Rehabilitation treatment of dysarthria

The purpose of dysarthria treatment is to promote the voice and speech of patients and restore the motor function of dysarthria organs. (1) The treatment of dysarthria can be designed according to different types, or according to different speech manifestations. From the current point of view of speech therapy, the focus of treatment is often abnormal speech performance, rather than the type of dysarthria. Therefore, the design of treatment scheme should focus on speech performance and take into account the characteristics of different types of dysarthria.

(2) Choose the treatment sequence according to the evaluation results. Under normal circumstances, according to the movements of breathing, throat, palate, palatopharyngeal region, tongue body, tip of tongue, lips and mandible, train one by one. Follow the principle of easy before difficult. For mild to moderate patients, self-active exercise is the main training method. For severe patients, more therapists need to use manual assistance because patients can't exercise autonomously or the exercise effect is poor.

(3) It is very important to choose appropriate treatment methods and appropriate intensity treatment methods to improve the curative effect. Improper treatment will reduce the patient's desire for training and make the patient learn the wrong joint movement mode. In principle, the more times and time of treatment, the better, but it should be adjusted according to the specific situation of patients to avoid excessive fatigue. In general, 30 minutes of treatment is appropriate. Relaxation training

1. Relax your feet, legs and hips.

A. Bend your toes downward for 3-5s, then relax and repeat several times.

B. Rotate the ankle, one foot at a time, and then relax.

C. Sit down, put your feet flat on the floor, press hard for 3s, then relax, repeat several times, and feel the stress and relaxation of gastrocnemius.

D straighten your legs and knees for 3s, and then relax. The patient should feel the exertion and relaxation of the thigh.

E. Exercise the contraction and tension of quadriceps femoris and gluteus maximus, put your hands on your knees (sitting posture), lean forward and stand for 3s, then sit down and relax, and repeat several times. Encourage patients to experience the tension and relaxation of these muscles.

F. Remind the patient that the lower limbs and buttocks should feel relaxed now.

2. Relax the abdomen, chest and back

A focus on the abdomen, chest and back, but keep your feet, legs and hips relaxed.

B. Abdominal contraction makes abdominal muscles contract continuously for 3s, then relax and repeat several times. Patients are required to pay attention to the tension of back muscles and chest muscles when abdomen is closed, and experience a sense of relaxation when relaxing.

Encourage the patient to take a steady deep breath when the muscles relax.

3. Relax your hands and upper limbs

A focus on the upper limbs and hands, while continuing to feel the relaxation of feet, legs, hips, abdomen and chest and back.

B. clench your fist, then relax your throat for a few seconds and repeat it several times.

C. Lift both upper limbs forward to shoulder level for 3s, then put them down and repeat several times.

D. Sit in combination with the above actions, make a fist for 3s when the upper limb is raised horizontally, then put down the arm and release it several times.

E. remind patients of the contrast between tension and relaxation. If your hand is still tense, shake your wrist smoothly until you relax.

4. Relax your shoulders, neck and head

A. Arch your shoulders up for 3s, then relax and repeat several times.

B hang your head forward, then lean back smoothly and slowly turn your head from one side to the other. Then turn your head slowly, you can close your eyes to prevent dizziness.

C. In order to ensure the smooth and slow head movement, the therapist can stand behind the patient and hold the patient's head with his hand to do the above actions.

D raise your eyebrows, wrinkle your forehead, then relax, repeat several times, and pay attention to the difference between feeling nervous and relaxed.

E. Keep your lips closed for 3s, then relax, open your mouth and repeat several times.

F. Move the jaw slowly and steadily, rotate up and down, left and right, and then relax.

G. Wrinkle your face as hard as possible, keep it for 3s, then relax and repeat it several times.

Respiratory training

A. Breathing training

1. Put one hand on the diaphragm and the other hand on one side of 1 1 and 12 ribs. If the patient is paraplegic, the therapist can stand behind the patient with one hand on the patient's diaphragm and the other hand on one side of 1 1, 12 rib, or both hands on both sides of 1 1, 12 rib. Inhale smoothly through the nose, and then exhale slowly through the mouth. Note that the diaphragm moves outward and the ribs move upward and outward. Correct shoulder movements. There should be a pause between breaths to prevent hyperventilation.

2. When the number of therapists is 1, 2, 3, the patient inhales, then holds his breath 1, 2, 3, and then exhales 1, 2, 3. Gradually increase the expiration time until 10 second. When exhaling, you can make fricative sounds such as "S" and "F" for as long as possible, but there is no sound. After several weeks of practice, you can pronounce 10 when you exhale, and keep this level.

