166 Questions
What is the primary focus of treatment for motor speech disorders?
Relearning motor aspects of speech production
Which of the following best describes the concept of generalization in motor speech disorder treatment?
Improvements in targeted behaviors or related but untrained behaviors in different contexts
Which approach to treatment strategies focuses on specific functions in relevant speech tasks?
Improve impaired subsystem
What is an important indicator of treatment effectiveness according to the text?
Generalization with carryover into naturalistic environments
Why does the text caution against using nonspeech tasks in treatment?
Nonspeech tasks do not aid in improving articulators
What should be included in the routine reassessment process for speech production?
Speech production with different conversational partners
Which of the following is NOT a crucial consideration before initiating treatment?
Social media usage
What is an effective technique to establish respiratory support before working on other speech areas?
Making postural adjustments
Which treatment is underutilized but effective in improving subglottic air pressure?
Use of spirometer and EMST
Why is it important to make postural adjustments in patients with kyphotic posture before other treatments?
To reduce weight on the diaphragm and intercostals
What role does the velo-pharyngeal port play in speech improvement?
Controlling nasal airflow during speaking
How can the patient be cued to begin phonation in relation to exhalation?
/ah/ sound given until no air left
What is the result of increasing the amount of jaw excursion in relation to the phonatory system?
Improved clarity and volume
What is the primary focus of LVST program concept 1?
Improving vocal fold adduction
Why is intensive treatment a key component in the LVST program?
To maintain patient motivation and accountability
What is the role of calibration in the LVST program?
Helping the patient know and accept the effort required for louder voice production
Why is low cognition a benefit in participating in the LSVT program?
It simplifies the instructions for patients
Which speech production task is typically introduced in week 3 of the LVST program?
Reading aloud
How does incorporating sensory awareness training contribute to the success of the LSVT program?
It makes the patient more comfortable using their new louder voice
What can excessive airflow through the nose due to improper velum closure lead to?
Hypernasality
Which device might be necessary to use depending on the severity of subsystem impairment related to velum closure?
Palatal lift
Which factor is NOT part of the prosody manipulation during treatment?
Tone
Which technique involves reading cued material where slash marks indicate where to pause?
Cued reading
'Thinking in Boxes' involves chunking utterances into syntactic units to improve what aspect of speech?
Stress and intonation
"One word per tap" and "Finger or hand tapping" are associated with which technique used for controlling speech rate?
"Tap it out"
Which aspect is a key component of Lee Silverman Voice Treatment (LVST)?
Pitch range exercises
'Breath Cycle' awareness is targeted for improvement using which device?
Spirometer
'Thinking in Boxes' technique can help individuals with dysarthria in improving which aspect of speech?
Chunking utterances into syntactic units
'Stress, annunciation, and accuracy of communication' are improved through which approach during treatment of dysarthria?
'Contrastive stress drills'
What should a speaker do to improve comprehensibility based on York's recommendations?
Provide the listener with context
Which strategy is recommended for listeners to enhance communication effectiveness?
Choose time and place to talk wisely
How can a speaker facilitate communication based on the text?
Accompany speech with simple gestures
What is a recommended method for reducing background noise during speaking situations?
Create a private conference room
Which of the following is suggested to optimize hearing for frequent listeners?
Provide supplemental speech interventions
What is a key recommendation for listeners based on York's insights?
Watch for turn-taking signals
What percentage of the maximum forces do the tongue and lips use for speech production?
10-20%
Which medication is successful for spasmodic torticollis and spasmodic dysphonia?
Botox
What technique is used to bring a paralyzed vocal fold to midline?
Head turning towards the affected side
Which type of treatment focuses on reducing fatigue and conserving energy for communication?
Behavioral interventions
What is the primary focus of treatment for Ataxic Dysarthria related to respiration?
Coordinating exhale and inhale
Which pharmaceutical treatment is used to suppress choreic movements?
Haloperidol
What kind of intervention aims to modify the communication context?
