Management

Question 1

When do you need to treat speech breathing?

Answer 1

If a patient has issues with decreased loudness, speech-breathing coordination, reduced naturalness of speech

Question 2

RESPIRATION: Behavioural management

Answer 2

Increased inhalation (slow exhalation), optimal breath group, awareness of optimal breath group length, LSVT, postural changes

Question 3

RESPIRATION: Postural considerations

Expiratory weaker than inspiratory (e.g., MS, TBI, SCI)

Answer 3

Supine

Question 4

RESPIRATION: Postural considerations

inspiratory weaker than expiratory (e.g., ALS, lung disease)

Answer 4

Upright

Question 5

RESPIRATION: Prosthetic

Answer 5

Abdominal trussing, pushing on abdomen (medical supervision)

Question 6

PHONATION: Behavioural strategies

Answer 6

Effortful closure, phonation on exhalation, head turning, touch throat, breathy onset, LSVT

Question 7

RESONANCE: Prosthetic

Answer 7

Palatal lift, nose clip, nasal obturator

Question 8

RESONANCE: Behavioural

Answer 8

Speech hygiene, CPAP training, feedback

Question 9

ARTICULATION: Prosthetic

Answer 9

Bite block (hypokinetic, hyperkinetic, spastic; never flaccid)

Question 10

ARTICULATION: Behavioural

Answer 10

Strength/speed training (not for degenerative disease; only when weakness is impacting intelligibility; flaccid, UUMN, spastic, hypokinetic)
Biofeedback
Exaggerated articulation
Minimal contrasts (get good inventory, consider neighbourhood)
Intelligibility drills

Question 11

RATE: Prosthetic

Answer 11

Delayed auditory feedback (hypokinetic)
Pacing devices (hypokinetic, spastic-ataxic)
Alphabet supplementation

Question 12

RATE: Behavioural

Answer 12

Hand or finger tapping
Rhythmic cueing (point to words whole speaking in speech rhythm; Friedrich’s ataxia)
Visual feedback
‘Backdoor’ (increasing loudness, pitch variability, stress, phrasing)

Question 13

PROSODY: Behavioural

Answer 13

Breath group (chunk utterances)
Contrastive stress
Referential tasks
Work across breath groups

Question 14

Speaker Tx examples: Flaccid

Answer 14

Increasing respiratory support (MPT, subglottal air presure, posture, prosthetic, deep inhalation)
Surgery on VF
Palatal lift, surgery, CPAP
NSOMEs (non-degenerative only)

Question 15

Myasthenia Gravis contraindications

Answer 15

Behavioural speech tx

Question 16

Speaker Tx examples: Spastic

Answer 16

Medications, laryngeal botox

Relaxation, stretching

Question 17

Spastic contraindications

Answer 17

Effortful closure techniques

Question 18

Speaker Tx examples: Ataxic

Answer 18

Behavioural techniques (modifying rate or prosody)

Question 19

Ataxic contraindications

Answer 19

Muscle strength training, surgery, prosthetics

Question 20

Speaker Tx examples: Hypokinetic

Answer 20

Surgery, deep brain stimulation
Meds
Behavioural - rate control, increasing loudness, speech exercise, intensity
LSVT

Question 21

Speaker Tx examples: Hyperkinetic

Answer 21

Behavioural - decreased rate, postural changes, increase pitch, breathy onset, glottal attack
Meds
DBS

Question 22

Speaker Tx examples: UUMN

Answer 22

Treat areas of deficit

Question 23

Speaker Tx examples: Mixed dysarthria

Answer 23

Usually behavioural
Palatal lift (flaccid-spastic ALS)

Question 24

Communication Tx Speaker strategies (7)

Answer 24

Prepare listeners
Convey how communication should occur
Set context and identify topic
Modify sentence content, structure, length
Gestures
Monitor listener comprehension
Alphabet supplementation

Question 25

Communication Tx Listener strategies (4)

Answer 25

Maintain eye contact Active listening Modify environment Maximize listener hearing and vision

