Ch. 15 Differential Diagnosis

Question 1

What is the definition of differential diagnosis?

Answer 1

The process of narrowing possibilities and reaching conclusions about the nature of a deficit

Question 2

What should we always try to do when doing a speech eval.?

Answer 2

try to make a diagnosis

Question 3

If you can’t make a definitive diagnosis, what should you try to do?

Answer 3

Describe what you find, and state why a definitive diagnosis can’t be made.

Question 4

What are 2 reasons for not being able to make a diagnosis?

Answer 4

1. Non-cooperative patient

2. Equivocal/ uncertain findings

Question 5

T/F: If you can’t make a diagnosis, is it helpful to state what it is not?

Answer 5

True. Ex. If it’s not ataxic this helps to know that that because then we know the problem isn’t cerebellar. You could establish that a dysarthria is present but not specify the type.

Question 6

If a diagnosis is not determined, do not offer what?

Answer 6

A diagnosis.
You can only state that the diagnosis is undetermined. Using words such as “equivocal and probably” give indications of how confident you are.

Question 7

You should make the speech diagnosis relate to what?

Answer 7

The suspected neurological diagnosis or suspected site of lesion. This helps the neurologist if speech signs are not consistent with suspected diagnosis or site of lesion.

Question 8

It’s possible for more than one speech disorder to exist at the same time, so why is it sufficient to note all deviant characteristics of multiple disorders present?

Answer 8

If the disorder you identified doesn’t do this, then another disorder may be present.

Question 9

Why does an evaluation not always find deviant speech?

Answer 9

it may indicate normal speech but some diseases may change speech over time. It could also indicate a developmental problem of articulation as a result of neurological disorders.

Question 10

If you are providing a label for the diagnosis, then what are you doing?

Answer 10

you are providing a composite of information associated with that label. It’s shorthand for communication information about disorders.

Question 11

T/F: There is overlap among dysarthria’s in terms of certain characteristics.

Answer 11

True.
For example, many have imprecise articulation as a characteristic so that doesn’t help you distinguish between dysarthria’s. There are also certain characteristics that are unique to some dysarthria’s.

Question 12

What are 9 etiologies for a differential diagnosis?

Answer 12

1. Vascular (most common- hemorrhagic stroke)
2. Degenerative disease
3. TBI
4. Surgical trauma
5. Toxic/metabolic conditions
6. Infectious and inflammatory conditions
7. Demyelinating diseases
8. Anatomic malfunctions such as Arnold Chiari
9. Neuromotor Junction disorders

Question 13

What dysarthrias do degenerative diseases most often cause?

Answer 13

spastic, ataxic, hypokinetic, flaccid

Question 14

What dysarthria does TBI most commonly cause?

Answer 14

spastic

Question 15

Surgical traumas only cause what type of dysarthria?

Answer 15

flaccid

Question 16

Guillain Barre is usually associated with what dysarthria?

Answer 16

flaccid

Question 17

MS is usually associated with what dysarthria?

Answer 17

Ataxic

Question 18

Arnold -Chiari is most often associated with what dysarthria?

Answer 18

flaccid

Question 19

Which dysarthrias usually have an unknown etiology?

Answer 19

hyperkinetic, spastic and ataxic

Question 20

What oral mechanisms are found in flaccid?

Answer 20

atrophy and fasciculation’s

Question 21

What oral mechanisms are found in spastic?

Answer 21

pathological reflexes, hyperactive gag reflex and psudobulbar palsy

Question 22

What oral mechanisms are found in ataxic?

Answer 22

dysmetria in nonspeech jaw, face and tongue mvmts

Question 23

What oral mechanisms are found in hypokinetic?

Answer 23

orofacial tremors, masked face is common and not seen with other MSD’s.

Question 24

What oral mechanisms are found in hyperkinetic?

Answer 24

abnormal mvmts at rest and in speech that aren’t seen in other dysarthrias

Question 25

What oral mechanisms are found in uumn?

Answer 25

unilateral facial and lingual weakness without atrophy or fasciculation is common but not seen in other dysarthrias

Question 26

What are main speech characteristics of flaccid?

Answer 26

phonatory and resonatory abnormalities are most distinguishing characteristics

Question 27

What are main speech characteristics of spastic?

Answer 27

slow rate with slow but regular AMR’s, strained voice quality are most common and not seen in other dysarthrias.

Question 28

What are main speech characteristics of ataxic?

Answer 28

irregular articulatory breakdowns, irregular AMR’s and dysprosody are primary distinguishing characteristics.

Question 29

What are main speech characteristics of hypokinetic?

Answer 29

only dysarthria with rapid and blurred speech and AMR’s. Palilalia only occurs in this dysarthria.

Question 30

What are main speech characteristics of hyperkinetic?

Answer 30

abnormal mvmts

Question 31

What are main speech characteristics of uumn?

Answer 31

mildness and transient duration. no hypernasality. Voice sounds spastic because of strained voice.

Question 32

Where does damage for apraxia occur?

Answer 32

left hemi. -except when there is right hemi lang. dominance or mixed dominance. It occurs with supratentorial damage.

Question 33

Where does damage for dysarthria occur?

Answer 33

supratentorial, posterior fossa, spinal or peripheral lesions

Question 34

Where does damage for apraxia occur?

Answer 34

primarily with lesions to the carotid system

Question 35

Besides carotid lesions what else does dysarthria occur with?

Answer 35

other vascular systems lesions

Question 36

What disorder is UUMN hard to differentiate from?

Answer 36

AOS

Question 37

What are speech characteristics that differentiate AOS from dysarthria?

Answer 37

• neuromuscular problems occur w/ dysarthrias
• All subsystems affected in dysarthria
• Artic and prosody effected in AOS
• AOS more associated with aphasia than dysarthria
• Artic errors are usually distortions in dysarthria and apraxia
• Apraxic speakers grope and dysarthric speakers don’t

Question 38

Why are Conditions that have diffuse or multifocal damage are more likely to be associated with mutism?

Answer 38

Because of cognitive -affective disturbances

Question 39

What is anarthria?

Answer 39

lack of speech. They have significant neuromotor deficits in bulbar muscles that cause mutism. When attempting to speak, their restricted articulatory ROM, reduced loudness and strained, groaning quality

Question 40

T/F: Mutism related to apraxia can be associated with normal findings in oral mech exam.

Answer 40

True

Question 41

How are mute apraxic pts and mute aphasic similar and different?

Answer 41

They are similar except mute aphasics have problems following instructions. If mutism is present, aphasia is usually severe so they do poorly on language tests

Question 42

What are cognitive -affective disturbances?

Answer 42

May be due to reduced arousal and alertness. If speech does eventually occur, there are delays with brief unelaborated speech.