Chapter 3 Motor Speeh Disorders Exam Flashcards
What is the purpose of a motor speech disorders exam?
- To give a description
- to establish diagnostic possibilities
- to establish a diagnosis
- to establish implications for localization and disease diagnosis
- to specify a severity
What does the clinician describe during a motor speech disorders exam?
The patient’s speech and the structures and function of those structures.
What does the clinician need to determine after the description of the patient’s speech, structures and functions of those structures have been made?
Clinician needs to determine if the characteristics are normal or abnormal.
What happens if an aspect of speech structures or functions is abnormal?
The clinician attempts to make a differential diagnosis.
What happens in a differential diagnosis?
The clinician narrows the diagnostic possibilities and tries to arrive at a specific diagnosis.
What kind of information is described in the motor speech disorders exam?
The information provided is about the features of speech and the structures and function associated with speech.
What must occur after clinician determines that speech is not normal?
The clinician should determine some possible diagnoses.
i.e. is it neurological, developmental or acquired, is there a speech disorders present?
How does the clinician establish a diagnosis after a motor speech disorders exam?
The clinician should attempt to make a diagnosis from the acquired, developmental, neurological, motor speech. If that is not possible then put the list in order of most possible to least possible.
How does clinician establish implications for localization and disease?
The clinician should state the diagnosis and the localization associated with the diagnosis. For example, the clinician can state that the diagnosis is spastic dyasrthria which is associated with UMN involvement, or that the diagnosis is ataxic dysarthria which is associated with cerebellar involvement.
What should be done if a neurological diagnosis has already been made and it is inconsistent with the SLPs findings?
It should be noted.
What happens if the patient has been diagnosed with ALS, but the SLP finds a mixed dysarthria of ataxic-hypokinetic?
It should be noted that the dysarthria findings are inconsistent with a diagnosis of ALS.
What happens if a diagnosis is uncertain?
The SLP may indicate possible diagnoses. For example, if a stress test indicates a strong possibility of myasthenia gravis, SLP should note this.
What does the SLP have to do if a stress test indicates a strong possibility of myasthenia gravis?
The SLP needs to make note of it, NOT diagnose myasthenia gravis (not within our scope).
Why should an SLP always comment on the severity of a diagnosis?
1) To compare the patient’s complaints - it may provide information about a possible psychogenic component or lack of insight on the part of the patient.
2) It influences prognostic statements and decisions about how to manage the disorder.
3) It provides baseline information against which to compare progress or changes.
Severity statements usually refer to the what categories?
Mild, moderate, and severe
Provide an example of how the clinician establish implications for localization and disease of spastic dysarthria.
The diagnosis is spastic dysarthria which is associated with UMN involvement.
Provide an example of how the clinician establish implications for localization and disease of ataxic dysarthria.
The diagnosis is ataxic dysarthria which is associated with cerebellar involvement.
What are the general guidelines for exam?
- History
- salient
- confirmatory signs
- interpretation of findings
What information does history provide?
- time of onset
- course of development
- patient’s complaints and observations
- It provides an opportunity to listen to patient’s speech without them knowing you are listening to the speech.
Describe salient features:
Those features that contribute most directly to the diagnosis and most influence the diagnosis.
______ features are those that contribute most directly to the diagnosis and most influence the diagnosis.
Salient
List the salient features:
- strength
- speed
- range
- steadiness
- tone
- accuracy
Muscle weakness is most prominent in what type of dysarthria?
flaccid dysarthria
The weakness of muscles affect what 3 major speech valves?
- laryngeal
- velopharyngeal
- articulatory
Describe why strength is a salient feature.
In order to perform appropriately, muscles have to have a certain strength. If muscles are weak, they can’t work properly and may fatigue more quickly than usual.
What happens if muscles are weak?
They can’t work properly and may fatigue more quickly than usual.
Muscle weakness affects laryngeal, velopharyngeal, and articulatory valve. What are the other components of speech production that can also be impacted?
- respiration
- phonation
- resonance
- prosody
Why is speed a salient feature?
All speech movements require speed, especially the laryngeal, velopharyngeal, and articulatory valve movements.
Speech requires quick, unsustained and discrete movements which are called _______ ________. These can be ______ muscle contractions or _______ contractions.
phasic movements
single
repetitive
All speech movements require _______, especially the laryngeal, velopharyngeal, and articulatory valve.
speed
What are phasic movements?
Quick unsustained and discrete movements. These can be single muscle contractions or repetitive contractions. They start quickly, reach their target quickly and relax quickly.
Phasic movements are controlled primarily through _____ input.
