L3 Dysarthria Flashcards

1
Q

purposes of dysarthria assessment

A
  • To describe perceptual characteristics of the individual’s speech and relevant physiologic findings
  • To describe speech subsystems affected (i.e., articulation, phonation, respiration, resonance, and prosody) and the severity of impairment for each
  • To identify other systems and processes that may be affected (e.g., swallowing, language, cognition)
  • To assess the impact of the dysarthria on speech intelligibility and naturalness, communicative efficiency and effectiveness, and participation.
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2
Q

dysarthria assessment components

A
  • Case history
  • Oro-facial examination
  • Perceptual assessment of speech
  • Assessment of intelligibility, comprehensibility, efficiency
  • Assessment of activities and participation restriction
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3
Q

what to review in patient’s chart

A
  • Medical history
  • Investigations: MRI/CT Brain lesion site?
  • MDT involvement
  • Relevant surgery/hospitalisation
  • Medication
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4
Q

main points to ask in case history

A
  • Onset and course
  • Co-occurring deficits
  • Basic demographic and personal details (incl home. Occupational etc)
  • Facilitators of and barriers to communication
  • Current status in terms of speech
  • Perception of their speech
  • Consquences of their difficulties
  • Management to date
  • Expectations, awareness of medical diagnosis, prognosis etc.
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5
Q

what is an oro-facial exam

A

Assessment of speed, strength, range, accuracy, coordination, and steadiness of non-speech movements and assessment of the speech subsystems using objective measures, as available.

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6
Q

what does an oro-facial exam involve

A
  • Cranial nerve exam (CN V, VII, IX, X, XI, XII)—to assess facial, oral, velopharyngeal, and laryngeal function and symmetry
  • Observation of facial and neck muscle tone—at rest and during nonspeech activities (Clark & Solomon, 2012)
  • Assessment of sustained vowel prolongation—to determine if there is adequate pulmonary support and sufficient laryngeal valving for phonation
  • Assessment of alternating motion rates (AMRs) and sequential motion rates (SMRs) or diadochokinetic rates—to judge speed and regularity of jaw, lip, and tongue movement and, to a lesser extent, articulatory precision (see Kent, Kent, & Rosenbek, 1987
  • Fasiculations and lingual atrophy is something that can be found during an oro-facial exam and they occur in motor neuron disease
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7
Q

what is instrumental speech evaluation

A
  • Acoustic measures (visually represent features of the speech signal)
  • Physiologic measures (electromyography, kinematic, aerodynamic)
  • Visual imaging
  • Visually display and numerically quantify frequency, intensity and temporal components of speech
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8
Q

why do we not often use instrumental speech assessment

A
  • not always helpful for differential diagnosis
  • requires equipment most clinics don’t have access to
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9
Q

perceptual speech assessment importance

A

Perceptual assessment and classification are the “gold standard” (Duffy 2013)

  • Relies on auditory perceptual characteristics of the patient’s speech
  • First and most crucial component
  • Reliability depends on skill of clinician and it is difficult to quantify
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10
Q

five perceptual speech assessment tasks

A
  • vowel prolongation
  • alternating motion rates
  • sequential motion rates
  • contextual speech
  • speech stress testing
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11
Q

how to assess vowel prolongation

A

‘take a deep breath and say “ah” as long, steadily and clearly as you can’

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12
Q

parameters of interest when assessing vowel prolongation

A

pitch, voice quality, breath support

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13
Q

two causes of reduced vowel prolongation

A
  • Limited breath support (inadequate subglottic air pressure)
  • Impaired vocal cord adduction for phonation (air escape during phonation)
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14
Q

how to assess alternating motion rates

A

DDK - puh puh puh

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15
Q

parameters of interest when assessing AMRs

A

Speed and regularity of movements of articulators, articulatory precision

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16
Q

Diadochokinesis

A

the ability to perform rapidly repeating or alternating movements.

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17
Q

AMRs present in flaccid and spastic dysarthrias

A

slow and regular AMRs

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18
Q

AMRs present in ataxic and hyperkinetic dysarthria

A

low and irregular AMRs

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19
Q

how to assess sequential motion rates SMRS

A

DDK - puh tuh kuh

20
Q

parameters of interest when assessing SMRS

A

Rapid sequential movement from one artic position to another

21
Q

how to assess contextual speech

A

Speech paragraphs, (rainbow passage, grandfather passage), conversation, narratives

22
Q

parameters of interest when assessing contextual speech

A

Evaluation of integrated function of all components

23
Q

how is speech stress testing carried out

A

client told to count from 1-20

24
Q

parameters of interest in speech stress testing

A

Evaluate for deterioration related to fatigue

25
Q

what can speech stress testing screen for

A

myasthenia gravis

26
Q

what is myasthenia gravis

A

a disorder that causes a rapid fatigue of the muscles during a sustained motor activity

27
Q

how to differ between dysathria and apraxia of speech

A
  • Muscle weakness or spasticity are present in several dysarthria types but not AOS
  • several subsytems affected in dysarthria, but AOS only presents with articulatory and prosodic deficits.
  • dysarthric speech presents with more consistent error patterns unlike AOS
  • AOS presents with a variety of articulatory errors and groping, dysarthria does not
  • Poorer performance on SMRs than on AMRs in AOS
28
Q

perceptual assessment of respiration

A

Vowel prolongation
Counting from 1-5 altering the loudness on each number
Vocal volume in connected speech.

