1
Q
Overall goal of managing motor speech disorders is to…
A
Improve communication
2
Q
3 overall things that management should focus on
A
Restoring, compensation, adjusting to MSDs
3
Q
5 factors that the decision to treat and selection of management strategies are influenced by
A
- Medical diagnosis and prognosis
- Disability and societal limitations
- Environment in which communication will occur and the characteristics of the patient’s communication partners
- Patient’s motivation and needs for communication
- Presence and nature of additional problems that may affect communication (memory, learning impairments, oral sensory and motor deficits)
4
Q
Treatment should be terminated when _____, _____, or _______
A
- Functional goals are met
- True plateauing occurs
- Patient decides they no longer want treatment
5
Q
Management of MSDs can be _____, _____, or ______
A
Medical, prosthetic, or behavioral
6
Q
Medical management of MSDs can include
A
Pharmacologic and surgical (some might be done to improve speech and others can be done to treat general effects of the causal conditions)
7
Q
Prosthetic management includes
A
Mechanical and electronic devices (some improve speech or intelligibility whereas others augment or substitute verbal communication)
8
Q
Behavioral management for motor speech disorders includes
A
- Speech oriented treatment (improve intelligibility, efficiency, or naturalness or spoken communication by reducing or compensating for underlying impairment)
- Communication oriented treatment . (Emphasize environmental modifications and strategies for interacting and repairing breakdowns in communication when they occur) (AAC)
9
Q
General principles of management of MSDs (4 things)
A
- Recognizing the relevance of medical and speech diagnoses
- Advantages of starting management early on
- The need to acquire baseline data to set goals and measure change
- Value of increasing physiologic support early in treatment
10
Q
Actual treatment of MSDs must recognize (5 things)
A
- Patient’s need to make speech a conscious act
- Importance of principles of motor learning in the conduction of treatment
- Importance of drills
- Value of instruction, self-learning and feedback
- Value of consistent and variable practice
11
Q
Overall, treatment of flaccid dysarthrias should focus on…
A
Increase strength or compensate for weakness
12
Q
Flaccid dysarthria treatment should focus on the ____, _____, ____, and _____ components of speech
A
respiratory, phonatory, resonatory, and articulatory
13
Q
Respiratory goals for flaccid dysarthria
A
- Increase sub glottal air pressure on non speech tasks
- Increase maximum vowel duration
- Increase loudness
- Increase breath group duration and words per breath group
- Establish maximum breath groups for speech
14
Q
Methods to increase physiologic support for speech breathing in flaccid dysarthria
A
- Pushing/pulling exercises to increase respiratory support and drive
- Postural adjustments
- Prosthetic aids
- Compensatory efforts- deep inhalation, controlled exhalation, inspiratory checking, increased force
15
Q
Spastic dysarthria treatment techniques
A
- Relaxation exercises
- Stretching exercises of the articulators
- Reducing rate of speech movements
- Use of anti spasticity medications
16
Q
Ataxic dysarthria treatment techniques
A
- Pharmacological treatments have been effective
- Behavioral treatment is the focus
- Improve or compensate for difficulties related to motor control and coordination
- Modifying rate and prosody to improve intelligibility and when possible, modifying such to improve naturalness (LSVT)
17
Q
Treatment techniques for ataxic dysarthria
A
- Similar in nature to flaccid dysarthria
- Laryngeal surgical and neurosurgical interventions
- Deep brain stimulation- reduce activity in overactive brain structures through inhibition of neuronal firing or facilitation of inhibitory interneurons
- Pharmacological Treatments- Effects of parkinsonian medication can fluctuate as a function of the drug cycle
18
Q
Behavioral management of hypo kinetic dysarthria should focus on (4 things )
A
Respiration, phonation, rate, and prosody
19
Q
Popular behavioral treatment for hypo kinetic dysarthria
A
LSVT
20
Q
Hyperkinetic dysarthria treatment is primarily
A
Surgical, pharmacologic (although research has indicated that behavioral treatments have benefited some patients)
21
Q
Treatment for unilateral upper motor neuron dysarthria focuses on (3 things)
A
Rate, prosody, and articulation
22
Q
Mixed dysarthria treatment…
A
may vary
23
Q
Speaker oriented treatment for respiration
A
- Increasing respiratory support
- Prosthetic assistance
- Behavioral compensation and control
- Instrumental biofeedback
24
Q
Speaker oriented treatment for phonation
A
- Laryngeal framework and related laryngeal surgeries (medialization, larygoplasty, resection of recurrent laryngeal nerve)
- Injectable substances for vocal fold paralysis (collagen, homologous collagen, autologous fat)
- Botulinum toxin injections (for spasticity)
- Pharmacological management
25
3 Prosthetic managements for phonation
Portable voice amplifier, artificial larynx, vocal intensity controller
26
Behavioral management techniques for phonation
- Effort closure
- Initiate phonation at the beginning of exhalation
- Turning the head left or right
- Lateral digital manipulation
- LSVT
27
Surgical management technique for resonance
Pharyngeal flap or sphincter pharyngoplasty surgery for velopharyngeal insufficiency
28
Behavioral management for resonance
- Modify pattern of speaking
- Resistance training during speech
- Feedback
- Nonspeech velopharyngeal movements
29
Surgical management for articulation
Neural anastomosis
| Botox injection
30
Speaker oriented management for articulation can be
Surgical, pharmacological, prosthetic, behavioral
31
Behavioral techniques for articulation
- Strengthening
- Stretching
- Relaxation
- Instrumental biofeedback
32
Speaker oriented treatments for rate
- Rate modification
- Prosthetic management
- Nonprosthetic rate reduction strategies
33
What are some non prosthetic rate reduction strategies?
