Dysarthria

Question 1

151. Your patient demonstrates rapid speech rate, fleeting dysfluencies, and reduced loudness. She reports feeling as if she speaks loudly, but everyone asks her to speak up. What type of dysarthria do you diagnose?
     a. Flaccid
     b. Spastic
     c. Hypokinetic
     d. Hyperkinetic
     e. Ataxic

Answer 1

c. Hypokinetic

Question 2

152. You read in your patient’s medical chart that he was in a coma for several months. What type of dysarthria do you expect to see?
     a. Flaccid
     b. Spastic
     c. Hypokinetic
     d. Hyperkinetic
     e. Ataxic

Answer 2

a. Flaccid

Question 3

153. You conduct a motor speech evaluation and notice frequently perfect articulation, with inconsistent imprecision. The most notable characteristic of the patient’s diadochokinetic rates is irregular timing. What type of dysarthria do you diagnose?
     a. Flaccid
     b. Spastic
     c. Hypokinetic
     d. Hyperkinetic
     e. Ataxic

Answer 3

e. Ataxic

Question 4

154. What condition is the most likely to result in a mixed flaccid-spastic dysarthria?
     a. Cardiovascular accident (CVA)
     b. Parkinson’s disease
     c. Repeated head trauma (such as that experienced by boxers)
     d. TBI
     e. Huntington chorea

Answer 4

d. TBI

Question 5

155. Your patient demonstrates overall good intelligibility with occasional disruptions and imprecision caused by involuntary movements. Loudness is typically within normal limits but is intermittently too loud or too soft. What type of dysarthria do you diagnose?
     a. Flaccid
     b. Spastic
     c. Hypokinetic
     d. Hyperkinetic
     e. Ataxic

Answer 5

d. Hyperkinetic

Question 6

156. Why does spastic dysarthria rarely co-occur with apraxia of speech?
     a. Spastic dysarthria is caused by damage to the brainstem
     b. Apraxia of speech is caused by lesions in the basal ganglia
     c. Spastic dysarthria is caused by bilateral upper motor neuron lesions
     d. Apraxia of speech is typically caused by a right-sided CVA
     e. Apraxia of speech is caused by a cerebellar lesion

Answer 6

c. Spastic dysarthria is caused by bilateral upper motor neuron lesions

Question 7

157. You are working in an amyotrophic lateral sclerosis
     (ALS) clinic, where you monitor patients every 3 months. Of the following situations, which would you expect?
     a. Individuals with bulbar onset require motor speech intervention later than those with spinal onset
     b. Advanced audio coding (AAC) is not needed
     c. Patients demonstrate primarily hypokinetic dysarthria
     d. Individuals with spinal onset require motor speech intervention later than those with bulbar onset
     e. Patients exhibit no cognitive deficits

Answer 7

d. Individuals with spinal onset require motor speech intervention later than those with bulbar onset

Question 8

158. You are working in a Parkinson’s disease clinic in which the neurologist specializes in early diagnosis and intervention. Your treatment regimen is as follows:
     a. Begin the Lee Silverman Voice Treatment (LSVT) when the patient demonstrates or reports that the disease is affecting his or her speech, even if the effect is mild
     b. Begin LSVT when the patient demonstrates or reports that the disease affects speech moderately to severely
     c. Begin LSVT only when intelligibility is less than 80%
     d. Begin articulatory intervention to maintain intelligibility when changes to speech are apparent
     e. Begin respiratory intervention to provide an adequate driving force for voice production when changes in speech are apparent

Answer 8

a. Begin the Lee Silverman Voice Treatment (LSVT) when the patient demonstrates or reports that the disease is affecting his or her speech, even if the effect is mild

Question 9

159. Beukelman and colleagues 2004) recommended an AAC assessment for individuals with ALS when their speaking rate approaches 125 wpm. Why?
     a. Slow speech reduces intelligibility
     b. Listeners do not tolerate speaking rates less than 125 wpm
     c. Rapid deterioration in intelligibility often occurs when speaking rate reaches roughly 50% of habitual speed
     d. Cognitive decline parallels speaking rate decline
     e. Emotional deterioration parallels speaking rate decline

Answer 9

c. Rapid deterioration in intelligibility often occurs when speaking rate reaches roughly 50% of habitual speed

