SlideShare a Scribd company logo
Oro-motor Rehabilitation
Presentar : Ashik Dhakal
Moderator : Mr. Sydney Roshan Rebello
Learning objectives
• Introduction to oromotor dysfunction and it’s rehabilitation
• Factors affecting oral motor function
• Brief discussion about speech and swallowing dysfunction
• Clinical conditions leading to OMD
• References
Introduction
• Oro-motor dysfunction refers to the disturbance in vital functions (drinking,
chewing, sucking, swallowing, speech) that are dependent upon the co-ordinated
interaction of a set of neural structures.
• It also involves language motor articulation and gestural communication by means
of facial expression.
• Oral-motor rehabilitation is use of variety of exercises to develop
awareness, strength, coordination and mobility of the oral muscles. e.g,
improve muscle tone of the face or to reduce tongue thrust.
Factors affecting oral motor function
• Presence of medical conditions affecting function
• Presence of seizures
• Cognitive level
• Hypersensitivity
• Positioning
• Gagging, coughing.
• Tongue thrust
• Food texture, temperature
• Time alloted for intake.
Major Oromotor dysfunction
• Speech pathology
• Swallowing difficulty
Speech pathology
• Speech is one of our most important human behaviour which sets us apart from
animals like tool making.
• Disruption in the ability to communicate may impact on a person’s daily life in
important way.
• Disruption can be caused by
1. Structural abnormality (e.g., cleft palate)
2. Neurological conditions (e.g., stroke, Parkinson’s disease)
3. Non organic conditions ( non organic articulatory disorder)
• The use of speech for communication involves fine motor coordination of
components of the oral-motor system.
• Gestures, pantomime and other non-verbal pragmatic language behaviours, are also
essential elements of communication.
• The common of speech language pathology involves, aphasia, dysarthria.
Epidemiology
• Communication disorders exact a large economy costing US economy an estimated
$30 billion a year.
• National institute on deafness and other communication disorders (NIDCD)
estimated, 14 million population with speech and language disorder.
• In population >65 of age, 10.8% have speech and language disorder, <45 of age ,
9.9%.
• The largest population of communication impaired are children with language
disorder (43.7%), and articulation disorder (32.1%), aphasia 15% of adult speech
language impaired population.
Aphasia
• Aphasia is an impairment of language, affecting the production or
comprehension of speech and the ability to read or write.
• Aphasia can be severe or very mild depending on the pathology.
• It is estimated that there are more than 1 million individual with aphasia in the
US alone, and approximately 84,000 new patients with aphasia each year.
• The majority are older than 65 years of age and acquired aphasia as a result of a
stroke.
• Smaller number are the consequences of head trauma and neoplasm.
Types of Aphasia
1. Fluent Aphasia : speech output that is facile in articulation, produced at a
normal rate, with preserved flow and melody is referred to as fluent aphasia.
2. Non- fluent Aphasia : speech output that is characterised as hesitant,
awkward, interrupted, and produced with effort.
3. Global aphasia : a severe aphasia with marked dysfunction across all
language modalities and with severely limited residual use of all
communication modes for oral- aural interaction is referred as global
aphasia.
Evaluation of recovery
• If complete recovery from aphasia is to occur, it usually happens within a
matter of hours or days following onset.
• Once aphasia has persisted for several weeks or months a complete return to a
premorbid state is usually the exception.
• Two separate recovery dimensions
1. Objective : attempts to quantify the extent to which the patient has regained
language abilities.
2. Humanistic term : measures the recovery of functional communication
Treatment
• The primary assumption in treatment of aphasia is that language in the brain is not
“erased”, but that retrieval of its individual units has been impaired.
• Approaches to aphasia therapy have generally followed one of two models : a sub-
stitute skill model or a direct treatment model.
• Substitute skill model can be found in deaf individuals, some of whom use speech
reading, a visual input rather than an auditory input as an aid to comprehend spoken
language .
• In direct treatment model, specific exercise individually designed to ameliorate
specific linguistic deficits are the basis of treatment.
• The performance aspect of language — in which repeated practice and teaching
strategies — are assumed to help restore impaired skills through a task oriented
approach (i.e, naming practice.)
• Self-cueing and repetition exercise that manipulate component of grammar and
vocabulary.
• Stimulating the patient to use residual language by — encouraging conversation
— in a permissive setting where a patient’s responses are unconditionally
accepted and — topics are of personal interest.
• Visual communication therapy (VIC) is an experimental techniques designed for
global aphasia.
• VIC employs an index card system of arbitrary symbols representing syntactic and
lexical component that patients learn to manipulate so as to
1. Respond to a command
2. Express needs, wishes, or other emotions.
• Weinrich et al demonstrated application of the VIC system called Computer -
Aided Visual Communication system (C-VIC) can lead to improved spoken
language.
• Visual Action Therapy (VAT) is designed to train people with global aphasia to use
symbolic gesture representing visually absent objects.
• The task leading to this goal include associating pictured forms with specific
objects, manipulating real object appropriately, and— finally producing symbolic
gesture that represent the objects used (e.g., cup, hammer, razor).
Functional communication treatment (FCT):
• This treatment is designed to — improve information processing — in the
activities necessary to conducting ADL, social interactions, and self
expression of both physical and psychological needs.
Promoting Aphasics’ Communicative Effectiveness (PACE)
• PACE is a technique — intended to reshape structured interaction — between
clinicians and patients — into more natural communicative changes, includes several
pragmatic components common to natural conversation.
• Other interactive approaches
1. Communication partners approach of Lyon : This is a treatment plan designed to
enhance communication and well-being in setting where the — person with aphasia
and the caregiver live.
2. Supported conversation approach by Kagan : In this volunteers are trained as
conversation partners to facilitate conversation by using available modalities.
3. Social model of aphasia approach introduced by Simmons-Mackie : This focuses on
fulfilment of social needs and the encouragement of a greater conversational burden on
the part of communication partners.
Dysarthria
• The term dysarthria refers to an impairment of speech production resulting — from
damage to the central or peripheral nervous system, — which causes weakness,
paralysis, or incoordination of the motor-speech system (respiration, phonation,
articulation, resonance and prosody).
• The type and degree of dysarthria depends on the underlying etiology, — degree of
neuropathology,— coexistence of other disabilities, —and the individual responses
of the patient to the condition.
• When patient are totally unintelligent as the result of severe motor-speech system
impairment, they exhibit anarthria.
• Dysarthria is generally reflected in deficits occurring in multiple motor-speech
system, but may sometimes occur in a single system (i.e., an impairment of soft
palate movement resulting in cerebral palsy).
• It is notable prevalent in CP, TBI, cerebrovascular accidents, Parkinson’s disease,
ALS, neoplasm and demyelinating disease (e.g., multiple sclerosis).
Types of dysarthria :
• Spastic, flaccid, ataxic, hypo-kinetic, and hyperkinetic.
• When two or more types co-exist, it is called mixed dysarthria.
• Spastic dysarthria : affects strength, speed, precision, and coordination of
speech musculature movement
Treatment
• Treatment must be individually designed.
• Improve the intelligibility of speech, which can be negatively affected if the speaker
is in a dark, noisy place.
• As a patient’s overall physical coordination and precision of movement increases, —
corresponding improvement in the control of the motor-speech system, — hence in
speech intelligibility.
• To rehabilitate speech, use speech.
Dysphagia
• Generally refers to any difficulty in swallowing, including asymptomatic
impairments.
• It is a common problem affecting 1/3 to 1/2 of the stroke population and 1/6 of
elderly individual.
• It is common in head and neck cancer, degenerative disorder of the nervous
system, gastroesophageal reflux disease, and inflammatory muscle disease.
Types
• According to the location of the problem
1. Oropharyngeal : arises from abnormalities of muscles, nerves or structures of the oral
cavity, pharynx, and upper oesophageal sphincter.
2. Oesophageal : arises from abnormality of the body of the esophagus, lower
oesophageal sphincter, or cardia of the stomach, usually due to mechanical causes or
motility problem.
• According to
1. Mechanical - due to structural lesion of the foodway
