Practice Exam Questions

Question 1

Define dysarthria and dyspraxia, explaining the difference between the two.

Answer 1

Dysarthria and dyspraxia are both types of neurologic motor speech disorder that are symptoms , not diseases in themselves. The speech motor pathway includes both planning (first) and execution (second) phases and these disorders present at different stages in the pathway and so result in a different presentation of errors.

Dyspraxia/Apraxia of speech is an impairment in the ability to plan the motor movements required for normal speech. There is only 1 type, causing problems with articulation or prosody. A person with dyspraxia may talk in monotone or have trouble repeating a sequence. The cause can be unknown or related to brain injury.

Dysarthria , on the other hand, is an impairment at the level of motor execution. Speech becomes unclear due to brain injury which effects muscle tone or coordination. It can sound slurred, slowed, too soft or hoarse according to which muscles are effected in any of the 5 subsystems of speech (respiration, phonation, resonance, articulation, prosody). There are 7 types.

Question 2

Explain what is meant by Maximum phonation time. When would this be used?

Answer 2

Maximum phonation time measures the length of time a person can continuously and voluntarily make their vocal folds vibrate. Men average around 30 seconds and women average around 20 but there is a lot of variation. You can use it as an assessment to check voice and to a get a baseline before intervention and then measure improvement after some time. This ability may be impacted by swollen, paralysed or otherwise injured vocal folds (e.g. vocal fold cysts), which problems impair the mucosal wave function. Low MPT can also be indicative of poor lung capacity.

Question 3

Describe typical speech production, integrating relevant head and neck anatomy

Answer 3

Planning and execution take place. There is an idea or an intention to say something. Planning begins in the association cortex while the basal ganglia organises the motor plan with the cerebellum. This passes to the thalamus for refinement and onto the primary motor cortex. Next it moves to the descending motor tracts of the pyramidal system and the cranial and spinal nerves innervate muscle control from the neuromuscular junction. phonation (voice sound) travels up through the laryngeal space and into the mouth and nasal cavities, where the sound waves bounce off surfaces (and each other) to create resonance and project voice out of mouth or nose The articulators (i.e., tongue, lips, teeth) shape phonation (voice) into meaningful speech sounds.

Question 4

Describe typical voice production, integrating relevant head and neck anatomy

Answer 4

• Take in air * Close (adduct) vocal folds with lateral cricoarytenoid muscles and create a tight seal (medial compression) using the interarytenoid muscles. * air in the lungs builds sub-glottic pressure underneath vocal folds. * Exhaling pushes it through the closed vocal folds, rippling (mucosal wave) creating vibration (phonation or voice). The Bernoulli Effect keeps both vocal folds vibrating. * The vocal folds are loosened to create changes in pitch. Cricothyroid muscles (lengthen vocal folds – higher pitch) Thyroarytenoid muscles (shorten vocal folds = deeper pitch). * phonation (voice sound) travels up through the laryngeal space and into the mouth and nasal cavities, where the sound waves bounce off surfaces (and each other) to create resonance and project voice out of mouth or nose.

Question 5

How do the CBOS units align with the Clinical Reasoning Cycle?

Answer 5

CBOS Units Clinical
Reasoning

1 Assessment describe the client’s situation and collect cues and information

2 Analysis & Interpretation process data and identify the issue/s

3 Planning EB3P establish goals

4 Implement take action

7 Lifelong learning e reflect

Question 6

Describe a facilitator and barrier to each of the three main types of teams in which speech pathologists typically practice: Multidisciplinary teams, Interdisciplinary teams and Transdisciplinary teams.

Answer 6

Multi disciplinary teams have the same overarching purpose and each member within the team has their discipline specific goals for the client. Facilitating working this way is the fact that members don’t need to schedule mutual time for meetings. A barrier to its success is that all clinicians are competing for client time.

