Assessment and Treatment of Dysarthria

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Questions and Answers

What type of exercises are recommended for a patient with severe weakness due to cranial nerve damage?

Strengthening exercises are recommended.

How can damage to the Trigeminal Nerve affect speech production?

It can lead to jaw weakness, affecting articulation.

What specific exercise can help improve lip strength in patients with Facial Nerve damage?

Lip puckering exercises are effective.

What is one surgical treatment for resonance deficits caused by Vagus Nerve damage?

<p>A pharyngeal flap surgery is one option.</p> Signup and view all the answers

What modification can a speaker use to help minimize the effects of hypernasality?

<p>Increasing loudness while speaking can help.</p> Signup and view all the answers

Why is it important to reduce the rate of speech in dysarthric patients?

<p>It increases intelligibility and lessens the perception of hypernasality.</p> Signup and view all the answers

What type of procedures are known to improve phonation deficits?

<p>Pushing and pulling procedures improve phonation.</p> Signup and view all the answers

What is the impact of using a prosthetic palatal lift for patients with Vagus Nerve damage?

<p>It helps push the velum upward and is often successful.</p> Signup and view all the answers

What technique is used to relax the head and neck for patients with spastic dysarthria?

<p>The clinician gently tilts the patient's head back and forth while providing gentle massage to reduce muscle tone.</p> Signup and view all the answers

Describe the yawning-sigh exercise and its purpose in treating spastic dysarthria.

<p>The patient inhales slowly while fully opening the mouth as if yawning, then exhales with a prolonged sigh to relax neck muscles.</p> Signup and view all the answers

What is the primary disorder associated with unilateral upper motor neuron damage?

<p>The primary disorder is articulation, particularly weakness in the lower face, lips, and tongue on the opposite side.</p> Signup and view all the answers

Identify two common etiologies for unilateral upper motor neuron damage.

<p>Stroke and traumatic brain injury (TBI) are common etiologies.</p> Signup and view all the answers

How does the pacing board aid patients with spastic dysarthria during articulation training?

<p>A pacing board allows the patient to say one word for each finger movement to improve speech timing.</p> Signup and view all the answers

What role do intelligibility drills play in the treatment of spastic dysarthria?

<p>Intelligibility drills help improve the clarity and comprehensibility of speech.</p> Signup and view all the answers

Explain the purpose of using delayed auditory feedback in treating spastic dysarthria.

<p>Delayed auditory feedback provides patients with their own voice after a short delay to improve speech monitoring.</p> Signup and view all the answers

What are some techniques included in the oral motor exercises for patients with spastic dysarthria?

<p>Oral motor exercises include tongue and lip stretching, as well as traditional articulation treatments.</p> Signup and view all the answers

What role does holding breath play in vocal fold adduction?

<p>Holding breath helps fully adduct the vocal folds.</p> Signup and view all the answers

Describe the hard glottal attack and its components.

<p>The hard glottal attack involves complete and rapid adduction of the vocal folds, a build-up of subglottic air pressure, and then an explosion of the folds while initiating phonation.</p> Signup and view all the answers

How can head turning assist individuals with unilateral vocal fold weakness?

<p>Head turning can provide sideways pressure on the larynx to increase adduction of the weakened vocal fold.</p> Signup and view all the answers

What are some exercises to improve pitch range variation?

<p>Pitch range exercises include prolonging /a/ at both low and high pitches and reading sentences with pitch variation cues.</p> Signup and view all the answers

What effect does damage to the hypoglossal nerve have on speech?

<p>Damage to the hypoglossal nerve results in weakness and reduced motion of the tongue, leading to imprecise consonant production.</p> Signup and view all the answers

What is the purpose of intelligibility drills in articulation treatment?

<p>Intelligibility drills help improve a patient's articulation by having them repeat words that the clinician cannot understand, facilitating feedback and correction.</p> Signup and view all the answers

Explain the use of minimal contrast drills in speech therapy.