Environmental Interventions
What benefits are associated with speaking slow according to the text?
Improved articulation and respiration
What aspect of speech does the LSVT program primarily focus on improving?
Loudness
What is a common feature among commercial products for dysarthria treatment?
Include examples of documentation and sample reports
What is the key aspect of dysarthria rehabilitation addressed in the Dysarthria Rehabilitation Program?
Articulation
What is the main outcome associated with outpatient speech-language pathology services based on data from ASHA's NOMS?
Improved communication functioning
Which neurological conditions have been studied and applied the LSVT program according to the text?
Parkinson's disease and various neurological conditions
What is the primary purpose of the Dysarthria Rehabilitation Program?
Enhancing articulatory movements
What is a common feature of the LSVT program that helps in addressing voice symptoms in Parkinson's disease?
Exaggerating one component of speech
Nonspeech tasks should be used in treatment to improve speech production.
False
Focusing on simpler targets in motor speech disorder treatment results in greater learning.
False
Improving intercostals and the system of respiration is not related to addressing low vocal volume in speech treatment.
False
Treatment for motor speech disorders involves two approaches: improving subsystem function and using compensatory strategies.
True
Carryover of improved communication into naturalistic environments is not an important indicator of treatment effectiveness.
False
Generalization involves lasting performance enhancements in targeted behaviors in different contexts, tasks, or settings.
True
The LVST program concept 2 focuses on pushing patients to new effort levels by putting the 'load on the larynx'.
True
LVST therapy sessions are 1 hour long, 5 times a week, for 4 weeks.
False
Calibration in the LVST program ensures that the patient knows and accepts the amount of effort needed to consistently decrease loudness within normal limits.
False
In the LVST program, the patient needs to have 'knowledge of results' to automatically use a quieter voice.
False
The LVST Program focuses on improving fundamental frequency range through sensory processing retraining.
True
LVST therapy includes hierarchy activities like reading aloud in week 2 and phrases in week 4.
False
Making postural adjustments in kyphotic patients is the most challenging aspect of treating the Respiratory System first.
False
One of the conditions to consider before treatment is the patient's previous degree of occupation.
False
It is recommended to take quick and short breaths during therapy sessions to enhance expressive communication.
False
The use of spirometer and EMST is highly recommended to build vocal capacity in patients with speech disorders.
True
Improving voice quality involves changing tone, texture, and movement of speech musculature to reduce naturalness in speech.
False
Controlling vocal folds is essential to enhance the naturalness of speech production.
True
One of the aspects to improve in speech therapy is the strength and control of the velo-pharyngeal port.
True
Phonation should start before exhalation to optimize breath group during speech therapy.
False
Improving inhalation/exhalation relationship is not necessary for appropriate speech production in respiratory therapy.
False
'Stress patterns' refer to words that are produced with different levels of emphasis during communication tasks.
True
The velum is responsible for closing off the nasal cavity from the oral cavity.
False
A palatal lift is used to lower the velum in cases of hypernasality.
False
Prosody involves manipulation of four factors: loudness, pitch, duration, and quality.
False
Rigid control techniques are recommended to increase the rate of speech in individuals undergoing treatment.
False
The LVST program primarily focuses on improving articulation in individuals with motor speech disorders.
False
Spirometer is used to increase awareness of the 'Breath Cycle' in individuals with dysarthria.
True
Cued reading material can be helpful in improving overall control of speech and stress and intonation.
True
'Thinking in Boxes' involves chunking utterances into syntactic units to enhance breath support in speech.
False
Articulatory placement cues involve the use of ultrasound for biofeedback in speech production.
True
'One word per tap' technique is associated with using a metronome to control the rate of speech.
True
Optimizing hearing for frequent listeners includes reducing background noise.
True
Using alphabet supplementation is a recommended strategy for improving comprehensibility for both the speaker and the listener.
False
It is advised to avoid communication over long distances to enhance speech comprehension.