2. Functional - by physiologic abnormality of foodway function
Symptoms and signs
1. Oral or pharyngeal Dysphasia
• Coughing or chocking with swallowing
• Difficulty initiating swallowing
• Sensation of food sticking in the throat
• Drooling
• Unexplained weight loss
• Change in dietary habits
• Recurrent pneumonia
• Change in voice or speech
• Nasal regurgitation
• Dehydration
2. Esophageal dysphasia
• Sensation of food sticking in the chest or throat
• Oral or pharyngeal regurgitation
• Drooling (inability to swallow saliva)
• Unexplained weight loss
• Change is dietary habits
• Recurrent pneumonia
• Dehydration
Physical examination
• An examination of oral cavity and neck - structural abnormalities, weakness or
sensory deficits.
• The findings of Dysphonia or dysarthria is often associated with oropharyngeal
dysphasia.
• Changes in voice quality or spontaneous coughing after swallowing suggest the
presence of pharyngeal dysfunction.
• Neurological examination is necessary, as they commonly cause dysphagia.
• The findings of atrophy or fasciculation of the tongue or palate suggest LMN
dysfunction of the brainstem motor nuclei.
• Gag reflex is not strongly predictive of the ability to swallow, it may be absent in
normal individual and normal in severe dysphasia and aspiration.
• History and physical examination are limited in their ability to detect and
characterise dysphagia, so instrumental studies are usually necessary.
Swallowing trial
• Should be performed by different consistencies, not only by water.
• Always start with very small amount 1/2 of 1 teaspoon;
1. Smooth pudding consistency
2. Sorbet
3. Thickened liquid
4. Carbonated liquid
• Correct positioning of the fingers during the clinical or bed-side
swallowing examination
Observation during the swallowing
• Observe : avoidance of certain food and liquids
1. Lip closure - any leakage anterior or posterior
2. Tongue movement
3. Mastication
4. Feeding respiratory pattern
• Listen : voice quality
1. Cough
2. Wet voice - saliva
• Feel : finger positioning
1. Swallowing movement
2. Delayed pharyngeal swallow
• Morphological evaluation of dysphagic patient
• Evaluation for sensitivity and reflex
• Oral feeding test in dysphagia
Instrumental Diagnostic studies
1. Videoflurographic swallowing
2. Fiberoptic laryngoscopy : if vfss cannot be performed.
3. Esophagoscopy : in case of esophagial dysphasia, biopsy for mucosal
abnormality.
4. Manometry : detect motor disorders of the oesophagus.
• EMG : useful in detecting LMN dysfunction of the larynx and pharynx if
neuromuscular disease is suspected
Differential diagnosis
• Myocardial ischemia
• Globus sensation
• Heartburn due to gastroesophageal reflux disease.
• Indirect aspiration (aspiration of refluxed gastric contents).
Functional limitation
• Depends on nature and severity of dysphasia,
• Many individuals modify their diet, some may require inordinate amount of time
to consume meal.
• In severe cases tube feeding is necessary.
• These alterations in the ability to eat a meal may have profound effect on
psychological and social function.
• Difficulty in eating meal may disrupt relationship and result in social isolation.
• Some patient may require supervision during meals or feel unsafe when eating
alone, causing further disruption of social and vocational function
Complications
• Aspiration pneumonia
• Airway obstruction
• Dehydration/ starvation.
• Severe dysphasia : social isolation - depression - suicide (reported in severe
cases)
Treatment
• Tx depends on its cause and mechanism.
Rehabilitation
• Goal of therapy : reducing aspiration, increasing the ability to eat and drink , and
optimising nutritional status.
• Best therapy for activity is activity itself, swallowing (safe and effective) is the
best therapy for swallowing disorder.
• Diet modification - common treatment, behavioural techniques (modification of
posture, head position, and respiration as well as specific swallow manoeuvres).
• Exercise therapy : when problem is related to weakness of the muscles of
swallowing,
• Choice of exercise should be individualised according to the physiologic
assessment,
1. Tongue weakness - protrude and lateralise of the tongue are strengthened using
the manual resistance.
2. Upper oesophageal sphincter opens poorly : strengthening of the anterior supra-
hyoid muscle(supine, flex neck against gravity)
1. Active exercise
• Targeted for : weakness and disrupted muscle tone
• Strength training : increases muscle strength and endurance.
2. Passive exercise
• Targeted : hypertonicity and spasticity
• Massage : relaxes muscle and reduce muscle tension
• Stretching : inhibit stretch reflex — decrease muscle tone — increase ROM
3. Physical modalities
• Targeted : muscle spasm and dysphagia
• Physical agent : heat, cold, electricity & vibration
Surgery
• Cricopharyngeal myotome (effectiveness is controversial)
• Oesophagotomy : in case of oesophageal cancer or obstructive strictures.
• Percutaneous endoscopic gastoctomy (PEG)( feeding gastrotomy) : indicated
when the severity of dysphasia makes it impossible to obtain adequate
alimentation and/or hydration orally, although intravenous hydration or ng tube
feeding may be sufficient on a time-limited basis.
Treatment complication
• VFSS is very safe and well tolerated
• Substituting thick for thin fluids — reduce fluid intake — dehydration —
malnutrition
• Failure to re-evaluate in timely manner — unnecessary prolongation of dietary
restriction — increase risk of malnutrition — adverse psychologic effects of
dysphagia.
• PEG : direct sequel-pain, infection, and obstruction of the feeding tube are
common. May promote aspiration pneumonia in individuals with severe
gastroesophageal reflux disease.
Clinical conditions leading to OMD
1. Stroke
• Symptoms vary with lesion location and size.
• Subcortical as well as right and left hemispheric strokes : pharyngeal and laryngeal
sensory deficits may occur.
• Subcortical stroke (paralytic dysphagia) : mild oral transit delays and a delay in
triggering the swallow.
• Right hemispheric stroke (pseudobulbar dysphagia) : mild oral transit delays and
some delay in pharyngeal trigger and laryngeal elevation.
• The pharyngeal stage lasts longer, and there may be penetration of the larynx and
aspiration, there may also be reduced upper esophageal sphincter opening.
2. Traumatic brain injury
• Type and severity depends on the cause of the injury and location and size of
brain lesions.
• Diffuse brain damage, closed head injury — impaired cognition, information
processing, and attention — communication disorder.
• Behavioural and cognitive problems — affect — self-feeding and swallowing,
and abnormal pathological reflexes — can affect — oral and pharyngeal control.
• Increased or reduced muscle tone — may cause decreased mouth opening,
decreased lip closure, drooling, decreased tongue control, and pocketing of the
bolus in the cheek.
• Delayed pharyngeal swallow trigger, nasal regurgitation, decreased base of tongue
movement, and decreased laryngeal elevation with resulting pharyngeal residue
may be seen.
• Overall mealtime may be slow.
3. Alzheimer’s Disease : Pseudo-bulbar Dysphagia
• Decreased attention span and apraxia for swallowing and self-feeding may be seen.
• Oral and pharyngeal responses slow — need for physical and verbal cues to self -
feed are needed.
• Difficulty with self-feeding is common, and challenges with initiating the meal
may be present.
• Agitation and behavioural challenges can hamper the eating process.
• Patient prefer sweet-flavored and pureed foods.
• Patients are prone to aspiration in later stages of the disease.
4. Developmental disabilities.
• Cerebral palsy and mental retardation — together or in isolation — may present
deficits of bolus formation and transit — delayed swallow reflex, pharyngeal dys-
motility, esophageal disease, and aspiration.
• Abnormal oral reflexes and oral hyposensitivity or hypersensitivity may be
observed.
• Poor postural, head, neck, and limb control can affect swallowing.
• Behaviours such as eating too quickly and putting too much food in the
mouth can affect efficiency and safety of swallowing.
5. Multiple sclerosis
• Dysphagia symptoms vary with location of plaques in the central and peripheral
nervous systems.
• Weakness of the oral structures and the neck muscles may be seen.
• Delayed pharyngeal swallow and weakness of pharyngeal contractions may be
seen.
• Dysphagia worsens with disease progression.
6. Parkinson disease
• Impulsiveness and poor judgment can affect swallowing.
• Jaw rigidity, abnormal head and neck posture, impaired coordination of tongue
movements, mastication and orofacial motions are affected along with tongue
control.
• Alterations in the pharyngeal aspect of the swallow occur including pharyngeal
residue and delayed pharyngeal elevation.
• Abnormal head, neck, and trunk posture along with difficulty coordinating
upper extremity movements for self-feeding are seen.
• Feeding and swallowing may be too slow and laborious
to allow sufficient nutritional intake.
• Orofacial fatigue may make eating and swallowing more
difficult as a meal progresses.
References
• Manual of physical medicine and rehabilitation, Hanley and Balfus
• Susan B. Sullivan
• Occupational therapy for physical Dysfunction, Trombly Latham
• Dysphasia rehab manual, Masami Akai
• Braddom’s Physical Medicine and Rehabilitation
Thank You

