3.1 - Motor Speech Exam Flashcards
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
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
What is the purpose of a Motor Speech Exam?
7
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
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
What are the 3 General Exam Guidelines for Motor Speech Exams?
History (always take a good history)
Salient Features
Movement abnormalities/Confirmatory signs
What are the 6 Salient Features we look for in a Motor Speech Exam?
Strength
Speed
Range
Steadiness
Tone
Accuracy
What are the 4 Movement Abnormalities we look for in a Motor Speech Exam?
VOM: velocity/speed
ROM: range
DOM: direction
Accuracy
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
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)
What structures and movements do we exam during a Motor Speech Exam?
(7)
Face
Jaw
Tongue
Velopharynx
Larynx
Reflexes
Volitional vs Automatic Movements
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”)
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)
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
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
If multiple areas are compromised in a Motor Speech Exam, the issue is probably ________.
Neurological
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.)
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.)
When performing a Motor Speech Exam, what do we want to look at with the Larynx?
Ability to cough
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)
Which side of the Velopharynx will raise higher: the stronger side or the weaker side?
The stronger side
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.)
What are we generally looking at with Respiration during a Motor Speech Exam?
Only if there are issues that affect speech
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
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)
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?
No
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