3. Continue the above exercises. When exhaling, the fricative sound becomes stronger or weaker, so as to strengthen and weaken the pronunciation intensity of the fricative sound. Do as many intensity changes as possible in one breath. Instruct the patient to feel the movement and pressure of the diaphragm, which shows that the patient can control the exhaled airflow.

4. Breathe out a long and short or a long and short, or a fricative sound with the same rhythm, but don't make a sound, such as S-. Exhale one vowel as long as possible, then pronounce two or three vowels in one breath, and then fricative sounds are pronounced together with vowels. 5. Breathe in a low voice 1, 2, 3, and gradually increase to 1 ~ 10.

6. Change the pronunciation intensity when counting, as in Exercise 5.

B. practice lifting or paddling the upper arm to increase vital capacity. Exhale when your arms are raised to help you breathe.

C use transparent glass marked with scale (cm) to increase the air flow, fill it with one third of water, put the straw into the water, blow air into the straw, observe the scale reached by bubbles and the duration of blowing bubbles, tell the patient the result of blowing bubbles, and record the progress.

Pronunciation training

A. Pronunciation startup

1. When exhaling, the mouth is round, with an "H" shape and then an "A". After repeated practice, gradually reduce the time to pronounce the "H" sound, increase the time to pronounce the "A" sound, and finally practice pronouncing other sounds.

2. As in the above exercise, do the mouth shape of the fricative first, and then do the mouth shape of the vowel, such as "s … a, s … u".

3. hoarseness is caused by tense throat, so friction relaxation technique can be used. Massage and vibration massage can be performed in the geniohyoid muscle and mandibular hyoid muscle. After massage, the tension in the throat is reduced, so you can practice pronunciation. Another method is to ask the patient to yawn with the exhalation and pronounce words when yawning and exhaling. When yawning, you can completely open the glottis and stop the adduction of vocal cords.

4. Delayed dysarthria can have different degrees of laryngeal adductor paralysis, and you can do any of the following recommended exercises.

A. Make a fist with both hands, raise it to chest level, and then suddenly push down the arm to expel gas.

B raise your hands to the chest level, and suddenly push the chest wall inward with your palm to exhaust.

C. suddenly press the armrest of the desktop or chair with both hands.

D raise your arms to shoulder height, bend your elbows and cross your fingers, and then suddenly force your hands apart. In all cases, the patient should exhaust the airflow loudly and then continue to practice vowels.

The way to further promote the beginning of pronunciation is to take a deep breath, cough when exhaling, and then turn this pronunciation into vowels. Once pronunciation is established, patients should be encouraged to sigh loudly to promote pronunciation.

6. Blasting sounds can also be used to assist pronunciation starting, such as ba and bu.

B. continuous pronunciation, continuous pronunciation, continuous pronunciation

1. When the patient can start pronunciation correctly, they can continue pronunciation training. Pronounce vowels as long as possible in one breath, and record the continuous pronunciation time with a stopwatch, preferably 15 ~ 20s.

2. From one vowel to two or three vowels in one breath.

C. volume control

1. Instruct patients to pronounce "M" continuously.

2. The sound "M" is pronounced together with vowels "A", "I" and "U", gradually shortening "M" and lengthening vowels.

3. If the patient has difficulty in pronouncing the double lip sound "M" continuously, he can pronounce the nasal sound "N".

4. Read aloud the words, phrases and sentences that begin with "m". The purpose is to improve the exhalation and volume, compare vowels through the change of lip position, and promote vowel sound.

5. Back ordinal number 1 ~ 20, back Sunday, take a breath, the volume is as loud as possible, and take a deep breath.

6. In order to improve the volume control, volume change training can be carried out. When the numbers are 1 ~ 5 and 6 ~ 10, the trading volume changes from small to large, then from large to small, or from large to small alternately. Vowel, the volume changes from small to large, from large to small, and the volume changes alternately. In the retelling exercise, the maximum volume is encouraged, and the therapist gradually lengthens the distance from the patient until the treatment room can accommodate the longest distance. Encourage patients to fill the room with sounds and remind patients to relax as much as possible and take deep breaths.

D. tone control

1. Expand the range and guide patients to sing scales. Any vowel or consonant vowel can be sung together, such as "A, A, A", "ma, ma, ma". If the patient can't sing a complete scale (octave), he can concentrate on training three different pitches and gradually expand the range later.

