Definitions
Relatively permanent changes in the capability for movement resulting from practice or experience
Motor learning
Improvement or resolution
Chronic
Worsening
Fluctuating
Medical Prognosis
Includes pharmacologic and surgical interventions that directly or indirectly affect speech
Medical Intervention
What does improving speech require?
Speaking
Leads to more persistent gains and better ultimate performance
Greater frequency
Performance during acquisition
Accuracy during session
Activity limitations (disability)
Participation restrictions (handicap)
Environment (physical, social, attitudinal influences)
Limitations and Restrictions of Function
Prosthetic or assistive devices that are available to improve speech
Prosthetic Management
Practice is fundamental to creating lasting neuronal changes that reflect motor learning, and hundreds (or more) of repetitions may be necessary to develop a lasting skill.
Drill is essential
Easy tasks should precede difficult ones and treatment sessions should start with easy familiar tasks, proceed to novel or more difficult tasks, and end with tasks that ensure success.
Task ordering
Performance levels after the completion of practice
Retention
Environment (e.g., noise, distance, distractions)
Partners (e.g., familiar/unfamiliar, number of listeners, cognitive and sensory problems, psychosocial relationships)
Environment and Communication Partners
All intervention efforts that are neither solely medical nor prosthetic
Behavioral Management
In which the learner determines how best to achieve goals
Discovery learning
Task difficulty should be increased when what percentage of responses are acceptable?
90%
Generalization of practice to related but untrained movements
Transfer
Motivation to communicate and to improve communication
Need to communicate, as influenced by multiple factors (e.g., personality; lifestyle; motor, sensory and cognitive status; general health; participation environments)
Motivation and Needs
When an MSD severely limits the degree to which speech and the gestures that normally accompany it transmit messages comprehensibly and efficiently, the affected person many need to augment or substitute other means of communication for speech.
Augmentative and Alternative Communication
Can be useful when a specific motor behavior or acoustic result is the focus of treatment
Instrumental feedback and biofeedback
Therapy may be most productive _______ in the day.
Performance during therapy sessions
Acquisition
Access
Setting (acute, acute rehabilitation, skilled nursing facility, nursing home, home)
Cost, reimbursement, service coverage limits
Health Care System
Management includes important and often crucial couseling and supportive help
Counseling and Support
What should be the primary focus of treatment activities for most patients?
Speech tasks
Clinicians generally prefer __________ therapy.
Individual