therapies

Background Information on Speech Mechanics

  • Porosity: This concept relates to the characteristics and behaviors of speech targets in the context of speech therapy.

Speech Production Issues

  • Higher-Level Targets: Refers to complex aspects such as:

    • Respiration: Essential for voice production and can affect articulation.

    • Resonation: Resonance issues can impact sound quality and clarity in speech production.

  • Articulation:

    • Issues in articulation must not be addressed in isolation. They can stem from problems in:

    • Respiration: If respiration is inadequate, articulation efforts may fail.

    • Voice: Poor voice quality affects intelligibility.

    • Resonance: Insufficient resonance may hinder clear articulation.

Articulation Problems

  • Can arise from:

    • Spasticity: Muscle stiffness or involuntary muscle contractions can complicate movement needed for articulation.

    • Plasticity: Changes in muscle properties affecting articulation efficiency.

    • Hyperkinesias: Excessive movement can disrupt the normal process of articulation.

    • Coordination Issues: Difficulty in coordinating the actions of articulators, such as the tongue, lips, and jaw.

Supporting Articulation

  • Strategies include:

    • Palatal Lift: A device that supports the velum, enhancing resonance and thus improving articulation.

    • Bite Blocks: Utilizes different levels of jaw height for optimizing speech production.

    • Helps in controlling jaw movements necessary for different speech sounds.

    • Development of jaw-rated bite blocks to strengthen jaw positions used for speech.

    • Functionality demonstrated in exercises where one alters jaw height for producing different sounds (e.g., high for "ah").

  • Specific Exercises with Bite Blocks: Intended to:

    • Specifically target jaw positions ranging from narrow (for high sounds) to wide (for lower sounds).

    • Practicing various articulations at set levels of jaw depression can enhance speech production.

Examples of Exercises

  • In a scenario working with children using bite blocks:

    • Adjustments are made to ensure optimal seating position (90-degree angles at joints), with hands on laps to focus attention.

    • Students perform tasks like biting down, which can help stabilize the mandible and focus on articulation.

Spasticity Management

  • Stretching and Massage:

    • Used to alleviate tension in muscles that are spastic; effectiveness is usually short-term.

    • Repeatable slow-motion stretches are key to routine management of spasticity.

Oral Motor Exercises

  • Definition: Exercises aimed primarily at strengthening oral articulators (e.g., lips, tongue, jaw).

  • Types:

    • Speech Oral Motor Exercises: Targeting specific speech functions.

    • Non-Speech Oral Motor Exercises (NOMS): More controversial, focus on strength without speech context.

    • They can be problematic if they don’t adhere to effective exercise principles:

      • Requires substantial repetitive effort.

      • Needs active resistance that increases as strength improves.

Key Considerations for Oral Motor Exercises

  • Task Specificity: Exercises must closely resemble speech tasks to ensure benefits carry over into actual speech capabilities.

  • For Weak Articulators: Begin with basic strength-building exercises and transition them into speech tasks once foundational strength is established.

Compensatory Strategies

  • Over Articulating Speech: A teaching strategy used for enhancing clarity and slowing down speech for better intelligibility without restoring lost abilities.

  • Benefits:

    • Slows speech which allows greater clarity.

Strategies for Articulation Improvement

  • Intelligibility vs. Articulation:

    • Intelligibility: How well speech can be understood.

    • Articulation: The physical production of speech sounds.

Additional Therapy Strategies

  • Contrastive Stress Drills: Exercises to teach variation in stress placement for enhancing meaning.

  • Breath Groups: Training to break speech into manageable, understandable segments, often encouraging pauses for breath, simplifying speech patterns for listeners.

  • Use of Pacing Boards: Simple visual tools to help regulate speech rate.

Neurodegenerative Disease Specific Techniques

  • Respiratory Muscle Strength Training: Not widely supported for patients with rapid degeneration, as it potentially increases weakness.

  • Speech Amplification Devices: Useful for individuals with soft voices, allowing them to communicate more effectively without additional strain.

  • Voice Recognition Software: Advances are being made to recognize dysarthric speech patterns, increasing accessibility.

AAC (Augmentative and Alternative Communication)

  • AAC devices may be necessary for patients with significant articulation issues, with cognitive demands tailored to the user's abilities.

Conclusion and Recommendations

  • Any interventions must consider individual capabilities and customize techniques accordingly for optimal communication efficiency.