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92 Cards in this Set
- Front
- Back
Tx goals (3) |
restore function (rehab) promote use of residual function (compensate) reduce need for lost function (compensate) |
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two guiding principles |
1. be as specific in your training as possible in relationship to what your goal is. 2. work at the highest, most functional, level possible |
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treatment |
focus of therapy is dictated by affected subsystems and nature of damage |
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flaccid treatment focus on |
increasing tone and strength |
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spastic tx focus on |
decreasing tone, increasing ROM |
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HYPOkinetic |
increasing ROM, strength (?) |
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HYPERkinetic |
increasing control |
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Ataxic |
increasing control |
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activity level |
increasing speech accuracy, communication efficacy |
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participation level |
improving level of independence and functional communication specific to individ pt |
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Respiration Goals |
to establish correct breathing pattern increase VC to facilitate control of inhalation and exhalation to improve strength and coordination of resporiatory muscles |
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Respiration activity |
to establish breath support for speech production |
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Respiration strategies |
modify posture establish diaphragmatic breathing practice, slow, deep breathing sustained phonation rhythmic exhalation monitoring breath groups |
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phonatory system goals |
to establish good coordination or respiration and phonation to achieve an appropriate vocal onset to achieve optimuum pitch to facilitate variation of pitch and inflection to achieve appropriate resonance and projection |
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phonatory strategies |
yawn sigh easy onset massage and relaxation vocal strengthening exercises (push- pull) cough- voice sustaining vowels volume control pitch expansion glides |
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Resonation goals |
improve velopharyngeal closure improve oral flow |
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resonation strategies |
intra-oral pressure (blow cheeks) blowing (straws, balloon, kleenex) pressure consonants alternate oral and nasal consonants |
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Articulation goals |
increase strength increase/ decrease tone increase ROM improve coordination articulators |
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articulation activity |
improve phoneme precision increase co-articulatory coordination |
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articulation strategies- strengthening |
tongue- IOPI protocol, maximum contractions
lips & face- maximum contractions resistance movements, neuromuscular facilitation |
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articulation strategies- ROM/ reduce tone |
tongue, lips, face massage, stretcing negative practice biofeedback EMG |
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articulation precision |
reduce rate overarticulate articulation drill modify articulation difficulty |
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articulation intelligibility |
intelligibilty within specific contexts |
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artic intelligibility |
reduce rate overarticulate increase effort modify environment train listeners teach nonverbal comm strategies AAC |
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Prosody Goals |
to improve emotive stress improve linguistic stress to produce natural speech melody |
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prosody strategies |
pitch control loudness control imitation of stress patterns production of specified stress patterns terminal declination question inflection intra- word stress |
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Management goals |
primary goal: maximize the effectiveness, efficiency and naturalness of communication restore, compensate, and adjust |
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Restore lost function |
REHAB attempt to reduce impairment success depends on etiology, type and seerity |
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promote the use of residual function |
COMPENSATE modifications of rate and prosody prosthetic devices environmental modifications AAC |
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reduce need for lost function |
ADJUST reorganization of their work environment or responsibilities change in social plan for porgressive |
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factors influencing management |
medical dx and prognosis impairment, limitations, restrictions envinron/ comm partners motivation and needs associated problems health care system |
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medical diagnosis and prognosis |
neurologic disease develop acutely, subacutely, or chronically plateauing, chronic, stable, progressive |
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impairment, limitation and restrictions |
ongoing intervention not recommended if an MSD is not associated with activity limitations |
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environment |
noisy, poorly lit, bustling places or quiet familiar settings |
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motivation and needs |
personal goals premorbid personality, lifestyle, intelligence, personality coexsisting motor, sensory, and cognitive deficits general health issues environment age educational level |
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associated problems |
other neurologic deicits limb motor deficits are common cognitive deficits can significantly i influence the conduct of management |
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focus of tx |
treat component that will result in quickest functional gains first. one with the greatest functional benefit |
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medical intervention |
pharmacologic and surgical interventons often precedes or is provided concurrently w other management approaches |
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pharmacologic management |
behavioral management should be delayed until drug therapy that might improve speech begins sometimes cures the disorder |
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surgical management |
tumors, aneurysms, seizures, are examples of procedures rather than the deficits themselves some cases, surgery may resolve signs &symptoms |
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surgical management |
some surgeries are performed for the sole purpose of improving speech *pharyngeal flap or sphincter pharyngoplasty procedure to improve velopharyngeal function for speech |
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Apraxia of speech |
usually occurs with aphasia a disturbance in the programmng of movements for speech muscles are capable of normal functioning appropriate message has been formulated |
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Pt perception and complaints |
doesn't come out right articulation most often cited stutter like p |
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key features of AOS |
groping of articulators variable errors increased difficulty w volitionality and complexity difficulty with repetition ARTIC and PROSODY |
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tasks to inclue in AOS |
automatic speech (counting) DDK of increasing complexity words of increasing complexity repeated trials of the same word |
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nonverbal tasks AOS |
increasing complexity (oral apraxia) right handed tasks upon verbal command (limb apraxia) apraxia batter for adults spontaneous speech |
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therapy principles |