2. When the pitch of the patient is established, the "sliding" training can be carried out, which is the premise of pitch training. Vowels, from low-medium-high; High-medium-low; Medium height; Medium and low; High-medium-high; Low-high-middle sliding.

3. The patient imitates the therapist to do the following exercises: La-La Hello!

Mom/Mom, have you eaten?

Mom, mom/mom, do you want a pen?

4. When listening, patients should imitate these different pitch changes and make sure that these pitch changes represent different meanings or tones. If the patient has mastered the above exercises, he can repeat some exclamations, questions and greetings.

E. nasal control

1. Inhale deeply, bulge your cheeks, hold for a few seconds, and then exhale.

2. Using straws with different diameters and blowing in the mouth will help the lips to close and increase the muscle strength of the lips.

3. Practice double lip sounds and retrolingual sounds, such as "Ba, Da, Ga".

4. Practice making fricative sounds, such as "fa, sa".

5. Alternate lip and nose consonants training, such as "Ba, Ma, Mi and Pai" soft palate training, please refer to the training of pronunciation organs.

Exercise training of oral and vocal organs

A. proprioception neuromuscular promotion

1. Sensory stimulation: Pull a piece of ice up from the corner of the mouth along the abdomen of zygomatic muscle, which can stimulate the smiling muscle and pull it down to the corner of the mouth for 3 ~ 5s. After repeated stimulation, the effect appears immediately, but the duration is short. Its mechanism is to stimulate temperature receptors, and impulses reach the central nervous system through fibers, which increases the sensitivity of muscle spindles, excites neuromuscular muscles and contracts muscles. Another method is to brush gently and quickly along the above parts for one minute with a soft brush. The effect after brushing teeth is that it appears 20 ~ 30 min after re-stimulation.

2. The pressing, pulling and resisting activities of facial muscles are based on the coordinated movement of various muscle groups. Do it on both sides at the same time when practicing.

A. Apply pressure with the fingertip of your finger or thumb, such as touching the lateral side of the submental glossal muscle, and apply pressure on the hyoid bone, which is helpful for swallowing. B. Traction refers to repeatedly patting the contracted muscle fibers with your fingers when you exercise again to stimulate greater contraction. If you pat gently along the contracted smiling muscles, you can promote the smiling action.

Resistance refers to applying a force in the opposite direction of motion to strengthen it. Only when the patient can achieve a certain degree of muscle contraction can it be performed. Resistance acts on the key side, and it can only act on the affected side if the strength of the affected side is strong enough. When patients can't do a certain exercise without help, pressure and traction technology can be used to promote the implementation of exercise. Generally, pressure and traction techniques are implemented first, and then resistance techniques are implemented with the improvement of functions.

B. Training of vocal organs

1. Mandibular improvement

A. Open your mouth as wide as possible, lower your chin, and then close it. Repeat slowly for 5 times and rest. In the future, we should speed up, but keep the maximum range of motion of the upper and lower jaws.

B. The mandible extends forward and slowly moves from one side to the other. Repeat 5 times and rest.

2. Lip closure and lip angle abduction

A. Blow your lips forward as far as possible (in the position of U sound), and then close them back as far as possible (in the position of I sound). Repeat 5 times and rest. Gradually increase the speed of alternating motion and maintain the maximum range of motion.

B, one side of the mouth closed, action for 3s, and then rest. Repeat 5 times and rest. The key moves alternately with the affected side.

C. Close your lips tightly, clamp the tongue depressor, and increase the intensity of lip closure. The therapist can pull the tongue depressor outward, and the patient can close his lips to prevent the tongue depressor from pulling out.

D drum cheeks for a few seconds, and then suddenly exhaust, which helps to send out sonic boom. Patients can also squeeze their cheeks with their fingers while bulging their cheeks.

3. Tongue extension, tongue elevation, alternating movement and circular movement

A. Stick out your tongue as far as possible, then take it back, roll it up and back, repeat for 5 times, rest and gradually increase the amount of exercise. A The therapist can put the tongue depressor in front of the patient's lips, and the patient will stick out his tongue to touch the tongue depressor. B. Use the tongue depressor to resist the extension of the tongue, so as to strengthen the extension force of the tongue. C maintain the maximum range of motion, increase the number of repetitions, and improve the speed of motion. The number of repetitions and the speed of movement can be recorded by a stopwatch.

B. the tip of the tongue should be as long as possible. Repeat this action 5 times and rest. Gradually increase your exercise. When practicing, you can hold your jaw with your hands to prevent it from raising. When the motion intensity of the tongue increases, the tongue depressor can assist and resist the upward motion of the tip of the tongue to increase the motion intensity.

