Management of Motor Speech Disorders

These vocabulary flashcards cover core concepts, terminologies, and principles from the lecture on managing motor speech disorders, spanning assessment considerations, treatment approaches, motor-learning principles, prosthetic and medical options, and evidence-based practice.

Motor Speech Disorder (MSD) Management

Comprehensive process aimed at maximizing a patient’s ability to communicate rather than merely restoring normal speech.

Communication vs. Speech Focus

Therapy should target the ultimate goal of conveying thoughts and feelings, not just producing normal-sounding speech.

Medical Prognosis (Treatment Factor)

The expected medical course that helps determine appropriateness, timing, and goals of intervention.

Stage of Recovery

Phase in which the patient currently resides (acute, chronic, worsening, fluctuating) that guides treatment intensity and focus.

Activity Limitation (Disability)

Problems executing tasks such as speaking normally; one component of the WHO ICF model.

Participation Restriction (Handicap)

Limitations in fulfilling life roles due to communication problems; part of WHO ICF model.

Environmental Factors (WHO ICF)

Physical, social, and attitudinal influences that affect communication success and treatment planning.

Third-Party Payor Considerations

Insurance guidelines and cost-effectiveness constraints that influence frequency and duration of therapy.

Therapy Termination Criteria

Points when treatment stops: goals achieved, progress plateau, patient choice, or change in condition requires reassessment.

Staging Management (Degenerative MSD)

Providing the right intervention at the right time through scheduled reassessments and counseling.

Medical Intervention (MSD)

Treatment through surgery or drugs that may cure, improve, or stabilize the neurologic condition affecting speech.

Pharmacologic Management

Use of medication (e.g., levodopa for PD) to modify neurologic deficits that influence speech.

Deep Brain Stimulation (DBS)

Surgical implantation of electrodes in basal ganglia or thalamus to manage PD, tremor, or dystonia; can help or worsen speech.

Prosthetic Management

Use of devices that modify the vocal tract, speech signal, or speaking manner (e.g., palatal lift, pacing board, AAC).

Palatal Lift

Prosthetic device that elevates the soft palate to reduce hypernasality in velopharyngeal insufficiency.

Nasopharyngeal Obturator

Prosthesis that occludes a velopharyngeal opening to improve resonance.

Voice Amplifier

Device that increases loudness of the speech signal to reduce communicative effort.

Augmentative & Alternative Communication (AAC)

Low- to high-tech strategies or devices that supplement or replace spoken communication.

Behavioral Management

Intervention approach that is neither purely medical nor prosthetic and aims to maximize communication through learned strategies.

Speech-Oriented Approaches

Therapy focusing on improving intelligibility and naturalness by reducing speech impairment itself.

Communication-Oriented Approaches

Strategies that enhance communicative effectiveness even if speech does not improve (e.g., eye contact, informing listeners).

Compensation (Speech Therapy)

Teaching patients to make optimal use of residual abilities to achieve faster improvements in communication.

Reducing Impairment

Direct or indirect exercises aimed at remediating physiologic deficits in respiration, phonation, resonance, articulation, or prosody.

Motor Learning

Permanent changes in movement capabilities achieved through extensive, varied practice across contexts.

Neural Plasticity Rationale

The nervous system can reorganize and recover with use, underpinning all behavioral interventions.

Use It or Lose It (Principle)

Failure to engage neural circuits leads to functional degradation.

Use It and Improve It

Training drives improvement in specific brain functions.

Specificity (Motor Learning)

Plasticity is greatest for the exact movement patterns that are trained; speech tasks should therefore dominate therapy.

Repetition Matters

Sufficient practice trials are required to induce lasting neural change.

Intensity Matters

Higher practice intensity accelerates and strengthens motor learning.

Time Matters

Different forms of neural plasticity emerge at various times; therapy should be started early yet allow recovery phases.

Salience Matters

Meaningful, purposeful tasks (important words, phrases) enhance attention and learning.

Age Matters

Younger brains show greater plasticity, but gains are still possible across the lifespan.

Transference

Training in one behavior can enhance acquisition of similar behaviors.

Interference (Plasticity)

Learning one skill may impede acquisition of others if not planned carefully.

Drill

Systematic, repetitive practice essential for motor learning; hundreds of repetitions may be needed.

Blocked Practice

Consistent practice of one task before moving to the next; helpful early or with severe impairment.

Random (Variable) Practice

Practice of tasks in varied order to promote generalization and naturalness once accuracy is established.

External Feedback

Information provided about performance or results that guides corrections; frequency and timing must be managed for learning.

Knowledge of Results (KR)

Feedback on the outcome (e.g., “That was 80% intelligible”).

Knowledge of Performance (KP)

Feedback on the movement pattern itself (e.g., “Your tongue didn’t elevate enough”).

Isometric Exercise

Muscle contraction without movement; useful early for strength when range is limited.

Isotonic Exercise

Muscle contraction through movement; preferred for speech as it meets specificity and agility needs.

Speed-Accuracy Trade-Off

Increasing speed tends to reduce accuracy; therapy prioritizes accuracy first to ensure intelligibility.

Fatigue Effects

Reduced performance caused by physical or mental fatigue; scheduling and rest intervals are crucial.

Individual Therapy

One-on-one sessions enabling flexible, intensive, and personalized practice; common in early stages.

Group Therapy

Sessions with multiple patients that foster peer feedback, generalization, and psychosocial support.

Baseline Data

Initial objective measures against which treatment progress is compared.

Therapy Frequency

How often sessions occur; higher frequency (e.g., 2×/day acute) recommended early, tapering later.

Home Exercise Program (HEP)

Daily practice assigned to maintain gains and increase repetitions outside therapy sessions.

Rehabilitation Treatment Taxonomy (RTT)

Emerging multidisciplinary framework for describing and categorizing MSD interventions.

Evidence-Based Practice (EBP)

Integration of best research evidence with clinical expertise and patient values in treatment decisions.

Practice Guidelines

Literature-based recommendations designed to optimize effectiveness and cost-efficiency of care.

Message Banking

Pre-recording personal phrases for future AAC use, often recommended for ALS patients.

Motor Reorganization Requires Use

Active engagement in speaking is essential for cortical reorganization and recovery.

Mental Practice

Cognitive rehearsal of movements that, combined with physical practice, enhances motor learning.

Error Rate Target

Aim for 60-80% success initially, progressing toward 80-90% to consolidate new skills.

Overtraining

Extending practice beyond mastery to enhance retention and durability of gains.

Patient-Centered Counseling

Educative and empathetic dialogue that builds understanding, motivation, and realistic expectations.

Therapy End Reality Check

Recognition that therapy may not always work; clinicians must know limits and discharge appropriately.

‘Use It or Lose It’ Reminder

Final exhortation emphasizing continuous practice to maintain speech gains.