More Related Content

What's hot

Neurodevelopmental Treatment
Neurodevelopmental TreatmentNeurodevelopmental Treatment
Neurodevelopmental Treatment
Stephan Van Breenen
 
vojta therapy
vojta therapyvojta therapy
vojta therapy
Dr. PETETI SAIRAM
 
Brunnstrom approach
Brunnstrom approachBrunnstrom approach
Brunnstrom approach
Brunnstrom approachBrunnstrom approach
Brunnstrom approach
Fizio
 
Perceptual and cognitive disorder
Perceptual and cognitive disorderPerceptual and cognitive disorder
Perceptual and cognitive disorder
Shiva Tiwari
 
Physiotherapy Management in Head Injury Based on RLA Scale
Physiotherapy Management in Head Injury Based on RLA ScalePhysiotherapy Management in Head Injury Based on RLA Scale
Physiotherapy Management in Head Injury Based on RLA Scale
Jebaraj Fletcher
 
Spasticity management
Spasticity managementSpasticity management
Spasticity management
JWANIKA VANSIYA
 
Sensory Integration Therapy
Sensory Integration TherapySensory Integration Therapy
Sensory Integration Therapy
sharadello
 
Cbr
CbrCbr
New bobath concept
New bobath conceptNew bobath concept
neural mobilization
neural mobilizationneural mobilization
neural mobilization
Nityal Kumar
 
Brunnstrom Approach
Brunnstrom Approach Brunnstrom Approach
Brunnstrom Approach
Himani Kaushik
 
Physiotherapy management of Multiple sclerosis
Physiotherapy  management of Multiple sclerosisPhysiotherapy  management of Multiple sclerosis
Physiotherapy management of Multiple sclerosis
Keerthi Priya
 
VOJTA APPROACH.pptx
VOJTA APPROACH.pptxVOJTA APPROACH.pptx
VOJTA APPROACH.pptx
Yash Anghan
 
Motor relearning program
Motor relearning programMotor relearning program
Motor relearning program
Dr. Satish Pimpale
 
Roods approach
Roods approachRoods approach
Roods approach
Nerusu sai priyanka
 
Neurodevelopemental Therapy (Bobath approach)- Principles and Evidence
Neurodevelopemental Therapy (Bobath approach)- Principles and EvidenceNeurodevelopemental Therapy (Bobath approach)- Principles and Evidence
Neurodevelopemental Therapy (Bobath approach)- Principles and Evidence
Susan Jose
 
sensory integration
sensory integrationsensory integration
sensory integration
jessymaria4
 
abnormal muscle tone
abnormal muscle toneabnormal muscle tone
abnormal muscle tone
Dr. Satish Pimpale
 
Roods approach
Roods approach   Roods approach

What's hot (20)

Neurodevelopmental Treatment
Neurodevelopmental TreatmentNeurodevelopmental Treatment
Neurodevelopmental Treatment
 
vojta therapy
vojta therapyvojta therapy
vojta therapy
 
Brunnstrom approach
Brunnstrom approachBrunnstrom approach
Brunnstrom approach
 
Brunnstrom approach
Brunnstrom approachBrunnstrom approach
Brunnstrom approach
 
Perceptual and cognitive disorder
Perceptual and cognitive disorderPerceptual and cognitive disorder
Perceptual and cognitive disorder
 
Physiotherapy Management in Head Injury Based on RLA Scale
Physiotherapy Management in Head Injury Based on RLA ScalePhysiotherapy Management in Head Injury Based on RLA Scale
Physiotherapy Management in Head Injury Based on RLA Scale
 
Spasticity management
Spasticity managementSpasticity management
Spasticity management
 
Sensory Integration Therapy
Sensory Integration TherapySensory Integration Therapy
Sensory Integration Therapy
 
Cbr
CbrCbr
Cbr
 
New bobath concept
New bobath conceptNew bobath concept
New bobath concept
 
neural mobilization
neural mobilizationneural mobilization
neural mobilization
 
Brunnstrom Approach
Brunnstrom Approach Brunnstrom Approach
Brunnstrom Approach
 
Physiotherapy management of Multiple sclerosis
Physiotherapy  management of Multiple sclerosisPhysiotherapy  management of Multiple sclerosis
Physiotherapy management of Multiple sclerosis
 
