Assessment Flashcards
Why assess speakers with MSDs?
- To detect or confirm suspected hypothesis/problem
- Establish a prognosis
- Specify more precisely for treatment
- Establish criteria for treatment termination
- Establish differential diagnosis
- To classify the problem within a specified disorder group
- To determine site of lesion or disease process
- Degree of severity
6 Wh- questions to ask during a neurological exam?
- When onset and what were the symptoms at onset
- What can be found in the physical exam?
- Where is the lesion situated?
- Why is the patient ill? (Etiology)
- What is the course of the illness? (Prognosis)
- What is the management? (Treatment)
What should be included in a motor speech exam?
- Patient history
- Exam of the oral mechanism during NON SPEECH activities
- Assessment of perceptual speech characteristics
- Assessment of intelligibility, comprehensibility and efficiency
What are the 6 salient feature of a neuromuscular exam?
- Strength: Reduced usually consistently but sometimes progressively
- Speed: Reduced or variable (increased only in hypo kinetic dysarthria)
- Range: Reduced or variable (predominantly excessive only in hyperkinetic dysarthria)
- Steadiness: Unsteady, either rhythmic or arrhythmic
- Tone: Increased, decreased, or variable
- Accuracy: inaccurate, either consistently or inconsistently
What are you looking for in non-speech activities during an oral motor assessment?
- Size
- Strength
- Symmetry
- Range
- Tone
- Steadiness
-Speech - Accuracy
- At rest, during sustained postures and during movement
- Face, jaw, tongue, palate, laryngeal performance, respiratory, reflexes
When assessing laryngeal performance what is the objective?
- Assess gross integrity of VF adduction
How do you assess laryngeal performance?
- Cough: observe “sharpness” not loudness
- Breathy = weakness, poor respiratory support
- Glottal Coup: sharpness
- Differential diagnosis….
- Weak cough but sharp glottal coup = respiratory pathology
- Weak coup but normal cough OR weak cough and weak coup = laryngeal weakness or laryngeal and respiratory weakness
How do you assess if respiration is adequate for speech production?
- Posture
- Shortness of breath
- Resting rate regular
- Frequency hiccups
- Weak cough
- Simple water manometer: 5 seconds bubbles in 5 cm of water - enough breath support for speech
Why do we assess reflexes during an exam?
- Help localize whether CNS or PNS
How do we assess reflexes during an exam?
- Jaw jerk = pathologic if easily elicited in adults than it is an indicator of trigeminal nuclei impact in mid pons
- Reflexes appearing in adults that are typically seen at birth = CNS pathology (frontal lobe or subcortical)
- Gag reflex = normal with stroke of back of tongue
- Sucking reflex = pathological response, if pursed or pouting lips affected than it is confirmatory UMN premotor area, dementia.
- Snout reflexes = difficult to assess over 60 years old (similar response to sucking)
- Normal reflexes reflect normal nervous system function
- No relex = PNS pathology
What are you doing and looking for during an exam of volitional tasks to assess for nonverbal oral apraxia?
- Use verbal commands unless poor receptive language than model
- Assess ability to perform without…
- approximations
- frank errors
- frustrating awareness of performance
- attempts self-corrections
What are some tasks you can use to assess nonverbal oral movement control and sequencing?
- Cough
- Click your tongue
- Blow
- Puff out your cheeks
- Bite your lower lip
- Smack your lips
- Stick our your tongue
- Lick your lips
Why and how do we assess perceptual speech characteristics?
- To identify deviant speech characteristics
- The presence of a deviant speech characteristic is generally more important to differential diagnosis than its severity
- Using a rating scale: to identify normal, mild, moderate, severely deviant
- Assess the following characteristics: Pitch, loudness, vocal quality, resonance and intra oral pressure, respiration, arituclation, and motion rates
Why perform a physiological speech assessment?
- To isolate respiratory, phonatory, VF and articulation independently
- And how they work together
How can you physiologically assess respiratory-phonatory?
Tasks: Vowel prolongation at modal pitch (MPT) and sustained AMRs
