Chapter 15 Differential Diagnosis Flashcards
What is different diagnosis?
The process of narrowing possibilities and reaching conclusions about the nature of a deficit.
When doing a speech evaluation always try to:
Make a diagnosis
If you can’t make a definitive diagnosis then:
> Describe what you find
State why you couldn’t make a diagnosis
State what it’s not definitely not
Do not offer a definitive diagnosis, use words like undetermined, equivocal, probably possible
Make a speech diagnosis related to:
The suspected neurological diagnosis or suspected site of lesion and state whether the speech signs are consistent or inconsistent with them
Just because a person is diagnosed with a type of disease doesn’t mean that they:
Have deviant speech at the time of the evaluation due to the severity and the level of progression of a disease
Etiologies and differential diagnosis:
Some etiologies help determine what to expect in terms of speech deficits
Vascular Etiologies:
> Can cause any type of dysarthria
Most commonly associated with Spastic, UUMN, and Ataxic dysarthria
Hemorrhagic stroke is the most common cause of dysarthrias
Degenerative Diseases:
> Can cause any type of dysarthria
> Most commonly causes Spastic, Ataxic, Hypokinetic, Flaccid dysarthria
Parkinson’s Disease only associated with:
Hypokinetic dysarthria
ALS only associated with:
Mixed Flaccid-Spastic dysarthria
TBI etiologies in general:
> Can cause any type of dysarthria
TBI close head injury etiologies:
Most commonly associated with Spastic dysarthria
TBI open head injury etiologies:
Most commonly associated with Spastic, Ataxic, and UUMN dysarthria (the CNS dysarthrias)
TBI skull fractures and neck trauma etiologies:
Flaccid dysarthria only
Surgical Trauma etiologies:
> Can cause ANY type of dysarthria EXCEPT Hypokinetic
ENT, chest/cardiac surgeries are ONLY associated with Flaccid dysarthria
Neurosurgery is associated CNS dysarthrias and Flaccid dysarthria
CNS dysarthrias
Ataxic, Spastic, & UUMN
Toxic/Metabolic etiologies
> Most commonly associated with Hyperkinetic and Ataxic dysarthrias
Infectious and inflammatory conditions:
Rarely causes dysarthrias and is dependent on the condition
Demyelinating diseases:
> Can cause ANY type of dysarthria
RARELY associated with Hypokinetic
Dependent on the disease
Guillain Barre
Associated with Flaccid dysarthria
MS
Associated with Ataxic dysarthria
Anatomic Malformation (of the brain Arnold-Chiari)
Associated with Flaccid dysarthria
Neuromotor Junction Disorder etiologies (PNS diseases)
Only associated with Flaccid dysarthria
Dysarthrias that can (most commonly) be presented without a neurological diagnosis:
Hyperkinetic, Spastic, & Ataxic
Oral Mechanism Findings
certain findings in the oral mechanism are not required for Motor Speech Disorders but are used as confirmatory signs
FLACCID Oral Mechanism Findings
> Atrophy and fasiculations
Hypoactive gag reflex most often occur
Nasal regurgitation may be seen
Rapid loss of intelligibility = Myasthenia Gravis
SPASTIC Oral Mechanism Findings
> Pathological oral reflexes
Hyperactive gag reflex
Pseudobalbar effect
Problems w/ drooling and swallowing
ATAXIC Oral Mechanism Findings
> Dysmetria in non speech jaw/face/tongue movements
HYPOKINETIC Oral Mechanism Findings
> Orofacial tremors
>Masked face is common
HYPERKINETIC Oral Mechanism Findings
> Abnormal movements at rest and in speech
UUMN Oral Mechanism Findings
> Unilateral facial and lingual weakness w/o atrophy or fasciculations
Speech characteristics of Flaccid dysarthria
>Phonatory/Resonatory abnormalities are the most common characteristics: >Breathiness (with greater hoarseness) >Diplophonia >Audible inspiration >Short phrases >Rapid deterioration of speech= MG
Speech characteristics of Spastic dysarthria
> Slow rate
Slow regular AMRs
Strained voice quality
All three above not typical in any other
Speech characteristics of Ataxic dysarthria
> Irregular articulatory breakdowns
Irregular AMRs
Dysprosody
Speech characteristics of Hypokinetic dysarthria
> Rapid blurred speech
Rapid blurred AMRs may occur
Palilalia does not occur with any other
Speech characteristics of Hyperkinetic dysarthria
> Abnormal movements
Speech characteristics of UUMN dysarthria
> Mildness (irregular AMRs, strain)
>Transient duration
