General Assessment of Dysarthria

Question 1

components of the assessment

Answer 1

• history
• oral mechanism exam
• speech motor exam

Question 2

history/chart review

Answer 2

• course of disorder/disease
• treatment plans
• patient response to treatments
• make sure to get all the records, as multiple providers may be involved

Question 3

course of disorder/disease

Answer 3

• onset: when, what symptoms
• course: gradual or rapid, progressive or stable
• how long between onset and diagnosis

Question 4

interview with patient and family: get client’s impression of the disorder

Answer 4

• 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

Question 5

history: demographics

Answer 5

• age
• education
• occupation
• family information
• previous disorders (speech and otherwise)

Question 6

history: associated problems

Answer 6

• limb movement
• language
• cognition, memory
• emotion, behavioral
• hearing
• swallowing (check for changes in weight or enjoyment of eating)

Question 7

history: complaints and consequences

Answer 7

• patient complaints and descriptions of teh disease symptoms
• consequences of the disorder

Question 8

consequences of the disorder

Answer 8

• how is daily life affected
• job changes
• social changes (withdrawal)
• behavioral issues in children

Question 9

history: management

Answer 9

• health care management
• level of understanding of disease by patient and family

Question 10

health care management

Answer 10

• 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

Question 11

communicative needs: what are the typical environments for the speaker and levels of speech usage frequently used?

Answer 11

1. undemanding: quiet for long periods of the day
2. intermittent: quiet for long periods many days but interspersed with typical conversational speech
3. routine: frequent talking periods on most days, typically conversational speech
4. extensive: goes beyond everyday conversational speech (talk for long periods, presentations)
5. extraordinary: very high speech demans

Question 12

topics to explore during a communicative needs interview

Answer 12

• 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

Question 13

oral mechanism exam

Answer 13

• 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

Question 14

oral mechanism exam: examine structure

Answer 14

• size
• symmetry at rest
• presence of lesions or growths
• mucosal normalcy

Question 15

oral mechanism exam: examine range of movement

Answer 15

• lack of movement or reduced range of movement
• symmetry of range of movement

Question 16

oral mechanism exam: examine strength

Answer 16

• 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)

Question 17

oral mechanism exam: examine rate, coordination, and accuracy of movement

Answer 17

• 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)

Question 18

oral mechanism exam: examine muscle tone and muscle tension

Answer 18

• 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

Question 19

oral mechanism exam: response to instructions

Answer 19

• 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

Question 20

oral mechanism exam: examine sensation

Answer 20

touch, taste, proprioception

Question 21

oral mechanism exam: swallowing abilities

Answer 21

• 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

Question 22

motor speech exam

Answer 22

• 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

Question 23

motor speech exam: must use connected speech to assess function in addition to the oral mechanism exam

Answer 23

use sentences/imitation, reading passages, conversation

Question 24

motor speech exam: make sure that the speech severity is expected from the oral mechanism exam

Answer 24

look for compensations which may improve speech and other influences which may worsen speech

Question 25

speech rate

Answer 25

• measure speech rate from your connected speech sample
• can also measure the number of intelligible words per minute