3.1 - Motor Speech Exam Flashcards by Jamie Bevill

Voice, speech and language undergo _______ and _______ change when people fall prey to certain organic and psychiatric illnesses. Such changes can be the ____________ early in its evolution.

Audible

Visible

First and only sign of a disease

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The manner in which speech becomes defective logically reflects the ______ and _______ of the illness. A specialist trained in the analysis and interpretation of _____________ can contribute to medical diagnosis and selection of ensuing treatment.”

Pathophysiology

Psychodynamics

Abnormal communication

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What is the purpose of a Motor Speech Exam?

Description of disorder

Establishing diagnostic possibilities

Establishing a diagnosis

Establishing implications for localization and disease diagnosis

Specifying severity

Developing a treatment plan

Developing a discharge plan

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Why might we be called to assess patient’s in a psych ward?

Neurological issues can sometimes appear to be psychiatric issues due to the patient’s poor decision making, emotional level, and behavioral issues

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What are the 3 General Exam Guidelines for Motor Speech Exams?

History (always take a good history)

Salient Features

Movement abnormalities/Confirmatory signs

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What are the 6 Salient Features we look for in a Motor Speech Exam?

Strength

Speed

Range

Steadiness

Tone

Accuracy

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What are the 4 Movement Abnormalities we look for in a Motor Speech Exam?

VOM: velocity/speed

ROM: range

DOM: direction

Accuracy

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What are the 7 parts of a Clinical Motor Speech Exam?

History

Oral structures non-speech

Vowel prolongation

Alternating motor rates (AMR’s) diadochokinetic rates

Sequential motor rates (SMR’s)

Contextual speech

Stress testing

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What are we looking for when we take a patient history during a Motor Speech Exam?

(8)

Introduction and goal setting

Basic data

Onset and course

Associated deficits

Patient’s perception of deficit

How patient perceives the consequences of the disorder

Previous management

Awareness of diagnosis and prognosis (does pt. understand why they are there)

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What structures and movements do we exam during a Motor Speech Exam?

(7)

Face

Jaw

Tongue

Velopharynx

Larynx

Reflexes

Volitional vs Automatic Movements

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What 9 General Items are we looking for in a Motor Speech Exam?

Facial Symmetry

Muscle Tone

Palsy (present/absent)

Raise Eyebrows

Frown

Vocal Quality

Volitional Cough

Throat Clear

Phonation Time (prolonged “ah”)

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What 5 items in the Oral Cavity are we looking for in a Motor Speech Exam?

Dentition

Hygiene

Excess Secretions/Awareness of Drooling

Sensory Awareness

Debris (in mouth)

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What 6 qualities of the Jaw are we looking for in a Motor Speech Exam?

Position at rest

Presence of Involuntary Movement

DDK

Range of opening and closure

Range of lateralization

Opening and closing with resistance

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What 6 qualities of the Lips are we looking for in a Motor Speech Exam?

Position at rest

Smile

Frown

Ability to say /u/

Ability to alternate between /u/ and /i/

Puff cheeks and hold

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If multiple areas are compromised in a Motor Speech Exam, the issue is probably ________.

Neurological

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When performing a Motor Speech Exam, what do we want to look at on the Face?

(3)

Face at rest (symmetry, drooping, etc.)

Face during sustained posture (expressionless, expressions held too long, etc.)

Face during movement (abnormalities, extraneous movement, tremors, etc.)

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When performing a Motor Speech Exam, what do we want to look at with the Jaw?

(3)

Jaw at rest (is it too low, etc.)

Jaw during sustained posture (involuntary movement, etc.)

Jaw during movement (deviations. resistance, etc.)

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When performing a Motor Speech Exam, what do we want to look at with the Larynx?

Ability to cough

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When performing a Motor Speech Exam, what do we want to look at with the Velopharynx?

(2)

At rest

During movement (symmetry, elevation, nasal airflow, resonance)

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Which side of the Velopharynx will raise higher: the stronger side or the weaker side?

