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45 Cards in this Set
- Front
- Back
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Goals of Motor Speech Evaluation |
a. to understand pt's prob --> leading to a diagnosis
b. to est. a beginning level of tx |
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**
Establishing Diagnostic Possibilities (7 Questions to be Answered) |
a. is there a prob with pt's speech?
b. is yes, what's best way to describe it? c. does prob seem to be result of neurologic disorder? (if no, not a motor speech disorder) |
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Establishing Diagnostic Possibilities (7 Questions to be Answered) |
d. if so, did it appear suddenly or slowly? (sudden=recent trauma, slowly=progressive neurological disorder)
e. is the prob related strictly to speech production or is it more of a prob with lang, such as aphasia? f. if it's a speech production prob, do most of probs seem to be related to sequencing of phonemes? (apraxic in nature)? g. if there are no phoneme sequencing errors, what are the characteristics of the pts' speech errors and any associated motor probs? (wh/ type of dysarthria is it) |
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Establishing Diagnostic Possibilities (7 Questions to be Answered) |
a. answer one question at a time in differential diagnostic to narrow down possibilities of disorder
b. u can have pt with probs in nervous system but speech sounds "ok" --> motor speech prob exist in ears of listener, so he doesn't have ms probs, just neurological c. ask nurse for best time of day to assess pt d. many pt's will have aphasia AND motor speech probs so some can attributed to aphasia, not ms |
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*****
Specifying Severity |
a. severity estimate is imp. b/c it helps you come up with:
-prognosis and mgmt decision making -can serve as baseline data against wh/ future changes can be compared -psychogenic contributions, level of insight, or level of concern about speech, if masmatch |
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a
5 Speech Production Components |
a. respiration
b. phonation c. resonance d. articulation e. prosody NB: bottom up! NB: if one is damaged = motor speech disorder |
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aa
Respiration |
a. power source for speech production
b. provides subglottic air pressure for vocal fold vibration c. more pressure/air = louder d. when impaired, causes: short phrase length (most common), reduced loudness, and breathy voice |
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aaa
Phonation |
a. production of voiced phonemes thru vf vibration
b. need to be able to completely adduct vf c. need perfect combo of pressure & adduction to voice d. when impaired, causes: breath or harsh voice, strained voice (too much adduction), and reduced ability to change pitch or loudness (wh/ is prosody prob caused by probs w/ phonatory musc) |
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Resonance |
a. proper placement of oral or nasal tone onto phonemes
b. oral res: velum raised/ closed c. nasal res: velum lowered/ open d. accomplished by mvmt of velum e. when impaired, causes: hypernasality (common w/ motor speech pts) |
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aaaaa
Articulation |
a. shaping of vocal airstream into phonemes
b. manner and place of artic by diff articulators (CN 5&7) c. if impaired, causes: imprecise consonants, distorted vowels, and irregular artic breakdown (unpredicted artic errors) |
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b
Prosody |
a. melody of speech: stress (for words) and intonation (for phrases)
b. stress: accomplished by changing pitch, loudness, & duration c. intonation: accomplished thru pitch change and stress - use to get across correct meaning d. coordination of various components needed - relies on normal functioning of other production components e. if impaired: reduced ability to change pitch or loudness, monopitch/monoloudness, and irreg pitch, loudness or duration variations |
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bb
Salient Neuromuscular Features Affecting Speech Production |
a. muscle strength
b. speed of mvmt c. range of mvmt d. motor steadiness e. muscle tone f. accuracy of mvmt |
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bbb
Muscle Strength, Speed of Mvmt & Range of Mvmt |
a. muscle strength: reduced, usually consistently
b. speed of mvmt: reduced or variable (increased in hypokinetic dys) c. range of mvmt: reduced or variable (increased only in hyperkinetic dys) |
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bbbb
