chapter 3

Question 1

What is the goal of motor speech evaluation?

Answer 1

• Understand a patient’s problem

- Determine beginning level of treatment

Question 2

what are the 2 basic methods of evaluating motor speech disorders?

Answer 2

instrumentation

perceptual analysis

Question 3

what is perceptual analysis?

Answer 3

relies on clinician’s ears (and eyes) to judge

Question 4

What are the suggessted questions for motor speech evaluations?

Answer 4

1. Is there a problem with the patient’s speech?
2. If there is a problem, what is the best way to describe it?
3. Does the problem seem to be the result of a neurologic disorder?
4. If it seems to be neurologic in origin, did it appear suddenly or slowly?
5. Is the problem related strictly to speech production, or is it more of a problem with language, such as aphasia?
6. If it is a problem of speech production, do most of the problems seem to be related to the sequencing of phonemes?
7. If there are no phoneme sequencing errors, what are the characteristics of the patient’s speech errors and any associated motor problems?

Question 5

what are some other goals/ considerations for motor speech evaluations?

Answer 5

• prognosis
• treatment focus
• treatment termination
• baseline for measuring change

Question 6

what are the five necessary components for normal speech production?

Answer 6

Respiration, phonation, resonance, articulation, prosody

Question 7

what happens when their is a neuromotor disturbance in any of the 5 components for speech?

Answer 7

dysarthria or apraxia

Question 8

what is dysarthria?

Answer 8

Speech production deficit resulting from neuromotor damage to PNS or CNS

Question 9

what is apraxia of speech?

Answer 9

Motor speech disorder often associated with damage to left hemisphere of brain

Question 10

what area of the 5 components does dysarthria impact?

Answer 10

any of the 5

Question 11

what area of the 5 components does apraxia impact?

Answer 11

articulation and prosody

Question 12

is apraxia of speech caused by msucle weakness or slowness?

Answer 12

no, caused by left hemisphere damage

Question 13

what is the cause of flaccid dysarthria?

Answer 13

Damage to cranial nerves, spinal nerves, or neuromuscular junction

Question 14

what is the cause of spastic dysarthria?

Answer 14

Bilateral damage to the upper motor neurons of the pyramidal and extrapyramidal systems; often caused by brainstem strokes

Question 15

what causes unilateral UMN dysarthria?

Answer 15

Unilateral damage to upper motor neurons

Question 16

what causes ataxia dysarthria?

Answer 16

Damage to the cerebellum or the neural tracts that connect the cerebellum to the rest of the CNS

Question 17

what are problems related to ataxic dysarthria?

Answer 17

Problems controlling the timing and force of speech movements, results in speech that often has a “drunken” quality.

Question 18

what are the symptoms of UMN dysartria?

Answer 18

Imprecise consonants are the most common characteristic; there may be irregular articulatory breakdowns or harsh vocal quality in some patients

Question 19

what is the result of spastic dysarthria?

Answer 19

Spasticity and weakness in the speech musculature that results in harsh or strained-strangled phonation, imprecise consonants, hypernasality, and abnormal prosody

Question 20

what is the result of flaccid dysarthria?

Answer 20

Muscle weakness resulting in imprecise consonants, breathy phonation, hypernasality, shallow breath support, and abnormal prosody

Question 21

what is the cause of hypokinetic dysarthria?

Answer 21

A reduction of dopamine in part of the basal ganglia; Parkinsonism is the most common cause of this dysarthria

Question 22

what is the result of hypokinetic dysarthria?

Answer 22

A reduction in the range and speed of speech movements; harsh or breathy phonation imprecise consonants, and abnormal prosody (in some patients, there is increased rate of speech)

Question 23

what is the cause hyperkinetic dysarthria?

Answer 23

Often associated with damage to the basal ganglia but in some conditions the cause is unknown

Question 24

what ist he result of hyperkinetic dysarthria?

Answer 24

Involuntary movements that interfere with normal speech production; unexpected inhalations and exhalations, irregular articulatory breakdown, and abnormal prosody

Question 25

what is the cause of mixed dysarthria?

Answer 25

Neurological damage that extends to more than one portion of the motor system

Question 26

what it he result of mixed dysarthria?

Answer 26

Any combination of the characteristics in the six pure dysarthrias

Question 27

what is respiration?

Answer 27

primary function for speech production

Question 28

what is a result of nerve damage that impacts respiration?

Answer 28

short phrases and reduced loudness + breathy voice

Question 29

what is phonation?

Answer 29

production of voiced phonemes through vocal fold vibrations in larynx

Question 30

what is normal phonation?

Answer 30

complete adduction of vocal folds; sufficient subglottic air pressure

Question 31

what happens if the nerves innervating phonation are impacted?

Answer 31

flaccid dysarthria, spastic dysarthria, neuromotor damage to laryngeal muscles

Question 32

what is resonance?

Answer 32

proper placement of oral or nasal tonality onto phonemes during speech by lowering or raising the velum

Question 33

what is oral resonance?

Answer 33

Produced when velum is raised and closes off nasal cavity from vocal air stream

Question 34

what is nasal resonance?

Answer 34

Produced when velum is lowered (so airstream goes through the nose) and oral cavity is blocked by the lips or tongue

Question 35

what happens when nerves innervating velar muscles are damaged?

Answer 35

Damage to nerves innervating velar muscles may cause hypernasal quality

Question 36

what is articulation?

Answer 36

shaping of vocal air stream into phonemes

Question 37

what happens when there is neuromotor damage to articulators?

