Treatments
These treatments are for UUMN lesions.
if the focus is on articulation use SLOP and BOSS. where there are language or cognitive deficits, focus therapy there.
Treat language, apraxia, cognition first, then dysarthria.
Apraxia of speech is caused by damage to this hemisphere.
left frontal-parietal, Broca's region
These salient and deviant features are found in UUMN lesions.
salient: harsh, hoarse qualities. mild hypernasality, slow rate, unilateral VF weakness, reduced respiratory drive.
deviant: spasticity and/or incoordination, imprecise consonants, irregular articulation breakdowns, slow/irregular/imprecise AMRs.
These are the 2 most common types of mixed dysarthria.
flaccid + spastic and ataxic + spastic
Goal of communication with MSDs.
maximize effectiveness, efficiency, and naturalness of communication.
Flaccid dysarthria treatment
focus on increasing strength or compensating for weakness. benefits from postural adjustments. pushing/pulling for adduction of VFs. teach conservation of strength by limiting utterances.
AOS is this kind of issue.
motor planning and programming issue. The muscles are not affected, just the connection between articulators and brain.
When UUMN lesion is present, we treat these before the dysarthria.
treat the language issues, apraxia, and cognition first.
ALS is most commonly accompanied by this type of dysarthria.
Flaccid-spastic mixed dysarthria
3 goals of communication with MSDs
1. restore: communication to original function, reduce the impairment as much as possible.
2. compensate: modify environment to enhance intelligibility, comprehensibility, and efficiency or use AAC
3. adjust: SLP's job, adjust to loss of job, lifestyle change, etc.
spastic dysarthria treatment
relaxation exercises for hypertonic muscles, treat pseudobulbar effect with meds, avoid adduction exercises since muscles already spastic.
T/F all people with AOS have aphasia.
False. People with AOS are suspected to have aphasia unless otherwise tested.
This etiology is the main cause of UUMN lesions.
stroke/vascular
T/F. Pure dysarthrias are more common than mixed.
False. Mixed dysarthrias are more common than pure.
These are the 5 approaches to management.
2. prosthetic: AAC, palatal lift, picture books
3. behavioral: interventions that are neither medical nor prosthetic, can be speech oriented or communication oriented.
4. AAC
5. counseling & support
Ataxic treatment
improving or compensating for motor control and coordination problems. help with rate and prosody to improve intelligibility and naturalness. use techniques that emphasize rate, loudness, and pitch control.
Speech characteristics and non-speech characteristics of AOS
Speech: slow rate, inconsistent articulation errors, disrupted prosody, artic substitutions
non-speech: groping, right side weakness, spasticity, limb apraxia
When the lesion is on this hemisphere, UUMN occurs with apraxia or aphasia.
Left hemisphere
MS = this type of mixed dysarthria
MSA = this type of mixed dysarthria
PSP = this type of mixed dysarthria
Friedrich's ataxia = this type of mixed dysarthria
Wilson's disease =
TBI =
MS = ataxic-spastic
MSA = hypokinetic, spastic, ataxic
PSP = hypokinetic-spastic
Friedrich's = ataxic-spastic/pure ataxic
wilson's disease = mixed dysarthia
TBI = mixed
hyperkinetic treatment
mainly surgical or pharmacological. botox for tremor and dystonia. deep brain stimulation.
Hypokinetic treatment
SPEAK OUT, LSVT, tapping, metronomes, dopamine for PD, botox injections for spasmodic dysphonia.
Tips for people with AOS
speak slowly, think about what you say before you say it, shorter utterances, use facial expressions and gestures to clarify message, stay calm, writing or AAC when necessary, say message in different way
right hemisphere
This is the golden rule for mixed dysarthrias.
Treat the component that is most severely affecting speech production or is the most prominent first.
AOS treatment
metronome, tapping, pacing boards, AAC, using less complex words and high-frequency words
ALSO
PROMPT, integral stimulation, sound production treatment