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Motor Speech > Lecture 4 > Flashcards

Lecture 4 Flashcards

1
Q

What are the goals of Ax in MSD?

A
  • diagnosis
  • determining severity of speech impairment (speech intelligibility)
  • determining underlying reasons for reduced intelligibility and perceptual abnormalities
  • determining Tx targets
  • documenting progress
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2
Q

What are the 6 components of Ax for MSD?

A
  1. History (chart review & interview)
  2. Oral motor & sensory exam
  3. Intelligibility testing
  4. Perceptual evaluation of speech
  5. Instrumental assessment
  6. Diagnostic therapy probes
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3
Q

What are some questions to ask during an interview?

A

-Pt description of problem
-date of onset
-pattern of onset
-nature of symptoms
-medical/surgical history
-medications
-impact on daily functions
etc.

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4
Q

What information do we get from an OME?

A

Info on

  • structural integrity (presence of structures, inflammation, changes in colour, proportionality)
  • severity of physical change/damage
  • localization of damage (UMN vs. LMN, CN)
  • symmetry
  • NO INFO ABOUT SPEECH
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5
Q

What is one way we can slightly decrease subjectivity of OMEs?

A

you create protocols that you follow for each person every time. This consistency allows us to understand the range of severities and symptoms

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6
Q

What are 3 ways you can organize an OME?

A
  • by cranial nerve
  • by structure
  • by subsystem
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7
Q

Which parameters of muscle function do we assess during an OME?

A
  • strength of muscle contractions
  • range of non-speech movements
  • speed of NS movements
  • accuracy of NS movement
  • muscle tone
  • symmetry
  • coordination of rapid, repeated, NS movements
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8
Q

Which structures do we assess for CN V?

A

Jaw

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9
Q

In regards to the jaw, what do we look at during an OME?

A

• Rest Position (skin over masseter & temporalis)
• Clench jaw – palpate masseter & temporalis for asymmetry, volume and tone.
• On opening – observe size & deviation of mandible
• During movement
• Test opening and closing of jaw against
resistance
• Elicit jaw-jerk

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10
Q

CN V has __________ innervation for UMNs

A

bilateral

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11
Q

What happens if there is unilateral UMN damage to CN V?

A

no effect

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12
Q

What happens if there is bilateral UMN damage to CN V?

A

open jaw,

positive jaw jerk

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13
Q

What happens if there is unilateral LMN damage to CN V?

A

jaw deviates towards WEAK side on opening
(felt as asymmetry during
clenching)

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14
Q

What happens if there is bilateral LMN damage to CN V?

A

open jaw, absent

(normal) jaw jerk

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15
Q

What structures do we assess for CN VII?

A

face and lips

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16
Q

In regards to the face and lips, what do we look at during an OME while they are at rest?

A 
-Symmetry at angles of mouth
• Flattening of nasolabial folds
• Drooling
• Eyelids partially closed
• Eyes shut involuntarily or not at all
• “Masked face”
• Absence of wrinkling on forehead
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17
Q

In regards to the face and lips, what non-speech movements do we look at during an OME?

A 
• Smile, pucker, rounding, pout
• Alternating smile-pucker
• Labial seal: puff cheeks, clinician pushes
air out
• AMR - /ba-ba/
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18
Q

What is special about the UMN supplying the face?

A

It has bilateral innervation for the forehead and the lower face has unilateral - contralateral innervation

19
Q

What happens if there is unilateral UMN damage to CN VII?

A

lower face ONLY is affected (on pucker, lips deviate toward the weak side; contra- to the side of damage)

20
Q

What happens if there is unilateral LMN damage to CN VII?

A

affects upper

and lower face. On pucker, lips deviate towards the weak side (ipsi to side of damage)

21
Q

What happens if there is bilateral LMN damage to CN VII?