VOJTA APPROACH.pptx
VOJTA APPROACH.pptxVOJTA APPROACH.pptx
VOJTA APPROACH.pptx
 
Motor relearning program
Motor relearning programMotor relearning program
Motor relearning program
 
Roods approach
Roods approachRoods approach
Roods approach
 
Neurodevelopemental Therapy (Bobath approach)- Principles and Evidence
Neurodevelopemental Therapy (Bobath approach)- Principles and EvidenceNeurodevelopemental Therapy (Bobath approach)- Principles and Evidence
Neurodevelopemental Therapy (Bobath approach)- Principles and Evidence
 
sensory integration
sensory integrationsensory integration
sensory integration
 
abnormal muscle tone
abnormal muscle toneabnormal muscle tone
abnormal muscle tone
 
Roods approach
Roods approach   Roods approach
Roods approach
 

Similar to Oromotor rehabilitationppt.pptx

Communication disorder and it's management
Communication disorder and it's managementCommunication disorder and it's management
Communication disorder and it's management
keerti Gour (PT) Shakya
 
Speech therapy
Speech therapy Speech therapy
Speech therapy
Sravan Sureshkumar
 
Brocas Aphasia
Brocas AphasiaBrocas Aphasia
Brocas Aphasia
Anam_ Khan
 
Speech defect and speech therapy
Speech defect and speech therapySpeech defect and speech therapy
Speech defect and speech therapy
Hari Nagar
 
An introduction to speech therapy
An introduction to speech therapyAn introduction to speech therapy
Neurodevelopment
NeurodevelopmentNeurodevelopment
Neurodevelopment
AlinaArif3
 
Communication impairment
Communication impairmentCommunication impairment
Communication impairment
kanagaraj Ramalingam
 
Cerebral palsy by dr.asim
Cerebral palsy  by dr.asimCerebral palsy  by dr.asim
Cerebral palsy by dr.asim
zahid mehmood
 
Communication problem &amp; its management.
Communication problem &amp; its management.Communication problem &amp; its management.
Communication problem &amp; its management.
Srinivas Nayak
 
Cerebral palsy by dr.asim
Cerebral palsy  by dr.asimCerebral palsy  by dr.asim
Cerebral palsy by dr.asim
zahid mehmood
 
aphasia in brief
aphasia in briefaphasia in brief
aphasia in brief
pooja tomar
 
Dental management of handicapped children
Dental management of handicapped childrenDental management of handicapped children
Dental management of handicapped children
Saeed Bajafar
 
Fluency disorder (Stuttering also known as stammering)
Fluency disorder (Stuttering also known as stammering)Fluency disorder (Stuttering also known as stammering)
Fluency disorder (Stuttering also known as stammering)
Emmanuel Raj
 
American guideline in speech and language pathology
American guideline in speech and language pathologyAmerican guideline in speech and language pathology
American guideline in speech and language pathology
Anam_ Khan
 
Speech defects and speech
Speech defects and speechSpeech defects and speech
Speech defects and speech
GAMANDEEP
 
Inclusiveness unit 1&2 note.pptx
Inclusiveness unit 1&2 note.pptxInclusiveness unit 1&2 note.pptx
Inclusiveness unit 1&2 note.pptx
yolachattpg
 
Communication Disorder SPED
Communication Disorder SPEDCommunication Disorder SPED
Communication Disorder SPED
Deb Homillano
 
Cerebral cortex
Cerebral cortexCerebral cortex
Cerebral cortex
bigboss716
 
Therapies To Break The Chains Of Disabilities
Therapies To Break The Chains Of DisabilitiesTherapies To Break The Chains Of Disabilities
Therapies To Break The Chains Of Disabilities
Brandon Ridley
 
Perception.pptx
Perception.pptxPerception.pptx
Perception.pptx
Jerslin Muller
 

Similar to Oromotor rehabilitationppt.pptx (20)

Communication disorder and it's management
Communication disorder and it's managementCommunication disorder and it's management
Communication disorder and it's management
 
Speech therapy
Speech therapy Speech therapy
Speech therapy
 
Brocas Aphasia
Brocas AphasiaBrocas Aphasia
Brocas Aphasia
 
Speech defect and speech therapy
Speech defect and speech therapySpeech defect and speech therapy
Speech defect and speech therapy
 
An introduction to speech therapy
An introduction to speech therapyAn introduction to speech therapy
An introduction to speech therapy
 
Neurodevelopment
NeurodevelopmentNeurodevelopment
Neurodevelopment
 
Communication impairment
Communication impairmentCommunication impairment
Communication impairment
 
Cerebral palsy by dr.asim
Cerebral palsy  by dr.asimCerebral palsy  by dr.asim
Cerebral palsy by dr.asim
 
Communication problem &amp; its management.
Communication problem &amp; its management.Communication problem &amp; its management.
Communication problem &amp; its management.
 
Cerebral palsy by dr.asim
Cerebral palsy  by dr.asimCerebral palsy  by dr.asim
Cerebral palsy by dr.asim
 
aphasia in brief
aphasia in briefaphasia in brief
aphasia in brief
 
Dental management of handicapped children
Dental management of handicapped childrenDental management of handicapped children
Dental management of handicapped children
 
Fluency disorder (Stuttering also known as stammering)
Fluency disorder (Stuttering also known as stammering)Fluency disorder (Stuttering also known as stammering)
Fluency disorder (Stuttering also known as stammering)
 
American guideline in speech and language pathology
American guideline in speech and language pathologyAmerican guideline in speech and language pathology
American guideline in speech and language pathology
 
Speech defects and speech
Speech defects and speechSpeech defects and speech
Speech defects and speech
 
Inclusiveness unit 1&2 note.pptx
Inclusiveness unit 1&2 note.pptxInclusiveness unit 1&2 note.pptx
Inclusiveness unit 1&2 note.pptx
 
Communication Disorder SPED
Communication Disorder SPEDCommunication Disorder SPED
Communication Disorder SPED
 
Cerebral cortex
Cerebral cortexCerebral cortex
Cerebral cortex
 
Therapies To Break The Chains Of Disabilities
Therapies To Break The Chains Of DisabilitiesTherapies To Break The Chains Of Disabilities
Therapies To Break The Chains Of Disabilities
 
Perception.pptx
Perception.pptxPerception.pptx
Perception.pptx
 

More from Ashik Dhakal

case presentation, gbs.pptx
case presentation, gbs.pptxcase presentation, gbs.pptx
case presentation, gbs.pptx
Ashik Dhakal
 
SCI case presentation
SCI case presentationSCI case presentation
SCI case presentation
Ashik Dhakal
 
physiotherapy in pediatric case
physiotherapy in pediatric case physiotherapy in pediatric case
physiotherapy in pediatric case
Ashik Dhakal
 
ANTENATAL AND POSTNATAL EXERCISES WITH EVIDENCE
ANTENATAL AND POSTNATAL EXERCISES WITH EVIDENCEANTENATAL AND POSTNATAL EXERCISES WITH EVIDENCE
ANTENATAL AND POSTNATAL EXERCISES WITH EVIDENCE
Ashik Dhakal
 
