Assessment and Treatment of Dysarthria PDF

Assessment and Treatment of Dysarthria Dr. Tala Nazzal PhD in Cognitive Science and Language An-Najah National University Faculty of Medicine...

Assessment and Treatment of Dysarthria Dr. Tala Nazzal PhD in Cognitive Science and Language An-Najah National University Faculty of Medicine and Health Sciences| Department of Allied and Applied Medical Sciences| Division of Audiology and Speech Sciences  Treatment differ from clinician to clinician Combination of various treatment is recommended Some treatments may focus on which cranial nerve is damaged. Strengthening exercise are most appropriate for patient with sever weakness. Damage to The Trigeminal Nerve: Jaw muscle strengthening 3 set of opening and closing full mouth. When accomplished , increasing the strength of the mouth by bite down on. Resistance movement of the jaw –open jaw –don’t let close and vise versa.  Damage to The Facial Nerve Results in decreased lip strength and range of movement, which results in distorted bilabial, labiodental phonemes Lip strengthening. Lip puckering: The patient is asked to pucker his lip fully and hold them in position for a given period of time (10 sec). Determine if you can move the pucker from side to side, and hold it. Repeat until 10 consecutive trials are completed. Holding a smile wildly as possible for 5-10 sec.  Damage to The Vagus Nerve Resonance deficit o Surgical and prosthetic treatment: 1. Using pharyngeal flap tissue attached to the velum to insure VP closure. 2. Teflon injection into the pharynx at the point where soft palate normally makes contact when elevated. ▪ inconsistent effect of the two procedures –work well for some patient but not for others. 3. Prosthetic palatal lift –helps pushing the velum upward –most successful. Modification of Speech: Can minimize the effect of hypernasality Increase loudness Ask the speaker to speak loudly because loudness help to mask nasal sounds Reduce the rate of speech Increase intelligibility and lessen the perception of hypernasality Phonation Deficit Pushing and pulling procedures – Having a sitting patient push up on the arms of the chair while phonating an open vowel or having the patient pull up on the edge of a heavy table while prolonging a vowel. It helps vocal folds adduction by providing overall contraction of muscles Holding breath It helps fully adduct the vocal folds Hard glottal attack– complete and rapid adduction of the vocal folds, build-up of subglottic air pressure, and then an explosion of the folds while initiating phonation. Head turning and sideways pressure on the larynx – When there is unilateral weakness or paralysis of one vocal fold – resulting in a breathy voice and increase adduction. Prosodic Deficit -Treatment Pitch range variation ▪ Pitch range exercise Prolonged /a/ at a low pitch and then the highest pitch possible. The patient is asked to read sentences with arrows above the words that indicate pitch variation  Damage to The Hypoglossal Nerve Weakness and reduced motion of the tongue, which results in imprecise consonant production. Tongue strengthening exercises: Resistance. Resistance on lateralization (clinician push to the middle). Elevation of the back of the tongue against the tongue depressor. All these are done while the patient looks at a mirror to enhance awareness of his tongue movement and to increase monitoring of performance accuracy. Traditional Articulation Treatment Concentrate on improving the articulation of phonemes 1. Intelligibility drills The patient reads list of words or sentences while the clinician does not look at him; if the clinician does not understand a word the patient needs to determine what is the word that is not understood and try to Say it again, if the second attempt fail, clinician gives feedback on the specified word. 2. Phonetic placement Instruction to the patient about the correct position of the articulators before the patients attempt to produce the targeted sound. Traditional Articulation Treatment (Cont.) 3. Minimal contrast drills: Pairs of words that vary by only one phoneme: Voicing (park-bark) Manner (dime-mime) Place (sea-she) Vowels (man-men) It can be used alone or in phrases, or in sentences. Resonance Treatment Surgical and prosthetic treatment. Decrease velar hypertonicity by stimulating the tongue and the velum with foreign objects in the mouth. Massaging the velum with a tongue depressor to reduce hypertonicity. Use a tongue depressor to press the velum upwards. Having the patient speak more loudly masks the hypernasality and may increase intelligibility. Treatment of spastic Dysarthria Phonation: Head and neck relaxation: The clinician stands behind the pt. , and slowly and gently tilts it back and forward; then, Rt. and Lt. 10-sec holding in each position (at the extreme position). Gentle massage of the pt. neck (sides and back) to reduce the increased muscle tone. Yawn –sight exercise: Pt. is asked to inhale slowly while fully opening the mouth as if yawning when the inhalation is completed. The pt. exhale while producing prolonged sight. The yawning motion re-facilitates the relaxation of neck muscles and reduces hypertension. After the prolonged sigh, vowels, words beginning with vowels, and sentences included. Treatment of spastic Dysarthria (Cont.) Articulation stretching exercise- Tongue The clinician pulls pt. tongue gently forward until resistance is felt The next step is forward this to Lt and Rt. Any movement should be done carefully by the clinician. Lip stretching The clinician pulls the pt. lip away from the face gently Holding a smile. Pursing the lips (kissing). Puffing out the cheeks. Unilateral upper motor neuron Definition “Unilateral damage to the upper motor neurons, that carry impulses to the cranial nerves of speech muscles, its primary disorder is articulation, demonstrable weakness of the lower face, lips, and tongue, on the opposite side. The most apparent damage is to the muscles of the lower face and tongue because the cranial nerves serving these structures are innervated by UMN. Etiologies: Stroke. Tumors. TBI. Treatment Intelligibility drills Phonetic placement Minimal consonant drills Oral motor exercise  Treatment Respiration Slow and controlled exhalation pt. is asked to Inhale fully and exhale slowly using a stopwatch to determine the length of exhalation. Speak immediately after exhalation Articulation Intelligibility drills Phonetic placement Minimal contrast drills Treatment Articulation : Pacing Board Pt says one word every time his finger is moved to the next slot. Hand/finger taping Delayed auditory feedback- Electronic device “feeds patients with their own voice after a short delay, 50-100 ms. Stretching exercise Tongue, lips. Traditional articulation treatment Intelligibility drills Phonetic placement  Treatment plan Provides a comprehensive program of treatment from the beginning to dismissal. Developed before the beginning of treatment Can be modified Include: Background information from the diagnostic report, brief information. An 18 years old female was seen for speech and language evaluation at An-Najah speech clinic. Speech test results revealed that she has miss-articulation of the /S/, /Z/, / / and the / /.