Motor speech: assessing dysarthria Flashcards

1
Q

Primary function of respiration for speech? If there is damages, what does it affect?

A
  • Provides subglottic air pressure for phonation
  • Nerve damage leads to weak muscles w/difficulties moving air in and out of lungs→ short phrases, reduced loundness, and breathy voice
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2
Q

Primary function of phonation for speech production? If there is damage, what does it affect?

A
  • Normal phonation= complete adduction of VFs and sufficient subglottic air pressure
  • Neuromotor damage to the nerve that innervates VF→ flaccid dysarthria, spastic dysarthria, neuromotor damage to laryngeal muscles
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3
Q

Primary function of resonance for speech productions? If there is damage, what does it affect?

A
  • Proper placement of oral or nasal tonality onto phonemes during speech accomplished by raising and lowering of velum
  • Oral resonance- velum is raised and closes off nasal cavity
  • Nasal resonance- velum is lowered and oral cavity is blocked by tongue and lips
  • Damage to nerves innervating velar muscles may cause hypernasal quality
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4
Q

Primary function for articulation for speech production? If there is damage, what will it affect?

A
  • Shapes the vocal air stream into phonemes
  • Neuromotor damage to articulators may affect lips, tongue, jaw, velum, or vocal folds and results in articulation errors (imprecise consonants or distorted vowels)
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5
Q

Primary function of prosody for speech production? If there is damage, what will it affect?

A
  • Melody of speech, using stress, and intonation to convey meaning
  • Neuromotor damage can affect prosody→ monopitch, and monoloudness; involuntary movements can result in irregular pitch variations, loudness, and prolonged intervals
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6
Q

Standardized test for apraxia

A

Apraxia battery for adults-second edition

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7
Q

Standardized test for dysarthria

A
  • Frenchay Dysarthria Assessment-2
  • Assessment of intelligibility of Dysarthric speech
  • Speech intelligibility test for windows
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8
Q

What 6 salient features should we assess?

A
  • Muscle strength
  • Speech of movement
  • Range of motion
  • Accuracy of movement
  • Motor steadiness
  • Muscle tone
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9
Q

Muscle strength

A
  • Typical speech- requires adequate strength to perform speech production tasks
  • Decreased muscle strength- can affect respiration, articulation, resonance, phonation, prosody
  • Assessed by- asking the patient to press the tongue against tongue blade
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10
Q

Speed of movement

A
  • Typical speech- requires very rapid muscle movements of tongue and vocal folds
  • Reduced speech movement is a characteristic of most dysarthrias except hypokinetic dysarthria
  • Assessed by- alternate motion rates (AMR) and sequential motion rates (SMR)
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11
Q

Range of movement

A
  • Typical speech- requires range of movement of articulators
  • Reduced ROM- may cause inability to open jar or completely adduct vocal folds
  • Assessed by- asking patient to extend or hold articulators in various position
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12
Q

Accuracy of movement

A
  • Typical speech- requires accurate movements of articulators
  • Reduced accuracy of movement may cause- distorted consonants; hypernasality
  • Assessed by- conversational speech; spoken paragraph reading
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13
Q

Motor steadiness

A
  • Typical speech- ability to hold articulators still
  • Reduced motor steadiness- tremors and large, inovoluntary movements
  • Assessed by- asking patient to hold position of prolonged vowel
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14
Q

Muscle tone

A
  • Typical speech- requires muscle ready for quick movements
  • Reduced muscle tone may cause- weakness or paralysis; spasticity or rigidity
  • Assessed by- listening to speech, looking at affected body parts
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15
Q

Specific tasks during oral mech exam

A
  • face and jaw muscles at rest/during movement
  • tongue at rest/during movement
  • velum and pharynx at rest/during movement
  • laryngeal function
  • auditory perceptual evaluation
  • phonatory respiratory system
  • resonation system
  • combined systems
  • stress test
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16
Q

Face and jaw muscles at rest/during movement

A

look for abnormal muscle tone, asymmetry, restricted ROM

17
Q

Tongue at rest/during movement

A

involves function of hypoglossal cranial nerve (XII)

18
Q

Velum and pharynx at rest/during movement

A

many of these muscles innervated by vagus (X)

19
Q

Laryngeal function

A

can not be observed directly→needs instrumentation= laryngeal mirror, flexible naso-endoscope

20
Q

Auditory-perceptual evaluations of motor speech mechanism

A

clinician’s ear is the best instrument

21
Q

Phonatory-respiratory system

A

deep breath and say /a/ holding as long as possible

22
Q

Resonation system

A

assessed velopharyngeal function= take deep breath and say /u/ as long as possible while clinician squeezes nose

23
Q

Combined systems (phonation, respiration, resonation, articulation)

A

alternate AMR and SMR

24
Q

Stress testing of the motor speech mechanism

A

used to screen for Myasthenia gravis= count 1-100

25
Q

Testing for nonverbal oral apraxia

A
  • Nonverbal oral apraxia- disruption in sequencing of oral movements that are nonverbal (Can be present w/ w/out apraxia of speech
  • Have patients perform voluntary, nonverbal oral movements w/out demonstrating beforehand
26
Q

Testing for apraxia of speech

A
  • Sequencing difficulty, pauses, distortions
  • Count from 1-20 backwards; read sentences, including spontaneously and on demand
27
Q

Analysis of connected speech

A

–Clinician records patient reading a standard reading passage
–Rate patient performance on the qualities listed