Motor Imagery in Neuro rehabilitation
Motor Imagery in Neuro rehabilitation Motor Imagery in Neuro rehabilitation
Motor Imagery in Neuro rehabilitation
Ashik Dhakal
 
journal club 2.pptx
journal club 2.pptxjournal club 2.pptx
journal club 2.pptx
Ashik Dhakal
 
Hemiplegic Shoulder
Hemiplegic ShoulderHemiplegic Shoulder
Hemiplegic Shoulder
Ashik Dhakal
 
Hemiplegic gait
Hemiplegic gaitHemiplegic gait
Hemiplegic gait
Ashik Dhakal
 
My Thesis practicle
My Thesis practicle My Thesis practicle
My Thesis practicle
Ashik Dhakal
 
Theories of motor control
Theories of motor controlTheories of motor control
Theories of motor control
Ashik Dhakal
 
Physiotherapy in Psychiatry
Physiotherapy in Psychiatry Physiotherapy in Psychiatry
Physiotherapy in Psychiatry
Ashik Dhakal
 
journal club 2.pptx
journal club 2.pptxjournal club 2.pptx
journal club 2.pptx
Ashik Dhakal
 
journal club - MT and ESWT for spasticity.pptx
journal club - MT and ESWT for spasticity.pptxjournal club - MT and ESWT for spasticity.pptx
journal club - MT and ESWT for spasticity.pptx
Ashik Dhakal
 
JC DNI improves MI in PD.pptx
JC DNI improves MI in PD.pptxJC DNI improves MI in PD.pptx
JC DNI improves MI in PD.pptx
Ashik Dhakal
 
PNF VS MIRROR EXERCISE PILOT STUDY .pptx
PNF VS MIRROR EXERCISE PILOT STUDY .pptxPNF VS MIRROR EXERCISE PILOT STUDY .pptx
PNF VS MIRROR EXERCISE PILOT STUDY .pptx
Ashik Dhakal
 
Exercise prescription for CVD
Exercise prescription for CVDExercise prescription for CVD
Exercise prescription for CVD
Ashik Dhakal
 
locked in syndrome
locked in syndrome locked in syndrome
locked in syndrome
Ashik Dhakal
 
brunnstrom's approach ppt.pptx
brunnstrom's approach ppt.pptxbrunnstrom's approach ppt.pptx
brunnstrom's approach ppt.pptx
Ashik Dhakal
 
Biofeedback 2nd yearpdf.pdf
Biofeedback 2nd yearpdf.pdfBiofeedback 2nd yearpdf.pdf
Biofeedback 2nd yearpdf.pdf
Ashik Dhakal
 
Neurodevelopmental Therapy (NDT)
Neurodevelopmental Therapy (NDT)Neurodevelopmental Therapy (NDT)
Neurodevelopmental Therapy (NDT)
Ashik Dhakal
 

More from Ashik Dhakal (20)

case presentation, gbs.pptx
case presentation, gbs.pptxcase presentation, gbs.pptx
case presentation, gbs.pptx
 
SCI case presentation
SCI case presentationSCI case presentation
SCI case presentation
 
physiotherapy in pediatric case
physiotherapy in pediatric case physiotherapy in pediatric case
physiotherapy in pediatric case
 
ANTENATAL AND POSTNATAL EXERCISES WITH EVIDENCE
ANTENATAL AND POSTNATAL EXERCISES WITH EVIDENCEANTENATAL AND POSTNATAL EXERCISES WITH EVIDENCE
ANTENATAL AND POSTNATAL EXERCISES WITH EVIDENCE
 
Motor Imagery in Neuro rehabilitation
Motor Imagery in Neuro rehabilitation Motor Imagery in Neuro rehabilitation
Motor Imagery in Neuro rehabilitation
 
journal club 2.pptx
journal club 2.pptxjournal club 2.pptx
journal club 2.pptx
 
Hemiplegic Shoulder
Hemiplegic ShoulderHemiplegic Shoulder
Hemiplegic Shoulder
 
Hemiplegic gait
Hemiplegic gaitHemiplegic gait
Hemiplegic gait
 
My Thesis practicle
My Thesis practicle My Thesis practicle
My Thesis practicle
 
Theories of motor control
Theories of motor controlTheories of motor control
Theories of motor control
 
Physiotherapy in Psychiatry
Physiotherapy in Psychiatry Physiotherapy in Psychiatry
Physiotherapy in Psychiatry
 
journal club 2.pptx
journal club 2.pptxjournal club 2.pptx
journal club 2.pptx
 
journal club - MT and ESWT for spasticity.pptx
journal club - MT and ESWT for spasticity.pptxjournal club - MT and ESWT for spasticity.pptx
journal club - MT and ESWT for spasticity.pptx
 
JC DNI improves MI in PD.pptx
JC DNI improves MI in PD.pptxJC DNI improves MI in PD.pptx
JC DNI improves MI in PD.pptx
 
PNF VS MIRROR EXERCISE PILOT STUDY .pptx
PNF VS MIRROR EXERCISE PILOT STUDY .pptxPNF VS MIRROR EXERCISE PILOT STUDY .pptx
PNF VS MIRROR EXERCISE PILOT STUDY .pptx
 
Exercise prescription for CVD
Exercise prescription for CVDExercise prescription for CVD
Exercise prescription for CVD
 
locked in syndrome
locked in syndrome locked in syndrome
locked in syndrome
 
brunnstrom's approach ppt.pptx
brunnstrom's approach ppt.pptxbrunnstrom's approach ppt.pptx
brunnstrom's approach ppt.pptx
 
Biofeedback 2nd yearpdf.pdf
Biofeedback 2nd yearpdf.pdfBiofeedback 2nd yearpdf.pdf
Biofeedback 2nd yearpdf.pdf
 
Neurodevelopmental Therapy (NDT)
Neurodevelopmental Therapy (NDT)Neurodevelopmental Therapy (NDT)
Neurodevelopmental Therapy (NDT)
 

Recently uploaded

Skin Diseases That Happen During Summer.
 Skin Diseases That Happen During Summer. Skin Diseases That Happen During Summer.
Skin Diseases That Happen During Summer.
Gokuldas Hospital
 
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfNAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
Rahul Sen
 
Ageing, the Elderly, Gerontology and Public Health
Ageing, the Elderly, Gerontology and Public HealthAgeing, the Elderly, Gerontology and Public Health
Ageing, the Elderly, Gerontology and Public Health
phuakl
 
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
MuskanShingari
 
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan PatroJune 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
Kanhu Charan
 
biomechanics of running. Dr.dhwani.pptx
biomechanics of running.   Dr.dhwani.pptxbiomechanics of running.   Dr.dhwani.pptx
biomechanics of running. Dr.dhwani.pptx
Dr. Dhwani kawedia
 
PARASITIC INFECTIONS IN CHILDREN peads.pptx
PARASITIC INFECTIONS IN CHILDREN peads.pptxPARASITIC INFECTIONS IN CHILDREN peads.pptx
PARASITIC INFECTIONS IN CHILDREN peads.pptx
MwambaChikonde1
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
suvadeepdas911
 
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.GawadHemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
NephroTube - Dr.Gawad
 
