Dysarthria assessment Flashcards
Differentiating between dysarthria, AOS, and aphasia
- Are speech and oral mechanisms related to neuromuscular execution?
- Are all sub-system components affected?
- Are deviant speech characteristics consistent and not influenced by linguistic variables?
- Does the patient also have physiological impairments, eg. paralysis, paresis, ataxia, involuntary movements?
- Is their speech affected by word length?
Differentiating between dysarthria types
- Medical information, including aetiology
- Speech characteristics
- Oromotor findings
Establishing diagnostic possibilities if speech is abnormal (7)
- Is the problem neurological?
- Recently acquired or longstanding?
- Is it an MSD or another neurological communication disorder, eg. aphasia
- If neurologic and MSD, is it a dysarthria or AOS?
- If dysarthria, what type?
- Localised to where?
- How severe?
Traditional components of dysarthria assessment (4)
- Case history
- Neuromuscular assessment (OPE)
- Perceptual assessment of speech characteristics
- Assessment of intelligibility
Additional components of dysarthria assessment (3)
- Acoustic analysis
- Functional communication assessment
- Psychosocial impact/QOL
Possible case history topics for dysarthria
- Onset and course (eg. when, fluctuate, meds)
- Associated deficits (eg. swallowing, emotions, weight)
- Patient’s perception (eg. appearance/feeling of face, describe speech,
- Consequence (eg. intelligibility, repeat, participation)
- Management (eg. strategies, SP in past, frustrating)
- Awareness of diagnosis (eg. does doctor know, have they been provided with info)
Functional/informal assessment of dysarthria
- Role play
- Observation during daily tasks with varying speech demands
- Over the phone/skype
Assessment batteries for psychosocial impact of dysarthria
- Dysarthria Impact Scale
- Quality of Life in the Dysarthria Speaker
- Semi-structure interviewing
- Other tools: AusTOMS, social network analysis, checklists, standardised QOL scales (eg. stroke impact scale, WHO-QOL), self-efficacy scales, visual analogue scales
Assessing environmental factors in dysarthria
Environmental checklist/inventory
Observation and assessment across different contexts
- Noise
- Proximity/distance
- Lighting
- Group vs 1:1
- Familiarity of listeners
- Environmental supports/technology
Identify barriers and facilitators
Assessing intelligibility in dysarthria
- Primary measure of disability and is an index of severity
- Speech intelligibility = words understood/words spoken x100
- Standardised intelligibility assessments: single words vs sentences (ASSIDS)
- Speech sampling: conversation, reading aloud, picture naming
- Informal/functional tasks: eg. over the phone, large proximity, background noise
Assessment of Intelligibility of Dysarthric Speech (ASSIDS/AIDS) - use and limitations
Objective means of measuring intelligibility and speaking rate of dysarthric individuals
- Quantifies single word intelligibility, sentence intelligibility and speaking rate
- Record speaker producing 50 words, listener judges by multiple choice formate or transcription format, results are compared
- 22 sentences recorded, listener transcribes sentences, measure number of words correctly transcribed and duration of sample
Limitations
- Not diagnostic
- Requires judges
- Lacks norms
- Time consuming
- Reliability
What is intelligibility vs comprehensibility
Intelligibility = degree to which the acoustic signal is understood by the listener
Comprehensibility = extent to which the listener understands the utterances produced
Assessing comprehensibility in dysarthria
- Intelligibility does not = understanding, not the best measure?
Clinical outcome assessments of dysarthria (4)
- Patient-reported outcome (PRO): eg. Dysarthria Impact Scale
- Observer-reported outcome (ObsRO): eg. Communication Effectiveness Survey completed by communication partners
- Clinician-reported outcome (ClinRO): eg. ‘speech’ item in disease severity scale, UPDRS
- Performance outcome (PerfO): acoustic outcomes from set tasks
Complexity of speech tasks
- Speech tasks can be cognitively demanding, metrically complex, or both
- Low cog load = sustained vowel - automatic connected speech - unprepared monologue = high cog load
- Eg. Poor performance on a motor only task like sustained vowel means it’s less of a language cog/problem and more motor
Digital/acoustic analysis of dysarthria
Considerations:
- Manufacturer
- Battery life
- Comparability of mics
- Recording environment
- Web-based vs in home assistants
- Ease of use
- Portability
- Budget
- Cloud vs local storage
- On boards vs API processing
Eg. computers may be more reliable at picking things up than clinicians
Eg. computers can detect pre-symptomatic Huntington’s disease
Neuromuscular assessment for MSDs
Could be done with OPE or Frenchay
- Non-speech examination of the motor speech apparatus, info about speed, strength, range, tone, accuracy, symmetry, size, steadiness of orofacial movements
- Can assist diff diagnosis between AOS and dysarthria types
OPE informal protocol described in Duffy
- Assess each functional component of speech mechanism
- Test cranial nerve and muscle function
- Evaluate rate, strength, symmetry, tone, range, speed, accuracy
-Evaluate type of breathing, eg. clavicular or diaphragmatic at rest/during speech/speech-like tasks - Count as far as possible in one breath, should be able to get to 20
- Evaluate laryngeal/voice function, eg. prolonged vowel, pitch, loudness, voice quality
Perceptual assessment of dysarthria, benefits, limitations
Using eyes and ear to idenify deviant speech features across sub-systems and hypothesise level of breakdown and classify MSD type
Benefits
- Gold standard
- Cheap, easily administered
- Widely used by clinicians
Limitations
- Subjective (intra-inter-rater reliability
- Difficulty in specifying deviant features
- Some features influence the perception of others
- Listener may be influenced by what they have just heard
Perceptual assessment informal protocol of dysarthria
Speech tasks used:
- Contextual/conversation/picture description
- Reading a standard passage
- Sustained vowel, norms in Duffy
- DDK rates, norms in Duffy
- Sub-system assessment, eg. Frenchay
- Rating of overall severity/intelligibility
- Stress testing
Rate performance across dimensions on a 5 or 7 point scale
What can a sustained vowel tell us?
- > 8-9 secs considered normal
- Make judgements regarding pitch, loudness and voice quality
- Observe jaw, face, tongue and neck
- Consider acoustic analysis
What can DDK tell us?
- Speech and regularity of reciprocal movements of jaw, lip, anterior/posterior tongue
- Articulatory precision
- Adequacy of velopharyngeal closure
- Respiratory and phonatory support for sustaining the task
- Want at least a 10 second sample
- Count number of syllable repetitions
- Easier to do via acoustic analysis, can record it and compare later
What can stress tests tell us?
- About fatigue
- Should be done when LMN weakness of unknown origin is present OR when patient complains of rapid/dramatic change in speech with continued speaking
- To assess fatigue, get them to read aloud naturally/count about 2 digits per second, continue for 2-4 mins without a rest
What can FDA-2 tell us?
- Sub-system assessment
- Assessment of individual sub-systems help identify underlying pathophysiology
- Reflexes, respiration, lips, palate, laryngeal, tongue, intelligibility
- Rated A-E, function-no function