True
In meetings and group settings, amplifying the speaker's voice is not suggested as a method to enhance communication.
False
Using predictable types of sentences and wording is not a recommended technique for improving speech comprehensibility.
False
Gestural supplementation is solely recommended as a speaker's strategy and not for enhancing listener comprehension.
False
LSVT® was originally created for individuals with hyperkinetic dysarthria.
False
Approximately half of the adults with diseases of the central nervous system who received outpatient speech-language pathology services became intelligible to all listeners following treatment.
False
The Dysarthria Rehabilitation Program focuses on improving speech intelligibility through visual aids only.
False
Voice Therapy for Parkinson's disease involves significant respiratory difficulties as causes of voice symptoms.
True
The LSVT Program is primarily focused on improving articulation and phonation.
False
Outpatient speech-language pathology services have been shown to have no impact on the intelligibility and communication functioning of patients with central nervous system diseases.
False
The jaw uses 2% of its maximal forces during speech production.
True
Phonetic placement is a treatment approach used for Respiratory Weakness.
False
Botox is not an effective treatment for spasmodic torticollis.
False
Medical cannabis is primarily used to treat myoclonic movements.
False
Behavior-Based Treatment primarily focuses on sensory tricks to suppress involuntary movements.
True
Relaxation therapy has consistently positive results in treating motor speech disorders.
False
Pitch range exercises are not part of Prosody treatment.
False
Complete inhalation is cued to begin phonation in relation to exhalation.
False
Articulation drills are suggested for patients with UUMN Dysarthria.
True
EMST primarily focuses on correcting posture for patients with Respiratory Weakness.
False
Define: acquisition, retention, and generalization
Retention = lasting performance enhancements no = no Acquistion = temporary improvements during treatment Generalization = improvements in either related but untrained behaviors (response) or in targeted behaviors in different contexts, tasks, or settings (stimulus)
How is inhalation modified?
Increasing duration of air intake
How is exhalation modified?
Vowel prolongation
How is respiratory support established?
Making postural adjustments
How can respiratory flexibility be increased?
Producing words with a variety of stress patterns
How can forced vital lung capacity be increased?
Use of spirometer and EMST
Which of the following is not an approach to treating prosody, specifically in regards to rate control?
Contrastive stress drills
How can voice quality be improved?
Postural adjustments, relaxation therapy
How can the naturalness of speech be enhanced?
Controlling vocal folds
How can you improve the strength and control of the velopharyngeal port?
Practicing nasal vs. oral airflow patterns
You are a clinician treating a patient with dysarthria. You focus the patient’s attention to the accuracy, range of motion , and direction of articulators movement during speech. You provide feedback on articulatory placement cues, and vocal postural cues. What subsystem are you treating?
Articulation
You are clincian working with a patient with dysarthria. You are working on improving voice quality, overall speech naturalness, and strength and control of the velopharyngeal port. What subsystem are you targeting?
Phonatory
You are the clinician assigned to provide treatment to a patient with dysarthria. You work on postural adjustments, increasing the duration of air intake, vowel prolongations, and producing words with a variety of stress patterns. What speech subsystem are you targeting?
Respiratory
Which of the following is an example of feedback the clinician can provide during treatment of the articulatory system?
All of the above
You are the clinician assigned to treat a patient with a dysarthria. In the session, you target the manipulation of loudness, pitch, and duration. What speech subsystem are you treating?
Prosody
Rate control-intelligibility generally improves with rate and to communication
Rate control-intelligibility generally improves with decreased rate and attention to communication:
What do contrastive stress drills target?
Stress, annunciation, and accuracy of communication
What is a benefit of pitch range exercises?
Brings flexibility and change of intonation into voice
"Thinking in Boxes" targets many aspects of speech production. Which of the following does it NOT target?
Clarity and volume
Reciting syllables to a metronome, "tap it out", and cued reading materials target which speech subsystem?
Prosody - rate control
Which speech subsystem is targeted through the use of constrastive stress drills, pitch range exercises, and intonation profiles?