Question 10

160. At your monthly rounds, you are discussing a patient with ALS. You recommended a palatal lift prosthesis, but other team members saw no reason for this intervention because of the degenerative nature of the disease. To make your case, you recall that Esposito and associates (2000) recommended considering a palatal lift prosthesis for individuals with ALS. What was their rationale?
     a. Reducing hypernasality increased intelligibility about 30%
     b. Wearing a palatal lift prosthesis improved swallowing
     c. A palatal lift reduced the need for an AAC device
     d. Speaking was less effortful with the lift in place
     e. Conversational partners reported less listener burden

Answer 10

d. Speaking was less effortful with the lift in place

Question 11

161. You are counseling a patient with Parkinson disease who is considering neurosurgical intervention (e.g., pallidotomy, thalamotomy). On the basis of the available literature, what can you tell her about the likely benefit of such procedures on her speech production?
     a. There will probably be significant postoperative improvements in ratings of general motor function and disease severity, but not in speech production
     b. There will probably be significant postoperative improvements in speech production, but not in ratings of general motor function
     c. Any improvements in speech production will probably not be maintained
     d. Multiple surgical procedures are necessary to effect improvement in speech and motor function
     e. The risks associated with surgery outweigh the benefits

Answer 11

a. There will probably be significant postoperative improvements in ratings of general motor function and disease severity, but not in speech production

Question 12

162. A candidate for intervention at the level of the respiratory system should demonstrate all the following except:
     a. Estimated subglottal pressure of less than 5 cm H20
     b. Subglottal pressure of 5 cm H20 sustained for less than 5 seconds
     c. Moderate to severe breathiness
     d. Inadequate subglottal pressure for phonation
     e. Ability to say only one word at a time

Answer 12

c. Moderate to severe breathiness

Question 13

163. What is the typical limitation of studies in which instrumentation-based biofeedback (such as a Respitrace) is used to improve speech breathing patterns?
     a. Participants show improvement in the clinic but are unable to generalize the target behaviors
     b. Speech breathing patterns do not change
     c. Participants develop exaggerated speech breathing patterns in the clinic
     d. Participants move too quickly through the training task hierarchy
     e. It is not possible to set objective criteria to move through the training task hierarchy

Answer 13

a. Participants show improvement in the clinic but are unable to generalize the target behaviors

Question 14

164. One of the most basic abilities required for adequate speech breathing is inspiratory checking. Why?
     a. It encourages laryngeal valving to control expiratory airflow
     b. It promotes increased prephonatory inspiration
     c. It regulates expiratory airflow by controlling the descent of the rib cage
     d. It strengthens the muscles of expiration
     e. It reduces the likelihood of inspiratory stridor

Answer 14

c. It regulates expiratory airflow by controlling the descent of the rib cage

Question 15

165. Of the following, which is not a critical component of the LSVT?
     a. Intensive practice
     b. “Think loud”
     c. Daily home practice
     d. “Big breaths”
     e. Increasing pitch range

Answer 15

d. “Big breaths”

Question 16

166. An individual with isolated damage to the pharyngel branch of the vagus nerve will most likely benefit from:
     a. An obturator
     b. A palatal lift prosthesis
     c. Sucking and blowing exercises
     d. Palatal icing
     e. Biofeedback through the use of the Nasometer

Answer 16

b. A palatal lift prosthesis

Question 17

167. A patient would be an appropriate candidate for a palatal lift prosthesis if he or she:
     a. Sustained subglottal pressure of 5 cm H20 for 1 second
     b. Demonstrated a velopharyngeal orifice area of 3 mm^2 as measured by the pressure-flow procedure (Warren & DuBois, 1964)
     c. Produced 15% nasalance on the Zoo passage, as measured by the Nasometer
     d. Demonstrated occasional velopharyngeal closure during nonnasal sounds
     e. Demonstrated fair to good articulation

Answer 17

e. Demonstrated fair to good articulation

Question 18

168. How does the continuous positive air pressure (CPAP) program developed by Kuehn (1997) follow the principles of motor learning and strength training?
     a. The patient is encouraged to practice three times a week
     b. It incorporates nonspeech tasks in the therapy program
     c. The velum is closing against resistance during speech
     d. It stimulates the velum in a manner comparable with icing
     e. The practice stimuli are blocked by phonemes

