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Motor Speech Exam 3 > Chapter 3 > Flashcards

Chapter 3 Flashcards

1
Q

What are some purposes of a motor speech exam?

A

To give a:

  1. Description
  2. Establish diagnostic possibilites
  3. To establish a diagnosis
  4. To establish implications for localization and dz. diagnosis
  5. To specify a severity
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2
Q

What is the purpose of giving a description in a motor speech exam?

A
  • obtain information about the features of speech and the structures and functions associated with speech.
  • normal/abnormal characteristics
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3
Q

What are some general guidelines for an exam?

A
  1. History (onset, pt. c/o, listen to pts. speech)
  2. Salient Features (contribute and influence dx)
  3. Strength (can affect 3 major speech valves, laryngeal, velopharyngeal, and articulatory)
  4. Speed (too much speed is associated w/decreased ROM).
  5. Range (varies w/ ataxic and hyperkinetic)
  6. Steadiness
  7. Tone
  8. Accuracy
  9. Confirmatory Signs
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4
Q

Muscle weakness is most prominent in which dysarthria?

A

Flaccid

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5
Q

too much speed is associated with what?

A

decreased ROM

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6
Q

Slow movement is most often seen in which Dysarthria?

A

Spastic

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7
Q

ROM varies with which 2 Dysarthrias?

A

Ataxic and Hyperkinetic

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8
Q

What are confirmatory signs?

A

additional cues about pathology in nervous system

-signs other than problematic speech characteristics noted and other than the neuromuscular symptoms.

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9
Q

What are some confirmatory signs within the speech system?

A
  1. Atrophy
  2. Fasciculations
  3. Reduced Tone
  4. Emotional Lability
  5. Reduced Normal Reflexes
  6. Pathological Reflexes
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10
Q

Confirmatory signs of non-speech motor system include:

A
  1. Gait
  2. Muscle Stretch Reflexes
  3. Pathologic Reflexes
  4. Hyperactive limb reflexes
  5. limb atrophy
  6. fasciculations
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11
Q

How should the SLP make a diagnosis?

A

integrate the info from history, salient speech features, and confirmatory signs

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12
Q

What are the components of a MS Exam?

A
  1. History (perceptions, complaints)
  2. Basic Data (age, occupation)
  3. Onset and course of speech deficit
  4. Associated Deficits
  5. Pts. Perception of Deficit
  6. Consequences of Disorder
  7. Management
  8. Awareness of Diagnosis and prognosis
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13
Q

Examination of the speech mechanism in non speech activities:
-what should we look for in face at rest?

A

Face at Rest: symmetry, tone, emotion, no extra movement.
Ask pt. to relax, look ahead, and open lips slightly to breath through mouth.
-Are face, corners of mouth, all symmetric?
any drooping of eyelids, corners of mouth?

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14
Q

Examination of the speech mechanism in non speech activities:
what should we look for in face during sustained posture?

A

Have pt retract, round, puff out lips. Puff cheeks, open mouth, and hold for a few seconds.
In these sustained postures, note symmetry, asymmetry, ROM, sagging/drooping of mouth).
-can the pt. resist the movement of clinician trying to push upper or lower lip towards midline while in retracted, sustained posture?
-look for tremors
-can postures be held for several seconds?
-Clinician try to spread pts. lips, can they resist this?

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15
Q

Examination of the speech mechanism in non speech activities:
what should we look for in face during movement?

A

expressiveness, symmetry, emotional responses, range of movement (compare vol. vs. involuntary movement)

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16
Q

Examination of the speech mechanism in non speech activities: Jaw at rest?

A 
tightly closed/opened at rest?
hang lower than normal?
tremors/other involuntary movements?
fasciculations?
pull to one side?
does pt. clench teeth?
17
Q

Examination of the speech mechanism in non speech activities: tongue at rest

A

have pt. open mouth and observe tongue in mouth.
-should be relaxed on the floor of mouth.
tongue symmetrical, have normal bulk?
-atrophy?
-fasciculations?
-other movements?
-wet or dry? (wet could be zerstomia, dry could be associated with various causes)

18
Q

Examination of the speech mechanism in non speech activities: tongue during sustained postures?

A
  • have pt. protrude tongue and hold it
  • look for tongue deviation to one side, if deviation is subtle, have pt. repeat the process several times and look for consistent deviation.
  • Look for ROM of tongue protrusion.
  • use tongue blade to push against tip of tongue- can pt. resist?
  • have pt. push against inside of each check with tongue as you press against cheek with fingers.
  • try to push tongue to one side. can pt. resist?
19
Q

Examination of the speech mechanism in non speech activities: Velopharynx at Rest?

A
  • have pt. open mouth widely
  • push down gently on tongue with tongue blade
  • look at palate- hang low? symmetrical?
20
Q

Examination of the speech mechanism in non speech activities: Velopharynx during movement?

A
  • have pt. say prolonged and intermittent “ah”
  • look at palatal movement
  • symmetry of movement? If asymmetric, does the palate elevate more strongly to opposite side to that which hung lower at rest?
  • hold mirror at nose during vowel prolongation and repetition or pressure consonants? Evidence of nasal airflow?
  • hold pts. nose during vowel prolongation, is there a difference in resonance?
  • have pt puff check and contain air while you try to push against cheeks. can pt. resist?
21
Q

Examination of the speech mechanism in non speech activities: Larynx

A
  • assess vf adduction through coughing
  • listen for a sharp cough, not its loudness (if weak, indicates poor vocal fold closure, or poor respiratory support).
  • have pt. produce a glottal “coup”. This should be sharp and require little respiratory support.
  • if cough is weak, and coup is sharp, implicates poor respiratory support.
  • both weak, then poor vocal fold closure (which can be combined with poor respiratory support)
  • stridor=poor vf abduction
22
Q

Examination of the speech mechanism in non speech activities: Respiration

A

-is pt’s posture normal? slouched? bent forward?
head drooped forward?
-does pt. c/o shortness of breath?
-shoulder movement or neck extension during inspiration? this is associated with respiratory weakness and reduced loudness.
-flaring of nares in breathing?
-breathing rate regular? (may be related to movement disorders)
-persistent hiccups?
-is there a contrasting sharpness of cough to glottal coup?
-

23
Q

Examination of the speech mechanism in non speech activities: Respiration
what task could you do?

A

fill a glass with water
attach straw to glass with paper clip
-straw must be 5 cm in water
-pt should blow into straw to maintain a stream of bubbles for 5 seconds. if they can do this, respiratory support is okay!
pt. must be able to maintain a labial seal and be able to impound through VP Closure

24
Q

Two types of Reflexes?

A
  1. Normal-normal nervous system function

2. Pathological- primitive reflexes present during infancy but disappear as the nervous system matures

25
Q

How is the gag reflex elicited?

A

touching back of tongue, faucial pillars, posterior pharyngeal wall.

26
Q

which nerve provides sensory information to the brain? from gag reflex?

A

Glossopharyngeal nerve

27
Q

which nerves are the motor response from in gag reflex?

A

glossopharyngeal and vagus

Motor Speech Exam 3 (6 decks)

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