5 Effective Homeopathic Medicines for Irregular Periods
5 Effective Homeopathic Medicines for Irregular Periods5 Effective Homeopathic Medicines for Irregular Periods
5 Effective Homeopathic Medicines for Irregular Periods
Dr. Deepika's Homeopathy - Gaur City
 
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Kunj Vihari
 
Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.
Gokuldas Hospital
 
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdfPollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdf
Chulalongkorn Allergy and Clinical Immunology Research Group
 
Giloy in Ayurveda - Classical Categorization and Synonyms
Giloy in Ayurveda - Classical Categorization and SynonymsGiloy in Ayurveda - Classical Categorization and Synonyms
Giloy in Ayurveda - Classical Categorization and Synonyms
Planet Ayurveda
 
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấuK CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
HongBiThi1
 
What is Obesity? How to overcome Obesity?
What is Obesity? How to overcome Obesity?What is Obesity? How to overcome Obesity?
What is Obesity? How to overcome Obesity?
Healthmedsrx.com
 
How to choose the best dermatologists in Indore.
How to choose the best dermatologists in Indore.How to choose the best dermatologists in Indore.
How to choose the best dermatologists in Indore.
Gokuldas Hospital
 
Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024
Torstein Dalen-Lorentsen
 
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOWPune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Get New Sim
 
How to Control Your Asthma Tips by gokuldas hospital.
How to Control Your Asthma Tips by gokuldas hospital.How to Control Your Asthma Tips by gokuldas hospital.
How to Control Your Asthma Tips by gokuldas hospital.
Gokuldas Hospital
 

Recently uploaded (20)

Skin Diseases That Happen During Summer.
 Skin Diseases That Happen During Summer. Skin Diseases That Happen During Summer.
Skin Diseases That Happen During Summer.
 
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfNAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
 
Ageing, the Elderly, Gerontology and Public Health
Ageing, the Elderly, Gerontology and Public HealthAgeing, the Elderly, Gerontology and Public Health
Ageing, the Elderly, Gerontology and Public Health
 
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
 
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan PatroJune 2024 Oncology Cartoons By Dr Kanhu Charan Patro
June 2024 Oncology Cartoons By Dr Kanhu Charan Patro
 
biomechanics of running. Dr.dhwani.pptx
biomechanics of running.   Dr.dhwani.pptxbiomechanics of running.   Dr.dhwani.pptx
biomechanics of running. Dr.dhwani.pptx
 
PARASITIC INFECTIONS IN CHILDREN peads.pptx
PARASITIC INFECTIONS IN CHILDREN peads.pptxPARASITIC INFECTIONS IN CHILDREN peads.pptx
PARASITIC INFECTIONS IN CHILDREN peads.pptx
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
 
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.GawadHemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
 
5 Effective Homeopathic Medicines for Irregular Periods
5 Effective Homeopathic Medicines for Irregular Periods5 Effective Homeopathic Medicines for Irregular Periods
5 Effective Homeopathic Medicines for Irregular Periods
 
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.Tele Optometry (kunj'sppt) / Basics of tele optometry.
Tele Optometry (kunj'sppt) / Basics of tele optometry.
 
Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.Know the difference between Endodontics and Orthodontics.
Know the difference between Endodontics and Orthodontics.
 
Pollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdfPollen and Fungal allergy: aeroallergy.pdf
Pollen and Fungal allergy: aeroallergy.pdf
 
Giloy in Ayurveda - Classical Categorization and Synonyms
Giloy in Ayurveda - Classical Categorization and SynonymsGiloy in Ayurveda - Classical Categorization and Synonyms
Giloy in Ayurveda - Classical Categorization and Synonyms
 
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấuK CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
 
What is Obesity? How to overcome Obesity?
What is Obesity? How to overcome Obesity?What is Obesity? How to overcome Obesity?
What is Obesity? How to overcome Obesity?
 
How to choose the best dermatologists in Indore.
How to choose the best dermatologists in Indore.How to choose the best dermatologists in Indore.
How to choose the best dermatologists in Indore.
 
Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024
 
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOWPune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
Pune Call Girls 7339748667 AVAILABLE HOT GIRLS AUNTY BOOK NOW
 
How to Control Your Asthma Tips by gokuldas hospital.
How to Control Your Asthma Tips by gokuldas hospital.How to Control Your Asthma Tips by gokuldas hospital.
How to Control Your Asthma Tips by gokuldas hospital.
 

