Adult Speech Flashcards
Why conduct an OMA for adult speech?
Structures and functions of the oro-musculature are integral to speech function.
Impairment of groups of muscles can indicate underlying neurological dysfunction and assists differential diagnosis
Completion of a cranial nerve exam (CN V, VII, IX, X, XI, XII)—to assess facial, oral, velopharyngeal, and laryngeal function and symmetry
Why conduct a case history for adult speech?
- Provides informal speech sample
- Gain information about client knowledge and awareness of condition
- Initial goal setting
- Experienced clinicians often reach a diagnosis by the time greetings and amenities have been exchanged and a history obtained. Subsequent formal examination confirms, documents, refines, and sometimes revises the diagnosis.
- The history reveals the time course of complaints and the patient’s observations about the disorder. It also puts contextual speech on display at a time when anxiety is generally less than during formal examination, when the patient may not feel speech is the subject of scrutiny, and when physical effort, task comprehension, and cooperation are not essential. (Duffy, 2013)
What questions will you ask in case history for adult speech?
- Condition onset
- Course/nature of associated deficits
- Client’s perception of the problem
- Current/prior management
- Medical history and medications
- Communication partners/contexts where most difficult
What are the general goals of dysarthria assessment?
Dysarthria assessment aims to describe the features of the client’s speech, establish a diagnosis, classify the type and severity of the disorder and informs the prognosis and treatment plan (Duffy, 2013)
describe perceptual characteristics of the individual’s speech and relevant physiologic findings;
describe speech subsystems affected (i.e., articulation, phonation, respiration, resonance, and prosody) and the severity of impairment for each;
identify other systems and processes that may be affected (e.g., swallowing, language, cognition); and
assess the impact of the dysarthria on speech intelligibility and naturalness, communicative efficiency and effectiveness, and participation.
Describe the process of doing an AMR:
“take a breath and repeat ‘puh-puh-puh-puh-puh’ for as long and steadily as you can. ” This should be followed by a 2- to 3-second example by the clinician. A 3- to 5-second sample usually suffices. Patients can be told to stop when the sample is sufficient for clinical judgments. Repeat for ‘tah’ and ‘kah’. 5-7 reps per second, with ‘kah’ being slower.
What is the purpose of doing an AMR?
Useful for judging the speed and regularity of reciprocal jaw, lip, and anterior and posterior tongue movements.
Observation articulatory precision, the adequacy of velopharyngeal closure, and respiratory and phonatory support for sustaining the task.
The primary value of AMRs is for assessing the speed and regularity of rapid, repetitive articulatory movements.
Inability to sustain speech AMRs for more than a few seconds often reflects inadequacies at the respiratory-phonatory or velopharyngeal levels.
AMR rates are generally slow or normal in people with MSD.
Extraneous movements (e.g. tongue protrusion, lip smacking, pursing) may represent an underlying movement disorder
Describe how to conduct an SMR:
The patient should be asked to “take a breath and repeat ‘puh-tuh-kuh puh-tuh-kuh puh-tuh-kuh’ over and over again until I tell you to stop.” This should be followed by a 2- to 3-second example by the clinician. Some people need reinstruction in the sequence, and slow or unison practice is sometimes necessary for the task to be grasped. When the sequence cannot be learned, repetition of “buttercup, buttercup, buttercup . . .”
What is the purpose of doing an SMR?
Measure ability to move quickly and in proper sequence from one articulatory position to another.
Planning or programming demands for SMRs are higher than for AMRS
Useful for differentiation when apraxia of speech is suspected
What physical characteristics are you looking for during non-speech dysarthria assessments?
SSTARS
Strength Speed Tone Accuracy Range Stability ... of movements.
Describe how to conduct a vowel prolongation:
Say: “take a deep breath and say ‘ah’ for as long and as steadily as you can, until you run out of air.” Record the best of 3 attempts. Compare with norms.
Fill out mayo clinic sections on pitch, voice quality and loudness, excluding mono-pitch and monoloudness.
Why would you do a vowel prolongation?
To determine if there is adequate pulmonary support and sufficient laryngeal valving for phonation
Note the pitch, loudness and voice quality.
Note maximum phonation time (norms available – above 9 seconds considered normal)
Duration can be used as baseline dataObserve jaw, face, tongue and neck for quick or slow movements that may indicate movement disorder (it should be a fixed posture task)
What is stress testing?
Patient should be asked to read aloud or count as precisely as possible at a rate of about two digits per second. This should be continued without rest for 2 to 4 minutes.
Listen for deterioration of voice quality, resonance or perceptual characteristics that indicate weakness
Why perform stress testing?
When LMN weakness of unknown cause is present or when the patient complains of rapid or dramatic changes in speech with continued speaking or general physical effort, speech stress testing should be pursued.
Significant deterioration of voice quality, resonance, or articulation consistent with perceptual characteristics associated with weakness can reflect myasthenia gravis, especially if speech then improves significantly after a few minutes of rest.
What is Intelligibility? How to assess it?
The degree to which the listener (familiar/unfamiliar) understands the individual’s speech; typically reported as a percentage of words correctly identified by a listener
To Ax:
Use material unknown to the listener and with low semantic predictability.
Include words that provide a sampling of most of the phonemes.
Tasks include single-word production and sentence production (recorded and later transcribed by a judge).
What subsystems to you assess and why?
Respiration, phonation, articulation, resonance, prosody.
