Multiple Sclerosis - A Practical Guide to Rehabilitation - 32

AIMS

A PRACTICAL GUIDE TO IDIOPATHIC PULMONARY FIBROSIS

* Intelligibility (words, sentences, conversations)
* Influencing factors (hearing, sight, teeth,
language, mood, posture, rate, sensation)
The Assessment of Intelligibility of Dysarthric
Speech can be used for adolescents and adults,
and requires 30 minutes to complete. This test
quantifies single word intelligibility, sentence
intelligibility, and speaking rate. It provides an
index of severity and can be used to monitor
progress on speech-language interventions.109
The Speech Intelligibility Test111 can also be used
to monitor progress. Computer software
randomizes stimuli, and the test can be performed
on screen or as printed hard copy. Words and
sentences are judged by an unfamiliar listener. It
takes 10 minutes to complete.
Individuals with MS should be referred to an SLP
for evaluation when any of the following speech
changes are noted:
* Slurring of speech sounds
* Changes in loudness (too loud, too soft, or
fluctuating loudness)
* Changes in voice quality (hoarse, breathy,
strained, or strangled)
* Abnormal pauses during speech (may also
indicate word retrieval difficulties)
* Abnormal stress/emphasis on words
* Impaired pitch control
* Change in normal pitch (higher, lower, pitch
breaks)
* Hyper- or hyponasality
* "Running out of air" while speaking
* Anterior loss of saliva or food when chewing
* Weakness or decreased range of motion in lips,
cheeks, tongue, soft palate, and/or muscles of
the head, neck, and trunk
Among the most frequently reported speech
change in persons with MS is decreased
loudness.100,112 Vocal fold weakness can also be
present.113,114 In addition, weakness in expiratory
and laryngeal muscles is noted in the MS
population.115,116,117,118 Expiratory muscle weakness

32

may be present early in the disease course and in
patients with mild to moderate disability.119
To date, expiratory muscle strength training
(EMST) has not been shown to limit the impact
of expiratory strength in speech and cough
function, although more research is needed to
determine possible benefits.119,120,121 Conversely,
Lee Silverman Voice Treatment administered by a
trained SLP may provide benefit in increasing
loudness, prosodic variation, and articulatory
accuracy.122,123
An important consideration when evaluating and
treating speech and voice impairments is the
demands of the environment on the speaker. MS
fatigue can have a significant impact on all
parameters of speech and voice, and fluctuations
in the quality and efficiency of speech and voice
throughout the day are common. MS
exacerbations or progression of the disease can
worsen or bring on new symptoms. In addition,
speech and voice parameters can worsen due to
xerostomia, gastroesophageal reflux,
pseudoexacerbation, medication effects, or
lifestyle habits, such as tobacco and alcohol use
and vocal abuse or misuse.
Together with patient history and physical
findings, informal and formal dysarthria testing
informs diagnosis, recommendations for
treatment, development of individualized
intervention strategies, and referral to other
disciplines if necessary. Patient and
family/caregiver education is essential. Verbal and
written information explaining results of speech
and voice assessments in easily understandable
vocabulary should be provided to patients and the
support team. The rationale for recommendations
and any referrals should also be carefully
explained, as should augmentative and alternative
communications when beneficial. Patient, family,
and caregiver input regarding desires and
expectations from treatments should always be
solicited during such discussions.

Speech, Swallowing Issues, and Oral Health



Multiple Sclerosis - A Practical Guide to Rehabilitation

Table of Contents for the Digital Edition of Multiple Sclerosis - A Practical Guide to Rehabilitation

Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 1
Multiple Sclerosis - A Practical Guide to Rehabilitation - 2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 3
Multiple Sclerosis - A Practical Guide to Rehabilitation - 4
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Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover3
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover4
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