Oromotor rehabilitationppt.pptx

  • 1. Oro-motor Rehabilitation Presentar : Ashik Dhakal Moderator : Mr. Sydney Roshan Rebello
  • 2. Learning objectives • Introduction to oromotor dysfunction and it’s rehabilitation • Factors affecting oral motor function • Brief discussion about speech and swallowing dysfunction • Clinical conditions leading to OMD • References
  • 3. Introduction • Oro-motor dysfunction refers to the disturbance in vital functions (drinking, chewing, sucking, swallowing, speech) that are dependent upon the co-ordinated interaction of a set of neural structures. • It also involves language motor articulation and gestural communication by means of facial expression.
  • 4. • Oral-motor rehabilitation is use of variety of exercises to develop awareness, strength, coordination and mobility of the oral muscles. e.g, improve muscle tone of the face or to reduce tongue thrust.
  • 5. Factors affecting oral motor function • Presence of medical conditions affecting function • Presence of seizures • Cognitive level • Hypersensitivity • Positioning • Gagging, coughing. • Tongue thrust • Food texture, temperature • Time alloted for intake.
  • 6. Major Oromotor dysfunction • Speech pathology • Swallowing difficulty
  • 7. Speech pathology • Speech is one of our most important human behaviour which sets us apart from animals like tool making. • Disruption in the ability to communicate may impact on a person’s daily life in important way. • Disruption can be caused by 1. Structural abnormality (e.g., cleft palate) 2. Neurological conditions (e.g., stroke, Parkinson’s disease) 3. Non organic conditions ( non organic articulatory disorder)
  • 8. • The use of speech for communication involves fine motor coordination of components of the oral-motor system. • Gestures, pantomime and other non-verbal pragmatic language behaviours, are also essential elements of communication. • The common of speech language pathology involves, aphasia, dysarthria.
  • 9. Epidemiology • Communication disorders exact a large economy costing US economy an estimated $30 billion a year. • National institute on deafness and other communication disorders (NIDCD) estimated, 14 million population with speech and language disorder. • In population >65 of age, 10.8% have speech and language disorder, <45 of age , 9.9%. • The largest population of communication impaired are children with language disorder (43.7%), and articulation disorder (32.1%), aphasia 15% of adult speech language impaired population.
  • 11. • Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write. • Aphasia can be severe or very mild depending on the pathology. • It is estimated that there are more than 1 million individual with aphasia in the US alone, and approximately 84,000 new patients with aphasia each year. • The majority are older than 65 years of age and acquired aphasia as a result of a stroke. • Smaller number are the consequences of head trauma and neoplasm.
  • 13. 1. Fluent Aphasia : speech output that is facile in articulation, produced at a normal rate, with preserved flow and melody is referred to as fluent aphasia.
  • 14. 2. Non- fluent Aphasia : speech output that is characterised as hesitant, awkward, interrupted, and produced with effort.
  • 15. 3. Global aphasia : a severe aphasia with marked dysfunction across all language modalities and with severely limited residual use of all communication modes for oral- aural interaction is referred as global aphasia.
  • 16.
  • 17. Evaluation of recovery • If complete recovery from aphasia is to occur, it usually happens within a matter of hours or days following onset. • Once aphasia has persisted for several weeks or months a complete return to a premorbid state is usually the exception. • Two separate recovery dimensions 1. Objective : attempts to quantify the extent to which the patient has regained language abilities. 2. Humanistic term : measures the recovery of functional communication
  • 18. Treatment • The primary assumption in treatment of aphasia is that language in the brain is not “erased”, but that retrieval of its individual units has been impaired. • Approaches to aphasia therapy have generally followed one of two models : a sub- stitute skill model or a direct treatment model. • Substitute skill model can be found in deaf individuals, some of whom use speech reading, a visual input rather than an auditory input as an aid to comprehend spoken language . • In direct treatment model, specific exercise individually designed to ameliorate specific linguistic deficits are the basis of treatment.
  • 19. • The performance aspect of language — in which repeated practice and teaching strategies — are assumed to help restore impaired skills through a task oriented approach (i.e, naming practice.) • Self-cueing and repetition exercise that manipulate component of grammar and vocabulary. • Stimulating the patient to use residual language by — encouraging conversation — in a permissive setting where a patient’s responses are unconditionally accepted and — topics are of personal interest.
  • 20. • Visual communication therapy (VIC) is an experimental techniques designed for global aphasia. • VIC employs an index card system of arbitrary symbols representing syntactic and lexical component that patients learn to manipulate so as to 1. Respond to a command 2. Express needs, wishes, or other emotions. • Weinrich et al demonstrated application of the VIC system called Computer - Aided Visual Communication system (C-VIC) can lead to improved spoken language.
  • 21. • Visual Action Therapy (VAT) is designed to train people with global aphasia to use symbolic gesture representing visually absent objects. • The task leading to this goal include associating pictured forms with specific objects, manipulating real object appropriately, and— finally producing symbolic gesture that represent the objects used (e.g., cup, hammer, razor).
  • 22.
  • 23. Functional communication treatment (FCT): • This treatment is designed to — improve information processing — in the activities necessary to conducting ADL, social interactions, and self expression of both physical and psychological needs.
  • 24. Promoting Aphasics’ Communicative Effectiveness (PACE) • PACE is a technique — intended to reshape structured interaction — between clinicians and patients — into more natural communicative changes, includes several pragmatic components common to natural conversation.
  • 25.
  • 26. • Other interactive approaches 1. Communication partners approach of Lyon : This is a treatment plan designed to enhance communication and well-being in setting where the — person with aphasia and the caregiver live. 2. Supported conversation approach by Kagan : In this volunteers are trained as conversation partners to facilitate conversation by using available modalities. 3. Social model of aphasia approach introduced by Simmons-Mackie : This focuses on fulfilment of social needs and the encouragement of a greater conversational burden on the part of communication partners.
  • 27. Dysarthria • The term dysarthria refers to an impairment of speech production resulting — from damage to the central or peripheral nervous system, — which causes weakness, paralysis, or incoordination of the motor-speech system (respiration, phonation, articulation, resonance and prosody). • The type and degree of dysarthria depends on the underlying etiology, — degree of neuropathology,— coexistence of other disabilities, —and the individual responses of the patient to the condition. • When patient are totally unintelligent as the result of severe motor-speech system impairment, they exhibit anarthria.
  • 28. • Dysarthria is generally reflected in deficits occurring in multiple motor-speech system, but may sometimes occur in a single system (i.e., an impairment of soft palate movement resulting in cerebral palsy). • It is notable prevalent in CP, TBI, cerebrovascular accidents, Parkinson’s disease, ALS, neoplasm and demyelinating disease (e.g., multiple sclerosis).
  • 29. Types of dysarthria : • Spastic, flaccid, ataxic, hypo-kinetic, and hyperkinetic. • When two or more types co-exist, it is called mixed dysarthria.
  • 30. • Spastic dysarthria : affects strength, speed, precision, and coordination of speech musculature movement
  • 31. Treatment • Treatment must be individually designed. • Improve the intelligibility of speech, which can be negatively affected if the speaker is in a dark, noisy place. • As a patient’s overall physical coordination and precision of movement increases, — corresponding improvement in the control of the motor-speech system, — hence in speech intelligibility. • To rehabilitate speech, use speech.
  • 32. Dysphagia • Generally refers to any difficulty in swallowing, including asymptomatic impairments. • It is a common problem affecting 1/3 to 1/2 of the stroke population and 1/6 of elderly individual. • It is common in head and neck cancer, degenerative disorder of the nervous system, gastroesophageal reflux disease, and inflammatory muscle disease.
  • 33. Types • According to the location of the problem 1. Oropharyngeal : arises from abnormalities of muscles, nerves or structures of the oral cavity, pharynx, and upper oesophageal sphincter. 2. Oesophageal : arises from abnormality of the body of the esophagus, lower oesophageal sphincter, or cardia of the stomach, usually due to mechanical causes or motility problem. • According to 1. Mechanical - due to structural lesion of the foodway 2. Functional - by physiologic abnormality of foodway function
