Motor Speech Disorders Exam Flashcards
What are the purposes of the exam? (8)
1 To give a description
2 determine if the characteristics are normal or abnormal
3 To establish diagnostic possibilities
4 To establish a diagnosis
5 To establish implications for localization and disease diagnosis
6 If a neurological diagnosis has already been made and it is inconsistent with the SLPs findings, that should also be stated
7 If a diagnosis is uncertain
8 To specify a severity
A weak cough can be caused by:
poor vocal fold closure
respiratory problems
How do you tell if the problem is with the vocal folds or the respiratory system?
Test the glottal coup (glottal attack)
If they have a poor glottal attack, the problem is with the :
vocal folds not the respiratory system
After the evaluation, we describe (2):
- features of speech
- structures and function associated with speech
- The clinician describes the patient’s speech and the structures and function of those structures
Once the description is complete the clinician determines if the characteristics are:
- normal or abnormal
What are 2 ways we can increase volume?
Build up sub-glottal pressure
- take more air in
- keep vocal fold more tightly constricted
If some aspect found to be abnormal the clinician:
attempts to make a differential diagnosis
In a differential diagnosis, the clinician narrows the diagnostic possibilities and tries to arrive at a specific diagnosis
Structures =
the anatomy
Function =
the physiology
If the anatomy is ok, does that mean the function is ok too?
No, not necessarily
If the physiology is ok, does that mean the anatomy is ok too?
No, not necessarily
Making a diagnosis:
The clinician should attempt to make a diagnosis.
i.e. is this a neurological problem, is it an acquired or developmental problem, is there a motor speech disorder present, if so is it apraxia or dysarthria, if dysarthria, what type of dysarthia is it?
If that is not possible then put the list in order of most possible to least possible
Establishing implications for localization and disease diagnosis:
The clinician should state the diagnosis and the localization associated with that diagnosis.
For example, the clinician can state that the diagnosis is spastic dysarthria which is associated with UMN involvement, or that the diagnosis is ataxic dysarthria which is associated with cerebellar involvement
What’s on example of a neurological diagnosis being inconsistent with the SLPs findings?
If the patient has been diagnosed with ALS but the SLP finds a mixed dysarthria of ataxic-hypokinetic, it should be noted that the dysarthria findings are inconsistent with a diagnosis of ALS
IF a diagnosis is uncertain what does the SLP do?
Indicate possible diagnoses.
For example, if a stress test indicates a strong possibility of myasthenia gravis, the SLP should note this
Severity rating statement:
mild, moderate, or severe
The SLP should always comment on severity for the following reasons (3):
- To compare to patient’s complaints - it may provide information about a possible psychogenic component or lack of insight on the part of the patient.
- It influences prognostic statements and decisions about how to manage the disorder.
- It provides baseline information against which to compare progress or changes.
Parts of the Motor Speech Exam (General Guidelines):
4
1 History - very important
2 Salient Features
3 Confirmatory signs
4 Interpretation of Findings
What do we get from the Case History? (3)
- time of onset
- course of development
- patient’s complaints and observations
*provides an opportunity to listen to patient’s speech without them knowing you are listening to the speech
What are salient features?
Those features that contribute most directly to the diagnosis and most influence the diagnosis.
See page 71, table 3-1
What types of salient features do we look for? (6)
1 Strength 2 Speed 3 Range 4 Steadiness 5 Tone 6 Accuracy
“RATSSS”
Why do we assess strength?
In order to perform appropriately, muscles have to have a certain strength.
If it is weak, it can’t work properly and may fatigue more quickly than usual.
This weakness of muscles can affect the 3 major speech valves
Muscle weakness can also impact the other components of speech production such as respiration, phonation, resonance, and prosody.
Muscle weakness is most prominent in flaccid dysarthria
What are the 3 major speech valves?
1 laryngeal
2 velopharyngeal
3 articulatory