General Assessment of Dysarthria Flashcards
components of the assessment
- history
- oral mechanism exam
- speech motor exam
history/chart review
- course of disorder/disease
- treatment plans
- patient response to treatments
- make sure to get all the records, as multiple providers may be involved
course of disorder/disease
- onset: when, what symptoms
- course: gradual or rapid, progressive or stable
- how long between onset and diagnosis
interview with patient and family: get client’s impression of the disorder
- important or worrisome symptoms for them
- see what level the patient is at in the chronic disease hierarchy
- patient’s awareness of the disorder
- cognitive skills and orientation of the patient
history: demographics
- age
- education
- occupation
- family information
- previous disorders (speech and otherwise)
history: associated problems
- limb movement
- language
- cognition, memory
- emotion, behavioral
- hearing
- swallowing (check for changes in weight or enjoyment of eating)
history: complaints and consequences
- patient complaints and descriptions of teh disease symptoms
- consequences of the disorder
consequences of the disorder
- how is daily life affected
- job changes
- social changes (withdrawal)
- behavioral issues in children
history: management
- health care management
- level of understanding of disease by patient and family
health care management
- medications (related and unrelated to disease)
- adaptive equipment (related and unrelated)
- who is integrating care from all providers?
- health care proxy, DNR orders, and other ethical issues
communicative needs: what are the typical environments for the speaker and levels of speech usage frequently used?
- undemanding: quiet for long periods of the day
- intermittent: quiet for long periods many days but interspersed with typical conversational speech
- routine: frequent talking periods on most days, typically conversational speech
- extensive: goes beyond everyday conversational speech (talk for long periods, presentations)
- extraordinary: very high speech demans
topics to explore during a communicative needs interview
- people typically involved as communicators with pt
- physical places in which pt communicates
- single behaviors (ex: singing/performing)
- activities/routines
- events
- objects (ex: hearing aids)
- medications
- goals
- feelings
oral mechanism exam
- use mostly nonspeech activities
- examine structure
- look for dyskinesia
- examine range of movement
- examine strength
- examine rate, coordination, and accuracy of movement
- examine muscle tone and muscle tension
- test for primitive reflexes
- response to instructions
- examine sensation
- screen swallowing abilities
oral mechanism exam: examine structure
- size
- symmetry at rest
- presence of lesions or growths
- mucosal normalcy
oral mechanism exam: examine range of movement
- lack of movement or reduced range of movement
- symmetry of range of movement
oral mechanism exam: examine strength
- symmetry in strength
- check using resistance
- make sure to tell the client to work as hard as they can so you measure maximal strength (may need to coach them as you go)
oral mechanism exam: examine rate, coordination, and accuracy of movement
- can use speech and nonspeech AMRs
- make sure to tell the client to do the task as quickly and as accurately as they can (may need to coach them as you go along)
oral mechanism exam: examine muscle tone and muscle tension
- look at muscle tone at rest and with movement (hypotonic or hypertonic)
- ask the patient to contract and relax different muscles to examine ability to modulate tone
oral mechanism exam: response to instructions
- how well does the patient modify his/her actions based on your instructions?
- the better the client is at modulating the behaviors based on instructions, the better the prognosis for improvement with therapy
oral mechanism exam: examine sensation
touch, taste, proprioception
oral mechanism exam: swallowing abilities
- make sure that there are not dietary restrictions in place (related or unrelated to swallowing function) before beginning
- be careful with children due to allergies
motor speech exam
- must use connected speech to assess function in addition to the oral mechanism exam
- use connected speech to assess perceptual characteristics
- distinguish speech characteristics among motor speech disorders
- can use perceptual judgments formed during the interview to guide the oral mechanism and motor speech examinations
- make sure that the speech severity is expected from the oral mechanism exam
motor speech exam: must use connected speech to assess function in addition to the oral mechanism exam
use sentences/imitation, reading passages, conversation
motor speech exam: make sure that the speech severity is expected from the oral mechanism exam
look for compensations which may improve speech and other influences which may worsen speech
speech rate
- measure speech rate from your connected speech sample
- can also measure the number of intelligible words per minute
