Motor Speech Exam 2

Front 1

Purpose of Motor Speech Examination (3)

Back 1

1. Description

2. Establishing a diagnosis and its implications

3. Severity

Front 2

Guidelines for Examination (3)

Back 2

1. History

2. Identification of salient speech features

3. Identification of confirmatory signs

Front 3

Identification of salient speech features - look at... (6)

Back 3

1. Strength

2. Speed

3. Range

4. Steadiness

5. Tone

6. Accuracy

Front 4

For history, gather information about: (9)

Back 4

– Time of onset
– Nature of onset and course of disease
– Patient’s observations/ perceptions of deficits
– Nature of symptoms
– Associated deficits
– Effect on quality of life
– Build rapport
– Social history
– Medical history

Front 5

Strength abnormality associated with MSD

Back 5

Reduced, usually consistently but
sometimes progressively

Front 6

Speed abnormality associated with MSD

Back 6

Reduced or variable except hypokinetic

Front 7

Range abnormality associated with MSD

Back 7

Reduced or variable except hyperkinetic

Front 8

Steadiness abnormality associated with MSD

Back 8

Unsteady, rhythmic or arrhythmic

Front 9

Tone abnormality associated with MSD

Back 9

Increased, decreased or variable

Front 10

Accuracy abnormality associated with MSD

Back 10

Inaccurate, either consistently or inconsistently

Front 11

Asses salient features across...

Back 11

subsystems

Front 12

neuromuscular features of _____________ interact and influence each other

Back 12

movement

Front 13

Rare for only a single __________________ feature to be present

Back 13

abnormal neuromuscular

Front 14

salient features contribute most directly to...

Back 14

diagnosis

Front 15

What do confirmatory signs do?

Back 15

Give additional cues about the location of the pathology

Front 16

MSD diagnosis does not require _____________ to be present

Back 16

confirmatory signs

Front 17

Confirmatory signs can be present in...

Back 17

speech and non‐speech muscles‐atrophy, fasciculations, reduced normal reflexes

Front 18

Confirmatory signs are not ___________ of MSD

Back 18

diagnostic

Front 19

4 main segments of Motor Speech Examination

Back 19

1. History

2. Examination of the oral mechanism at rest or during nonspeech activities

3. Perceptual assessment of speech characteristics

4. Assessment of intelligibility

Front 20

Perceptual assessment of speech characteristics - Assessing what? (5)

Back 20

1. Articulation

2. Phonation

3. Respiration

4. Resonance

5. Prosody

Front 21

________________ assessment may be a part of assessment when essential

Back 21

Instrumental

Front 22

Patients complaining of significant _____________ warrant a detailed evaluation (with respect to phonation)

Back 22

dysphonia

Front 23

Phonation - assess the following areas (5)

Back 23

1. Perceptual

2. Acoustic

3. Aerodynamic

4. Visualization

5. Self-rating

Front 24

Phonation - What do you use for perceptual assessment?

Back 24

CAPE-V

Front 25

Phonation - What do you use for acoustic assessment?

Back 25

Computer program

Front 26

Phonation - What are you assessing in the acoustic assessment? (3)

Back 26

1. Frequency

2. Intensity

3. Perturbation measures

Front 27

Phonation - What are you looking for with frequency? (3)

Back 27

1. Fundamental frequency

2. Frequency range

3. Frequency variability

Front 28

Phonation - What are you looking for with intensity? (3)

Back 28

1. Fundamental intensity

2. Dynamic range

3. Intensity variability

Front 29

Phonation - What are you looking for with perturbation measures? (3)

Back 29

1. Jitter

2. Shimmer

3. Harmonics-to-noise ratio

Front 30

Phonation tasks (3)

Back 30

1. Vowel prolongation /a/ - 3-5 trials of 4 seconds

2. CAPE-V Sentences

3. Conversation/Reading

Front 31

Phonation tasks can be used for...

Back 31

perceptual and acoustic assessment

Front 32

Phonation - Aerodynamics (Instrumental) measures (4)

Back 32

1. Vital Capacity

2. Airflow Rate

3. Subglottal Pressure

4. Maximum Phonation Time

Front 33

Phonation - Aerodynamics - Use of a system similar to...

Back 33

Phonatory Aerodynamic System (PAS)

Front 34

Low-tech phonation assessment can be performed using....

Back 34

a spirometer for VC and airflow

Front 35

Subglottal pressure adequacy can be assessed using...

Back 35

a water glass manometer (5 for 5 testing) provided patient has VP closure and a tight lip seal

Front 36

Assessing phonation with visualization

Back 36

– Endoscopy/stroboscopy

Front 37

Who can do endoscopy or stroboscopy for phonation?

