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Primary goal for therapy
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maximize effectiveness, efficiency, and naturalness of communication
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AOS therapy focus
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restoring/compensating for impaired function and adjusting to the loss of normal speech; improving the programming of speech; tasks that give the greates
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t and fastest benefit
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Dysarthria therapy focus
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improving the physiologic support of speech
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AOS therapy time allowance
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allow time for learning to be solidified; don't stop therapy as soon as improvements are seen
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Progressive diseases
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goals should not be to work toward improvement but to maximize communication
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Medical approach to management
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no medications just for apraxia, but may be used to treat underlying disorder; medical treatments/strategies used for dysarthria not appropriate for AOS
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Prosthetic management/AAC
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pacing devices may help reduce rate of speech; DAF not typically beneficial, devices like palatal lifts not usually necessary
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Behavioral management
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all approaches
emphasize careful selection of stimuli, orderly progression of treatment items, and intensive and systematic drill
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Severe AOS
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no sound can be produced, work on nonspeech oromotor exercises and use targets that approximate speech movements
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Drill
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intensive and systematic drill essential to burn into motor program; stimuli carefully ordered
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Beginning at sound, syllable, or word level
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benefit from a "listen and watch me" approach; clinician models and explains what needs to be done using phonetic placement info and cues for rate and stress; fades cues ASAP
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Rosenbek's Step 1
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integral stimulation - patient listens and watches SLP, then patient imitates while SLP simultaneously produces target
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Rosenbek's Step 2
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Same as step 1 but patients response is delayed and clinician mimes response without sound
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Rosenbek's Step 3
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integral stimulation followed by imitation without any simultaneous cues by clinician
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Rosenbek's Step 4
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Integral stimulation with several successive productions without any intervening stimuli and without simultaneous cues
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Rosenbek's Step 5
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written stimuli presented without auditory or visual cues, followed by patient production while looking at written stimuli
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Rosenbek's Step 6
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written stimuli with delayed production following removal of written stimuli
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Rosenbek's Step 7
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response elicited by questions
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Rosenbek's Step 8
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response target produced in role play situation
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Sound production treatment (SPT)
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Wambaugh; uses minimal contrasts to aid in refining movement patterns that differentiate sounds; works in hierarchy similar to 8-step plan
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Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPTS)
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developed for children with AOS; tactile-kinesthetic input, finger placement on patient's face and neck; usually used with severe AOS with very limited verbal output
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Biofeedback
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may be useful in addition to other therapies but not by itself, EMG feedback may help muscle relaxation, electromagnetic articulography provides visual feedback
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Techniques for sound, syllable, and word level
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class="flashcard__a_text">for problems initiating have patient yawn, sigh, and cough; may help to work on nonsense words; work on isolated sounds then shape into words
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Techniques for multiple syllable level
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focus on rhythm, stress, and intonation while working on articulation; use phonemic contrasts
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Rate and rhythm approaches
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rate modification via pacing board, letter board, finger tapping, metronome; finger counting (one finger for each word uttered); prolonging vowel and stretching out words; singing familiar words; MIT
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Key-word technique
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words correctly produced to gain control over speech then use initial sound of this word to lead into another word
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Multiple Input Phoneme Therapy (MIPT)
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use with severely aphasic and apraxia patients whose repetition abilities are impaired and who have frequent stereotypical words/phrases; may aid in reducing struggle to speak voluntarily
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MIPT Step 1
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ID most frequently occurring stereotype and use as target of treatment
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MIPT Step 2
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clinican produces target many times emphasizing initial phoneme, patient taps simultaneously
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MIPT Step 3
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patient then joins in with repetitions
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MIPT Step 4
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clinician fades voice but mouths utterance and taps with patient
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MIPT Step 5
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repeat steps for other stereotypical utterances. Idea to say stereotypical utterances voluntarily
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MIPT Step 6
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then work on new words with same initial phoneme as stereotypical utterance
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MIPT Step 7
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targets then broaden to include all phonemes
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Voluntary Control of Involuntary Utterances (VCIU)
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similar to MIPT but relies on written and verbal input; Nancy Helms-Estabrooks
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Script Training
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limited number of words/phrases learned and practiced in specific scripts; moderate to severe aphasia with apraxia
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Severe apraxia techniques
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use automatic speech tasks, use carrier phrases, singing and familiar songs, pair symbolic gestures with associated sound/word may help to elicit word
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