Samenvatting Spraak therapie - verworven: alle HC, OC, ppt, cursus met notities zijn hierin verwerkt
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Course
Spraak therapie
Institution
Thomas More Hogeschool (tmhs)
Spraak therapie - verworven: alle HC, OC, ppt, cursus met notities zijn hierin verwerkt
De hoor -en oefencolleges werden bijna volledig uitgetypt. Aanvullingen vanuit de cursus zijn in het blauw weergegeven.
Veronique De Nutte
Alle HC’s, OC’s en de cursus zijn hierin
verwerkt
SPRAAK THERAPIE
VERWORVEN
2021-2022
,Inhoud
1 Algemene aanschouwingen: neurale herstelmechanismen en principes van motorisch leren ..... 7
1.1 Inleiding ................................................................................................................................... 7
1.2 Managementbenaderingen................................................................................................... 10
1.2.1 MSS’en: drie managementbenaderingen (Duffy) ......................................................... 11
1.3 Therapiedoelen en beïnvloedende variabelen in gedragsinterventie bij MSS’en ................ 13
1.3.1 Therapiedoelen ............................................................................................................. 13
1.3.2 Beïnvloedende factoren in de keuze voor of tegen therapie, en de doeltreffendheid
van de spraakmotorische therapie................................................................................................ 14
1.3.3 Concreet therapiekader voor personen met een MSS.................................................. 18
1.3.4 ICF, nood en motivatie om de MSS te verbeteren? ...................................................... 21
1.4 Rationale en principes van gedragsinterventies bij spraakmotorische stoornissen ............. 21
1.4.1 Neurale herstelmechanismen ....................................................................................... 21
1.4.1.1 Neurorevalidatie ....................................................................................22
1.4.1.2 Gedragsplasticiteit en neuroplasticiteit ...............................................22
1.4.1.3 Neurorevalidatie ....................................................................................24
1.4.1.4 Interhemisferische reorganisatie, maladaptieve plasticiteit,
functieherstel kan vertragen ..................................................................................25
1.4.1.5 Herstel en aanpassing ...........................................................................25
1.4.2 Therapeutische benaderingswijzen............................................................................... 27
1.4.2.1 Directe therapie: gericht op de patiënt ..............................................28
1.4.2.1.1 Impliciet leren: stimulatietherapie (= re-activatie –
facilitatietherapie) ...............................................................................................28
1.4.2.1.2 Expliciet leren: strategietraining.........................................................28
1.4.2.2 Indirecte therapie: therapie gericht op omgeving
(biopsychologische benadering) ..........................................................................30
1.4.3 Theoretisch kader voor de klinische praktijk................................................................. 31
1.4.4 Principes van motorisch leren (MLP of PML) ................................................................ 31
1.4.4.1 Motorisch leren = hoe kan men motorische prestaties verbeteren en
vervolgens behouden?...........................................................................................32
1.4.4.2 Motorisch leren = verfijnen en versterken van Motorische plannen /
bewegingsprogramma’s door ervaring ................................................................33
1.5 OC 1: algemene beschouwingen ........................................................................................... 39
1.5.1 Topic 1: Neurale herstelmechanismen en therapeutische benaderingswijzen ............ 39
1.5.1.1 Oefening 1..............................................................................................40
1.5.1.2 Oefening 2..............................................................................................43
1.5.1.3 Oefening 3 – zie oefenbundel ..............................................................44
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, 1.5.2 Topic 2: motorische leerprincipes (MLP)....................................................................... 45
1.5.2.1 Oefening 4:.............................................................................................46
1.5.2.2 Oefening 5..............................................................................................47
1.5.2.3 Oefening 6:.............................................................................................48
1.5.2.4 Oefening 7..............................................................................................49
2 Spraakapraxie ................................................................................................................................ 50
2.1 Doelstellingen van de behandeling van SA ........................................................................... 50
2.1.1 Therapie bij spraakapraxie ............................................................................................ 50
2.1.2 Doelstellingen afhankelijk van Ernst van SA.................................................................. 51
2.1.3 Continuüm van de principes van motorisch leren afhankelijk van de ernstgraad
(Paemeleire) .................................................................................................................................. 52
2.1.4 Therapiemethoden gericht op ...................................................................................... 53
2.2 Overzicht van bestaande therapiemethoden ....................................................................... 54
2.2.1 De Integrale stimulatiemethode ................................................................................... 54
2.2.2 De articulatorisch-motorische methode ....................................................................... 58
2.2.3 PROMPT ......................................................................................................................... 61