Interdisciplinary teams work towards group defined goals and are facilitated by the fact that clinicians share an understanding of the treatment path. A barrier to its success may lie in the need for more communication between busy clinicians

Transdisciplinary teams assign treatment objectives to one team member. A facilitator of this method is that clients are not overwhelmed by competing appointments and confusing instructions. For the clinicians however, the risk of working beyond their scope of practice causes a grey area of indemnity. If an OT teaches a SP how to complete an exercise, who is responsible if the client has an injury ?

Question 7

Describe the factors that may contribute to dysphagia in the elderly.

Answer 7

Ageing varies from person to person, however, in general most people notice some deterioration with age. Medical conditions, such as Parkinson’s Disease, can impact swallowing and when unwell decompensation can detrimentally effect swallowing. Muscle strength, lung elasticity and sensory perception usually decline with age. These things can result in tooth loss as gums weaken, tongue has less force and larynx, pharynx and oesophagus perform peristalsis less efficiently. Time taken is also increased as getting breath to swallow is harder. Taste is reduced with less saliva and reduced senses of smell and taste. It becomes more difficult to deal with mixed textures and distractions during meals. Malnutrition, dehydration and aspiration need to be monitored by looking for weight loss, dry lips and mouth, wet voice, and lung infections.

Question 8

CNs involved in Stage 1 of the Swallow:

Oral Preparatory Phase:

Answer 8

muscles of mastication (V - motor to TMJ; XII - motor to tongue; VII - lips and cheeks involved). Soft palate containing bolus in mouth - CN X. Taste - VII & IX. Salivary glands - VII and IX. General sensation detecting food and readiness of the bolus - V and IX

Question 9

CNs involved in Stage 2 of the Swallow:

Oral Phase:

Answer 9

tongue pushing bolus back and forming a chute- XII; muscles of soft palate containing bolus (X, XI); bolus detected in oropharynx (IX); Lip seal (VII).

Question 10

CNs involved in Stage 3 3 of the Swallow:

Pharyngeal Phase:

Answer 10

larynx is elevated (X, XI); soft palate elevated to close off nasopharynx (X, XI); detection of bolus in laryngopharynx (IX); vocal folds adduct and epiglottis descends (X, XI); pharyngeal muscle contraction (X, XI); general sensory info for swallow reflex to be activated (CNIX), hyoid and larynx elevated (so innovation of suprahyoids CNV/VII but sure there are more than this involved), tongue retracts (CNXII)

Question 11

CN involved in stage 4 of swallow - Oesophageal phase

Answer 11

oesophageal phase - reflexive phase - is X still involved here

Question 12

An acquired communication disorder that impairs a person’s ability to understand, produce and use language. 2 main types; fluent (Wernicke’s) and non-fluent (Broca’s) aphasia which result from damage to different brain areas. Typical presentation of non-fluent = client has trouble with expressive language (difficulty finding the right words) but language comprehension is comparatively intact (i.e., this will be much stronger than expression, although may still have a few receptive difficulties with more complex tasks). Typical presentation of fluent = client has trouble with receptive language and may be able to talk fluently but it doesn’t make sense.

Answer 12

Aphasia

Question 13

neurologic impairment in the ability to plan motor movements required for normal speech. (1 type that affects articulation or prosody subsystems) Typical presentation = might substitute sounds (e.g. “chicken” for “kitchen”)

Answer 13

Apraxia

Question 14

neurologic impairment at the level of motor execution for speech. Can affect the strength, speed, range, accuracy of muscle movements involved in any of the 5 subsystems of speech. There are 7 types which present differently related to where in the pathway the problem occurs. e.g. Could lead to slurred speech or speech with reduced loudness

Answer 14

Dysarthria

Question 15

swallowing disorder. Could involve sucking, chewing, drinking or swallowing. Could present with a cough after eating, a wet sounding voice, the sensation of food stuck in throat, oral residue after swallowing, the inability to eat/chew certain textures

Answer 15

Dysphagia

Question 16

provide a roadmap for Patty of what will happen next:
1.analyse and score the assessments to determine Heidi’s strengths and areas of need. See if there are any gaps in the assessment and if so, there may need to be additional assessments or questions for Patty and her husband. Write report.