- Hand or finger tapping
- Rhythmic cueing
- Visual feedback
34
Speaker oriented treatments for prosody and naturalness
- breath group
- contrastive stress tasks
- referential tasks (finding stress words for emphasis during speech)
35
Strategies for communication oriented treatment
- Prepare listeners with alerting signals
- Convey how communication should occur
- See the context and identify the topic
- Modify sentence content, structure, and length
- Use of gestures
- Monitor listener comprehension
36
List some listener strategies
- Maintain eye contact
- Listen attentively and actively work at comprehension
- Modify the physical environment
- Maximize listener hearing and visual acuity
37
List some interaction strategies
- Schedule important interactions
- Select a conducive speaking and listening environment
- Maintain eye contact between listener and speaker
- Identify breakdowns and establish methods for feedback
- Repair breakdowns
- Establish what works best and when
38
Treatment of AOS may be precluded if....
There is cooccurring aphasia
39
There are no surgical or pharmacological interventions for....
AOS
40
_____, _____, ______ can be effective tools in treating AOS
Rate control devices, biofeedback, and AAC
41
Are prosthesis for modifying the vocal tract and the acoustic signal appropriate for AOS?
NO
42
Are communication oriented approaches appropriate for AOS?
YES
43
Speaker oriented approaches to AOS focus mainly on ______ and ________
articulation and prosody
44
__________ is an important component of speaker oriented treatment of apraxia of speech
systematic, intensive, and extensive drill
45
Indirect pharmacological treatment for AOS
- Antibiotics for infection, anticoagulants to prevent stroke, anticonvulsants to prevent seizures
46
Indirect surgical procedures to treat AOS
Pharyngeal flap, tumor resection
47
AOS patients tend to benefit from prostheses that....
Promote rate reduction or pacing of word production
48
_____ can be used to pace word production and promoter movements
metronome
49
List some prostheses used as part of AAC systems
- Pictures, letter and word boards, electronic and computerized devices,
- Degree of accompanying aphasia can place limits on the sophistication of messages
- ASL can improve communication
50
AOS is predominantly a disorder of _______ and _______
articulation and prosody
51
______ and _____ drill is important to treat AOS
Intensive and extensive
52
Self feedback is important in drill therapy for (disorder)
AOS
53
What is specificity of training for speech tasks in AOS
Taking the simple form of a syllable and progressing it into the form of a word, phrase, and sentence
54
What is specificity of training for non speech tasks in AOS
Use of vegetative or reflexive actions such as grunting, coughing, and laughing which may be shaped into volitional control as a precursor to voluntary or automatic speech production
55
What is consistent or blocked practice
Use of multiple trials of multiple repetitions of sounds ,words, phrases, nonsense syllables, or non speech oral motor movements in treatment
56
What is variable or random practice
Multiple sounds are targeted or the patient is required to program more elements into responses with syllable to syllable or response to response variability. Minimal or greater contrasts are targeted.
57
What is speed-accuracy trade off in AOS treatment?
Reduced rate is often emphasized early in treatment, giving way to attempts to increase speed as accuracy increases
Once accurate articulation has been achieved during treatment, increased rate should be pursued
58
Imitation in AOS treatment. What is it?
Require volitional responses to clearly established targets with parameters that can be carefully selected to ensure an appropriate level of challenge and success.
59
Advantages of imitation in AOS treatment
Simplifies drill, facilitates obtaining a maximum number of responses, reduced demand for cognitive and linguistic processing and bypasses some of the language deficits that affect comprehension and formulation when aphasia is also present
60
1 important thing in treating acquired psychogenic and related nonorganic speech disorders
Require that speech symptoms and explanation for their existence be explained to the patient.
61
In psychogenic speech disorders, ________ is crucial to management
Clinician's attitude
62
Therapy for PNSDs involves
Efforts to reduce excessive musculoskeletal tension, may involve physical contact to decrease laryngeal tension, identify normal behaviors and gradually shape normal speech responses with continuous explanation and reinforcement for change
Motor Speech
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