  • 34. Symptoms and signs 1. Oral or pharyngeal Dysphasia • Coughing or chocking with swallowing • Difficulty initiating swallowing • Sensation of food sticking in the throat • Drooling
  • 35. • Unexplained weight loss • Change in dietary habits • Recurrent pneumonia • Change in voice or speech • Nasal regurgitation • Dehydration
  • 36. 2. Esophageal dysphasia • Sensation of food sticking in the chest or throat • Oral or pharyngeal regurgitation • Drooling (inability to swallow saliva) • Unexplained weight loss • Change is dietary habits • Recurrent pneumonia • Dehydration
  • 37. Physical examination • An examination of oral cavity and neck - structural abnormalities, weakness or sensory deficits. • The findings of Dysphonia or dysarthria is often associated with oropharyngeal dysphasia. • Changes in voice quality or spontaneous coughing after swallowing suggest the presence of pharyngeal dysfunction. • Neurological examination is necessary, as they commonly cause dysphagia.
  • 38. • The findings of atrophy or fasciculation of the tongue or palate suggest LMN dysfunction of the brainstem motor nuclei. • Gag reflex is not strongly predictive of the ability to swallow, it may be absent in normal individual and normal in severe dysphasia and aspiration. • History and physical examination are limited in their ability to detect and characterise dysphagia, so instrumental studies are usually necessary.
  • 39. Swallowing trial • Should be performed by different consistencies, not only by water. • Always start with very small amount 1/2 of 1 teaspoon; 1. Smooth pudding consistency 2. Sorbet 3. Thickened liquid 4. Carbonated liquid
  • 40. • Correct positioning of the fingers during the clinical or bed-side swallowing examination
  • 41. Observation during the swallowing • Observe : avoidance of certain food and liquids 1. Lip closure - any leakage anterior or posterior 2. Tongue movement 3. Mastication 4. Feeding respiratory pattern
  • 42. • Listen : voice quality 1. Cough 2. Wet voice - saliva • Feel : finger positioning 1. Swallowing movement 2. Delayed pharyngeal swallow
  • 43.
  • 44.
  • 45.
  • 46. • Morphological evaluation of dysphagic patient
  • 47.
  • 48. • Evaluation for sensitivity and reflex
  • 49. • Oral feeding test in dysphagia
  • 52.
  • 53. 2. Fiberoptic laryngoscopy : if vfss cannot be performed. 3. Esophagoscopy : in case of esophagial dysphasia, biopsy for mucosal abnormality. 4. Manometry : detect motor disorders of the oesophagus. • EMG : useful in detecting LMN dysfunction of the larynx and pharynx if neuromuscular disease is suspected
  • 54. Differential diagnosis • Myocardial ischemia • Globus sensation • Heartburn due to gastroesophageal reflux disease. • Indirect aspiration (aspiration of refluxed gastric contents).
  • 55. Functional limitation • Depends on nature and severity of dysphasia, • Many individuals modify their diet, some may require inordinate amount of time to consume meal. • In severe cases tube feeding is necessary.
  • 56. • These alterations in the ability to eat a meal may have profound effect on psychological and social function. • Difficulty in eating meal may disrupt relationship and result in social isolation. • Some patient may require supervision during meals or feel unsafe when eating alone, causing further disruption of social and vocational function
  • 57. Complications • Aspiration pneumonia • Airway obstruction • Dehydration/ starvation. • Severe dysphasia : social isolation - depression - suicide (reported in severe cases)
  • 58. Treatment • Tx depends on its cause and mechanism.
  • 59. Rehabilitation • Goal of therapy : reducing aspiration, increasing the ability to eat and drink , and optimising nutritional status. • Best therapy for activity is activity itself, swallowing (safe and effective) is the best therapy for swallowing disorder. • Diet modification - common treatment, behavioural techniques (modification of posture, head position, and respiration as well as specific swallow manoeuvres).
  • 60. • Exercise therapy : when problem is related to weakness of the muscles of swallowing, • Choice of exercise should be individualised according to the physiologic assessment, 1. Tongue weakness - protrude and lateralise of the tongue are strengthened using the manual resistance. 2. Upper oesophageal sphincter opens poorly : strengthening of the anterior supra- hyoid muscle(supine, flex neck against gravity)
  • 61. 1. Active exercise • Targeted for : weakness and disrupted muscle tone • Strength training : increases muscle strength and endurance. 2. Passive exercise • Targeted : hypertonicity and spasticity • Massage : relaxes muscle and reduce muscle tension • Stretching : inhibit stretch reflex — decrease muscle tone — increase ROM
  • 62. 3. Physical modalities • Targeted : muscle spasm and dysphagia • Physical agent : heat, cold, electricity & vibration
  • 63. Surgery • Cricopharyngeal myotome (effectiveness is controversial) • Oesophagotomy : in case of oesophageal cancer or obstructive strictures. • Percutaneous endoscopic gastoctomy (PEG)( feeding gastrotomy) : indicated when the severity of dysphasia makes it impossible to obtain adequate alimentation and/or hydration orally, although intravenous hydration or ng tube feeding may be sufficient on a time-limited basis.
  • 64. Treatment complication • VFSS is very safe and well tolerated • Substituting thick for thin fluids — reduce fluid intake — dehydration — malnutrition • Failure to re-evaluate in timely manner — unnecessary prolongation of dietary restriction — increase risk of malnutrition — adverse psychologic effects of dysphagia. • PEG : direct sequel-pain, infection, and obstruction of the feeding tube are common. May promote aspiration pneumonia in individuals with severe gastroesophageal reflux disease.
  • 66. 1. Stroke • Symptoms vary with lesion location and size. • Subcortical as well as right and left hemispheric strokes : pharyngeal and laryngeal sensory deficits may occur. • Subcortical stroke (paralytic dysphagia) : mild oral transit delays and a delay in triggering the swallow.
  • 67. • Right hemispheric stroke (pseudobulbar dysphagia) : mild oral transit delays and some delay in pharyngeal trigger and laryngeal elevation. • The pharyngeal stage lasts longer, and there may be penetration of the larynx and aspiration, there may also be reduced upper esophageal sphincter opening.
  • 68. 2. Traumatic brain injury • Type and severity depends on the cause of the injury and location and size of brain lesions. • Diffuse brain damage, closed head injury — impaired cognition, information processing, and attention — communication disorder. • Behavioural and cognitive problems — affect — self-feeding and swallowing, and abnormal pathological reflexes — can affect — oral and pharyngeal control.
  • 69. • Increased or reduced muscle tone — may cause decreased mouth opening, decreased lip closure, drooling, decreased tongue control, and pocketing of the bolus in the cheek. • Delayed pharyngeal swallow trigger, nasal regurgitation, decreased base of tongue movement, and decreased laryngeal elevation with resulting pharyngeal residue may be seen. • Overall mealtime may be slow.
  • 70. 3. Alzheimer’s Disease : Pseudo-bulbar Dysphagia • Decreased attention span and apraxia for swallowing and self-feeding may be seen. • Oral and pharyngeal responses slow — need for physical and verbal cues to self - feed are needed. • Difficulty with self-feeding is common, and challenges with initiating the meal may be present.
  • 71. • Agitation and behavioural challenges can hamper the eating process. • Patient prefer sweet-flavored and pureed foods. • Patients are prone to aspiration in later stages of the disease.
  • 72. 4. Developmental disabilities. • Cerebral palsy and mental retardation — together or in isolation — may present deficits of bolus formation and transit — delayed swallow reflex, pharyngeal dys- motility, esophageal disease, and aspiration. • Abnormal oral reflexes and oral hyposensitivity or hypersensitivity may be observed.
  • 73. • Poor postural, head, neck, and limb control can affect swallowing. • Behaviours such as eating too quickly and putting too much food in the mouth can affect efficiency and safety of swallowing.
  • 74. 5. Multiple sclerosis • Dysphagia symptoms vary with location of plaques in the central and peripheral nervous systems. • Weakness of the oral structures and the neck muscles may be seen. • Delayed pharyngeal swallow and weakness of pharyngeal contractions may be seen. • Dysphagia worsens with disease progression.
  • 75. 6. Parkinson disease • Impulsiveness and poor judgment can affect swallowing. • Jaw rigidity, abnormal head and neck posture, impaired coordination of tongue movements, mastication and orofacial motions are affected along with tongue control. • Alterations in the pharyngeal aspect of the swallow occur including pharyngeal residue and delayed pharyngeal elevation.
  • 76. • Abnormal head, neck, and trunk posture along with difficulty coordinating upper extremity movements for self-feeding are seen. • Feeding and swallowing may be too slow and laborious to allow sufficient nutritional intake. • Orofacial fatigue may make eating and swallowing more difficult as a meal progresses.
  • 77. References • Manual of physical medicine and rehabilitation, Hanley and Balfus • Susan B. Sullivan • Occupational therapy for physical Dysfunction, Trombly Latham • Dysphasia rehab manual, Masami Akai • Braddom’s Physical Medicine and Rehabilitation