managing dysarthrias

Question 1

speaker-oriented treatment

Answer 1

medical, prosthetic, and behavioral tx directed at modifying respiration, phonation, resonance, artic, rate, prosody, and naturalness

Question 2

Respiration - Increasing respiratory support tx

Answer 2

• Require 5cm water pressure for 5 sec
• Controlled exhalation
• Pushing, pulling, bearing down
• Inspiratory and Expiratory Muscle Strength Training

Question 3

Respiration - prosthetic tx

Answer 3

• Abdominal trussing for posture and support
• Abdominal force for increased expiratory strength

Question 4

respiration- behavioral tx

Answer 4

• Deep breath before speech
• Limit breaths per expiration: Establish optimal breath group and advance as tolerated
• Speech breathing treatment + Lee Silverman Voice Therapy (LSVT)

Question 5

phonation- surgical tx

Answer 5

• VF paralysis or bowing: Medialization (type I) thyroplasty, Arytenoid adduction surgery, Surgical anastomosis
• Adductor spasmodic dysphonia: Recurrent laryngeal nerve resection, Botox injection, Laryngeal adductor denervation-reinnervation, Lateralization (type II) thyroplasty

Question 6

phonation- prosthetic tx

Answer 6

• SpeechVive for increasing loudness in individuals with Parkinson’s disease
• Ambulatory voice monitoring and feedback devices
• Portable voice amplifier

Question 7

phonation- behavioral tx

Answer 7

For unilateral/bilateral VF paralysis: effort closure techniques, initiate phonation at the beginning of exhalation, turning head, lateral digital manipulation, LSVT

Question 8

resonance - medical/surgical tx

Answer 8

injection pharyngoplasty

Question 9

resonance- prosthetic tx

Answer 9

• palatal lift prosthesis
• nasal obturator
• one-way nasal speaking valve

Question 10

resonance- behavioral tx

Answer 10

• Modifying the pattern of speaking
• resistance training (CPAP)
• feedback
• nonspeech velopharyngeal movement

Question 11

artic- medical/surgical tx

Answer 11

• Neural anastomosis
• Botox injection

Question 12

artic- prosthetic tx

Answer 12

bite block for jaw opening

Question 13

artic-behavorial

Answer 13

• Strength training: Not generally advised or considered effective
• Stretching: may have some effect on increasing ROM and decreasing the effects of spasticity on speech; Sustained maximum jaw opening; tongue protrusion, retraction, or lateralization; and lip retraction, pursing, and puffing
• Relaxation: Not advised; focus on speech movements
• Biofeedback: Limited research
• Traditional articulation methods: Integral stimulation, phonetic placement, phonetic derivation; Minimal contrasts, clear speech, intelligibility drills

Question 14

rate

Answer 14

Possibly most effective treatment area at increasing intelligibility

Question 15

rate- prosthetic tx

Answer 15

• Delayed auditory feedback, pacing board
• auditory and visual metronomes
• alphabet supplementation

Question 16

rate- behavioral tx

Answer 16

• Slow speech rate, hand or finger tapping, rhythmic cueing, visual feedback, backdoor approaches
• SLP should also adopt approach to model

Question 17

naturalness

Answer 17

reflects the overall adequacy of prosody

Question 18

prosody- behavioral tx

Answer 18

• Breath group- prosodic pattern during a single exhalation
• Chunking utterances
  Contrastive stress tasks
  Referential tasks
  Can convey stress by modifying pitch, loudness, or duration

Question 19

flaccid- main issue

Answer 19

weakness
note: Exercises will not be successful if LMN innervation is completely lost

Question 20

flaccid- respiratory weaknesss

Answer 20

• need increase physiologic support for speech breathing
• increase subglottal air pressure on nonspeech tasks, increase maximum vowel duration, increase loudness, increase breath group duration and words per breath group, and establish maximum breath groups for speech

Question 21

flaccid- Adductor VF weakness/paralysis

Answer 21

• medialization thyroplasty, arytenoid adduction surgery, surgery to reinnervate a paralyzed vocal fold, or injectable substances to bulk up the vocal folds

Question 22

flaccid- Velopharyngeal dysfunction

Answer 22

palatal lift prosthesis

Question 23

flaccid- Lingual and labial weakness

Answer 23

bite block

Question 24

flaccid- myasthenia gravis

Answer 24

behavioral speech treatment contraindicated

Question 25

spastic tx

Answer 25

- Relaxation and stretching exercises? - Behavioral treatment for pseudobulbar affect? - Behavioral treatment for most affected speech characteristics

Question 26

ataxic tx

Answer 26

- focus on BEHAVIORAL tx - emphasis on improving or compensating for problems related to motor control and coordination - Modifying rate and prosody to improve intelligibility - Further modifying rate and prosody to improve naturalness - Techniques that emphasized rate, loudness, or pitch control

Question 27

hypokinetic- surgical tx

Answer 27

- VF paresis or bowing = medialization laryngoplasty or VF injections - Neurosurgical: thalamotomy, pallidotomy, and deep brain stimulation

Question 28

hypokinetic - pharmacologic tx

Answer 28

Dopamine agonist medications (e.g., Simenet)

Question 29

hypokinetic - behavioral tx

Answer 29

- Rate control techniques (DAF, pacing boards), loudness (intensity monitors, amplification devices, improving posture, EMST) - LSVT LOUD

Question 30

LSVT LOUD characteristics

Answer 30

1. Intensity (four times per week for 1 month) 2. Requirement for energetic, high levels of physical effort to increase loudness and vocal fold adduction 3. Exclusive focus on respiratory-phonatory effort (i.e., not resonance, articulation, rate or prosody) 4. Focus on increasing sensory awareness of loudness and effort. Exercise includes vowel, word, phrase, sentence, and conversation production tasks.

Question 31

hyperkinetic - Primarily surgical and pharmacologic tx

Answer 31

- Essential tremor, dystonia, dyskinesia, tics = deep brain stimulation - Spasmodic dysphonia (SD) = Botox injection

Question 32

hyperkinetic - behavioral prosthetic tx

Answer 32

- Jaw, tongue, or face dystonia =bite block, gum - Adductor SD =increasing pitch, breathy vocal quality - Adductor SD = hard glottal attacks, voicing voiceless consonants

Question 33

UUMN - behavioral tx

Answer 33

- Focus on rate, prosody, and articulation - Compensation > restoration - Mirror for reduced saliva management - As dysarthria is usually mild, SLP focus shifts to co-occurring impairments

Question 34

mixed tx

Answer 34

- Treat individual dysarthrias - note: Some treatments may be contraindicated by the presence of another dysarthria type

Question 35

ALS tx

Answer 35

palatal lift prosthesis

Question 36

PSP tx

Answer 36

LSVT

Question 37

communication-oriented tx

Answer 37

1. Speaker strategies 2. Listener strategies 3. Interaction strategies

Question 38

speaker strategies

Answer 38

- prep listeners with alerting signals - convey how communication should occure - set context/identify topic - modify sentence content, structure, length - gesturess - monitor listener comprehension - alphabet supplementation

Question 39

listener strategies

Answer 39

- maximize hearing and visual activity - eye contact - optimized physical environment - improve listening skills: perceptual training and listener familiarization

Question 40

interaction strategies

Answer 40

- schedule important interactions - select conductive speaking and listening environment - identify breakdowns sand est. methods of feedback - repair breakdowns - est. what works best and when