Answer 18

c. The velum is closing against resistance during speech

Question 19

169. The most useful tasks for differential diagnosis of dysarthria in a motor speech evaluation are:
     a. Assessment of conversational speech and alternating motion rates (AMRs)
     b. Articulation testing in all positions of words
     c. Intelligibility testing in words and sentences
     d. Assessment of sustained phonation and an examination of speech mechanism
     e. Assessment of production of words with plosives and nasals

Answer 19

a. Assessment of conversational speech and alternating motion rates (AMRs)

Question 20

170. A comparison of single word and sentence intelligibility can guide treatment by demonstrating:
     a. Whether a pacing strategy would be a viable option
     b. Whether the patient has adequate subglottal pressure for voicing
     c. Whether improving articulation of individual phonemes will increase intelligibility
     d. Whether oromotor exercises would benefit the patient
     e. How many words a patient can say in one breath

Answer 20

a. Whether a pacing strategy would be a viable option

Question 21

171. Increased vocal effort is considered to be a holistic intervention strategy because:
     a. Respiratory effort decreases
     b. Articulatory precision is typically not affected
     c. It affects more than one physiological system
     d. It improves comprehensibility
     e. It is typically accompanied by increased speaking rate

Answer 21

c. It affects more than one physiological system

Question 22

172. Comprehensibility may be
     improved by any of the following except:
     a. Oromotor exercises
     b. Alphabet board supplementation
     c. Training the listener
     d. Instructing partners in resolving communication breakdowns
     e. Being aware of contextual cues

Answer 22

a. Oromotor exercises

Question 23

173. An example of signal-independent information is:
     a. Precise articulation
     b. Normal voice quality
     c. Resonance within normal limits
     d. Awareness of topic
     e. Appropriate speaking rate

Answer 23

d. Awareness of topic

Question 24

174. Of the following, which is not an effect of alphabet board supplementation?
     a. Increased articulatory precision
     b. Longer listening processing time
     c. Syntactic information
     d. Reduced speaking rate
     e. Improved vocal quality

Answer 24

e. Improved vocal quality

Question 25

175. What internal evidence makes it difficult to recommend rate-control strategies?
     a. Few studies have demonstrated their efficacy
     b. Individuals dislike speaking slowly
     c. Research is typically based on a small number of participants
     d. Randomized control trials are lacking
     e. Participants in the available studies may not resemble your patient

Answer 25

b. Individuals dislike speaking slowly

Question 26

176. Of the following, which is the strongest argument against the use of oromotor exercises to treat dysarthria in adults?
     a. Patients may not perform them correctly
     b. Families may not understand why clinicians are not working directly on speech production
     c. Insurance companies will not pay for them
     d. Motor programming for speech tasks is different than motor programming for nonspeech tasks
     e. They are too tiring for the patients

Answer 26

d. Motor programming for speech tasks is different than motor programming for nonspeech tasks

Question 27

177. What is the benefit of increasing speaking rate in an individual with reduced articulatory precision who speaks slowly?
     a. It reduces listener burden
     b. Articulatory precision increases
     c. It increases comprehensibility
     d. It makes the speaker feel more “normal”
     e. There is no benefit

Answer 27

e. There is no benefit

Question 28

178. You instruct your patient with moderate spastic dysarthria to put breaks between words. Listeners report understanding more of his speech with this strategy. Why?
     a. Breaks provide linguistic boundaries for the listener
     b. Breaks allow the articulators to relax between words
     c. Breaks reduce laryngeal tension
     d. Breaks increase articulatory precision
     e. All the above

Answer 28

e. All the above

Question 29

179. You are screening a patient in acute care. You note that all speaking attempts are unintelligible, the patient does not initiate language, and comprehension appears poor. Your first priority is:
     a. Establish consistent
     “yes”/”no” responses
     b. Conduct a complete speech and language assessment
     c. Instruct the family to begin oromotor exercises
     d. Provide an electrolarynx for voicing
     e. Begin articulation therapy

Answer 29

a. Establish consistent
“yes”/”no” responses

Question 30

180. For clinical purposes, why are treatment effectiveness studies more relevant than treatment efficacy studies?
     a. They are based on a larger number of participants
     b. They are conducted under ideal clinical conditions
     c. They have an untreated control group
     d. They are conducted under typical clinical conditions
     e. Treatment is administered intensively

