer 35

should be explored esp in mild or moderate slow pts but slowing an already slow pt may produce addition distortions found 15% inc in intel in 9 SDs

Question 36

how can louder more forceful speech be used for oral articulation issues in SD?

Answer 36

should be considered LSVT LOUD w 5 spastic children - listeners preferred post tx speech, improved voice measures but could lead to inc distortions may need to explore in a v systematic way the effects of diff levels of force/rate on articulatory precision

Question 37

what are the 2 instrumental approaches for oral artic issues in SD?

Answer 37

Spectrographic feedback EMG feedback

Question 38

how can spectrographic feedback be used w oral artic issues in SD?

Answer 38

look at formant trajectories and fricative/stop spectra during various tasks

Question 39

how can EMG feedback be used w oral artic issues in SD?

Answer 39

EMG electrodes placed on the surface of the lip or jaw muscles may be used to provide the pt w info about muscle activity that can be used to facilitate muscle relaxation

Question 40

nemec and cohen 1984 found that EMG feedback w one spastic D...

Answer 40

could reduce jaw spasticity intel inc from 5% to 40% after 17 sessions

Question 41

marchant et al 2008 used EMG feedback by..

Answer 41

used superior orbicularis oris and submental surface EMG to provide feedback and reduce muscle tension during rest and nonspeech lingual and labial movements in a 13 yr old w SD (and CP) gradually reduced EMG levels speech intel improved when EMG tx was combined w phonetic placements

Question 42

what is the one prosthetic intervention for oral artic issues w SD?

Answer 42

bite block --> a small custom made piece of rubber-like material which is held bw the upper and lower teeth during speech helps maintain a constant and possible more open jaw position removes jaw contribution to lower lip and tongue movements