UMN
What is associated with decreased range of motion?
too much speed
In which dysarthria is there too much speed?
hypokinetic dysarthria
What happens when there is too much speed?
The articulators move so fast they can’t reach their targets.
What is most common in motor speech disorders, slow or fast movements?
slow
How are the slow movements demonstrated?
- slow initiating
- slow throughout the movement
- slow to stop or relax
What do slow movements affect?
All valves and prosody
The affects of slow movement is most seen in what type of dysarthria?
spastic dysarthria
Decreased _____ is common and can be associated with slow or excessive speeds.
ROM
Decreased ROM is common and can be associated with what?
slow or excessive speeds
ROM can vary with what dysarthrias?
ataxic dysarthria
hyperkinetic dysarthria
Patient’s can ____ and _____ the targets.
over
undershoot
What does tone refer to?
muscle tone and can be hypo or hyper.
When there is no steadiness, it manifests itself usually in MSDs as a ______ or other ______.
- tremor
- hyperkinesias
Tremors can be ____ to ____ and may affect _____ as well as other parts of the body.
mild, severe
speech
What can tremors affect?
Phonation and sometimes prosody
The effects of tremors in speech can best be heard in _____ _____.
vowel prolongation
Tremors may be seen in _____ tasks involving the ____ _____.
nonspeech
oral mechanism
What are the types of tremors?
- resting tremors
- intentional tremors
- terminal tremors (at the end of a movement)
List other hyperkinesias besides the tremors which may interfere with or be present during speech.
- dystonias
- choreas
- athetosis
Why is accuracy a salient speech?
Accurate movements are required for speech.
What happens if inaccurate movements are present?
They can result in speech errors.
What if there is too much force or too much ROM?
The articulators may overshoot the target and vice versa. Inaccurate movements also affect all major speech valves.
What are confirmatory signs?
Additional clues about the pathology in the nervous system. These are signs other than the problematic speech characteristics noted and other than the neuromuscular symptoms.
Confirmatory signs are signs other than the ______ ______ _______ noted and other than the _________ ______.
problematic speech characteristics
neuromuscular symptoms
What do confirmatory signs help support?
speech diagnosis
Confirmatory signs have to be present or not present?
Present
What are examples of confirmatory signs within the speech system?
- atrophy
- fasciculations
- reduced tone
- emotional liability
- reduced normal reflexes
- pathological reflexes
What are the confirmatory signs of the non-speech system?
- gait
- muscle stretch
- reflexes
- pathologic reflexes
- hyperactive limb reflexes and limb atrophy
- fasciculations
What should the SLP integrate to formulate a diagnosis?
- information from the history
- salient speech features
- confirmatory signs
The SLP should make a ____ diagnosis if possible, if not, what should you do?
definitive
make a formulation of diagnostic possibilities.
What is an example of a definitive diagnosis?
The patient presents with (an unambiguous) spastic dysarthria, with a possible accompanying ataxic component. There is no evidence of apraxia.
History: Introduction and goal setting-
-Ask the patient why they are there. this gives you information about the patient’s perceptions, complaints, etc.
History: Basic Data -
Get basic information such as age, married status, education, occupation, etc
Determine any previous speech problems and treatment, if any.
History: Onset and course of speech deficit.
-When did the speech problem begin
- how did it begin?
-how has the problem changed?, if it has changed.
-Is the problem variable?
Does teh speech return to normal at any time? If so when?
-Taking any medications, if so what?
-Does fatigue affect speech?
History: Associated deficits:
-swallowing/chewing/controlling bolus/drooling problems? Nasal regurgitation?
emotional expression changes? Laugh or cry more easily and without apparent cause?
History: Patient’s perception of deficit
Describe your problem with speech. Give examples
- . Is your speech slower or faster than usual;
- louder or softer;
- is speaking effortless;
- less intelligible
- does it feel different when you talk?
History: Consequence of disorder -
Do you have difficulty being understood by others?
- does this vary throughout the day or in different places?
- Do you still maintain your social network or do you go out less often?
- What changes have you made in your life due to the speech changes?
History: management -
- How have you tried to compensate for your speech problem?
- What works and what doesn’t work?
- What kind of professional help have you had?
- Do you need help not?
History: Awareness of diagnosis and prognosis
- Do you know the cause of your problem?
- What has the Dr. told you?
- What does this diagnosis mean to you?
- Do you know how the disorder will progress?
What is part of the examination of speech mechanism in non-speech activities?
- face
- tongue
- jaw
- reflexes
- larynx
- velopharyngeal port
- palate
- respiration