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.
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
3
Q
what to review in patient’s chart
A
- Medical history
- Investigations: MRI/CT Brain lesion site?
- MDT involvement
- Relevant surgery/hospitalisation
- Medication
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.
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.
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
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
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
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
10
Q
five perceptual speech assessment tasks
A
- vowel prolongation
- alternating motion rates
- sequential motion rates
- contextual speech
- speech stress testing
11
Q
how to assess vowel prolongation
A
‘take a deep breath and say “ah” as long, steadily and clearly as you can’
12
Q
parameters of interest when assessing vowel prolongation
A
pitch, voice quality, breath support
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)
14
Q
how to assess alternating motion rates
A
DDK - puh puh puh
15
Q
parameters of interest when assessing AMRs
A
Speed and regularity of movements of articulators, articulatory precision
16
Q
Diadochokinesis
A
the ability to perform rapidly repeating or alternating movements.
17
Q
AMRs present in flaccid and spastic dysarthrias
A
slow and regular AMRs
18
Q
AMRs present in ataxic and hyperkinetic dysarthria
A
low and irregular AMRs
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
what can speech stress testing screen for
myasthenia gravis
26
what is myasthenia gravis
a disorder that causes a rapid fatigue of the muscles during a sustained motor activity
27
how to differ between dysathria and apraxia of speech
- 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
perceptual assessment of respiration
Vowel prolongation
Counting from 1-5 altering the loudness on each number
Vocal volume in connected speech.
29
possible findings in perceptual assessment of respiration
* 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
preceptual assessment of phonation
* 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
possible findings of perceptual assessment of phonation
* 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
perceptual assessment of articulation
Speech production at word and sentence level
Picture description
Connected speech
33
possible findings of perceptual assessment of articulation
* 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
perceptual assessment of resonance
* 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
possible findings of perceptual assessment of resonance
* Hyponasal speech (Adenoids, deviated septum)
* Hypernasal speech (unilateral/bilateral velar paralysis or weakness)
35
perceptual assessment of prosody
* Connected speech
* Listen for dysprosody, monotonous speech, uneven and equal stress patterns in speech
36
possible findings of perceptual assessment of prosody
* 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
stress
changing the pitch, loudness and duration of syllables within words and words within phrases.
38
intonation
use of pitch and stress
39
formal dysarthria assessments
- 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
what is speech intelligibility
the accuracy with which an acoustic signal is conveyed by the speaker and recovered by the listener
41
word level intelligibility assessments
1. Multiple Word Intelligibility Test, (Kent et al. 1989).
2. Word section of Assessment of Intelligibility of Dysarthric Speech (Yorkston & Beukelman, 1981).
42
sentence level speech intelligibility assessments
Sentence section of Assessment of Intelligibility of Dysarthric Speech (Yorkston & Beukelman, 1981).
43
connected speech level speech intelligibility assessments
1. Reading passage (Grandfather passage)
2. Structured task (Map task)
3. Conversational speech
44
what is comprehensibility
- 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
how to assess comprehensibility
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
efficiency
‘refers to the rate at which intelligible or comprehensible information is conveyed’
