Client Information: 49-year-old female, with multiple sclerosis, resulting in mixed spastic-ataxic dysarthria and mild oral-phase dysphagia.  (Outpatient)

 

 

Goals for Treatment Presentation (60 Minute Session)

 

Impairment: To increase strength, ROM, and decrease tone

 

Activity: To establish breath support for speech production

 

Participation: To increase intelligibility of speech when communicating with family members. 

 

Therapy Activities

 

Impairment Level: Oral motor exercises, including:

  1. Pucker/smile exercises 10x (buccal strength)
  2. Retraction/Elevation of tongue 10x (ROM of tongue/strength)
  3. Open/Close mouth 10x (ROM, decrease tone)
  4. Tongue tension against cheek (increases strength)
  5. Slow, passive stretching (decreases tone, and increases ROM) (tongue, lips and jaw)

 

Activity Level:

  1. Modify posture (Increase volume area)
  2. Relaxation breathing (Yoga techniques)
  3. Prolong vowel sounds (Phonatory stability)

 

Participation Level:

  1. Over Articulate
  2. Reduce rate (be careful if wpm < 60)
  3. Continue Oral motor exercises (oral phase dysphagia)
  4. Continue respiration exercises (along with speech)

 

 

 

 

 

 

 

 

 

 

 

Speech Therapy                                                          Smith, M.

 

(S) ST this a.m. in clinician’s therapy room.  Pt was alert and cooperative during the therapy session.  Husband noted no changes in voice quality or swallowing functioning since the assessment.  (O) Oral motor exercises revealed difficulties with buccal weakness, lip retraction, and coordinated lip movement.  Tongue strength, ROM (for all oral structures), and coordination did not increase after repetitions.  Patient was able to slightly open and close mouth 50% of the trials attempted.  Patient allowed the clinician to perform slow, passive stretching exercises.  The clinician modified the patient’s posture to an upright position, to increase breath support.  The clinician instructed the client to imitate their breathing pattern using the “square” (hold breath four seconds, in through the nose for four seconds, hold for 4 seconds and breath out for four seconds, over and over) technique of breathing.  To increase phonatory stability, patient prolonged vowel sounds (/a/).  (A) MS resulting in mixed spastic-ataxic dysarthria and mild oral phase dysphagia.  (P) To increase strength, ROM, decreased tone, increase breath support, and increase intelligibility of speech.

 

Kellan Williams

Shaun Key

Heather Browning

Corinne Kelsey

Mandy Crow

Erin Ward