University:
Johns Hopkins University
Course:
ME.250 | Medicine
Academic year:

2023
Views:

321

Pages:

1
Author:

5prinzg1s

Neurological System Affected: Common Pt Complaints Associated neurological symptoms Possible Medical Dx POSSIBLE SPEECH SYSTEM DEFICIT Respiration- May have reduced vital capacity (duration of ah). Short breath groups may be caused by excessive laryngeal valving. Phonation- strained, strangled, harsh low pitch; some pitch breaks, little loudness variation Resonance- may be hypernasal, usually not nasal emission Articulation- imprecise consonants Prosody- slow rate, reduced stress, may be excess and equal stress SPASTIC DYSARTHRIA Bilateral upper motor neuron lesions (pyramidal and extrapyramidal) Slow speech rate, increased effort to speak, gets tired when speaking, poor control of emotions (note- medical intervention-Low dose of amitriptyline may be effective in managing psuedobulbar affect) -Excessive muscle tone/spasticity of limbs possible, loss of fine skilled movement -Abnormal reflexes may be present: suck, snout, jaw jerk, gag CVA (bilateral lesions to internal carotid, middle, and posterior cerebral arteries, multiple lacunar strokes or single brainstem stroke, brainstem tumor, degenerative (Primary Lateral Sclerosis, Progressive Supranuclear Palsy), toxic/metabolic, inflammatory disease (leukoencephalitis) POSSIBLE TREATMENT Maximum inhalation tasks Head and neck relaxation Easy onset of phonation Yawn-sigh Best pitch- Probe if pitch change helps perception of voice Medical Intervention- Botox injection – may reduce spasticity of VF, less common but possible recurrent nerve resection to paralyze 1 vocal fold Medication-Dantrium may reduce strained voice in some pts with spastic dysarthria Resonance- difficult to treat behaviorally. Increase loudness, increase open mouth articulation patterns Medical Intervention- Hypernasality may be difficult to manage with palatal lift if much spasticity is present in the palate. Nasal obturator, teflon injection into the pharyngeal wall or a pharyngeal flap are other options. Stretching or shaking exercises with articulators if spasticity interfering with attempts. Bite block. Exaggerating consonants/phonetic placement, minimal contrast drills. Intelligibility drills. Medical Intervention- Antispasticity medications such as Librium, Valium, Dantrium, Lioresal, and tizanidine are sometimes effective in decreasing limb spasticity, but their effects on articulation are uncertain, and sometimes results in side effects such as weakness which may harm speech. May need to further reduce rate for articulatory precision. Pitch range exercises/intonation profiles. Contrastive stress drills. If reduced breath groups, may need teach chunking into syntactic units