CH 3 MSD Exam

Question 1

what is the purpose of an exam? (5)

Answer 1

to give a description, establish diagnostic possibilities, establish a diagnosis, establish implications for localization and disease diagnosis, specify a severity

Question 2

what are the general guidelines for a MSD exam?

Answer 2

History, salient feature, confirmatory signs, diagnosis

Question 3

features that most influence the diagnosis (salient features)

Answer 3

speed, strength, range, steadiness (tremors), tone (hypo or hyper), accuracy

Question 4

what are some confirmatory signs?

Answer 4

atrophy, fasciculations, emotional lability, reduced normal reflexes, pathological reflexes

Question 5

what are the 3 parts to a motor speech exam?

Answer 5

history, examination of speech mechanism in nonspeech activities, assessment of perceptual speech characteristics

Question 6

what is included in the history section of a motor speech exam? (8)

Answer 6

basic data, onset and course of speech deficit, associated deficits, patients perception of deficit, consequence of disorder, management, awareness of diagnosis and prognosis

Question 7

what to look for with “face at rest”

Answer 7

ask pt to relax, look ahead, and open lips slightly to breathe through mouth.
look for symmetry, droopy face, symmetry, normal tone, no extraneous movement, eyelids, corner of mouth, flattening of nasolabial fold, mask like expressions, stiffness, tremors, fasciculations

Question 8

what to look for with “face during sustained postures”

Answer 8

have pt retract lips, round lips, puff cheeks, open mouth and hold for a few seconds
note symmetry, ROM, sagging or drooping of mouth.
try to push upper or lower lip toward midline while in retracted (smiling) position to see if pt can resist movement.
with lips rounded, try to spread lips and see if pt can resist

Question 9

what to look for with “face during movement”

Answer 9

during speech and nonspeech, look for expressiveness, emotional responses, ROM, compare both voluntary and involuntary movements

Question 10

what to look for with “jaw at rest”

Answer 10

at rest, tightly closed or open a little. hang lower than normal. tremors or other involuntary movements. pull to one side, compensate by clenching teeth?

Question 11

what to look for with “jaw during sustained posture”

Answer 11

mouth opening. jaw deviations to one side.
attempt to open jaw when pt is asked to clench teeth. can pt resist?
palpate masseter/temporalis muscle with pt clenching teeth. normal bulk?
wih pt holding mouth open, try to close it. can pt resist this?

Question 12

what to look for with “jaw in movement”

Answer 12

have pt rapidly open and close mouth. note speed and regularity. involuntary movements? symmetry, ROM?

Question 13

“tongue at rest”

Answer 13

have pt open mouth and observe tongue in mouth.
symmetrical, normal bulk and size?
atrophy, grooves, fasciculations? is tongue wet or dry

Question 14

“tongue in sustained postures”

Answer 14

have pt potrude tongue and hold it. consistent deviation?
use tongue blade to push against tip of tongue. resist?
have pt push against inside of each cheek with tongue as you press against cheek with finger. can pt resist this pressure?

Question 15

“tongue during movement”

Answer 15

ask pt to move tongue rapidly to side to side. look for speech regularity and ROM

Question 16

“VP at rest”

Answer 16

does palate hang low? symmetrical?

Question 17

“VP during movement”

Answer 17

while saying prolonged ah, look for palatal movement.
symmetry?
hold mirror at nose. nasal airflow?
hold pts nose during vowel prolongation. difference in resonance?
tongue anchor process (no longer valid). weakness
observe VP activity with videofluoroscopy

Question 18

“larynx”

Answer 18

assess vocal fold adduction thru sharp cough. weak cough can mean poor vocal fold closure or poor respiratory support
glottal coup should be sharp. if sharp but cough weak, means poor respiratory support
if both weak, poor vf closure and poor respiratory support
inhalatory stridor=poor vf closure
laryngoscopy

Question 19

“respiration”

Answer 19

note if normal posture. shortness of breath? shallow or rapid breathing?
persistent hiccups=medulla lesion
fill glass of water, pt blows into straw for 5 seconds. if doable, respiratory support should be okay

Question 20

“reflexes”

Answer 20

normal reflexes=indicate normal nervous system function
pathological reflexes=present during infancy but should disappear as nervous system matures. may reappear due to CNS diseases

Question 21

gag reflex

Answer 21

normal reflex. look for asymmetry
sensory=glossopharyngeal
motor+sensory=glossopharyngeal and vagus
if present on one side and not the other, clinically significant

Question 22

jaw jerk reflex

Answer 22

abnormal reflex. pt relaxes and drops jaw. tap with tongue blade on pts chin. jaw jerks towards closing.
sensory +motor=trigeminal nerve
indicates UMN disease

Question 23

sucking reflex

Answer 23

stroke upper lip with tongue blade toward midline. abnormal response is pursing or pouting of lips. indicates UMN disease. seen in people with dementia

Question 24

snout reflex

Answer 24

tap finger on tip of nose. abnormal reflex is puckering or protrusion of lower lip and depression of side of mouth

Question 25

palmomental reflex

Answer 25

stroking tongue blade on palm of hand. abnormal reflex is slight elevation of ipsilateral chin.

Question 26

nonverbal oral apraxia

Answer 26

automatic movements ok, voluntary movement impaired
often associated with verbal apraxia
should be assessed for if the pt has apraxia of speech or aphasia. occurs with left hemisphere lesion

Question 27

assessment of perceptual speech characteristics

Answer 27

MSD Rating Scale, synthesize info and compare to dysarthria and apraxia, administer tasks for speech assessment, dysarthria and apraxia tests

Question 28

what are the tasks for speech assessment?

Answer 28

vowel prolongation, AMR’s (dysarthria), SMR’s (apraxia), contextual speech, fatigue (counting for 2 min), assess speech motor planning (if apraxia suspected, look for groping, self correction, delayed response)

Question 29

what are some dysarthria tests?

Answer 29

frenchay test of dysarthria assessment

Question 30

what are some apraxia tests?

Answer 30

ABA (apraxia battery for adults),

Question 31

what are some tests for intelligibility, comprehensibility, and efficiency?

Answer 31

assessment of intelligibility in dysarthric speakers (AIDS)
Sentence intelligibility test
intelligibility part of frenchay
word intelligibility test