Prosody - stress and intonation
The goal making process is soley the responsible of the clinician. The client is not responsible for creating or owning goals.
False
In severe cases, implementation of alternative and augmentative communication strategies (e.g., simple gestures, alphabet boards, or electronic or computer-based equipment). What clinical population is this most relevant for?
ALS
If you want to make speech clearer, you should work on improving _________.
Articulation
One treatment approach available for individuals with dysarthria involves teaching caregivers and family members strategies to better communicate with the person with dysarthria.
True
What does Dr.B do? Think ______ Think ______ Think ______
slow loud clear
What has been reported as the cause of voice symptoms in individuals with Parkinson's disease?
Significant respiratory difficulties and bowed vocal folds
What 3 things does LVST incorporate?
Enhancing the vocal source (adduction) Using phonation as a trigger to increase effort and coordination through stimulating the “loud” global variable (respiratory support) Retraining sensory processing during the speech production (increasing fundamental frequency range)
Match the essential concepts of the LVST program to its description
Voice = Improving vocal fold adduction Maximum impact on intelligibility Immediate reinforcement High effort = Overrides rigidity and hypokinesia by pushing patients to new effort levels Trains new target by putting the “load on the larynx” Clinician Rationale Clinician effort equals patient effort Intensive treatment = Daily opportunity to practice increases the chance of “building daily increments of vocal effort” Maintain motivation and accountability Maximize habituation and carry over Provides an opportunity for clinician to see patient’s daily fluctuations Calibration = The patient knows and accepts the amount of effort needed to consistently increase loudness that is within normal limits Patient will use louder voice automatically Data- Patient needs to have “knowledge of results” Convince patient that loud/strong voice is WNL Habituation and carryover
Match the hierarchy activities of LVST to their designated week
Week 1 = Words Week 2 = Phrases Week 3 = Reading aloud Week 4 = Conversation
Which of the following is not a way to collect data in LVST?
Use of ultrasound
Which of the following is one way we can treat phonation deficits in flaccid dysarthria?
Hard glottal attack
Which of the following is not an example of treatment approaches for phonatory deficits in flaccid dysarthria?
Contrastive stress drills
Which of the following is not an example of treatment approaches for prosody deficits in flaccid dysarthria?
Phonetic placement
Which of the following is not an example of treatment approaches for articulation deficits in flaccid dysarthria?
Chunking utterances into syntactic units
Which of the following medications treat myoclonic movements?
Clonazepam or Valproic acid
Which of the following not a general approach to treating respiratory weakness in hyperkinetic dysarthria?
Inspiratory muscle training (EMST)
What neurological base do patients with ataxic dysarthria need to work on>
Coordination
In general, ____________ treatments are suggested for patients with UUMN dysarthria
Articulatory
The clincian is working with a patient with dysarthria. Their treatment strategy includes behavior-based treatment, and treatment of the respiratory system. They utilize expiratory muscle strength training in their sessions. Additionally, they coordinate with doctors who are treating the condition with medication. What type of dysarthria are you likely treating?
Hyperkinetic
You are the clinician assigned to treat a patient with dysarthria. Your supervisor instrcuts you to work on coordination rather than strengthening. She suggests the patient engage in slow and controlled exhalation. She reminds you that it is your responsibility to work on increasing length and steadiness of the airstream. The patient likely has ______ dysarthria.
Ataxic
What is the most effective motor speech disorder treatment?
LVST
Match the LVST concept to its name
Concept 1 = Voice Concept 2 = High effort Concept 3 = Intensive treatment Concept 4 = Calibration
Match the treatment approach to the targeted subsystem
Pushing and pulling effortful closure = Phonation Pitch range exercises = Prosody Intelligibility drills = Intelligibility Relaxation therapy = Behavior-based treatment
Match the treatment approach to the targeted subsystem
Correct posture = Respiratory Intonation profiles = Prosody Holding breath = Phonation Modifying the communication context = Environmental modification
Head turning toward the affect side in order to bring paralyzed vocal fold to midline = Phonation Constrastive stress drills = Prosody Exaggerating consonants = Articulation Expiratory muscle strength training (EMST) = respiratory
Match the type of treatment to its subsystem.