Answer 30

d. They are conducted under typical clinical conditions

Question 31

181. You are conducting a complete motor speech assessment to determine the most appropriate course of treatment for an individual with severe flaccid dysarthria. What test is the most useful?
     a. Single word and sentence intelligibility
     b. Articulation
     c. Articulatory force generation
     d. Oromotor strength
     e. Range of tongue movement

Answer 31

a. Single word and sentence intelligibility

Question 32

182. According to Ramig and colleagues (1995), “The LSVT group did not deteriorate to levels below pre-treatment in vocal intensity over the 12-month [follow-up] period.
     The placebo group had statistically significant deterioration of vocal intensity levels from before to 12 months after treatment in conversational monologues.”
     How would you interpret this statement?
     a. Across groups, gains apparent immediately after treatment were maintained 12 months after treatment
     b. Individuals who received LSVT maintained skills higher than pretreatment abilities
     c. Individuals who received LSVT did not achieve improvement with treatment
     d. Individuals who received LSVT performed better in conversational monologues than in structured practiced phrases
     e. Pretreatment baselines were inconsistent for conversational monologues

Answer 32

b. Individuals who received LSVT maintained skills higher than pretreatment abilities

Question 32

183. You completed an evaluation of a 25-year-old man 2 years post TBI, with a complaint of hypernasality and nasal emission and the findings are as follows:
     a. Nasalance during a nonnasal passage without nose clips = 45%
     b. Intelligibility without nose clips = 30%
     c. Intelligibility with nose clips = 30%
     d. Ability to sustain “ah” for 30 seconds
     e. Pressure sounds are produced with weak oral pressure

Answer 32

c. Intelligibility with nose clips = 30%

Question 33

184. You are evaluating a patient who appears very anxious and complains frequently of pain.
     Speech is completely intelligible, but voice quality is harsh and excessively soft, as though he is holding his breath. Speaking rate is somewhat fast. Your most appropriate immediate course of action is:
     a. Refer for a laryngeal videostroboscopic evaluation
     b. Initiate the LSVT
     c. Confer with his physician and neuropsychologist to obtain information regarding his pain
     d. Introduce a pacing strategy to reduce speaking rate
     e. Refer for psychological counseling

Answer 33

c. Confer with his physician and neuropsychologist to obtain information regarding his pain

Question 34

185. Your patient demonstrates 98% intelligibility, nasal emission on plosives, nasalance of 35%, adequate sub-glottal pressure for speech, absence of gag reflex, normal voice quality, and appropriate loudness. He wants to return to his former job as a radio broadcaster. The most appropriate intervention is:
     a. Drills to improve articulatory precision
     b. Fitting for a palatal lift prosthesis
     c. Palatal desensitization
     d. LSVT
     e. Drills to improve inspiratory checking

Answer 34

b. Fitting for a palatal lift prosthesis

Question 35

186. Your patient sustained a TBI three years ago and has had extensive therapy. He wishes to return to work as a telemarketer. He demonstrates mildly reduced articulatory precision, with intelligibility around 95%, slightly breathy voice quality, somewhat reduced loudness, 15% nasalance, normal gag reflex, and adequate subglottal pressure for speech. What is the most appropriate intervention?
     a. Drills on the specific sounds that are imprecise
     b. Fitting for a palatal lift prosthesis
     c. LSVT
     d. Amplification
     e. None, because his speech is adequate for functional communication

Answer 35

c. LSVT

Question 36

187. You are working with a college student who is majoring in business with a specialty in sales. He has spastic cerebral palsy. He is most intelligible when he puts breaks between words, but he states that his sales personality does not come through when he does so. What would you suggest?
     a. To use a pacing strategy all the time because that is when he is most intelligible
     b. To attempt stretching words out without breaks between them
     c. To speak naturally in his first attempt but use a pacing strategy if his speech is not understood
     d. To use a pacing strategy in his first attempt but proceed to natural conversational style if his speech is understood
     e. To have a backup AAC device with him at all times

Answer 36

c. To speak naturally in his first attempt but use a pacing strategy if his speech is not understood

