assessment of neuromotor speech disorders

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assessment of neuromotor speech disorders
2013-12-12 23:31:42
csd 442
csd 442
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  1. assessment consideration
    • differential diagnosis-determining what the disease is not, could be coexistence of several disorders
    • early intervention=treatment should begin as early as possible
    • examination of all subsystmes
    • primary goal is to maximized the effectiveness, efficiency and natrualness of communication
  2. examples of standardized tests for dysarthria
    • frenchay
    • dysarthria profile
  3. most tests will include the following assessment areas:
    • oral mechanics exam= overall assessment of structure and function of the speech structures
    •     -observation of oral structures at rest
    •     -isolated oral movements of these oral structures (ie purse lips etc)
    •     -diadochokinesis=or alternating oral non speech motion (open and close mouth rapidly, protrude retract tongue etc)
    • reflexes=ask them about the dif reflexes (ie gag)
    • speech assesment=
    •     -respiratory=observe chest excursions at rest, observe breathing during speech
    •     -laryngeal=time, ptich, volume
    • articulatory/resonance=
    •     -alternating speech motion using diadochodinetic tasks puh-tuh-kuh
  4. what other areas are good to observe
    • vision
    • dentition
    • mood
    • posture
  5. tests used for apraxia
    • 1. includes section to assess presence of limb apraxia (arm goes up instead of down)
    • 2. diadochokinesis
    • 3. repeating words of increasing length
    • 4. oral limb apraxia
    • 5. say same 10 words 3x in a row
    • 6. production of the grandfather passage
  6. treatment of neuromotor speech disoders
    • orderly progression of treatment tasks
    •     -sound hierarchy
    •     -task hierarchy
    • intensive and frequent drill
    • gradual removal of clinician cues
    • program must be individualized to the patient or speaking tasks
    • should be relevant to clients' everyday needs
  7. treatment of neuromotor speech disoders
    • medical=
    •     -pharmacologic=manage disorder with medications that treat symptims or illness
    •     -surgical=manage disorder through surgical devices
    • behavioral=strengthen the muscles
    •     -drill strength exercises fro all subsystems involved
    •     -use aac symbols. compensatory strategies
    •     -promote self-monitoring to enhance patient independence
    •     -educate family
  8. examples of behavioral therapy for the speech subsystems
    • respiration=increase resp support
    •     -blowing water through a straw
    •     -coach them to begin speech by taking a deep inhalation and pushing
    •     -max vowel prolongation
    •     -increadsing the length of phrases and sentences by focusing on breath groups
    •     -postural adjustments
  9. examples of behavioral therapy for the speech subsystems
    • stimulate velopharyngeal muscles
    • provide feedback to address nasla flow during speech
    • alternating oral/nasal syllables
    • pitch exercises
    • bearing down
    • easy onsets
  10. examples of behavioral therapy for the speech subsystems
    • strength training of the articulators 
    • stretch training for those with spasticity
    • target rate
    • precision of consonants
  11. what is cognition and language
    • cog=formulating an idea, comprehension, problem solving, memory and perception
    • lang-sensory, motor, and cognitive
    • comprehension=auditory or visual
    • production=motor systems. oral and manual
    • reading=visual or tactile
    • writing=motor or visual
    • non verbal gestures
  12. tbi
    • chi or ohi
    • age most affected is 35 and below
    • cause=head trauma by penetration or forceful impact
    • primary damage=
    •     -focal contusion
    •     -axonal shearing in which the axon is cut or myelin sheath is damaged, cause by skull breaking
    • secondary causes=
    •     -infection
    •     -hypoxia
    •     -edema (brain swelling)
    •     -infarction (tissue death)
    •     -hematomas (focal areas of blood or torn blood vessels)
    • we see cognitive as well as perceptual damage with tbi
  13. cva
    • cerebral vascular stroke (attack, accident)
    • most common cause of focal bd
    •     -blockage
    •     -break
    •         -specifically in blood vessels-brain misses out on o2 and will eventually die resulting in damage of neural tissues
    • usually people 65 and older
    •     -aa more likely to suffer because of ses, lack of healthcare etc
    • risk factors include
    •     -controlable and uncontrolable
  14. cva 
    uncontrollable and controlable
    • cont
    •   -diet
    •   -smoking
    •   -exercise
    •   -alcohol
    •   -hypertension
    • uncont
    •   -age
    •   -family history
    •   -sex
    •   -ethnicity
  15. cva
    mechanisms of
    • vascular system (circle of willis)
    • nervous system
    • limbic system
  16. dementia
    • chronic progressive deterioration of intellect, personality, and memory and...
    •     -communication processes
    •         =resulting from cns, dysfunction
    •         =7 mil people in the us
    •         =strongly associated with age and typically live with it for a decade
    •     -symtoms
    •         =gradual onset, difficult to diagnosis
    •         =personality changes
    •         =overal cognitive impairment
    •         =motor difficulties
    •         =loss of lang skills
    •         =progressive memory deficits