Speech Ramblings



Multiple Sclerosis (MS)GeneralDisease of white matter of CNSProgressive neurological deficitsCommon remission/relapsingEventually turns into continuous deterioration in 50% of ptsCognitive-Communication SymptomsIntellectual function declines over timeSeverity of cognitive change based on location and number of lesions within the CNSSome have affective disordersEuphoriaPathological laughing or weepingDepression increased suicide rateBipolar disorders/emotional lability SLP CONCERNS 3 main goals that may be addressed:Treatment of relapsePrevention of relapseTreatment of symptomsDysphagiaIn 1/5 of cases (rarely presenting symptom)Prevalence increases as disease progressesGenerally NOT in isolationScanning Speech – Often early symptomProlonged phonation of words w/slow and slurred articulationOther Speech Deficits – Spastic & Ataxic DysarthriaNasalizationWeak phonationPoor respiratory cycleChanges in pitchSlow rateDeteriorating intelligibilityFIVE STAGES, important to tx planning:No Detectable Speech Disorder40% of people with MS have normal speech/voices Fatigue is a common complaint in MS Treatment: energy conservation techniques may be introduced at this stageObvious Speech Disorder BUT IntelligibleMay or may not interfere with intelligibilitySpeech rate may be slow, prosody disturbed, low vocal qualityVocal instability occurs more on sustained phonation over connected speechTreatment: focus on vocal efficiency, contrastive stress (reduce monotone), and verbal repairsReduced Speech IntelligibilityWhen intelligibility is compromised – usually multiple neural systems Speakers at this stage are dealing with multiple problemsIncluding respiratory impairment, laryngeal impairment, or oral impairment – weakness, slowness, and slow coordinationTreatment: Maintaining appropriate speaking rate and intelligibility to resolve communication breakdownGood respiratory techniques for supportChunking units into smaller units to increase intelligibilityNatural Speech Supplemented by AACSeverely impaired speech – needs to be supplemented by other informationAlphabet supplementation technique, where the speaker points to the first letter of each wordSlows speech and provides listener with extra informationUsually have good hand function – tremors make this difficultOther breakdown strategies may be implemented because of increasing cognitive breakdown Want to train BEFORE they NEED ITNo Functional SpeechProviding Augmentative communication systems for individuals with MS and Profound dysarthriaAt this point hand function may be very limitedVisual problems usually occur too – if they are not need to assume that they will happen (PREPARE)No Specific AAC reported ................
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