A

complete facial paralysis

22
Q

List the signs of facial nerve paralysis

A
  • Paralysis of all the muscles of facial expression:
  • Facial asymmetry
  • Eyebrow droop
  • Loss of forehead & nasolabial folds
  • Drooping of corner of mouth
  • Uncontrolled tearing
  • Inability to close eye
  • Lips cannot be held tightly together
  • Facial muscle atrophy (late stage)
23
Q

What are 3 diseases that affect CN VII

A
  • bell’s palsy
  • acoustic neuroma
  • lyme disease
24
Q

Which structures do we assess for CN IX and X?

A

soft palate, pharynx and larynx

25
Q

What do we look for in the soft palate & pharynx

A

• Velar symmetry at rest
• Velar symmetry on phonation – look for
elevation & movement of faucial pillars
• Nasal emissions (using mirror) – during
cheek-puff, modified tongue anchor test,
and non-nasal speech samples
• Gag reflex

26
Q

What do we look for in the larynx

A
  • Prolongation of /a/: maximum phonation time, quality, pitch, pitch breaks, diplophonia, tremor or WOW (slow) or flutter (fast), voice arrest, fluctuation in loudness
  • Inhalatory stridor
  • Cough on demand, clear throat on demand
  • Glottal coup
27
Q

The UMNs of CNs IX & X have _____________ innervation

A

bilateral

28
Q

What happens if there is unilateral UMN damage to CN IX & X?

A

-no effect on velum & pharynx or the larynx

29
Q

What happens if there is bilateral UMN damage to CN IX & X?

A
  • symmetrically weak soft palate

- complete VF paralysis

30
Q

What happens if there is unilateral LMN damage to CN IX & X?

A

-during
phonation, soft palate deviates
towards the STRONG side
-unilateral VF paralysis

31
Q

What happens if there is bilateral LMN damage to CN IX & X?

A

-symmetrically
weak soft palate
-complete VF paralysis

32
Q

For CN IX & X LMN lesions, the lower the lesion the more _________ the damage

A

isolated

33
Q

Which structures do we assess for CN XII?

A

tongue

34
Q

What do we assess when looking at the tongue?

A

• Symmetry at rest and on protrusion
• Tremor? at rest and with movements
• Fasciculations? at rest, and on
lateralization
• ROM: protrusion, lateralization (internal
& external), elevation to alveolar ridge, elevation external, depression external, lip-lick, tongue wag, DDK
• Strength: against resistance (tongue depressor & inside cheek)

35
Q

The UMN of CN XII has __________ innervation

A

bilateral innervation, with the exception that the genioglossus has contralateral innervation

36
Q

What happens if there is unilateral UMN damage to CN XII?

A

tongue deviates to the weak side on protrusion

37
Q

What happens if there is unilateral LMN damage to CN XII

A

tongue
deviates to the weak side on
protrusion

38
Q

What happens if there is bilateral LMN damage to CN XII

A

bilateral tongue

weakness. Observe fasciculations and atrophy -> LMN lesion

39
Q

T or F: based purely on tongue deviation, we cannot distinguish between UMN unilateral damage and LMN unilateral damage

A

true

40
Q

What do we observe during an OME in terms of respiration?

A 
• Posture
• Shortness of breath
• Rapid, shallow, labored, noisy
• Nasal flare on inhalation
• Clavicular movement
• Listen for changes in loudness, breath group
duration, reduced phrase and word stress
41
Q

What reflexes should be measured during an OME?

A
  • gag

- pathological reflexes: jaw jerk, suck, root, snout

42
Q

In terms of sensory modalities, what do we need to assess?

A
  • vision
  • hearing
  • light-touch discrimination
  • two-point discrimination
43
Q

What are 4 formal tests related to OMEs?

A
  • Frenchay Dysarthria Assessment (FDA)
  • Oral Speech Mechanism Screening Examination (OSMSE-R)
  • Robbins & Klee
  • Verbal motor production assessment for children (VMPAC)

Motor Speech (15 decks)

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