MOTOR

• Treatments Approaches


  • Neurodevelopmental Approach
  • Physiologic Approach
  • Non-speech Approach
• Treatments for Resonance Deficits


  • Surgical and Prosthetic Treatments
  • Velar Strengthening and Nonspeech Exercises
  • Behavioral Approaches for Mild Hypernasality (Modification of Speech)
• Pharyngeal flap procedure


  1. Flap of tissue from the pharynx is surgically attached to the velum

  2. Sides of the flap are left loose to provide an opening between the oral and nasal cavities
• Posterior pharyngeal wall augmentation

  1. Teflon paste or hyaluronic acid is injected into the pharynx

  2. Injection creates a bulge and lessens the distance the velum must elevate before velopharyngeal closure is completed
• The effectiveness of these surgical procedures in individuals with dysarthria has been inconsistent
• Teflon injections have had especially mixed results
• Palatal lift


  A prosthetic treatment, essentially a dental retainer that has a rear extension that helps push upward on the velum
• Characteristics of individuals who are the best candidates for the palatal lift


  • Hypernasality is their most serious speech production deficit
  • Their medical condition is stable and not deteriorating
  • They have enough teeth onto which the lift can be attached
  • They do not have a hyperactive gag reflex or significant oral spasticity
  • They have the patience and motivation to use the lift
  • They are able to insert and remove the device independently
• The palatal lift is not appropriate for all patients
• Using a See-Scape


  1. A simple yet sensitive airflow instrument that can show the escape of air through the nostrils

  2. Used in combination with self-monitoring and biofeedback to improve the intelligibility of a palatal lift patient
• Velar strengthening and stimulation procedures do little to improve velopharyngeal closure in most cases of flaccid dysarthria
• Using a CPAP device


  1. Patient wears a nasal mask that sends a continuous flow of air through the nasal cavity and into the upper pharynx

  2. As the patient speaks, the velum is forced to work against the resistance of the downward flowing air
• Reducing rate of speech


  1. Use of finger or hand tapping to set the appropriate speaking rate

  2. Slower rate may decrease hypernasality by giving the velum extra time to fully close the velopharyngeal port
• Using more open-position mouth during speech


  1. Increase patient's awareness of hypernasal speech

  2. Have patient look in a mirror and repeat sentences with exaggerated jaw movements

  3. Use negative practice to demonstrate the positive effects of an open-mouth posture
• Increasing loudness


  1. Modeling appropriate loudness levels

  2. Using a sound pressure level meter to provide visual feedback
• Effortful closure


  1. Patient consciously puts more physical effort into speaking more loudly

  2. Pushing and pulling procedures may help with vocal fold adduction
• Holding breath


  Patient inhales deeply and holds breath, using a mirror to detect leaking air
• Hard glottal attack


  Patient holds a deep breath, bears down, and attempts to phonate a tight /a/
• Head turning and sideways pressure on the larynx

  When there is unilateral vocal fold weakness or paralysis, turning the head toward the affected side or pushing the larynx toward the unaffected side can improve phonation
• Damage to the exterior superior laryngeal branch of the vagus nerve can impair the function of the cricothyroid muscle, which helps vary vocal pitch
• Problems with intonation, stress, and rhythm contribute significantly to the unnatural prosody found in most individuals with motor speech disorders
• Hard glottal attack


  1. Hold a deep breath

  2. Bear down

  3. Attempt to phonate a tight /a/
• Hard glottal attack


  • Some patients can demonstrate a better quality phonation when they begin an utterance with it
• Head turning and sideways pressure on the larynx

  1. Turn head toward affected side

  2. Push larynx from affected side toward unaffected side
• Head turning and sideways pressure on the larynx


  When there is unilateral weakness or paralysis of one vocal fold, this can bring the weakened fold closer to the opposite fold, improving phonation quality
• Damage to the exterior superior laryngeal branch of the vagus nerve can impair the function of the cricothyroid muscle, which helps vary vocal pitch by stretching and relaxing the vocal folds
• Problems with intonation, stress, and rhythm contribute significantly to the unnatural prosody found in most individuals with all types of dysarthria
• Pitch range exercises


  1. Prolong an /a/ at lowest and highest pitch

  2. Sing up and down pitch range divided into 8 notes
• Pitch range exercises


  Assess patient's ability to perceive pitch changes, then exercises to help improve pitch control
• Intonation profiles


  1. Use lines to show intonation changes in written sentences

  2. Start with short, simple sentences and progress to longer
• Intonation profiles


  Lines indicate flat, dropping, or rising pitch
• Contrastive stress drills


  Clinician asks questions, patient answers adding stress on key words
• Contrastive stress drills


  Teach patient to use stress to convey intended meaning
• Chunking utterances into syntactic units


  Inhale at natural pauses within and between sentences
• Chunking utterances into syntactic units


  Helps maintain natural rhythm in speech for those with flaccid dysarthria
• Damage to the facial nerve affects speech production primarily by decreasing lip strength and range of movement, resulting in distorted bilabial and labiodental phonemes
• Damage to the hypoglossal nerve can cause weakness and reduced range of motion of the tongue, resulting primarily in imprecise velar and palatal consonant productions
• Traditional articulation drills


  • Repetitive practice
  • Clinician feedback
  • Increasing patient's awareness of articulation errors
• Intelligibility drills


  1. Patient reads words/sentences, clinician turns away and depends on articulation to understand

  2. Clinician provides feedback on unclear utterances
• Intelligibility drills


  Assess and improve patient's articulation clarity