Answer 16

B. Explain the role of each step:
1. Assessment is important for understanding strengths and weaknesses, so we need to have a really clear picture of this which is why assessment is so important. We use assessment in conjunction with information provided by the family to formulate goals and progress to intervention. Results may point to another area that needs to be looked into so that is why more assessment many need to be carried out.

Question 17

A. provide a roadmap for Patty of what will happen next:
After analysis and scoring of Ax tasks and writing report:
2.Combine knowledge gained from scientific research and my own clinical experience to determine a selection of the best evidence-based interventions to target Heidi’s areas of needs.

Answer 17

Reason to tell Heidi’s parents:
2. Once we know Heidi’s area of need, research allows the SP to determine the best course of action. It is really important that scientific research is combined with clinical experience to make sure the intervention is a good fit for the individual. This picture is not complete without also obtaining the families values so…

Question 18

A. provide a roadmap for Patty of what will happen next:
After analysis and scoring of Ax tasks and writing report, doing E3BP to determine best EB interventions to target Heidi’s areas of need:
3.Present the report and research to Patty and her husband and collaborate to determine the best approach. Provide information about the selection of intervention so that the family can make an informed decision. Intervention type will be determined based on E3BP including the families values and time commitment. Discuss the degree to which the family would like to be involved in therapy.

Answer 18

Explain the role of this to Heidi’s parents:
3. I will present the report to you and go over the findings and possible interventions so that you are fully informed so we are able to work collaboratively to make a decision about how you would like to proceed. I want to ensure the goals and intervention will be best for Heidi and your family. This will include how involved you would like to be and the time commitment that will work for you.

Question 19

A. provide a roadmap for Patty of what will happen next:
After analysis and scoring of Ax tasks and writing report, doing E3BP to determine best EB interventions to target Heidi’s areas of need, discussing report with her parents and collaborating to determine best approach to therapy:
4. Start intervention.

Answer 19

Explanation to Heidi’s parents:
4. When we start therapy, we aim to teach skill/s that the person is not doing very well, or something that is close to their current ability. It’s not just about therapy though, it’s also about working with Heidi and you and supporting you in ways to help Heidi that suit you. both at home and elsewhere. Sometimes it takes a bit of trial and error to see what works best. We need to continually evaluate this with respect to the goals we set and Heidi’s abilities and/or circumstances, and adjust old goals or make new ones. We also keep progress notes, write reports and consult with other professionals where needed.

Question 20

MPT is used to assess;

Answer 20

• how long a person can continuously control vocal fold vibration to produce a clear, smooth, effortless sound
• respiratory control and length of exhale which is the power source for voice.
  It would be used to assess voice quality in a person who may be experiencing issues such as hoarseness, croakiness, disruption to voice (cutting out) and shortness of breath while speaking.
  These issues could be as a result of; silent reflux, laryngitis, vocal fold cysts, chemicals, smoking etc.

Question 21

What is the difference between Dysarthria and Dyspraxia?

Answer 21

Dysarthria and dyspraxia are both types of neurologic motor speech disorder that are symptoms , not diseases in themselves. The speech motor pathway includes both planning (first) and execution (second) phases and these disorders present at different stages in the pathway and so result in a different presentation of errors.
Dyspraxia/Apraxia of speech is an impairment in the ability to plan the motor movements required for normal speech. There is only 1 type, causing problems with articulation or prosody. A person with dyspraxia may talk in monotone or have trouble repeating a sequence. The cause can be unknown or related to brain injury.
Dysarthria , on the other hand, is an impairment at the level of motor execution. Speech becomes unclear due to brain injury which effects muscle tone or coordination. It can sound slurred, slowed, too soft or hoarse according to which muscles are effected in any of the 5 subsystems of speech (respiration, phonation, resonance, articulation, prosody). There are 7 types.

NOTE  dysarthria can result from damage anywhere along the motor execution pathways (from the cortical structures, subcortical structures, or nerve pathways), not just “nerve damage”