C. the tongue surface is raised to the hard palate. The tip of the tongue can be close to the lower teeth, and the tongue surface is convex. Repeat 5 times and rest. Gradually increase your exercise.

D. The tip of the tongue extends outward and moves from one corner to another. Use tongue depressor to help and resist the movement of one tongue. B when doing the above exercise, gradually increase the movement speed.

E. The tip of the tongue "sweeps" around the upper and lower gums.

4. Soft palate elevation

A. sighing hard can promote the elevation of soft palate.

B pronounce "A" repeatedly, and rest for 3 ~ 5s after each pronunciation.

C. repetitive plops and vowels "pa, da"; Repetition of fricative sounds and closed vowels "four, Shu"; Repeat nasal and vowel sounds "Mom, you"

D. directly stimulate the soft palate with a fine brush.

E. If the soft palate is paraplegic, quickly rub the soft palate with ice cubes and rest after a few seconds, which can increase muscle tension.

F pronounce vowels immediately after stimulation, imagine the soft palate lifting, and then alternately pronounce nasal sounds and lip sounds as a control.

G. When pronouncing vowels, put a mirror, finger or tissue under your nostrils to see if there is any air leakage.

Alternate exercise

A. Alternate chin movements and open your mouth.

B. The alternating movement of lips requires the lips to contract forward and then contract.

C. The alternating movement of the tongue includes the extension and contraction of the tongue A; B the tip of the tongue increases or decreases in the mouth; The tongue moves from one corner of the mouth to the other.

D. repeat the action as soon as possible and then pronounce it.

Phonetic training

A. Phonetic training

1. Practice the pronunciation of "b". Encourage patients to observe the movements of therapists.

2. The patient looks at the pronunciation teacher in the mirror so as to correct his pronunciation in time.

3. The lips are closed and the cheeks are bulging, so that the gas pressure in the mouth rises, and the gas is suddenly ejected from the lips when pronouncing. 4. Read the tongue twister composed of "B" sound. Adults had better use real language, which is easy for patients to accept. For therapists, at this stage, the establishment of language is more important than the application of words.

B. compensation technology muscle weakness, limited range of motion or slow movement of the pronunciation organs make some patients unable to achieve completely accurate pronunciation. In this case, patients can learn pronunciation compensation method. These compensation methods can make the sound close to normal and be heard by others.

Language rhythm training

A. Stress rhythm training rhythm and stress are difficult to separate, because they are interdependent. Therefore, in the treatment, the two treatments adopt the same method.

1. Breathing control can make stress and light sounds show differences, thus producing the rhythm characteristics of language. Therefore, breathing training is not only helpful for pronunciation, but also lays the foundation for rhythm and stress control.

2. In order to promote rhythm control, patients can read poems aloud. Poetry has a strong sense of rhythm, and therapists can tap the rhythm points with their hands or pens to help patients control the rhythm.

3. Emphasis on stress is to highlight the semantic focus or express strong feelings, which makes the stress read loudly, so it is determined by the speaker's intentions and emotions, and there is no certain law.

4. When patients have established the concepts of rhythm and stress, they can identify and monitor stress with their own words in daily life. Patients and therapists stress sentences in daily conversations, and patients read stressed daily words and short passages.

B. intonation training

1. Practice the rising and falling of vowels, such as: a ... ↗ a ... ↗↘ a ... ↘.

2. Explain to patients that different feelings need to be expressed in different tones and demonstrate them to patients. Patients imitate different intonations to convey their feelings. For example, excited, bored, happy, angry, confused, disappointed, sad and encouraged.

3. Practice the intonation of simple declarative sentences and imperative sentences, which requires the tone at the end of the sentence.

4. Practice interrogative sentences, asking for a rising tone at the end of the sentence.

Training of alternative speech communication methods

Patients with severe dysarthria, due to the serious impairment of speech motor function, have difficulty in speech communication even after language training. In order to enable these patients to communicate socially, speech therapists can choose and train some methods to replace speech communication according to the specific situation of each patient and the actual requirements of future communication. At present, there are commonly used and simple drawing boards, word boards and sentence boards in China. There are many pictures of daily life on the drawing board, which will help patients with low educational level and loss of reading ability. Both the word board and the sentence board are marked with commonly used words and sentences, and some sentence boards can also leave gaps in appropriate positions for patients to write some supplementary information when needed. Word board and sentence board are used for patients with certain educational level and athletic ability.