Speaking immediately on exhalation = Respiration Minimal contrast drills = Articulation Chunking utterances into syntactic units = Prosody Sideways pressure on larynx = Phonation
Match the type of medication to what it treats
Haloperidol = Choreic movements Clonazepam or Valproic acid = for myoclonic movements Botox = spasmodic torticollis, spasmodic dysphonia, and several other dystonias Levodopa = Parkinson's disease
________ sensory tricks that suppress involuntary movements
Behavior - based treatment
You are clinician working with a client that has dysarthria. You work on modifiying the communication context by optimize hearing of frequent listeners, optimize adverse speaking situations, and reducing background noise. What treatment approach are you using?
Environmental interventions
Which of the following is not a supplemental speech intervention?
Environmental supplementation
You are treating the subtype of dysarthria not the impaired subsystem.
False
Which of the following is not an approach to reduce rate of speech?
Phonetic placement cues
Overall how can we improve intelligibility?
Using rate control
How can we improve clarity and volume
Increasing jaw excursion
How can we build forced vital lung capacity?
Use of spirometer and EMST
How can we establish respiratory support?
Increasing duration of air intake
Which of the following is one of the most efficacious and underutilized treatment to improve subglottic air pressure, the intercostal muscles?
Use of spirometer and EMST
How can we increase respiratory flexibility?
Producing words with a variety of speech patterns
How can we enhance the naturalness of speech?
Controlling vocal folds
How can we enhance clarity and volume?
Increasing jaw excursion
Which of the following helps reduce unwanted hypernasality?
Palatal lift
Study Notes
Optimize Hearing and Speaking
- Optimize hearing of frequent listeners
- Optimize adverse speaking situations
- Reduce background noise
- Mute TV
- Amplify speaker in meetings, groups, and noise
- Create a "private conference room" environment
Supplemental Speech Interventions
- Alphabet supplementation
- Topic supplementation
- Gestural supplementation
Improving Comprehensibility (Speaker)
- Provide listener with context
- Don't shift topics abruptly
- Use turn-taking signals
- Get your listener's attention
- Use complete sentences
- Use predictable types of sentences
- Use predictable wording
- Rephrase your message
- Accompany speech with simple gestures
- Take advantage of situational cues
- Make environment as friendly as possible
- Avoid communication over long distances
- Use alphabet board supplementation
- Have a handy backup system
Improving Comprehensibility (Listener)
- Know the topic of conversation
- Watch for turn-taking signals
- Give your undivided attention
- Choose time and place to talk
- Watch the speaker
- Piece together the cues
- Make the environment work for you
- Avoid communicating over long distances
- Make sure your hearing is as good as possible
- Decide on and incorporate strategies for resolving communication breakdowns
- Establish some rules of the game
- Facilitate communication with others
Treatment of Phonation Deficits
- Pushing and pulling-effortful closure techniques
- Improves glottal closure
- Minimizes vocal cord bowing
- Holding breath
- Hard glottal attack
- Head turning toward the affected side
- Sideways pressure on larynx
Treatment of Prosody
- Pitch range exercises
- Intonation profiles
- Contrastive stress drills
- Chunking utterances into syntactic units
Articulation Treatment
- Intelligibility drills
- Phonetic placement
- Exaggerating consonants
- Minimal contrast drills
Treatment for Hyperkinetic Dysarthria
- Medical treatment: pharmaceuticals to suppress involuntary movements
- Medical cannabis
- Haloperidol (for choreic movements)
- Clonazepam or Valproic acid (for myoclonic movements)
- Botox for spasmodic torticollis, spasmodic dysphonia, and other dystonias
- Behavior-based treatment: sensory tricks, relaxation therapy, and supportive psychotherapy
Treatment for Respiratory Weakness
- General approaches: correct posture
- Expiratory muscle strength training (EMST)
- Speaking immediately on exhalation
- Cueing for complete inhalation
Treatment for Ataxic Dysarthria
- Respiration: patients need to work on coordination rather than strengthening
- Slow and controlled exhalation
- Inhale fully and exhale slowly and steadily
- Clinician works on increasing length and steadiness of airstream
- Increase difficulty of task by having patient exhale for 3 seconds, stop for 1 second, then continue to exhale
Treatment for UUMN Dysarthria
- Traditional articulation treatment
- Intelligibility drills
- Phonetic placement
- Exaggerating consonants
- Minimal contrast drills
Behavioral Interventions
- Speaking rate modification
- Speakers usually reduce rate with intervention
- Maintain coordinated respiratory patterns
- Coordinated thoracic and abdominal breath
- Reduce fatigue
- Conserve energy for communication
Environmental Interventions
- How can the communication context be modified?### Treatment of Dysarthria
- Speech therapy approaches for dysarthria focus on improving motor aspects of speech production, including acquisition, retention, and generalization.