The stronger side

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When performing a Motor Speech Exam, what do we want to look at with the Tongue?

(3)

Tongue at rest

Tongue during sustained postures

Tongue during movement (protrusion, deviations, resistance, etc.)

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What are we generally looking at with Respiration during a Motor Speech Exam?

Only if there are issues that affect speech

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What are we looking at with Reflexes during a Motor Speech Exam?

(2)

Confirmatory signs regarding localization of disease in CNS or PNS

Normal or pathologic reflexes

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What Perceptual Assessment measures are we looking for during a Motor Speech Exam?

(1+8)

DAB Speech Dimensions (Mayo Clinic)

Respiration
Pitch
Loudness
Resonance
Voice quality
Articulation
Prosody
Other (motion rates, tics, palilalia)

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What are we looking for when evaluating Pitch during a Motor Speech Exam?

Is it typical for pt.'s age + gender

What are we looking for when evaluating Loudness during a Motor Speech Exam?

Is it too soft?

What are we looking for when evaluating Voice Quality during a Motor Speech Exam? (4)

Harshness (due to tension, nodules, etc.) Breathiness (poor adduction) Strained Strangled

What are we looking for when evaluating Resonance during a Motor Speech Exam?

Is the pt. hypernasal or hyponasal?

What tasks might we ask a patient to perform for perceptual measures during a Motor Speech Exam? (5)

Vowel prolongation Alternating motor rates (AMR’s) diadochokinetic rates Sequential motor rates (SMR’s) Contextual speech Stress testing

Do we normal ask patients to perform Vowel Prolongations if their voice sounds normal during a case history?

Why do we ask patients to perform Vowel Prolongations?

To isolate the respiratory-phonatory system used in speech

What speech dimensions are we looking for when we ask patients to perform Vowel Prolongations? (3)

Pitch Loudness Voice Quality

What are median rates in seconds for Vowel Prolongations in Young Males?

28.5 seconds

What are median rates in seconds for Vowel Prolongations in Young Females?

22.7 seconds

What are median rates in seconds for Vowel Prolongations in Elderly Males?

13.8 seconds

What are median rates in seconds for Vowel Prolongations in Elderly Females?

14.4 seconds

What should we ask patients about voice quality?

Is quality or quantity more important?

What are Alternating Motion Rates (AMR’s)?

Speed/regularity of reciprocal movements (jaw, lips, tongue)

What are we looking for in Alternating Motion Rates (AMR’s)? | 3

Articulatory precision Adequacy of V-P closure Respiratory/phonatory support

What are median DDK rates (per sec.)? | 3

/pʌ/ - 6.3 /tʌ/ = 6.2 /kʌ/ = 5.8

What are we looking for in DDK rates?

Precision

What are Sequential Motion Rates (SMR’s)?

Measure of sequential articulatory movements

What are Sequential Motion Rates (SMR’s) important for?

Apraxia of Speech assessments

What is the median rate for /pʌ tʌ kʌ/ in seconds?

5.0

What changes in Sequential Motion Rates (SMR’s) as a patient's disorder increases? (2)

Apraxia increases Ability to initiate decreases

What is Contextual Speech?

Integration of all components of speech

How do we assess Contextual Speech? | 3

Conversational speech Narrative discourse Grandfather passage

What are we looking for when assessing Speech Programming in a Motor Speech Exam? (7)

Distorted articulation Substitutions Omissions Repetitions Additions Articulatory postures Groping

What usually causes Distorted Articulation?

The tongue

What sorts of Substitutions are seen in a Motor Speech Exam? | 3

Sounds Words Gestures

What is Groping a classic symptom of?

Apraxia

Are Normative Tests often used to assess Dysarthria and Apraxia? Why or why not? (2)

No // They take a lot of time We can get the same information without a test

What is a normative test used to assess Dysarthria?

Frenchay Dysarthria Assessment-2

What is a normative test used to assess Apraxia?

