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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)

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

treatment

focus of therapy is dictated by affected subsystems and nature of damage

flaccid treatment focus on

increasing tone and strength

spastic tx focus on

decreasing tone, increasing ROM

HYPOkinetic

increasing ROM, strength (?)

HYPERkinetic

increasing control

Ataxic

increasing control

activity level

increasing speech accuracy, communication efficacy

participation level

improving level of independence and functional communication specific to individ pt

Respiration Goals

to establish correct breathing pattern


increase VC


to facilitate control of inhalation and exhalation


to improve strength and coordination of resporiatory muscles

Respiration activity

to establish breath support for speech production

Respiration strategies

modify posture


establish diaphragmatic breathing


practice, slow, deep breathing


sustained phonation


rhythmic exhalation


monitoring breath groups

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

phonatory strategies

yawn sigh


easy onset


massage and relaxation


vocal strengthening exercises (push- pull)


cough- voice


sustaining vowels


volume control


pitch expansion


glides

Resonation goals

improve velopharyngeal closure


improve oral flow

resonation strategies

intra-oral pressure (blow cheeks)


blowing (straws, balloon, kleenex)


pressure consonants


alternate oral and nasal consonants

Articulation goals

increase strength


increase/ decrease tone


increase ROM


improve coordination articulators

articulation activity

improve phoneme precision


increase co-articulatory coordination

articulation strategies- strengthening

tongue- IOPI protocol, maximum contractions



lips & face- maximum contractions


resistance movements, neuromuscular facilitation


articulation strategies- ROM/ reduce tone

tongue, lips, face


massage, stretcing


negative practice


biofeedback EMG

articulation precision

reduce rate


overarticulate


articulation drill


modify articulation difficulty

articulation intelligibility

intelligibilty within specific contexts

artic intelligibility

reduce rate


overarticulate


increase effort


modify environment


train listeners


teach nonverbal comm strategies


AAC

Prosody Goals

to improve emotive stress


improve linguistic stress


to produce natural speech melody

prosody strategies

pitch control


loudness control


imitation of stress patterns


production of specified stress patterns


terminal declination


question inflection


intra- word stress

Management goals

primary goal: maximize the effectiveness, efficiency and naturalness of communication




restore, compensate, and adjust

Restore lost function

REHAB


attempt to reduce impairment


success depends on etiology, type and seerity

promote the use of residual function

COMPENSATE


modifications of rate and prosody


prosthetic devices


environmental modifications


AAC

reduce need for lost function

ADJUST


reorganization of their work environment or responsibilities


change in social


plan for porgressive

factors influencing management

medical dx and prognosis


impairment, limitations, restrictions


envinron/ comm partners


motivation and needs


associated problems


health care system

medical diagnosis and prognosis

neurologic disease develop acutely, subacutely, or chronically




plateauing, chronic, stable, progressive

impairment, limitation and restrictions

ongoing intervention not recommended if an MSD is not associated with activity limitations

environment

noisy, poorly lit, bustling places or quiet familiar settings

motivation and needs

personal goals


premorbid personality, lifestyle, intelligence, personality


coexsisting motor, sensory, and cognitive deficits


general health issues


environment


age


educational level

associated problems

other neurologic deicits


limb motor deficits are common


cognitive deficits can significantly i influence the conduct of management

focus of tx

treat component that will result in quickest functional gains first. one with the greatest functional benefit

medical intervention

pharmacologic and surgical interventons


often precedes or is provided concurrently w other management approaches

pharmacologic management

behavioral management should be delayed until drug therapy that might improve speech begins




sometimes cures the disorder

surgical management

tumors, aneurysms, seizures, are examples of procedures rather than the deficits themselves




some cases, surgery may resolve signs &symptoms

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

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

Pt perception and complaints

doesn't come out right


articulation most often cited


stutter like p

key features of AOS

groping of articulators


variable errors


increased difficulty w volitionality and complexity


difficulty with repetition


ARTIC and PROSODY

tasks to inclue in AOS

automatic speech (counting)


DDK of increasing complexity


words of increasing complexity


repeated trials of the same word

nonverbal tasks AOS

increasing complexity (oral apraxia) right handed tasks upon verbal command (limb apraxia)




apraxia batter for adults


spontaneous speech

therapy principles

intensive treatment


multiple repetitions


progressive complexity

intensive treatment

daily or more


length of tx depends on stamina


balance intensity w fx, motivational fv

multiple repetitions

practice, practice, practice


be cognizant of frustration


variable practice, random tiral

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

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

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

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

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

phonetic placement

help the pt to correctly place articulators where they are needed to produce the target sound

phonetic derivation

taking a sound the pt can produce and adjusting it to make a new sound

integral stimulation

watch me and do what I do

speech entrainment

headphones in and watching the person say the word, they repeat it

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

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

moderate aos tx

contrastive stress drills


oral reading


problem solving approach

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

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

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

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

rate

the faster the articulatory sequence must be made the more difficult for the pt to produce

delay

if there is a delay between clinician model and pt response, imitation is more difficult

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

linguistic context

putting a word in a common phrase makes it easier to produce

situational context

easier for pts to talk to family and friends than strangers

meaningfulness

the more meaning the utterance has to the pt easier it is to produce

cues

the more cues provided to the pt the more chance the pt will correctly produce

hierarch of cues

from most to least cueing


the way you provide cues needs to be strategies and preplanned




document progress



stimulus modality

visual stimulation


tacticle and kinesthetic stimuli


auditory modality

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

PROMPT

provide pressure, kinesthetic, and proprioceptive cues to facilitate speech




highly structured finger placement

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

AAC

communication boards, books


need to remember hemiplegic pts this becmes the issue for lots of pts, they can only use in certain settings

Aphasia

usually in the context of stroke


acquired


neurogenic


language impairment (not cogn)


excludes general sensory

how the brain performs language


comprehension of speech

primarily auditory cortices


Wernickes

reading

visual cortex


wernickes area

spontaneous speech

wernicke's area


arcuate fasiculations


broca's area

damage to pre-motor cortex

apraxia of speech

damage to motor cortex

dysarthria

damage to pyramidial system

to cranial nerves, dysarthria



damage to wernicke's area

receptive

damage to broca's area

expressive (verbal

paraphasia

literal (phonemic) paraphasias


verbal (semantic)


unrelated


perseverative

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


Global aphasia (NON)

nonfluent

*expressive and receptive


severe impairment of all language ability


attentive, task oriented, socially appropriate


recurring stereotypical utterance


sometime AOS


Wernicke's aphasia (F)

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


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