ORG exam 1b Flashcards
assessment
motor speech disorders
Dysarthria(s)–group of spch production disorders resulting from CNS or PNS impairment leading to spch difficulty due to weakness, discoordination, poor tone, poor prosodic control – disorder of spch execution
Anarthria–complete loss of spch due to severe loss of neuromuscular control
Apraxia of Spch – Aphemia–impairment of spch production resulting from lesion in left cerebral hemisphere causing impairment of planning, programming and sequencing of movements for segmental and suprasegmental aspects of spch production; not due to weakness, slowness, or language dysfunction
SLP assessment goals
1) describe characteristics of spch disorder
2) propose differential diagnosis- most likely from list, at times can describe, but difficult to classify Many are mixed dysarthria
3) contribute to medical diagnosis- What neurologic system/disease implicated? If given neuro diagnosis, note what is atypical and suggest alternatives.
4) determine course of management
Neurological etiology, salient Characteristics, Severity of impairment
SLP assessment: case history ACDSDMIP- all children drink sweet dripping milk in pails.
1) age at onset- developmental versus acquired
2) course- kind of onset: chronic/acute
progressive/improving/exacerbating-remitting
3) neurologic diagnosis/pertinent medical history
4) site of lesion/ diagnostic info
5) associated deficits: sensorimotor, cognitive/linguistic, awareness
6) Medications & side effects, med schedule vs tx schedule
7) impact of the spch disorder- target our services, prove to insurance company
8) prior level of functioning
SLP assessment: oral mech
examination of spch structures during nonspch activities- same as swallowing
visual and tactile observation
Universal precautions- gloves etc
fewer auditory judgments
remember: no direct relationship between nonspch findings and spch findings
Are abnormalities sufficient to affect spch?
Think about how this task impacts on spch and on swallowing- The answer may be different for the two (ex no impact on spch, but yes impact on swallowing) because swallow requires strength, spch requires speed
SLP assessment: oral mech
Feature-Motor spch abnormality
CONTROL
*Strength- Reduced, usually consistently but sometimes progressively
*Tone-Increased, decreased, or variable
*Timing
*Steadiness-Unsteady, either rhythmic or arrythmic
MOVEMENT
*Speed-Reduced or variable- increased only in hypokinetic dysarthria
*Range-Reduced or variable (predominantly excessive only in hyperkinetic dysarthria)
*Accuracy-Inaccurate, either consistently or inconsistently
*Symmetry-Asymmetrical movements, appearance
Other
Size-Increased size, atrophy, usually asymmetrical
nerve tests: V trigeminal, VII facial, IX glossopharyngeal, X vagus, XII hypoglossal, OTHER
Velopharyngeal: CN V & X
impound air, Repeated glottal stops (5/sec) uh-uh: visualize movement
Jaw: CN V open/close mouth bite
Lips: CN VII- Pucker, Smile, puff cheeks
gag reflex: IX & X– may not have gag reflex
Laryngeal: CN X Vagus- cough & coup both bad: laryn prob; cough weak, coup okay: exhalation prob; s/z ratio (Z>S)- integrity of larynx, less air for z bc exhalation is restricted in fricative
Lingual XII: Symmetry Speed Range
Back-Body-Tip
Movements
Lateralize-Elevate-Extend-Retract
IOPI iowa oral perf inst
OTHER- reflexes: aberrent oral motor
Nonverbal oral movement sequences
perceptual analysis of speech: problems
- -perceptual judgments as to adequacy across spch dimensions: Intelligibility, naturalness
- -visual & tactile info needed to improve judgments, but most movements still not visible
- -Primary means for analyzing spch
- -Exact protocol may vary depending on patient needs
- -Not a simple process, because must distinguish several dimensions of impairment that are occurring simultaneously
- -Therefore interjudge agreement might vary
- -Important to determine both strengths and weaknesses in spch components
- -Validity and reliability of motor spch assessment tools not well established
- darley aronson brown rating scale for deviant spch*
- CAPE-V consensus auditory-perceptual evaluation of voice*
voice measures
a. vowel prolongation: maximum phonation time
comfortable loudness, pitch level, (> 7-8 s; most adults 20 s); whisper vs non-whispered; note voice quality: laryngeal efficiency; Steadiness/Duration: Respiratory capacity; Affected by age; Tests laryngeal and respiratory systems
b. Pitch range for prolonged vowels /a/
c. Maximum frication time: Prolong voiceless fricative /s/; Prolong voiced fricative: /z/; compute /s/ - /z/ ratio: should be slightly <1.0 if healthy system
d. Loudness range for prolonged vowels
be careful with medically fragile patients for whom these max. effort tasks can be very taxing
alternating motion rates AMR
diadochokinetics: speed, regularity, precision
normal values in table 3-3: 5-7 sylls/sec
Count by time - continue reps as long as possible
Time by count – for 5 secs
Looking for consistency
Syllables/Sec Pa 6.4 Ta 6.2 Ka 5.8
Affected by age: younger = slower
“buttercup” “pattycake”
citation tasks
motor spch programming
imitate words of increasing length
automatic spch activities– forwards and backwards: count 1-20, days of week (easier forward than backward)
apraxia better at forward than backward
singing
contextual speech
language formulation: conversation, narrative samples, picture descriptions, reading
Key sentences: nose occluded vs unoccluded
Make me a Hong Kong cookie (more nasals= more affected)
Buy Bobby a puppy.
stress testing
prolonged spch attempts
e.g. count or read for longer period
Note any deterioration over time- speed, resonance, intelligibility
Formal assessments: artic
Articulatory inventory: fisher logermann more age appropriate than GFTA, *also look at phonemes across contexts
formal assessments: motor speech
- Frenchay Dysarthria Assessment (Enderby)
- Assessment of Intelligibility of Dysarthric Spch
(Yorkston & Beukelman, 1981): single words, sentences, % correctly understood, rate - number of words/total speaking time - Apraxia Battery for Adults (Dabul)
- Screening Test for Developmental Apraxia of Spch (Blakeley)
Acoustic & Physiologic Analyses of speech
requires instrumentation
more available in clinical settings with computer technology and software
electropalatography
videofluoroscopy
aerodynamic measures - respiratory system: volumes/ capacities
subglottal air pressure
requires: pneumotachometer, spirometer, manometer
videonasendoscopy
