The document outlines various treatment strategies for spastic dysarthria including restorative and compensatory approaches. Restorative treatments target improving speech intelligibility, prosody, and naturalness through techniques like the Lee Silverman Voice Treatment. Compensatory strategies focus on improving communication through environmental modifications, communication strategies, and augmentative and alternative communication devices. A variety of direct speech production treatments and other options are described targeting areas like respiration, phonation, articulation, fluency, and prosody. Treatment selection depends on factors like severity, prognosis, and patient preferences.
2. GOAL
The treatment focuses on facilitating the;
Efficiency
Effectiveness
Naturalness of communication
3. TREATMENT APPROACHES
Treatment can be;
restorative ( aimed at improving or restoring impaired
function)
compensatory ( aimed at compensating for deficits not
amenable to retraining).
4. Restorative approaches focus on improving
uspeech intelligibility,
uprosody
unaturalness
uefficiency.
Compensatory approaches focus on
improving comprehensibility by
uincreasing the speaker's use of communication
strategies,
uimproving listener skills and capacity, and
ualtering the communication environment;
uincreasing effective use of AAC options; and
uincreasing use of non-AAC devices.
Treatment is not always restorative or
compensatory. Sometimes, it is directed at
preserving or maintaining function, such as when
an individual has a slowly progressing
degenerative disease.
5. TREATMENT OPTIONS
Treatments are grouped into
those that directly target the speech-production
subsystems and
other treatment options, including communication
strategies, environmental modifications, AAC, and
medical/surgical interventions by other specialists.
6. TREATMENT SELECTION
Treatment selection depends on a number of factors ie
the severity of the disorder
natural history and prognosis of the underlying
neurologic disorder
the perceptual characteristics of the individual's
speech and his or her communication needs
patient and family preference and engagement
the presence and severity of co-occurring conditions
7. 1.Treatments That Target Speech-
Production Subsystems
Respiration
Making postural adjustments (e.g., sitting upright to
improve breath support for speech)
Inhaling deeply before onset of speech utterance
(known as preparatory inhalation)
Using optimal breath groups when speaking (i.e., for
each breath, speak only the number of syllables that
can be comfortably produced)
Using expiratory muscle strength training to improve
8. (the individual blows into a pressure threshold
device with enough effort to overcome a preset
threshold)
Using inspiratory muscle strength training to improve
strength of the inspiratory muscles to permit better
sustained or repeated inspirations (the individual uses
a handheld device that is set to require a minimum
inspiratory pressure for inspiration to continue)
Using maximum vowel prolongation tasks
9. to improve duration and loudness of speech
Using controlled exhalation tasks (air is exhaled
slowly over time) to improve control of exhalation for
speech
Using nonspeech tasks to improve subglottal air
pressure and respiratory support (e.g., blowing into a
water glass manometer)
10. l
lThere are some treatments designed to
improve phonation which are as follows;
lLee Silverman Voice Treatment (LSVT)—an
intensive program that targets high phonatory
effort to improve loudness and intelligibility
lPitch Limiting Voice Treatment (PLVT)—a
program for increasing vocal loudness without
increasing pitch
lEffort closure techniques to increase adductory
forces of vocal folds (e.g., pulling upward on chair
seat; squeezing palms of hands together)
lImproved timing of phonation (e.g., initiating
phonation at beginning of expiration)
11. l
lPhonetic placement techniques (e.g., hands-
on, descriptive, pictures) to work on positioning
of the mouth, tongue, lips, or jaw during speech.
lPhonetic derivation techniques (nonspeech to
speech tasks such as "blowing" to /u/).
lExaggerated articulation (overarticulation) to
emphasize phonetic placement and increase
precision, sometimes called "clear speech."
lMinimal contrasts to emphasize sound
contrasts necessary to differentiate one
phoneme from another.
lIntelligibility drills in which the individual reads
words, phrases, or sentences and attempts to
repair content not understood by the listener.
12. lRate modification to facilitate articulatory precision—strategies
include
lpausing at natural linguistic boundaries (e.g., using printed script
marked at natural pauses);
lusing external pacing methods such as pacing boards, hand/finger
tapping, and alphabet boards;
lusing auditory feedback (e.g., delayed auditory feedback or
metronome);
lusing visual feedback (e.g., using computerized voice programs);
and
lusing approaches that reduce speech rate without directly targeting
it (e.g., increasing loudness, altering pitch variation, altering phrasing
or breath patterns).
13. l
Prosthetic management in collaboration
with other disciplines e.g;
lpalatal lift prosthesis and
lnasal obturator to occlude nasal
airflow.
lResistance training during speech
using continuous positive air pressure
(Kuehn, 1997).
14. l
lIncreasing awareness and ability to control respiration,
rate, and pitch to vary emphasis within multisyllabic words
and in connected utterances (e.g., using scripts, marked and
unmarked passages)
lImproving intonation by signaling stress with loudness,
pitch, or duration
lExtending breath groups to better align with syntactic
boundaries
lUsing contrastive stress tasks to improve prosody and
naturalness (e.g., repeating sentence with stress on different
word/s
15. OTHER TREATMENT OPTIONS
Communication Strategies
Environmental Modification
Augmentative and Alternative Communication (AAC)
Medical/Surgical Intervention
16. Communication Strategies
A variety of communication strategies can be used
by the speaker or his communication partner in order
to enhance communication when speech intelligibility
or efficiency is reduced.
These strategies can be used before, during, or after
other treatment approaches are implemented to
improve or compensate for speech deficits.
17. Speaker strategies include;
lmaintaining eye contact with the communication
partner
lpreparing the communication partner by gaining
his or her attention and introducing the topic of
conversation before speaking;
lpointing and gesturing to help convey meaning;
llooking for signs that the communication partner
has or has not understood the message; and
leffectively using conversational repair strategies
18. Communication-partner strategies include
lmaintaining eye contact with the speaker;
lbeing an active listener and making every effort to
understand the speaker's message;
lasking for clarification by asking specific questions;
lproviding feedback and encouragement; and
loptimizing the ability to hear the speaker and to
see the speaker's visual communication cues (e.g., by
wearing prescribed hearing aids and glasses during
conversations).
19.
Environmental modification involves ;
identifying optimal parameters to enhance
comprehensibility.
These parameters include;
lreducing background noise
lensuring that the environment has good lighting;
limproving proximity between the speaker and his or her
communication partner; and
lusing face-to-face seating for conversations.
20.
AAC involves supplementing or replacing natural
speech and/or writing.
The two forms of AAC are
lunaided
laided
Other augmentative supports include voice
amplifiers, artificial phonation devices and oral
prosthetics to reduce hypernasality.
21.
SLPs may refer the individual to a medical specialist to assess
for, medical interventions.
These interventions can include,
lpharyngeal augmentation, pharyngeal flap, or palatal
flap to treat velopharyngeal incompetency and improve
resonance
llaryngeal (vocal fold) augmentation , laryngoplasty, or
recurrent laryngeal nerve sectioning to improve phonation
lpharmacological management to relieve symptoms of
the underlying neurologic condition associated with
underlying neurological disease.