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
How can you assess respiratory-phonatory, VP and articulation mechanism as they are working together?
- SMRs
- Measuring accuracy and speed along with articulatory precision
- Helps differential diagnosis of AoS
How do you assess functions of all components of speech and primary valves together?
- Contextual speech
- Tasks: Conversational or narrative speech (conversation during patient history and narrative by reading a phonetically balance sample (grandfather passage)
How can you assess deterioration of vocal quality, resonance, and articulation over time?
- Stress testing
- Task: read aloud naturally or count (2 digits per second)
Timed for 2-4 minutes
How do you assess articulatory substitutions, repetitions, additions, blocks, hesitations, omissions and trial and error (motor speech planning and programming)?
- Tasks: SMRs, repeat complex, multi-syllabic words and sentences
- To assess more severe patients: singing, counting, rehearsing days of the weak, completing redundant sentences, imitating CVC syllables with same initial and final consonants
Published dysarthria assessment?
Frenchay dysarthria assessment (only one that distinguishes dysarthria type)
AOS assessment?
- Only one published
- Apraxia battery for adults (ABA-2)
- Verify presence of apraxia in adults and estimates severity
What are you assessing when looking at intelligibility?
- The degree to which the listener understand the acoustic signal produced by the speaker
- Can’t estimate this from conversation as one knows the topic and has other visual information
- valid measure of functional limitations
What are you assessing when looking at comprehensibility?
- The degree to which an utterance produced by a speaker is understood by the listener in a natural communication setting
What are you assessing when looking at efficiency?
- Efficiency refers to the rate at which intelligible or comprehensible information is conveyed
- Supplements measure of intelligibility and comprehensibility
- contributes to both perception of speech normalcy and normalcy of communication in social situations