Question 37

188. You are evaluating a 13-year-old girl who demonstrates idiopathic hypernasality. Its onset reportedly occurred after a fall off a horse, although her mother also mentioned a growth spurt. Her nasalance score during connected speech at typical loudness (about 70 dB SPL at 30 cm mouth-to-microphone distance) was 33%. It decreased to 27% with increased vocal effort (about 75 dB SPL). Her gag reflex was present. When discussing the evaluation results, you mention increased vocal effort as a possible therapy option. The girl’s immediate response is, “Oh, I could never talk that loud!” What strategy seems most appropriate?
     a. Convince her and her parents that increasing loudness is an effective way to improve velopharyngeal closure
     b. Recommend a pharyngeal flap
     c. Recommend a palatal lift
     d. Reassess her in 6 months
     e. Begin trial therapy with CPAP

Answer 37

e. Begin trial therapy with CPAP

Question 38

189. You are working with a 21-year-old individual who is fluent in both English and Spanish. She speaks English at work and Spanish with her parents at home. You conduct the motor speech evaluation in English. You notice left facial weakness, tongue deviation to the left, and the velum pulling toward the right on phonation. Intelligibility is 95%. There is no evidence of aphasia.
     What is the most reasonable conclusion regarding her intelligibility in both languages?
     a. English will be more intelligible because she speaks it more frequently
     b. Spanish will be more intelligible because it was her first language
     c. Intelligibility will be equal in both English and Spanish
     d. Her parents will have difficulty understanding her Spanish
     e. Her co-workers will have difficulty understanding her English

Answer 38

c. Intelligibility will be equal in both English and Spanish

Question 39

190. Why is it inappropriate to work on increasing vital capacity to improve speech breathing strategies in a person with flaccid dysarthria?
     a. Only a relatively small percentage of vital capacity is needed for speech production
     b. Individuals with flaccid dysarthria typically do not have speech breathing difficulties
     c. Vital capacity will increase spontaneously and dramatically as the patient begins to walk
     d. Increasing expiratory reserve volume is more beneficial
     e. Teaching the patient to speak on “residual air” will help them extend utterance length effectively

Answer 39

a. Only a relatively small percentage of vital capacity is needed for speech production

Question 40

191. Which is the most appropriate three-word phrase for assessing nasal air emission?
     a. “Never on Sunday”
     b. “Pop the top”
     c. “Use the rule”
     d. “Mom made marmalade”
     e. “Pinpoint the problem”

Answer 40

b. “Pop the top”

Question 41

192. The use of Permax to facilitate the uptake of dopamine in a person with hypokinetic dysarthria represents management at what level of the chronic condition model?
     a. Pathophysiology
     b. Impairment
     c. Functional limitation
     d. Disability
     e. Societal

Answer 41

a. Pathophysiology

Question 42

193. The most appropriate motor learning paradigm for speech generalization is:
     a. Therapy twice a week, single-sound drills, 100% feedback
     b. Therapy twice a week, randomized drills, 100% feedback
     c. Therapy five times a week, randomized drills, feedback every five productions
     d. Therapy five times a week therapy, single-sound drills, feedback every five productions
     e. Therapy five times a week therapy, single-sound drills, 100% feedback

Answer 42

c. Therapy five times a week, randomized drills, feedback every five productions

Question 43

194. The patient asks,
     “Will wearing my palatal lift make
     my soft palate work on its own?” You respond:
     a. “Yes, if you wear it consistently.”
     b. “Yes, it will stimulate the muscles of the soft palate.”
     c. “No, there is no evidence to show that wearing the lift stimulates the muscles.”
     d. “I don’t know. Everyone responds differently to it.”
     e. “Yes, if you continue your blow up a balloon every day.”

Answer 43

c. “No, there is no evidence to show that wearing the lift stimulates the muscles.”

Question 44

195. If an individual has difficulty lifting the tip of his or her tongue to make a /t/, an appropriate intervention could be:
     a. Tongue strengthening exercises
     b. Swallowing exercises
     c. Deliberate omission of /t/
     d. The substitution of /p/ for /t/
     e. Any compensatory strategy that minimizes the distance between the tongue and alveolar ridge

Answer 44

e. Any compensatory strategy that minimizes the distance between the tongue and alveolar ridge