29
Q

possible findings in perceptual assessment of respiration

A
  • Inability to generate enough air or pressure to vibrate the vocal folds
  • Breathy speech
  • shorter sentences / phrases per breath
  • decreased loudness or loudness decay
  • forced expiration/inspiration (caused by respiratory muscle weakness)
30
Q

preceptual assessment of phonation

A
  • Vowel prolongation
  • count from 1-5 altering the loudness on each number
  • Elicit cough or sharp “uh” sound
  • Note vocal quality, pitch and loudness in conversation and in connected speech
  • sing scale.
31
Q

possible findings of perceptual assessment of phonation

A
  • Pitch breaks
  • Inhalatory stridor
  • Strained strangled voice (increased tension)
  • Weak breathy voice (reduced tension)
  • Difficulty changing volume or pitch.
  • Weak monotonous voice (laryngeal dysfunction)
32
Q

perceptual assessment of articulation

A

Speech production at word and sentence level
Picture description
Connected speech

33
Q

possible findings of perceptual assessment of articulation

A
  • Imprecise consonants, distorted vowels (tongue weakness or paralysis)
  • Imprecise bilabial sounds (lip weakness)
  • Imprecise consonants, Irregular articulatory breakdowns (in-coordinated tongue, lip, jaw, laryngeal and palatal movements)
34
Q

perceptual assessment of resonance

A
  • Place small mirror under the nose and ask person to say /u/ for as long as possible.
  • Say “nay/bay” –Say “may/pay” ” – can you differentiate between phonemes?
  • Note resonance in conversation and in connected speech.
34
Q

possible findings of perceptual assessment of resonance

A
  • Hyponasal speech (Adenoids, deviated septum)
  • Hypernasal speech (unilateral/bilateral velar paralysis or weakness)
35
Q

perceptual assessment of prosody

A
  • Connected speech
  • Listen for dysprosody, monotonous speech, uneven and equal stress patterns in speech
36
Q

possible findings of perceptual assessment of prosody

A
  • Low pitch, tremor, pitch break
  • Aberrant rate (too fast/too slow/accelerating/variable)
  • Short rushes of speech
  • Abnormal stress (reduced, excessive)
  • Prolonged intervals/Inappropriate silences
37
Q

stress

A

changing the pitch, loudness and duration of syllables within words and words within phrases.

38
Q

intonation

A

use of pitch and stress

39
Q

formal dysarthria assessments

A
  • Frenchay Dysarthria Assessment- 2 (FDA) (Enderby 2008)
  • Assessment of Intelligibility of Dysarthric Speech (AIDS) (Yorkston & Beukelman 1981)
  • Sentence Intelligibility Test (SIT) Yorkston et al 1996)
  • Word Intelligibility Test (Kent et al 1989)
  • Robertson Dysarthria Profile (Robertson 1995)
40
Q

what is speech intelligibility

A

the accuracy with which an acoustic signal is conveyed by the speaker and recovered by the listener

41
Q

word level intelligibility assessments

A
  1. Multiple Word Intelligibility Test, (Kent et al. 1989).
  2. Word section of Assessment of Intelligibility of Dysarthric Speech (Yorkston & Beukelman, 1981).
42
Q

sentence level speech intelligibility assessments

A

Sentence section of Assessment of Intelligibility of Dysarthric Speech (Yorkston & Beukelman, 1981).

43
Q

connected speech level speech intelligibility assessments

A
  1. Reading passage (Grandfather passage)
  2. Structured task (Map task)
  3. Conversational speech
44
Q

what is comprehensibility

A
  • The extent to which a message can be understood by the listener within a communication context.
  • The emphasis is not on the speech signal itself but on signal independent information such as the semantic or syntactic or physical context.
45
Q

how to assess comprehensibility

A
  1. How does the speaker communicate his/her message to the listener? Verbal/non-verbal
  2. What strategies does he/she use?
  3. How does the communication partner facilitate communication?
  4. What would enhance the comprehensibility of the speaker’s message?
46
Q

efficiency

A

‘refers to the rate at which intelligible or comprehensible information is conveyed’