Dysarthria Assessment Flashcards
Impairment
abnormality of STRUCTURE or functionality at the organ level
-ex. CVA/neurological disorder has resulted/caused dysarthria
Disability
the effect the impairment has on funcion
-ex. for dysarthria this would be reduced ability to speak on the phone, give verbal direction ect
Handicap
effect the disability can have on an individual’s ability to participate in social situations
-impat quality of life
Instruments or Percepion
use both
- use instruments (batteries tests)
- look and listen
- use instruments as well as our perceptual skill
-*vital to examine physiological(how it is working) as well as peceptual(what you hear & see) aspects
Common Instruments used:
- dysarthria profile
- frenchay dysarthria assessment*
- assessment of intelligibility of dysathric speech
- oral speech mechanism screening examination (OSMSE-R)
Toos for any oral-mechanism exam:
- pin light
- tongue blade
- small mirror (to see nasal emission; can use spoon too)
- gloves
- stopwatch
- audio/video recorder (have to ask to use)
- clipboard
Respiration
Weakness of respiratory musculature: Redused overall loudness, monoloudness, short phrases (low breath support)
Abnormal tone: Reduced overall loudness, monolodness, reduced loudness control
Incoordination of respiratory musculature: sudden forced insperation/experation, speaking on low air
Respiration Assessment
- how loud is pt’s speech overall
- ask pt to count from 1-20 in one breath (dont cue to take deep breath)
- ask pt to produce /a/ (soft, loud and variation of voice)
- MPT: Males (25-35 sec.) Females (15-25sec.)
- listen to conversational speech to fid # of syllables your pt is producing on a single breath
- WNL’s is on average is b/w 12-20
Phonation
Weakness of laryngeal musculature: breathiness, hoarseness, monopitch, decreased loudness, short phrases, audibul insperation
Reduced tone in laryngeal musculature(LMN): breathiness, hoarseness, monotone, decreased loudness, low pitch
Increased tone in laryngeal musculature(UMN): strained-strangled disphonia, hoarseness, low or high pitch, monoloudness, pitch breaks (voice crackes)
Incoordination of laryngeal movements: inappropriate pitch changes, inconsistant horaseness, voicing errors, tremors, exsesive loudness variations, audible insporation
Phonation Assessment
- listen to pt’s spontaneous cough or ask pt to cough (vocal folds adduct when coughing)
- ask pt tp produce /a/ and hold it for as long as he/she can
- ask pt to sing a few notes up/down the musical scale; listen for smooth changes b/w notes
- reading or conversation allows you to listen for any normal/disordered characteristics (use grandfathe passage or rainbow passage)
Resonance
Weakness of velopharyngeal mechanism: hypernasality, nasal emission
Increased tone: hypernasality (may not have enough movement to close port)
Resonance Assessment
- have pt prolong /i/ or /i-u/ and alternate occlusion of the pt’s nose by squeezng the nostrils (should sound the same)
- have pt repeat sentences w/many nasal phonemes
- “many men may mourn him”
- “bob’s puppy was cute”
- if VPI (nasal emission) is suspected, place a mirror under the pt’s nose, use /si/ repetitively
- observe movement of velum by anchoring pt’s tongue w/blade and having him/her produce /a/
Articulation
Decrease strength(paresis): CI
Decreased coordination: IAB’s, distorted vowels
Decreased ROM: CI, distorted vowls
Increased tone: CI
Unpredictable movements: IAB’s, distorted vowels
Articulation Assessment (oral-motor movements unrelated to speech)
- ask pt to pucker and smile (provid resistance for both)
- ask pt to smack lips together (sharp clarity of sound)
- ask pt to puff cheeks/keep air in mouth (provide resistance; attempt to pop cheeks)
- ask pt to provide tongue (provide resistance w/tongue balde)
- ask pt to open mouth and maintain opening while elevating tongue to top teeth and bottom teeth
- ask pt to lateralize tongue tip; do inside of mouth too (provied resistance using gloved finger & tongue blade)
- ask pt to imitate strong tongue clicking/poping
- ask pt to say /k/ with as much force as possible (povide resistance by placing tongue blade on dorsum of tongue)
Articulation Assessment (oral-motor movements related to speec)
- ask pt to complete AMR or alternate motionrates as quickly and as evenly as possible (diadochokinesis)
- ask pt to complete SMR (sequential motion rates) as quickly and as evenly as possible
- have pt read or repeat words, phrases, sentences
- engage pt in conversation
Prosody I
Increased/decreased laryngeal tone, decreased ROM, unpredictable mvts: reduced stress, exces & equal stress
Dereased strength, coordination and ROM of lips/tongue: slow rate
Weak respiratory muscules, abnormal tone (respiration), reduced tone(lrnx): monotone/prosodic insufisentsy
Prosody II
Decreased respiratory support, unpredictable movements: prolonged intravals
Poor coordination or articulators, incoordination of lrnx mvts, low tone: prolonged phonemes
Decreased respiratory support: increased rate
Prosody III
Nasal air wastage, decreased respiratory support: short rushes of speech
Increased tone: poor intonation
Decreased coordination: poor pitch control
Poor laryngeal valving, decreased respiratory support: short phrases
Prosody Assessment
Stress:
- pretend to misunderstand something pt has said and ask them forclarification; opportunities in conversational speech
- use contrastive stress drills for perceptual assessment of stress and rhythm
Intonation:
1. ask pt to say a sentence w/different meanings; make sentence exclamatory vs. interrogative
Rate/Rhythm:
-conversational speech samples