Question 26

Communication Tx Interaction strategies (6)

Answer 26

``` Schedule important interactions Select environment Eye contact Identify breakdowns and establish feedback Repair breakdowns Combine and modify strategies ```

Question 27

Speech oriented approach

Answer 27

focus on restoring or modifying the patient’s speech

Question 28

Communication oriented approach

Answer 28

focus on improving communication by modifying | communication interactions

Question 29

Two main goals of speech oriented treatment

Answer 29

1. Primary goal is on intelligibility/accuracy of speech | 2. Secondary goal is on efficiency and naturalness

Question 30

Efficiency & Naturalness?

Answer 30

Efficiency means increasing the rate of speech without sacrificing intelligibility Naturalness involves targeting prosody (rate, rhythm, intonation and stress) as these give clues to meaning within an utterance

Question 31

Speech Oriented tx methods (general)

Answer 31

Reducing impairment by increasing physiologic support (behavioural) Compensating for impairment and maximizing the use of residual physiological support (behavioural, prosthetic, medical)

Question 32

the first step in your treatment / management

Answer 32

Understanding the WHY of the perceptual features

Question 33

When to begin therapy - Trauma (CVA, TBI)

Answer 33

Client should be medically stable Early intervention is best (usually within 1 – 4 weeks) Chronic phase can still see improvements (esp functional)

Question 34

When to begin therapy - Degenerative (i.e., PD, ALS, MS)

Answer 34

Early intervention is best – may help slow the deterioration of speech – may decrease the likelihood of maladaptive behaviours or strategies being learned

Question 35

When to begin therapy - Pediatric

Answer 35

Early intervention is best (once identified as having a MSD)

Question 36

Individual vs. group therapy

Answer 36

Individual therapy: Good early on allows you to focus on specific aspects Can obtain max number of responses Alter therapy based on clients responses Group: Practice strategies in a more natural communication setting Carry over of what is taught in individual therapy Meet others, share experiences, get feedback from peers

Question 37

Neurogenic stuttering: SLP Role

Answer 37

``` Behavioural: Improve self-monitoring Easy onset (yawn-sigh) Slowing rate of speech (pacing board, DAF*) Use of rhythm and singing Relaxation ```

Question 38

Palilalia: SLP Role

Answer 38

If there is underlying Dysarthria, treat the Dysarthria If palilalia is pervasive and disabling and client has intact cognitive abilities…try to decrease the behaviours Little is known about treatment... try: Rate reduction Increase awareness – self monitor Practice speech in contexts not as impacted by palilalia

Question 39

Foreign Accent Syndrome: SLP Role

Answer 39

Traditional treatments for AOS and aphasia can be used | Target vowels, prosody, syntax, word retrieval

Question 40

Aprosodia: SLP Role

Answer 40

Increase awareness (if necessary) Family education Contrastive and/or lexical stress “drills” May need to progress through a continuum of steps (i.e., model, unison, repeat…spontaneous) Cognitive-linguistic approach: Clients match emotion words with tone of voice or pictured facial expressions… producing words spontaneously with target emotion

Question 41

Mixed dysarthria more or less common?

Answer 41

More common

Question 42

Mixed Dysarthria causes

Answer 42

Combination of the same neurological event (e.g., multiple strokes in different parts of the brain/brainstem) Two or more neurological events (e.g., stroke and PD) Very commonly due to degenerative disease (e.g., ALS)

Question 43

Mixed dysarthria: ALS

Answer 43

Spastic + Flaccid

Question 44

Mixed dysarthria: Friedrich's ataxia

Answer 44

Ataxic – Spastic Dysarthria

Question 45

Mixed dysarthria: Progressive Supranuclear Palsy (PSP)

Answer 45

Hypokinetic – Spastic – Ataxic Dysarthria

Question 46

Mixed dysarthria: Multiple System Atrophy (MSA)

Answer 46

Any combination of Hypokinetic, | Hyperkinetic, Spastic, Ataxic

Question 47

Mixed dysarthria:

Answer 47

Spastic – Ataxic Dysarthria