Answer 37

articulation errors lol

Question 38

what type of articulation errors can occur?

Answer 38

be imprecise consonants, distorted vowels, inappropriate silences, and irregular articulatory breakdown

Question 39

what is prosody?

Answer 39

melody of speech, using stress and intonation to convey meaning

Question 40

what happens when neuromotor damage affects prosody?

Answer 40

monopitch and monoloud quality; involuntary movements resulting in pitch variations, loudness, and prolonged intervals

Question 41

what are the standardized tests for dysarthria?

Answer 41

Frenchay Dysarthria Assessment- Assessment of Intelligibility of Dysarthric Speech Speech Intelligibility Test for Windows

Question 42

what does the frenchay dysarthria assessment do?

Answer 42

aids in differential diagnosis among the dysarthria

Question 43

what does the assessment of intelligibility of dysarthria speech do?

Answer 43

provides an objective assessment of single-word and sentence intelligibility

Question 44

what does the speech intelligibility test for windows do?

Answer 44

computer version of Assessment of Intelligibility of Dysarthric Speech

Question 45

what is the apraxia battery for adults-second edition?

Answer 45

designed to diagnose apraxia of speech in adolescents and adults.

Question 46

what is the only published adult apraxia test?

Answer 46

Apraxia Battery for Adults-Second Edition

Question 47

what info does the Apraxia Battery for Adults-Second Edition | provide?

Answer 47

on severity, treatment suggestions, and changes over time

Question 48

what are the 6 salient features that need to constantly be assessed?

Answer 48

``` Muscle strength Speed of movement Range of motion Accuracy of movement Motor steadiness Muscle tone ```

Question 49

what happens if you have decreased muscle strength?

Answer 49

Can affect respiration, articulation, resonance, phonation, prosody

Question 50

how can you assess muscle strenght?

Answer 50

Asking patient to press tongue against tongue blade or to count aloud from 1 to 100

Question 51

what happens if you have reduced speech of movement?

Answer 51

characteristic of most dysarthrias except hypokinetic dysarthria

Question 52

what are some speech assesed tasks?

Answer 52

Alternate motion rates (AMR) | Sequential motion rates (SMR)

Question 53

what happens when you have reduced range of movement?

Answer 53

Inability to open jaw or completely adduct vocal folds | Prosody to be affected

Question 54

how can you assess range of movement?

Answer 54

Asking patient to extend or hold articulators in various positions

Question 55

what happens when you have reduced accuracy of movement?

Answer 55

Distorted consonants; intermittent hypernasality

Question 56

how can you assess accuracy of movement?

Answer 56

Conversational speech; spoken paragraph reading

Question 57

what may be a result of lack of motor steadiness?

Answer 57

Tremors | Large, involuntary movements that interfere with voluntary movements

Question 58

how can you assess motor steadiness

Answer 58

Hold a position or prolong a vowel

Question 59

what happens if you have reduced muscle tone?

Answer 59

weakness or paralysis

Question 60

what happens if you have increased muscle tone?

Answer 60

spasticity or rigidity

Question 61

how can you assess muscle tone?

Answer 61

Inferring when listening to patient’s speech | Looking at affected body parts

Question 62

how long does a motor speech evaluation take?

Answer 62

30-40 minutes

Question 63

how long does the short version of a motor speech exam take?

Answer 63

10-15 minutes

Question 64

what are some important things to gather from case history?

Answer 64

Rate of onset Site of lesion Current status of problem Visual acuity, hearing acuity, evidence of limb involvement

Question 65

what are you looking for when you look at face and jaw muscles at rest and during movement?

Answer 65

Abnormal muscle tone or strength Asymmetrical facial features Restricted range of movement

Question 66

what cranial nerve is involved with the tongue?

Answer 66

hypoglossal cranial nerve (XII)

Question 67

what cranial nerve innervates the velum and pharynx?

Answer 67

vague nerve (x)

Question 68

can you observe the laryngeal muscle during an oral mech?

Answer 68

no, need instrumentation

Question 69

what are some tasks that you can do to assess laryngeal function?

Answer 69

Can patient produce sharp cough? Can patient produce sharp glottal stop? Is inhalatory stridor present?

Question 70

what are specific tasks to assess phonatory respiratory system?

Answer 70

Deep breath and say “ah”, holding as long and steadily as clearly can Latency period between signal to say “ah” and initiation of phonation? Quality, pitch, loudness, and phonation

Question 71

how to assess resonation system?

Answer 71

Take deep breath and say /u/ as long as possible | Same task as above, but clinician squeezes nose

Question 72

how to assess combined systems?

Answer 72

AMR (puh, puh, puh) | SMR (puh, tuh, kuh)

Question 73

how to screen for for myasthenia gravis

Answer 73

ask Patient to count quickly from 1 to 100

Question 74

how do you test for non-verbal oral apraxia of speech

Answer 74

Have patient perform voluntary, nonverbal oral movements without demonstrating beforehand

Question 75

what is nonverbal oral apraxia of speech?

Answer 75

disruption in sequencing of oral movements that are nonverbal

Question 76

how do you test for apraxia of speech?

Answer 76

Repeat or read words of increasing complexity, beginning with same CVC syllable Repeat words with simple CVC consisting of identical initial and final consonants Count from 1 to 20 and backward Read sentences, including spontaneously and on demand

Question 77

how do you analyze connected speech?

Answer 77

have pt. read standard reading passage

Question 78

how do you assess intelligibilty?

Answer 78

word, phrase, sentence, or conversational level