2.2.4 Prosodie en muziek: effectiviteit? ................................................................................. 62
2.2.4.1 Tempo-vertragende methoden ...........................................................63
2.2.4.2 Melodic Intonation Therapy..................................................................64
2.2.4.2.1 Rationale van het oorspronkelijke MIT-programma.........................65
2.2.4.3 Speech-music therapy for Aphasia (SMTA) .........................................67
2.3 TIAS: therapeutisch instrument voor apraxie van de spraak ................................................ 68
2.3.1 TIAS Methodiek I: articulatorisch-motorische therapie ................................................ 71
2.3.2 TIAS Methodiek II: Adaptatietherapie ........................................................................... 75
2.4 Behandeling van spraakapraxie met afasie ........................................................................... 77
2.5 OC 2: Motorische spraakstoornissen: therapie bij spraakapraxie ........................................ 78
2.5.1 Casus mevrouw T........................................................................................................... 78
2.5.2 Oefening 2: moeilijkheidsgraad ..................................................................................... 80
2.5.3 Oefening 3: casus wa van dias (diagnostisch) naar tias (therapeutisch) ....................... 82
2.5.3.1 Diagnostische fase.................................................................................82
2.5.3.2 Oriënteringsfase .....................................................................................85
2.5.3.3 Oefenfase...............................................................................................87
3 Dysartrie ........................................................................................................................................ 89
3.1 Spraakgeoriënteerde interventies - management ................................................................ 90
3.1.1 Resonantie ..................................................................................................................... 90
3.1.1.1 Velofaryngale sluiting en spraak ..........................................................90
2
, 3.1.1.2 Velofaryngale sluiting: mechanisme ....................................................91
3.1.1.2.1 Velofaryngeale sluiting: spraaksymptomen .....................................91
3.1.1.3 Velofaryngale sluiting: management ..................................................92
3.1.1.4 Managemant Resonantie: velofaryngale sluiting ...............................93
3.1.1.4.1 Resonantie Chirurgie ..........................................................................93
3.1.1.5 Resonantie farmacologisch ..................................................................94
3.1.1.6 Resonantie prothese..............................................................................95
3.1.1.7 Resonantie Gedragstherapie ...............................................................96
3.1.2 Articulatie ...................................................................................................................... 98
3.1.2.1 Articulatie chirurgisch ............................................................................98
3.1.2.2 Articulatie farmacologisch....................................................................99
3.1.2.3 Articulatie prothese (geen evidentie) ..................................................99
3.1.2.4 Articulatie: gedragsinterventie ...........................................................100
3.1.2.5 Articulatie: oraal-motorische training.................................................100
3.1.2.6 Articulatie: accuratesse – dril..............................................................103
3.1.3 Tempo, prosodie en natuurlijke spraak....................................................................... 108
3.1.3.1 Suprasegmentele kenmerken.............................................................108
3.2 Communicatiegeoriënteerde benaderingen ....................................................................... 109
3.2.1 Communicatie (ernstige dysartrie) .............................................................................. 109
3.2.1.1 Alfabetsupplementatie (Yorkstone & Beukelman, 1977) .................109
3.2.1.2 Semantische cueing ............................................................................110
3.2.2 Dysamix (paemeleire) .................................................................................................. 110
3.3 Spraakgeoriënteerde training voor specifieke dysartrietypes ............................................ 111
3.3.1 Hypokinetische dysartrie (HC4) ................................................................................... 111
3.3.2 Hyperkinetische dysartrie............................................................................................ 111
3.3.3 Slappe dysartrie (HC5) ................................................................................................. 111
3.3.4 Spastische dysartrie ..................................................................................................... 112
3.3.5 Atactische dysartrie ..................................................................................................... 112
3.4 OC 3: Therapie bij dysartrie ................................................................................................. 112
3.4.1 Opdracht 1: Spreektempo berekenen ......................................................................... 113
3.4.2 Oefening 2: tempo verlagen met dysamix .................................................................. 114
3.4.3 Oefening 3: tempo verlagen met prosodietrainer ...................................................... 115
4 Therapie bij de hypokinetische dysartrie bij de ziekte van Parkinson ........................................ 116
4.1 Parkinsonismen en de ziekte van parkinson ....................................................................... 116
4.1.1 Wat is de ziekte van Parkinson? .................................................................................. 116
4.1.2 Pathofysiologie: wat loopt er fout in de hersenen? Oorzaak ...................................... 117
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