Motor Steadiness, Muscle Tone & Accuracy of Mvmt |
a. motor steadiness: unsteady, either rhythmic or arrhythmic
b. muscle tone: increased, decreased, or variable c. accuracy of mvmt: inaccurate, either consistently or inconsistently & depends on all of the other neuromuscular features mentioned previously |
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bbbbb
Confirmatory Signs |
a. signs, other than deviant speech char (diagnosis motor speech type) and the salient neuromuscular features, that help confirm the speech diagnosis
b. can be found in speech or nonspeech muscles NB: any speech production we write down = salient symptom, NOT confirmatory sign |
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c
6 Confirmatory Signs w/i Speech System |
a. atrophy
b. fasciculations c. emotional instability d. reduced normal reflexes e. presence of pathologic reflexes f. strength of cough of coup de glotte |
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cc
5 Confirmatory Signs w/i Nonspeech Motor System |
a. gait disturbances (cerebllum)
b. abnormal musc strength reflexes c. limb atrophy and fasciculations d. loss of automatic mvmts e. difficulty initiating limb mvmts |
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ccc
*Assessment Process* |
a. history
b. examination of oral mechanism during nonspeech activities c. perceptual analysis of speech char d. intelligibility assessment e. acoustic and physiologic analyses, if possible NB : come up w/ description of pt based on history/background/pt description of prob --> real diagnosis comes from what you hear, so listen! |
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cccc
History |
a. primary and secondary medical diagnoses
b. facts about onset and course c. associated deficits - other complaints d. site of lesion --- above can come from records of other professionals--- e. patient awareness of symptoms/perception of deficit (convo) f. degree of disability or handicap caused by prob (family members) |
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ccccc
Examination of Speech Mechanism During Nonspeech Activities |
a. cranial nerve/oral mechanism exam
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d
CN V |
a. trigeminal - sensation to face (3 sensory nuclei & 1 motor nucleus)
b. motor nucleus/function = mandible c. jaw and tongue deviate to weak/damaged side d. velum deviates to strong side |
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dd
CN V Tasks |
a. nonspeech: . first, look at pt's face while pt doing nothing, then open, close, and lateral mvmt and add resistance to test strength. note weakness, atrophy, groping, or deviation
b. speech: diadochokinesis of /pa/ --> observe # repeated in 5 secs (15-20), and observe artic accuracy and evenness of rate c. sensory: ask about numbness, light touch on each side to look for symmetry |
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ddd
CN VII |
a. facial (motor)
b. need firm cheek muscles and lip functioning (lip most important) |
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dddd
CN VII Tasks |
a. nonspeech at rest: symmetry, ptosis (droopy eyelid), masked face, weakness
b. nonspeech: lip retraction, lip pucker/smile, lip compression against force, wrinkle forehead when looking up speech: repetitive /pa/ w/ bite block to inhibit jaw help, compare # of times/sec with no bit block, if person needs jaw to help, may indicate trouble with lip mvmt (SEE DIAGRAM) |
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ddddd
CN IX and X |
a. glossopharyngeal & vagus --> both have to do with vocal fold closing
b. b/c so close together, hard to tell wh/ symptoms are from CN IX-XII c. 3 branches of vagus nerve: pharyngeal, external superior laryngeal, and recurrent laryngeal |
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e
Pharyngeal Branch |
a. mvmt of pharynx (for special vowels) and moves velum for resonance (more important)
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External Superior Laryngeal Branch |
a. innervates mvmt of cricothyroid musc (tense/stretch to change loudness or pitch, in order)
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Recurrent Laryngeal Branch |
a. innervates many intrinsic laryngeal muscles to abduct/adducts vocal folds wh/ affects vocal quality
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CN IX and X Nonspeech Tasks |
a. velar mvmt - symmetry when repeating /a/