<p>Minimal contrast drills use pairs of words that differ by only one phoneme to focus on articulation, such as 'park' versus 'bark'.</p> Signup and view all the answers

What techniques can be used to treat resonance issues related to velar hypertonicity?

<p>Techniques include massaging the velum with a tongue depressor, pressing the velum upwards, and encouraging louder speech to mask hypernasality.</p> Signup and view all the answers

Flashcards

Dysarthria

A type of dysarthria that results in weakness, incoordination, or paralysis of the muscles involved in speech production. It affects the ability to produce clear and understandable speech.

Speech Muscle Strengthening

A treatment approach that involves strengthening and improving the coordination of the muscles responsible for speech production.

Jaw Muscle Strengthening Exercises

Exercises designed to strengthen jaw muscles, often used for patients with damage to the Trigeminal Nerve.

Lip Strengthening Exercises

Exercises that focus on improving lip strength and range of motion, essential for patients with damage to the Facial Nerve.

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Lip Weakness and Speech Distortion

A condition that affects the ability to produce clear and understandable speech due to weakened or impaired lip and facial muscles.

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Surgical and Prosthetic Treatment for Resonance Deficit

A treatment approach that involves surgical or prosthetic interventions to address problems with the soft palate and velum, often used for patients with damage to the Vagus Nerve.

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Increase Loudness for Hypernasality

A strategy to minimize the effects of hypernasality by speaking louder to mask nasal resonance.

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Reduce Speech Rate for Hypernasality

A technique to improve speech intelligibility by reducing the speed of speech, often beneficial for hypernasality.

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Vocal Fold Adduction

The process of bringing the vocal folds together, essential for producing sound.

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Hard Glottal Attack

A technique that enhances vocal fold adduction by fully closing the vocal folds and building up air pressure below them.

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Prosodic Deficit

A speech disorder characterized by inconsistent pitch variation in speech.

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Pitch Range Exercises

Exercises designed to improve a speaker's range of voice pitch.

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Hypoglossal Nerve Damage

Impairment of the Hypoglossal nerve, leading to reduced tongue movement and difficulty producing clear consonants.

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Tongue Strengthening Exercises

Exercises that strengthen the tongue muscles to improve articulation.

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Traditional Articulation Treatment

A method for improving articulation by identifying and practicing specific sounds that are difficult to produce.

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Resonance Treatment

A treatment method for hypernasality that aims to reduce excessive nasal resonance.

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Unilateral Upper Motor Neuron Dysarthria

A type of dysarthria caused by damage to the upper motor neurons on one side of the brain, affecting the muscles on the opposite side, predominantly the lower face, lips, and tongue.

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Head and Neck Relaxation

A technique used to reduce muscle tone and increase relaxation in the neck and jaw, involving gentle tilting and massage.

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Tongue Stretching

A stretching exercise for the tongue where the clinician gently pulls the tongue forward until resistance is felt.

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Intelligibility Drills

Exercises designed to improve articulation by focusing on specific sounds and word combinations, targeting the affected speech muscles.

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Phonetic Placement

A method that helps improve speech by focusing on the correct placement of the tongue, lips, and jaw for different sounds.

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Slow and Controlled Exhalation

Exercises that involve increasing the strength and stability of the respiratory system, particularly focusing on controlled exhalation.

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Pacing Board

A treatment approach that uses a structured board with slots to help the patient maintain a consistent speaking rate.

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Delayed Auditory Feedback

A treatment technique involving a device that plays back the patient's voice with a slight delay, aiding in improving speech rhythm and fluency.