- Treatment targets include respiration, phonation, articulation, prosody, and rate control.
Principles of Treatment
- Treat the mechanism of dysfunction, rather than just the symptoms.
- Focus on more complex targets, such as over articulation and improved breath support, rather than simpler targets.
- Use compensatory strategies to improve communication, including environmental modifications and strategies for communication partners.
LSVT Program
- Founded by Lorraine Olson Ramig, Ph.D., CCC-SLP, the LSVT program is a 1st speech treatment with short and long-term efficacy data documenting increased functional communication.
- The program focuses on improving vocal fold adduction, high effort, and intensive treatment.
- Key concepts include:
- "THINK LOUD" to improve vocal fold adduction and maximum impact on intelligibility.
- High effort to override rigidity and hypokinesia.
- Intensive treatment to increase daily increments of vocal effort and maintain motivation and accountability.
- Calibration to ensure patient knows and accepts the amount of effort needed to consistently increase loudness.
Speech Production Tasks
- Hierarchy activities include:
- Week 1: Words
- Week 2: Phrases
- Week 3: Reading aloud
- Week 4: Conversation
- Data collection is key, including measuring vocal output, amplitude, length, and pitch.
Treatment of Flaccid Dysarthria
- Do not use oral strengthening exercises.
- Focus on improving respiratory support, including postural adjustments, modifying inhalation, and modifying exhalation.
Respiratory System
- Establishing respiratory support, including making postural adjustments and increasing respiratory flexibility.
- Modifying inhalation and exhalation, including increasing duration of air intake and controlled exhalation.
- Improving inhalation/exhalation relationship and increasing respiratory flexibility.
Phonatory System
- Improving voice quality, including postural adjustments, relaxation therapy, and controlling vocal folds.
- Increasing jaw excursion to gain clarity and volume.
Articulatory System
- Focus on accuracy, range of motion, and direction of articulators movement during speech.
- Feedback from the clinician can include articulatory placement cues, modeling speech production, and use of ultrasound for biofeedback.
Prosody and Rate Control
- Manipulation of loudness, pitch, and duration.
- Approaches to reducing rate of speech, including rigid control techniques, pacing, and metronome.
- Improving stress and intonation, including contrastive stress drills and pitch range exercises.
Clinical Applications
- Treatment approaches for individuals with dysarthria include:
- Improving breath support to improve loudness.
- Improving articulation to improve clarity.
- Strengthening muscles.
- Increasing awareness of the "Breath Cycle".
- Teaching caregivers and family members strategies to better communicate with the person with dysarthria.
- Implementing alternative and augmentative communication strategies in severe cases.
Learn about the treatment for Motor Speech Disorders (MSD), focusing on relearning motor aspects of speech production through acquisition, retention, and generalization. Understand the targets of treatment, including the use of nonspeech tasks.
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