b. cough - test w/ glottal coup. (need good respiratory function and laryngeal function to make strong cough) c. glottal coup - test w/ cough. (just need good vf closure so tests laryngeal and phonatory functions) d. inhalatory stridor- unilateral damage when other side of vf compensates for damaged side not closing. if bilateral damage, u make noise when breathing cause no complete closure and some find hard to breath well - recurrent laryngeal branch affected NB: can make weak cough and weak coup or weak cough and strong coup but not strong cough and weak coup |
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CN IX and X Speech Tasks |
a. observations for palatal mvmt during sustained phonation
b. observation of resonance - hypernasal if prob w/ velum c. observation of voice quality d. unilateral damage to branch that innervates velum, velum pulls to strong side but pt can compensate well e. bilateral damage impairs production - hypernasal or breathy |
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f
CN XII |
a. hypoglossal (tongue, motor)
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CN XII Nonspeech Tasks |
a. observe atrophy or fasciculations of tongue in mouth:
-size (big enuf to cover teeth - atrophy will shrink it) -symmetry (same amt of teeth covered on both sides) -stability (doesn't shake - fasciculations) b. observe tongue out of mouth- protrusion, retraction, lateral mvm and elevation w/o resistance |
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CN XII Speech Tasks |
a. amr - /ta/ for tongue tip and /ka/ for tongue back - need good function to produce these so have them repeat them clearly and quickly (/pataka/
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Evaluate Respiratory Adequacy for Speech |
a. observe posture- abdominal, thoracic vs clavicular breathing
b. evaluate breathing rate (16-18cycles/minutes) c. evaluate regularity of breathing d. evaluate respiratory driving pressure w/ water glass manometer: goal = 5 secs with straw depth at 5cm (pt has to be able to close lips around straw completely) |
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Phonatory-Respiratory System |
a. vowel prolongation /a/ - listen for: hypernasality
breathiness harshness diplophonia pitch loudness |
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g
Hypernasality |
a. resonance system
b. if something wrong with vagus nerve, you'll hear this on vowel production c. it's when you add nasal tone to non nasal sounds |
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gg
Harshness |
a. small opening in vocal fold closure, so air coming thru tight opening
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ggg
Diplophonia |
a. person can produce two diff tones (function of vagus nerve, again!)
b. when u have recurrent laryngeal branch of vagus nerve unilaterally damaged, u have two diff vf's so ttwo diff tones (increase tension and decrease mass to change tone of vfs normally) |
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gggg
Resonation System |
a. mirror test while producing /u/ or other high back vowels to test for nasal emission (don't test start or end of sentence when person takes a breath)
b. squeeze one nostril at a time to check if improvement in resonance - if sound quality better, air was leaking |
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ggggg
*Testing Combined Components* |
a. alternate motion rate (amr)
b. sequential motion rate (smr) c. connective speech NB: These three tests, test each of five components mentioned earlier |
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h
AMR |
a. diadochokinetic rate /pa/, /ta/, /ka/ (each separate)
b. quick, even rhythm, that's accurate c. listening for speech sound (wrong w/ dysarthria pts a lot of time) d. test for prosody |
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SMR |
a. test for apraxia of speech
b. /patakapatakapataka/ |
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hhh
*Connective Speech* |
a. gives you best combined components*
b. standard reading passage, narrative about pic scene, and conversational sample |
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Stress Testing |
a. count 1 - 100 vigorously and quickly at pretty loud rate
b. screening for myasthenia gravis --> rapid fatigue of muscles during sustained motor activity |
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Testing for Apraxia of Speech |
a. repeating or reading list of words from 2 to multi-syllabic words w/ same cvs syllable to see if longer is harder (kind, kindly, kindness)
b. sentence w/ multi syllabic words c. repeated days of week, cvc syllables w/ initial and final consonant, sing familiar tune (easier for apraxic patients b/c do better w/ automatic production d. count 1-20 forward and back (easier forward b/c automatic) e. pic description and sentence repetition (sent better b/c have to say what clinician says instead of picking diff word that's easier) |
