Managing AOS – Flashcards

NO!

Aphasia

Language: Aphasia first, then Apraxia

-Medical (not for apraxia-- but underlaying problem) -Prosthetic Management (AAC) - Behavioral management - Biofeedback (never alone)

-SOMETIMES a lift!! - Pacing devices (metronome, finger tapping, DAF *esp. with Brocas) -AAC (letterboards)

-Rosenbek's 8 step continum -PROMPTS (Prompts for Restructuring Oral Muscular Phonetic Targets) -MIT -MIPT (Multiple Input Phoneme Therapy) **Severe clients** - VCIU (Voluntary Control of Involuntary Utterances) SPT (Sound production treatment)

emphasizes careful selection of stimuli, orderly progression of treatment items and intensive and systematic drill

There are 9 1. One on one (in the initial stages) Intensive Drill 2. Self monitoring/correction skills 3. Listen and watch me approach for severe cases (fade asap) - SLP explains and cues for placement rate and stress 4. Start with automatic speech 5. visual feeback is helpful 6. If client can make sounds/syllables steer clear of non speech tasks 7. intensive practice multiple repetitions 8. begin with consistant practice then do variable 9. Reduce rate to improve accuracy

humming, coughing, laughing, singing (vegitative actions)

10 reps of stress on one syllable, then 10 reps of stress on another syllable **Consistancy!

1. Intergral Stimulation 2. IS then delay px's responce and mime with them 3. #2 without the mime 4. #3 with px making several responces 5. Replace IS with written stimuli, px produces responce once 6. #5 but remove the written stimuli before px says responce (10 sec delay) 7. Responce to a question 8. Responce to role play situation

Speechless techniques Use automatic speech tasks Use carrier phrases Sing familiar songs No phonation? --> Yawn/sigh/caugh/say ah etc use hand gestures to help elicit word (wave goodbye/OK sign etc)

Sound Production Treatment (Wambaugh) Uses minial contrasts (bye/pie) *goal to refine movements* works in heiarchy like Rosenburgs

Prompts for restructuring oral muscular phonetic Targets - developed for children but can be used for adults Tactile Kinesthetic input highly structured finger placement on patients face and neck tell the articulatory placement. Usually used with severe AOS with very limited verbal output.

Melodic Intonation Developed for nonfluent aphasia. - must have good verbal comprehension, limited spontaneous verbal output, good self-monitoring. -begins with hand-tapping rhythms, -simultaneous humming with clinician, -addition of words, phrases, gradual fading of model. Eventually modified to spoken song, then speech.

Doesn't use familiar tunes but emphasizes exaggerated pitch, tempo and rhythm.

Success due to pulling in the right brain. Therapy

EMG feedback may help to for muscle relaxation. Electromagnetic articulography provides visual feedback about tongue positions

-May help to work on nonsense words rather than words with meaning. -Work on isolated sounds then shape into words -Key-word technique -use words correctly produced to gain control over speech by us the initial sound of this word to lead into another word. -Cueing strategies are helpful especially phonetic placement cues.

Start with humming MMMM then ad MMMA then add on MMMMMAAAT

Used with severely aphasic and apraxic patients whose repetition abilities are impaired and who have frequent stereotypical words/phrases. May aid in reducing struggle to speak voluntarily.

*Identify most frequently occurring stereotype and use this as target of treatment. -Clinican produces target many times emphasizing initial phoneme while px taps - Px joins with reps -Cx fades but mouths and taps as Px says target - Reapeat steps for other utterances **goal is to say utterances voluntarily** - work on new words with same initial phoneme -targets broadened to include all phonemes

Similar to MIPT but relies on written as well as verbal input. *nancy helms estabrooks book

-Focus on rhythm, stress and intonation while working on articulation. -Use phonetic contrasts,sing-sting, to-chew. -Work on rate modification (pacing board, letter board, finger tapping, metronome) Contrastive stress tasks Pick a stimulable sound, keep utterance manageable, works best with mild/moderate apraxics. See Apraxia workbook.