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Motor Speech > Management > Flashcards

Management Flashcards

1
Q

When do you need to treat speech breathing?

A

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

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2
Q

RESPIRATION: Behavioural management

A

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

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3
Q

RESPIRATION: Postural considerations

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

A

Supine

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4
Q

RESPIRATION: Postural considerations

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

A

Upright

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5
Q

RESPIRATION: Prosthetic

A

Abdominal trussing, pushing on abdomen (medical supervision)

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6
Q

PHONATION: Behavioural strategies

A

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

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7
Q

RESONANCE: Prosthetic

A

Palatal lift, nose clip, nasal obturator

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8
Q

RESONANCE: Behavioural

A

Speech hygiene, CPAP training, feedback

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9
Q

ARTICULATION: Prosthetic

A

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

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10
Q

ARTICULATION: Behavioural

A

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

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11
Q

RATE: Prosthetic

A

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

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12
Q

RATE: Behavioural

A

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)

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13
Q

PROSODY: Behavioural

A

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

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14
Q

Speaker Tx examples: Flaccid

A

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

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15
Q

Myasthenia Gravis contraindications

A

Behavioural speech tx

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16
Q

Speaker Tx examples: Spastic

A

Medications, laryngeal botox

Relaxation, stretching

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17
Q

Spastic contraindications

A

Effortful closure techniques

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18
Q

Speaker Tx examples: Ataxic

A

Behavioural techniques (modifying rate or prosody)

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19
Q

Ataxic contraindications

A

Muscle strength training, surgery, prosthetics

20
Q

Speaker Tx examples: Hypokinetic

A

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

21
Q

Speaker Tx examples: Hyperkinetic

A

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

22
Q

Speaker Tx examples: UUMN

A

Treat areas of deficit

23
Q

Speaker Tx examples: Mixed dysarthria

A 
Usually behavioural
Palatal lift (flaccid-spastic ALS)
24
Q

Communication Tx Speaker strategies (7)

A 
Prepare listeners
Convey how communication should occur
Set context and identify topic
Modify sentence content, structure, length
Gestures
Monitor listener comprehension
Alphabet supplementation
25
Q

Communication Tx Listener strategies (4)

A

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

26
Q

Communication Tx Interaction strategies (6)

A 
Schedule important interactions
Select environment
Eye contact
Identify breakdowns and establish feedback
Repair breakdowns
Combine and modify strategies
27
Q

Speech oriented approach

A

focus on restoring or modifying the patient’s speech

28
Q

Communication oriented approach

A

focus on improving communication by modifying

communication interactions

29
Q

Two main goals of speech oriented treatment

A
  1. Primary goal is on intelligibility/accuracy of speech

2. Secondary goal is on efficiency and naturalness

30
Q

Efficiency & Naturalness?

A

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

31
Q

Speech Oriented tx methods (general)

A

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

32
Q

the first step in your treatment / management

A

Understanding the WHY of the perceptual features

33
Q

When to begin therapy - Trauma (CVA, TBI)

A

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

34
Q

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

A

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

35
Q

When to begin therapy - Pediatric

A

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

36
Q

Individual vs. group therapy

A

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

37
Q

Neurogenic stuttering: SLP Role

A 
Behavioural:
Improve self-monitoring
Easy onset (yawn-sigh)
Slowing rate of speech (pacing board, DAF*)
Use of rhythm and singing
Relaxation
38
Q

Palilalia: SLP Role

A

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

39
Q

Foreign Accent Syndrome: SLP Role

A

Traditional treatments for AOS and aphasia can be used

Target vowels, prosody, syntax, word retrieval

40
Q

Aprosodia: SLP Role

A

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

41
Q

Mixed dysarthria more or less common?

A

More common

42
Q

Mixed Dysarthria causes

A

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)

43
Q

Mixed dysarthria: ALS

A

Spastic + Flaccid

44
Q

Mixed dysarthria: Friedrich’s ataxia

A

Ataxic – Spastic Dysarthria

45
Q

Mixed dysarthria: Progressive Supranuclear Palsy (PSP)

A

Hypokinetic – Spastic – Ataxic Dysarthria

46
Q

Mixed dysarthria: Multiple System Atrophy (MSA)

A

Any combination of Hypokinetic,

Hyperkinetic, Spastic, Ataxic

47
Q

Mixed dysarthria:

A

Spastic – Ataxic Dysarthria

Motor Speech (6 decks)

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