Chapter 3

Question 1

What are the 4 general purposes of giving a MS Exam?

Answer 1

1) To give a description (F.S.F.)
2) To establish dx possibilities (differential dx).
3) To establish a dx
4) To establish implications for localization & dz dx

Question 2

What are the 3 descriptions related to speech that a clinician must make in an exam?

Answer 2

F.S.F

1) Features
2) Structures
3) Function

Question 3

T/F A clinician should never make a “possible” dx if they are uncertain.

Answer 3

False. Always indicate possible dxs.

Question 4

Why is it important to comment on the severity of a pt’s d/o? (3)

Answer 4

1) To compare to pt’s complaints. (is there a psychogenic component?)
2) Influences prognosis statements and decisions on how to manage d/o.
3) Provides baseline info to compare any changes overtime.

Question 5

What are salient features?

Answer 5

The features that contribute most directly to the dx and most influence the dx.

Question 6

What are the 6 salient features we must note during an exam?

Answer 6

1) Strength
2) Speed
3) Range
4) Steadiness
5) Tone
6) Accuracy

(S.S.S.R.A.T.)

Question 7

Weakness of muscles may affects which three major speech valves?

Answer 7

1) Laryngeal
2) Velopharyngeal
3) Articulatory

Question 8

What are phasic movements?

Answer 8

They are quick, unsustained, and discrete movements.

Important for SPEED.

Question 9

T/F Speed is associated with increased ROM.

Answer 9

True, but it is also associated w/ decreased ROM (ex: Hypokinetic).

Question 10

Slow mvmts is most apparent in which dysarthria?

Answer 10

Spastic.

Question 11

T/F ROM can vary w/ ataxic dysarthria.

Answer 11

True.

Question 12

How can you assess for tremors (where is it most apparent for MSD?)

Answer 12

Vowel prolongation.

Question 13

What are the three kinds of tremors?

Answer 13

Resting, intentional, terminal.

Question 14

What are terminal tremors?

Answer 14

Tremors at the end of a mvmt.

Question 15

Name some hyperkinesias that may affect speech?

Answer 15

Chorea, dystonia, athetosis.

Question 16

T/F Confirmatory signs need to be present in order to make a dx.

Answer 16

False.

Question 17

What are examples of confirmatory signs in the speech systems?

Answer 17

Atrophy, fasiculation, reduced tone, lability, reduced normal reflexes, reduced pathological reflexes.

Question 18

What are some examples of nonspeech confirmatory signs?

Answer 18

Fasciculations, pathological reflexes, gait, muscle stretch reflexes, limb atrophy, limb reflexes.

Question 19

What are the four major components of a MSD exam?

Answer 19

1) Hx
2) Salient features
3) Confirmatory signs
4) Interpretation of findings

????

1) Hx
2) assess speech mech in nonspeech activities
3) assess perceptual speech characteristics
- assess speech charcteristics.

Question 20

Overall, how do you assess the speech mechanism in non-speech activities?

Answer 20

FACE (rest, sustained posture, mvmt)
JAW (rest, sustained posture, mvmt)
TONGUE (rest, sustained posture, mvmt)
Velopharynx (rest, mvmt)
Larynx 
Respiration
Reflexes

Note: volitional vs. nonvolitional mvmts (oral mvmts).

Question 21

What is zerostomia?

Answer 21

Dry mouth.

Question 22

How would you assess the velopharynx during movement in nonspeech tasks?

Answer 22

Have pt puff up cheeks and try to “poke” air out.

Have the pt stick out his/her tongue and puff up their cheeks and note any nasal air emission.

Rationale: sometimes the back of the tongue closes off the VP port.

Can also be checked with videofluroscopy.

Question 23

How would you assess laryngeal function during nonspeech tasks?

Answer 23

Check for cough sharpness.
Have pt do glottal “coup.”
Is their any inhalatory stridor present?
Laryngoscopy.

Question 24

If the cough is weak, but the coup is sharp- what are the implications?

Answer 24

Poor respiratory support.

If both are weak, this means they may have poor respiration and poor VF closure.

Question 25

How would you assess for respiration in a nonspeech task?

Answer 25

Check how many breaths per min,
check for posture, 
is the breath rapid or slow.
Glass / straw.
check accessory muscle involvement.
Are there any hiccups present? (may indicate medulla lesion)

Question 26

What are normal reflexes vs. pathological reflexes?

Answer 26

Pathological = present during infancy, but not adulthood, CNS dz may bring them back.

Normal = cough, gag, etc.

Question 27

Which tasks would you use to assess speech characteristics in pts w/ MSD?

Answer 27

1) Vowel prolongation
2) AMRs
3) SMRs (particularly helpful in determining apraxia).
4) Contextual speech (gfather passage, convo).
5) Fatigue
6) Assess motor planning