Chapter 3 Flashcards
What are the 4 general purposes of giving a MS Exam?
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
What are the 3 descriptions related to speech that a clinician must make in an exam?
F.S.F
1) Features
2) Structures
3) Function
T/F A clinician should never make a “possible” dx if they are uncertain.
False. Always indicate possible dxs.
Why is it important to comment on the severity of a pt’s d/o? (3)
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.
What are salient features?
The features that contribute most directly to the dx and most influence the dx.
What are the 6 salient features we must note during an exam?
1) Strength
2) Speed
3) Range
4) Steadiness
5) Tone
6) Accuracy
(S.S.S.R.A.T.)
Weakness of muscles may affects which three major speech valves?
1) Laryngeal
2) Velopharyngeal
3) Articulatory
What are phasic movements?
They are quick, unsustained, and discrete movements.
Important for SPEED.
T/F Speed is associated with increased ROM.
True, but it is also associated w/ decreased ROM (ex: Hypokinetic).
Slow mvmts is most apparent in which dysarthria?
Spastic.
T/F ROM can vary w/ ataxic dysarthria.
True.
How can you assess for tremors (where is it most apparent for MSD?)
Vowel prolongation.
What are the three kinds of tremors?
Resting, intentional, terminal.
What are terminal tremors?
Tremors at the end of a mvmt.
Name some hyperkinesias that may affect speech?
Chorea, dystonia, athetosis.
T/F Confirmatory signs need to be present in order to make a dx.
False.
What are examples of confirmatory signs in the speech systems?
Atrophy, fasiculation, reduced tone, lability, reduced normal reflexes, reduced pathological reflexes.
What are some examples of nonspeech confirmatory signs?
Fasciculations, pathological reflexes, gait, muscle stretch reflexes, limb atrophy, limb reflexes.
What are the four major components of a MSD exam?
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.
Overall, how do you assess the speech mechanism in non-speech activities?
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).
What is zerostomia?
Dry mouth.
How would you assess the velopharynx during movement in nonspeech tasks?
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.
How would you assess laryngeal function during nonspeech tasks?
Check for cough sharpness.
Have pt do glottal “coup.”
Is their any inhalatory stridor present?
Laryngoscopy.
If the cough is weak, but the coup is sharp- what are the implications?
Poor respiratory support.
If both are weak, this means they may have poor respiration and poor VF closure.
How would you assess for respiration in a nonspeech task?
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)
What are normal reflexes vs. pathological reflexes?
Pathological = present during infancy, but not adulthood, CNS dz may bring them back.
Normal = cough, gag, etc.
Which tasks would you use to assess speech characteristics in pts w/ MSD?
1) Vowel prolongation
2) AMRs
3) SMRs (particularly helpful in determining apraxia).
4) Contextual speech (gfather passage, convo).
5) Fatigue
6) Assess motor planning
