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.

1. TREATMENT STRATEGIES FOR
SPASTIC DYSARTHRIA
PRESENTED TO:
MA'AM SAFA
PRESENTED BY:
MAHNOOR NASIR

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
uspeech intelligibility,
uprosody
unaturalness
uefficiency.
Compensatory approaches focus on
improving comprehensibility by
uincreasing the speaker's use of communication
strategies,
uimproving listener skills and capacity, and
ualtering the communication environment;
uincreasing effective use of AAC options; and
uincreasing 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
lThere are some treatments designed to
improve phonation which are as follows;
lLee Silverman Voice Treatment (LSVT)—an
intensive program that targets high phonatory
effort to improve loudness and intelligibility
lPitch Limiting Voice Treatment (PLVT)—a
program for increasing vocal loudness without
increasing pitch
lEffort closure techniques to increase adductory
forces of vocal folds (e.g., pulling upward on chair
seat; squeezing palms of hands together)
lImproved timing of phonation (e.g., initiating
phonation at beginning of expiration)

11. l
lPhonetic placement techniques (e.g., hands-
on, descriptive, pictures) to work on positioning
of the mouth, tongue, lips, or jaw during speech.
lPhonetic derivation techniques (nonspeech to
speech tasks such as "blowing" to /u/).
lExaggerated articulation (overarticulation) to
emphasize phonetic placement and increase
precision, sometimes called "clear speech."
lMinimal contrasts to emphasize sound
contrasts necessary to differentiate one
phoneme from another.
lIntelligibility drills in which the individual reads
words, phrases, or sentences and attempts to
repair content not understood by the listener.

12. lRate modification to facilitate articulatory precision—strategies
include
lpausing at natural linguistic boundaries (e.g., using printed script
marked at natural pauses);
lusing external pacing methods such as pacing boards, hand/finger
tapping, and alphabet boards;
lusing auditory feedback (e.g., delayed auditory feedback or
metronome);
lusing visual feedback (e.g., using computerized voice programs);
and
lusing 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;
lpalatal lift prosthesis and
lnasal obturator to occlude nasal
airflow.
lResistance training during speech
using continuous positive air pressure
(Kuehn, 1997).

14. l
lIncreasing 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)
lImproving intonation by signaling stress with loudness,
pitch, or duration
lExtending breath groups to better align with syntactic
boundaries
lUsing 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;
lmaintaining eye contact with the communication
partner
lpreparing the communication partner by gaining
his or her attention and introducing the topic of
conversation before speaking;
lpointing and gesturing to help convey meaning;
llooking for signs that the communication partner
has or has not understood the message; and
leffectively using conversational repair strategies

18. Communication-partner strategies include
lmaintaining eye contact with the speaker;
lbeing an active listener and making every effort to
understand the speaker's message;
lasking for clarification by asking specific questions;
lproviding feedback and encouragement; and
loptimizing 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;
lreducing background noise
lensuring that the environment has good lighting;
limproving proximity between the speaker and his or her
communication partner; and
lusing face-to-face seating for conversations.

20. 
AAC involves supplementing or replacing natural
speech and/or writing.
The two forms of AAC are
lunaided
laided
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,
lpharyngeal augmentation, pharyngeal flap, or palatal
flap to treat velopharyngeal incompetency and improve
resonance
llaryngeal (vocal fold) augmentation , laryngoplasty, or
recurrent laryngeal nerve sectioning to improve phonation
lpharmacological management to relieve symptoms of
the underlying neurologic condition associated with
underlying neurological disease.