Apraxia Battery for Adults – 2

What is the Frenchay Dysarthria Assessment-2?

Test for the differential diagnosis of dysarthria types

How many sections are in the Frenchay Dysarthria Assessment-2?

11 sections

What 11 areas are assessed in the Frenchay Dysarthria Assessment-2?

Reflexes Respiration Lips Jaw Tongue Palate Larynx Intelligibility Rate Sensation Associated factors

How long does it take to administer the Frenchay Dysarthria Assessment-2?

20+ minutes

When might we use the Frenchay Dysarthria Assessment-2?

When we are confident that dysarthria is the only issue

Why was the Apraxia Battery for Adults developed? | 2

To verify the presence of apraxia in adults To estimate the severity of the disorder

What can scores on the Apraxia Battery for Adults do? | 2

Describe patient performance over time Quantify the diagnosis and severity

How many subtests are on the Apraxia Battery for Adults?

6 subtests

What are the 6 subtests on the Apraxia Battery for Adults?

Diadochokinetic rates (1,2, + 3 syllables) Imitation of words of increasing length Latency and utterance time for picture naming (multisyllabic words) Repetition of polysyllabic words Inventory of 15 based on spontaneous speech, reading, counting Limb and oral apraxia test

When is Apraxia of Speech harder to identify?

When it is masked by severe motor speech disorders or aphasia

What are 3 crucial issues when assessing speech?

Intelligibility Comprehensibility Efficiency

How do we assess Intelligibility?

Degree to which the listener/assessor understands the acoustic signal of the speaker

How do we assess Comprehensibility?

Degree to which the listener/assessor understands the speaker on basis of acoustic signal and all other information contributing to understanding what is being said

How doe we assess Efficiency?

Rate at which intelligible or comprehensible information is conveyed

What are 4 Tests of Intelligibility?

Frenchay Dysarthria Assessment Assessment of Intelligibility in Dysarthria Speech (AIDS) Sentence Intelligibility Test Word Intelligibility Test

What 2 tests can be used for patients with severe unintelligibility to measure treatment progress?

Sentence Intelligibility Test Word Intelligibility Test

What does the Assessment of Intelligibility of Dysarthria Speech (AIDS) measure? (5)

Measure of word and sentence intelligibility (Intelligibility Score) Speaking Rate Index of Severity Rate of Intelligible Speech Rate of Unintelligible Speech

What are 2 Computerized Assessments of Intelligibility?

Computerized Assessment of Intelligibility of Dysarthric (CAIDS) -Computerized version of AIDS Speech Intelligibility Test (SIT)

What is the Computerized Assessment of Intelligibility of Dysarthria (CAIDS)?

Computerized version of AIDS

What is the Speech Intelligibility Test (SIT)? | 2

Computerized assessment Combines features of AIDS, CAIDS, + Phoneme Intelligibility Test

What two areas does the Speech Intelligibility Test (SIT) measure? (2)

Sentences Words

What does the Speech Intelligibility Test (SIT) measure in Sentences? (3)

Speech Intelligibility Speaking Rate Communication Efficiency

What does the Speech Intelligibility Test (SIT) measure in Words? (3)

Single word intelligibility Percent of accurate vowels/consonants Additional scoring for stops, fricatives, affricates, semi-vowels, nasals and pressure

What are three additional tools we might use when assessing Motor Speech Disorders?

Communicative Effectiveness Survey Dysarthria Impact Profile Dysarthria Self-Report Questionnaire

What is the Communicative Effectiveness Survey?

A questionnaire that asks patients to rate 8 statements about their speech on a spectrum of 1-4

What can the Communicative Effectiveness Survey be useful for? (2)

Evaluating the patient's perspective Evaluating the patient's goals

What is the Dysarthria Impact Profile?

A questionnaire that asks a patient to consider how dysarthria affects their everyday life

What is the Dysarthria Self-Report Questionnaire?

A very long questionnaire that asks patients to rate each statement with definitely false, mostly false, partly false, sometimes true, mostly true and definitely true