L2/3: Assessment Flashcards
5 components of assessment
history and interview
motor speech exam (non speech tasks)
motor speech exam (speech tasks)
assess of intelligibility
acoustic and physiological analysis (not essential)
why is history/interview of onset and course important? what are the main ideas of the questions you would ask?
useful for neurological diagnosis, prognosis, and management decisions
also reveals the patient’s perception of the prob
main ideas: was it sudden/gradual, other difficulties, did it change, other factors (ex. medication)
why is history/interview of associated problems important?
may provide confirmatory info
why is history/interview of the patient’s perception of the problem important?
can provide useful confirmatory info
why is history/interview of the consequences of the disorder important?
address functional consequences of MSDs
why is history/interview of the management of the disorder important?
gain info about what the pt and others (including other professionals) have done to manage the speech disorder
useful for determining prognosis and future management recommendations
why is examination of speech mechanism during non-speech activities informative?
they provide info about orofacial movements - particularly of the jaw, face, tongue, and palate
how is the examination of speech mechanism during non-speech activities completed? (4 types of observations)
observations are primarily visual and tactile but also auditory
the observations can be made:
- at rest
- during sustained postures
- during movement
- reflexes
what do observations of the speech mechanism during non-speech activities tell us?
may support conclusions drawn about speech
even if not confirmatory of a speech diagnosis they may nonetheless be important
assessment of mandibular musculature during non-speech activities tests…
V - trigeminal
assessment of lip and facial musculature during non-speech activities tests…
VII facial and III oculomotor
assessment of palatopharyngeal musculature during non-speech activities tests…
IX - Glossopharyngeal, X - vagus
assessment of laryngeal musculature during non-speech activities tests…
X-Vagus
assessment of tongue musculature during non-speech activities tests…
XII - hypoglossal
assessment of respiratory musculature can be done during non-speech activities tests by…
strong sniffs/gasps (inhalatory) etc
palmomental reflex
in response to brisk stroking of right and left palms leads to contraction of R/L mentalis or lower lip (ex. in ALS pts)
fasciculations
a spontaneous, involuntary muscle contraction and relaxation, involving groups of muscle fibers
vocal flutter is associated w
laryngeal weakness
what are the 5 ways the speech mechanism is examined in speech activities?
vowel prolongation
prolongation of /s/ and /z/
alternating movement rates (AMRs or DDKs)
stress counting: counting from 1-200 (ex. important in MG)
contextual speech (reading aloud, picture description, conversation)
norm of max phonation time for adult female 13-65
21 seconds
norm of max phonation time for adult male 13-65
25.89 seconds
norm of max phonation time for geriatric female 65+
13.55 seconds
norm of max phonation time for geriatric male 65+
14.68 seconds (SD=6.25)
what is the general rule for s/z ratios?
ratio of 1.4 considered upper limit for normal, expect 1.0 in adults
s/z ratio above 1.4 suggests
ratio above 1.4 suggests inadequate/inefficient laryngeal valving (/s/ longer than /z/)
sedate geriatrics s/z ratio norm
0.76
activate geriatrics s/z ratio norm
0.82
norm of rate of repetition for /pΛ/ for adults (syllables per sec)
4.5 - 7.5 syllables/second
what are the three measures of intelligibility in dysarthria?
rating scores
severity scores
phonetic intell testing
what is the sentence intelligibility test (SIT) at single word?
50 words, patient reads, naive listener picks from 10 possible words for each word
number of correct/total = % intell
what is the sentence intelligibility test (SIT) at sentence level?
22 sentences, patient reads sentences, naive listener transcribes them
number of words correct/total = % intell
sentence intell test (SIT) provides what type of score? what does it not provide?
severity score
does not provide a phonetic explanation for the intell deficit
describe the phonetic intelligibility test… what can it be used for?
70 word test
attempts to provide a phonetic explanation for the patient’s intell deficit
examines 19 phonetic errors that commonly occur in dysarthria
provides a phonetic error profile that shows the proportion off error for each phonetic error
profile can be used to determine which phonetic errors are contributing the most to the intell deficit
why is rate important to consider for intellgibility?
rate is an important component of intell
we may want to tweak a patient’s rate to see if it changes their intell
patients dont often find the optimum rate on their own - need help to find it