intensive treatment multiple repetitions progressive complexity |
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intensive treatment |
daily or more length of tx depends on stamina balance intensity w fx, motivational fv |
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multiple repetitions |
practice, practice, practice be cognizant of frustration variable practice, random tiral |
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progressive complexity |
easy to hard (0 to perfect) highly visible to least visible (ta- vs ka) sound to syllable word to phrase sentence to conversation |
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tx should focus on |
deficits of the pt teaching the pt the articulatory postures necessary to produce certain sounds providing pt with chances to produce more voluntary utterance |
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apraxia of speech |
motor planning impairment before you get to the muscles moving the plan is disrupted, the key is for volitional movement, motor programming impairment, the signal doesn't get to the muscles |
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severe AOS characteristics |
usually have no voluntary speech 1-2 months post onset, may produce stereotypic utterances almost always hemiplegic most are at least moderately aphasic |
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progression of tx |
should begin at a very easy level most pts cannot adjust their sounds to produce vowels only few can make consonant- vowel syllables |
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phonetic placement |
help the pt to correctly place articulators where they are needed to produce the target sound |
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phonetic derivation |
taking a sound the pt can produce and adjusting it to make a new sound |
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integral stimulation |
watch me and do what I do |
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speech entrainment |
headphones in and watching the person say the word, they repeat it |
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moderate AOS characteristics |
usually have some volitional speech 1-2 mnths post stereotypic utterances disappear as pt recovers mild-moderate oral and limb apraxia almost all are hemiplegic mild to moderate aphasia |
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progression of tx (moderate aos) |
tx can begin at the syllable, word or phrase leel pts are motivated to recover and most can work on their own they can generalize to new contexts progress quickly focus on controlling artic movements, being able to control the rate, changing the intonation, volitional control |
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moderate aos tx |
contrastive stress drills oral reading problem solving approach |
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problem solving approach teaches pt to |
anticipate hard words, difficult speaking situations be aware when he fails to communicate respond to communication failure in a planned and organized way |
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mild aos characteristics |
benefit from problem solving approach most improve enough to be able to be functional talkers mildly aphasic if at all benefit from artic drills instructions on how to compensate |
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mild aos tx |
repetition drills formulation and production of phrases, sentences and extended speech focus on improving the ability to accurately produce articulatory movements improving speech, prosody and rate |
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stimulus that affect response accuracy |
visibility- the more visible mvmts the easier they are to make length- the longer the word the more probable an error |
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rate |
the faster the articulatory sequence must be made the more difficult for the pt to produce |
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delay |
if there is a delay between clinician model and pt response, imitation is more difficult |
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context |
position of articulatory posture in a word can make the production harder 1st sound in a word is more likely to be correctly produced than sounds later in the words |
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linguistic context |
putting a word in a common phrase makes it easier to produce |
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situational context |
easier for pts to talk to family and friends than strangers |
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meaningfulness |
the more meaning the utterance has to the pt easier it is to produce |
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cues |
the more cues provided to the pt the more chance the pt will correctly produce |
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hierarch of cues |
from most to least cueing the way you provide cues needs to be strategies and preplanned document progress |
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stimulus modality |
visual stimulation tacticle and kinesthetic stimuli auditory modality |
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melodic intonation therapy |
severe aphasia/ apraxia increasing the use of non-dominant during speech involves structred drills, phrases are produced with exaggerated stress, rhythm and pitch |
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PROMPT |
provide pressure, kinesthetic, and proprioceptive cues to facilitate speech highly structured finger placement |
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multiple input phoneme therapy |
for severe AOS stereotype utterance bye bye bye bike fade stereotypic utterance into new one expand to more utterance, broaden phrases and sentences |
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AAC |
communication boards, books need to remember hemiplegic pts this becmes the issue for lots of pts, they can only use in certain settings |
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Aphasia |
usually in the context of stroke acquired neurogenic language impairment (not cogn) excludes general sensory |
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how the brain performs language comprehension of speech |
primarily auditory cortices Wernickes |
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reading |
visual cortex wernickes area |
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spontaneous speech |
wernicke's area arcuate fasiculations broca's area |
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damage to pre-motor cortex |
apraxia of speech |
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damage to motor cortex |
dysarthria |
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damage to pyramidial system |
to cranial nerves, dysarthria |
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damage to wernicke's area |
receptive |
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damage to broca's area |
expressive (verbal |
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paraphasia |
literal (phonemic) paraphasias verbal (semantic) unrelated perseverative |
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Broca's aphasia (NON) |
Non- fluent
expressive, anterior, motor, telegraphic abnormal prosody, long pauses short phrase length impaired articulation, misarticulations telegraphic utterance aud. comp. is less impaired repetition mild to severe naming mild to severe AOS often co-occurs |
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Global aphasia (NON) |
nonfluent
*expressive and receptive severe impairment of all language ability attentive, task oriented, socially appropriate recurring stereotypical utterance sometime AOS |
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Wernicke's aphasia (F)
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Fluent
Fluent speech- auditory comp deficit paraphasia's are frequent literal or sematic empty speech naming and repetition shows range of impairment auditory comprehension is on a continuum |
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Anomic aphasia (F) |
fluent category of aphasia, damage almost anywhere to produce this aphasia without clear localization auditory comp. repetition are mild- moderate naming and word finding severely impaired |