Week 3: Evaluation

Question 1

8 parts of the clinical evaluation

Answer 1

1. history
2. oral mech exam (confirmatory signs)
3. vowel prolongation (quality, duration, pitch, loudness, steadiness)
4. AMR’s speed and rhythm
5. SMR’s (sequencing/programming)
6. Contextual speech (all valves & components, prosody)
7. Stress testing (fatigue)
   Standardized measures

Question 2

Description: motor speech examination

Answer 2

Characterization of the features of speech and the structures and function that are related to speech
Represents the data upon which diagnostic and treatment decisions are made
This is the first step in diagnosis

Question 3

Establishing diagnostic possibilities: motor speech examination- 6 questions

Answer 3

1. Is the problem neurologic?
2. If the problem is not neurologic, is it nonetheless organic?
3. If the problem is or is not neurologic, is it recently acquired or longstanding?
4. If the problem is neurologic, is it an MSD or another neurologic communication disorder?
5. If an MSD is present, is it a dysarthria or apraxia of speech?
6. If dysarthria is present, what is its type?

Question 4

Establishing a motor speech diagnosis: motor speech examination- 2 considerations

Answer 4

Once all reasonable diagnostic possibilities have been recognized, a single diagnosis may emerge or, at the least, the possibilities may be ordered from most to least likely
– The process of narrowing diagnostic possibilities and arriving at a specific diagnosis is known as differential diagnosis

Question 5

Establishing implications for localization and disease diagnosis - motor speech examination- 3 considerations

Answer 5

– It is appropriate to address explicitly an MSDs implications for localization, especially if the referral source is unfamiliar with the method of
classification
– If a neurologic diagnosis has already been made, it is appropriate to address the compatibility of the speech diagnosis with it
– If neurologic diagnosis is uncertain or if speech is the only sign of disease, it is appropriate to identify possible diagnoses if the MSD is “classically” tied to them.

Question 6

Specifying severity- the severity of an MSD should always be estimated, and this is important for what 3 reasons?

Answer 6

The severity of an MSD should always be estimated – This estimate is important for at least three reasons: (1) it can be matched against the patient’s complaints; (2) it influences prognosis and
management decision making; (3) it is part of the baseline data against which future changes can be compared

Question 7

___________________ is also an essential part of the motor speech evaluation.

Answer 7

Assessing candidacy and stimulability for therapy

Question 8

The motor speech examination includes what 6 things?

Answer 8

History 
• Examination of the oral mechanism during
nonspeech tasks
• Assessment of perceptual characteristics
during speech tasks
• Assessment of intelligibility,  
comprehensibility, and 
efficiency

Question 9

The history section of the motor speech examination includes what 8 things?

Answer 9

1. Introduction and goal setting
2. Basic data
3. Onset and course
4. Associated deficits
5. Patient’s perception of deficit
6. Consequences of the disorder
7. Management
8. Awareness of medical diagnosis and progrnosis

Question 10

Most important 6 things to consider

Answer 10

1. Health state
2. Body functions and structures
3. Activity
4. Participation
5. Environmental factors
6. Personal factors

Question 11

4 goals: Seeing the big picture while evaluating structure and function

Answer 11

• First goal is to listen (and look) to see if person is normal or abnormal
• If abnormal next step is to identify the signs and associate them, if possible, to the functional components of the speech mechanism
• Simultaneously try to develop one or more hypotheses about the underlying pathophysiology
• Using spontaneous speech and verbal and nonverbal tests of maximum performance and performance l

Question 12

Motor speech abnormalities associated with strength

Answer 12

Reduced, usually consistently but sometimes progressively

Question 13

Motor speech abnormalities associated with speed

Answer 13

Reduced or variable (increased only in hypokinetic dysarthria

Question 14

Motor speech abnormalities associated with range

Answer 14

Reduced or variable (predominantly excessive only in hyperkinetic
dysarthrias)

Question 15

Motor speech abnormalities associated with steadiness

Answer 15

Unsteady, either rhythmic or arrhythmic

Question 16

Motor speech abnormalities associated with tone

Answer 16

increased, decreased, or variable

Question 17

Motor speech abnormalities associated with accuracy/direction

Answer 17

inaccurate, either consistently or inconsistently

Question 18

Define and explain: confirmatory signs

Answer 18

Additional clues about the location of pathology
• Signs other than deviant speech characteristics and the salient neuromuscular features that characterize them that help support the speech diagnosis

Question 19

3 examples of confirmatory signs

Answer 19

Atrophy and fasciculations are seen in lower motor neuron involvement and contribute to flaccid dysarthria
• Reflexes are often exaggerated in upper motor neuron development and suggest a co-‐‐existing dysarthria has at least a spastic element
• Abnormal movements such as myoclonus suggest co-‐‐existing speech deficit is likely a hyperkinetic dysarthria

Question 20

CN-V: name and function

Answer 20

Trigeminal,

jaw opening and jaw closing (mastication)

Question 21

CN-VII: name and function

Answer 21

Facial
Facial expression (smile, pucker, raise eyebrows)
Taste on anterior 2/3 of tongue

Question 22

Corticobulbar input to upper vs lower face

Answer 22

Lower face only gets unilateral UMN innervation (missing ipsilateral innervation). Upper face gets bilateral innervation
If facial weakness only in lower face, there is a disorder with the UMN’s. If facial weakness is in both upper and lower face but only on one side, then the disorder is with the LMN’s.

Question 23

Innervation to upper vs. lower face

Answer 23

Bilateral innervation to upper face, contralateral innervation to lower face

Question 24

CN-IX: name and function

Answer 24

Glossopharyngeal - taste on posterior 1/3 of tongue (back of tongue), helps with swallowing

Question 25

CN-X: Name and function

Answer 25

Vagus
Taste from base of tongue/epiglottis
innervates muscles of pharynx and larynx

Question 26

All intrinsic laryngeal muscles are innervated by RLN except for the _______?

Answer 26

cricothyroid

Question 27

SLN divides into what 2 branches? Importance?

Answer 27

intrinsic and extrinsic SLN; innervate above and below vocal folds and trachea

Question 28

CN-XII: Name and function; UMN input?

Answer 28

Hypoglossal
Tongue movement
Only receives contralateral UMN input- if unilateral stroke possible to have contralateral effects on tongue. Side tongue deviates towards is the side of the lesion (if LMN), opposite if UMN

Question 29

The tongue is the (most/least) _____________.

Answer 29

most mobile articulator.