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Study Notes

Assessment and Treatment of Dysarthria

  • Dysarthria treatment varies between clinicians
  • A combination of treatments is recommended
  • Treatments can focus on the damaged cranial nerve
  • Strengthening exercises are suitable for patients with severe weakness

Damage to the Trigeminal Nerve

  • Jaw muscle strengthening exercises are recommended
  • Three sets of opening and closing the mouth are performed
  • Increasing mouth strength by biting down
  • Resistance exercises for jaw opening and closing

Damage to the Facial Nerve

  • Lip strengthening exercises are crucial
  • Lip puckering: fully pucker lips and hold for 10 seconds
  • Determining if puckering can move from side to side
  • Repeat 10 consecutive lip puckering trials
  • Holding a wide smile for 5-10 seconds improves lip strength

Damage to the Vagus Nerve

  • Resonance deficits require surgical and prosthetic treatment
  • Pharyngeal flap tissue attachment to the velum ensures VP closure
  • Teflon injection into the pharynx where soft palate contacts when elevated
  • Prosthetic palatal lift pushes the velum upward (effective treatment)

Modification of Speech

  • Increasing loudness masks hypernasality
  • Reduced speech rate improves intelligibility and reduces perception of hypernasality

Phonation Deficit

  • Pushing and pulling procedures:
    • Sit and push up on chair while phonating an open vowel
    • Pull up on a table edge while prolonging a vowel
  • Vocal folds adduction through overall muscle contraction
  • Hard glottal attack: complete and rapid adduction, subsequent air pressure explosion initiates phonation
  • Head turning and sideways pressure on larynx treats unilateral weakness/paralysis for a breathy voice and increased adduction

Prosodic Deficit - Treatment

  • Pitch range exercise
  • Prolonged "a" sound at low and high pitches
  • Reading sentences with arrows to indicate pitch variation

Damage to the Hypoglossal Nerve

  • Tongue weakness and reduced motion causes imprecise consonant production
  • Tongue strengthening exercises:
    • Resistance
    • Lateralization resistance (clinician pushes the tongue to the middle)
    • Elevation of the back of the tongue against the tongue depressor
  • Exercises performed while looking in a mirror to enhance awareness.

Traditional Articulation Treatment

  • Focuses on improving phoneme articulation
  • Intelligibility drills: patient reads words/sentences without clinician looking. If the clinician doesn't understand, the patient tries again. If it fails, feedback is provided.
  • Phonetic Placement: instructions on the correct position of articulators before trying the sound.
  • Minimal contrast drills: use pairs of words/phrases that vary by only one sound to practice voicing, manner, place, or vowel sounds. These drills can be used alone or in phrases/sentences

Resonance Treatment

  • Surgical and prosthetic treatments
  • Decreasing velar hypertonicity by stimulating the tongue and velum with objects in the mouth
  • Massaging the velum with a tongue depressor to reduce hypertonicity
  • Using a tongue depressor to press the velum upwards
  • Increased volume masks hypernasality, potentially improving intelligibility.

Treatment of Spastic Dysarthria

  • Phonation: Head and neck relaxation; gentle massage. The clinician gently tilts the patient's head back and forth, then right and left. Hold at extreme positions for 10 seconds. Gentle massage to reduce muscle tone. Yawn exercises improve relaxation and reduce muscle tension
  • Articulation: Tongue stretching, lip stretching (smiling, pursing, puffing cheeks) exercises to improve flexibility and movement.

Unilateral Upper Motor Neuron

  • Unilateral damage to upper motor neurons affects cranial nerves
  • Impulses to speech muscles are affected, showing weakness on the opposite side of the face, lips, and tongue.
  • Most apparent damage is to muscles on the opposite side.
  • Common causes include stroke, tumors, and TBI

Treatment Plan

  • Comprehensive treatment plan developed before treatment begins
  • Plan can be modified during treatment
  • Including background information from diagnostic reports.
  • Example: An 18-year-old female with articulation errors of /s/, /z/, /ʃ/, and /Ê’/.

Treatment for Dysarthria (Additional details across various sections)

  • Respiration: Slow and controlled exhalation; inhale, exhale using a stopwatch.
  • Pacing Board: Patient says one word with each finger movement to the next slot.
  • Hand/finger taping: Delayed auditory feedback (50-100ms) using an electronic device for feedback.

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