Dysarthria Treatment Options – Flashcards

respiration phonation resonation articulation prosody

respiration phonation resonation articulation prosody

respiration phonation resonation articulation prosody

respiration phonation resonation articulation prosody

respiration phonation resonation articulation prosody

respiration phonation resonation articulation prosody

respiration phonation resonation articulation prosody

respiration phonation resonation articulation prosody

respiration phonation resonation articulation prosody

respiration phonation resonation articulation prosody

Facilitating Tasks: 1. push-pull tasks 2. breathing against resistance with device 3. biofeedback chest wall 4. maximum inhalation/exhalation 5. controlled exhalation 6. Breathing against resistance through pursed lips Compensatory Techniques: 1. teach to use shorter breath groups 2. postural adjustments (upright for inspiratory problems; supine for expiratory problems) 3. Prosthetic Assistance (rare) *non-speech tasks generally for speakers unable to generate adequate subglottal air pressure for phonation *speech tasks=inhale more deeply, use more force when speaking

Facilitating Techniques: 1. breath hold 2. hard glottal attack 3. loudness training (lee silverman) Compensating: 1. reduce background noise 2. turn head to side of weaker VF 3. use amplifier From presentations: 1. for hyperadduction,i) use yawn-sigh ii) yawn-sigh with vowels 2. for hypoadduction (hypokinetic or flaccid) use i) holding breath exercises (see if pt. can hold breath for at least 15 sec.) ii) use non-speech VF valving (clasp hands at chest level, push down on seat, etc. iii) hard attack phonation (use sparingly)(pump on their abdomen, and have them resist w/glottal push; at moment of strained voice quality, stop pumping and have pt. say /a/ for as long as possible; eventually straining is faded) 1. For incoordination and timing: i) Laryngeal Timing and coordination (objectives: to maintain steady pitch and/or loudness during various levels of speech; switch btwn voiced and voiceless congnates) (get baseline for connected speech using 7 pt rating scale; ex.1: (baseline)have them say /pi/ 3x, 3 sec each, w/o breaths btwn; then for tx do same thing w/see scape in nose; ex.2: get baseline (repeat one of these 3x with 1 sec breath btwn each, should be 80% correct:/pi;pu;ti;ki;ku;si;su;shi;shu;fi;fu/; then actual tx: use see-scape and have pt inhale deeply and repeat previous steps: see-scape float should remain at top of tube during each syllable) ex. 3: have pt. take deep breath and say /u-a-i-E-o-I/, 2 sec per vowel; then do the same thing with see-scape and nose clip. Ex. 4: get a baseline w/ the pt saying the previous vowels for 1, 2 or 3 sec; then for tx may use see-scape and nose clip: have pt produce vowel train with 3sec /u/, 1 sec /a/, 2 sec /i/, 3sec /E/, 1 sec /o/. Step 5: get baseline measure of pt ability to say "paper-cookie-fee-show-sue" on 1 breath (have pt. prolong final sound of each word for diff lengths of time (up to 3s), and vary pauses; pt tx: repeat previous using see-scape

Facilitating Techniques: 1. no treatment efficacy to support non-speech activities (work on it in speech tasks) 2. no evidence for blowing 3. CPAP Compensating: 1. open mouth more when talking *consider palatal lift if other symptoms are minimal and hypernasality is the major problem

Facilitating Articulation 1. speech tasks 2. use strengthening only if weakness interferes with intelligibility (and strengthen only until they can use those muscles in speech) 3. strengthening should be done 3-5 times per session w/5-10 exercise sessions per day 4. strengthening not usually done with hypertonic muscles 5. use drills to contrast correct, incorrect 6. analyze why errors are made 7. work on movements and syllables rather than fixed positions 8. accept approximations use intelligibility drills to help patient learn how to use strategies when breakdowns occur

1. rate and rhythm: * for many people, reducing rate results in substantial improvement in speech intelligibility *improving rate often addresses rhythm also a. pacing board, finger tapping, alphabet board b. rhythmic approaches c. computerized pacing d. oscilloscope e. delayed auditory feedback f. direct magnitude production (speak at habitual rate, then 1/2 the rate or 2X the rate) 2. stress: *signaled by pitch, loudness and duration a. contrastive stress drills (you want a cup of COFEE?) 3. Intonation: *changes in pitch during speech; declarative, interrogative a. word level: i) have patient read word lists w/intonation patterns marked ii) ask pt questions that require word level answers and listen for the intonation pattern used b. sentence level: i) give pt sentences to read w/ varying emotions (happy, sad, surprised)

1. difficult to modify 2. circumlaryngeal massage 3. head and neck roll/stretching 4. easy onset techniques

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1. environmental education 2. environmental alteration a. teach speaker to set the context for the listener b. turn down background noise c. move away from the noise d. get visual attention e. don't use louder speech, move closer f. lighting g. resonance, acoustics e. posture f. external aids (voice amplifier, etc.) 3. speaker strategies a. teach strategies to clarify when message wasn't understood i) total repetition ii) partial repetition iii)elaboration iv) spell unclear words v) use shorter phrase vi) use a synonym to converge words vii) syntactic revision (change phrase structure) viii) simplification (abbreviate word/phrase ix) semantic specification (use more detail, but fewer syllables) x) use gestures xi) AAC devices (spelling board, picture boards, amplifiers, pacing boards

1. muscle relaxation and postural adjustment 2. air pressure generation 3. prolonged inhalations and prolonged exhalations 4. quick breathing 5. inhalatory/exhalatory synchronization 6. isolated sound productions 7. connected speech breathing