Back 37

SLP or ENT

Front 38

Self-rating phonation measures (2)

Back 38

1. Voice handicap index

2. Voice related quality of life

Front 39

For Respiration, examine functioning of (3)

Back 39

1. Diaphragm

2. Abdominal wall

3. Rib cage wall

Front 40

4 essential features of respiratory assessment

Back 40

1. Air pressure
2. Lung volume
3. Airflow
4. Respiratory shape

Front 41

For respiration, make the observations (7)

Back 41

– Posture: normal, abnormal, sustenance of good posture
– Shortness of breath: at rest, during speech, during physical exertion
– Breathing rapid, shallow or labored
– Abdominal and chest wall movement
– Is breathing accompanied by movement/strain of the pectoral girdle
– Regularity of breathing rate
– Persistent hiccups

Front 42

Sharpness of cough vs. glottal coup to...

Back 42

separate respiratory from laryngeal
contributions

Front 43

Weak/ breathy cough may reflect...

Back 43

vocal fold adductor weakness, poor respiratory support or both

Front 44

Glottal coup

Back 44

sharp glottal sound or grunt, requires minimal respiratory support

Front 45

What measures lung volumes and capacities?

Back 45

spirometet

Front 46

Clinical use of spirometers

Back 46

common in hospital respiratory units

Front 47

What are the kinematic measures for respiratory system? (3)

Back 47

1. Magnetometers

2. Strain-gauge belt pneumographs

3. Respitrace

Front 48

What do the kinematic measures asses?

Back 48

Speech breathing
patterns,

lung
volumes,

chest wall
coordination,
percent
contribution of
ribcage

Front 49

Clinical use of respitrace

Back 49

Respitrace common in hospital respiratory units and speech science labs

Front 50

NOMS (what does it stand for?)

Back 50

National Outcomes Measurement System

Front 51

What is NOMS?

Back 51

Voluntary data collection system developed to
illustrate the value of speech‐language pathology
services provided to adults and children with
communication and swallowing disorders

Front 52

How to become a participating data collection site for NOMS

Back 52

SLPs working in healthcare or school settings can
register their organization in the NOMS Adult and/or NOMS Pre‐Kindergarten Componen

Front 53

Key to NOMS

Back 53

the use of ASHA's Functional Communication Measures (FCMs)

Front 54

Information needed for NOMS (7)

Back 54

• Demographics
• Diagnosis
• Functional status using the Functional Communication Measures (FCMs), the seven‐ point rating scales developed by ASHA
• Treatment setting
• Service delivery model(s)
• Amount, frequency, and intensity of services
• Discharge disposition

Front 55

ASHA Functional Communication Measures (FCMs)

Back 55

• Series of 8 disorder‐specific seven‐point rating scales endorsed and used by Centers for Medicare and Medicaid Services Physician Quality Reporting System
• Ranging from least functional (Level 1) to most
functional (Level 7)

Front 56

FCMs developed by

Back 56

ASHA

Front 57

FCMs developed to...

Back 57

describe the different aspects of
a patient’s functional communication and swallowing abilities over the course of speech‐language pathology intervention

Front 58

Parts of FCM (areas) (8)

Back 58

• Attention
• Memory
• Motor Speech
• Reading
• Spoken Language Comprehension
• Spoken Language Expression
• Swallowing
• Writing

Front 59

FCM - each level contains references to... (3)

Back 59

– intensity and frequency of the cueing method
– use of compensatory strategies required to
become functional and independent in various
situations and activities.
– Both the amount and intensity of the cueing must be considered in scoring an FCM.

Front 60

FCM Level 1

Back 60

The individual attempts to speak, but speech cannot be understood by familiar or unfamiliar listeners at any time.

Front 61

FCM Level 2

Back 61

The individual attempts to speak. The communication partner must
assume responsibility for interpreting the message, and with consistent and
maximal cues, the patient can produce short consonant‐vowel combinations
or automatic words that are rarely intelligible in context.

Front 62

FCM Level 3

Back 62

The communication partner must assume primary responsibility for
interpreting the communication exchange; however, the individual is able to
produce short consonant–vowel combinations or automatic words intelligibly.
With consistent and moderate cueing, the individual can produce simple
words and phrases intelligibly, although accuracy may vary.

Front 63

FCM Level 4

Back 63

In simple structured conversation with familiar
communication partners, the individual can produce simple
words and phrases intelligibly. The individual usually requires
moderate cueing in order to produce simple sentences
intelligibly, although accuracy may vary

Front 64

FCM Level 5

Back 64

The individual is able to speak intelligibly using simple
sentences in daily routine activities with both familiar and
unfamiliar communication partners. The individual occasionally
requires minimal cueing to produce more complex
sentences/messages in routine activities, although accuracy may
vary and the individual may occasionally use compensatory
strategies.

Front 65

FCM Level 6

Back 65

The individual is successfully able to communicate
intelligibly in most activities, but some limitations in intelligibility
are still apparent in vocational, avocational, and social activities.
The individual rarely requires minimal cueing to produce
complex sentences/messages intelligibly. The individual usually
uses compensatory strategies when encountering difficulty

Front 66

FCM Level 7

Back 66

The individual’s ability to successfully and
independently participate in vocational, avocational, or social
activities is not limited by speech production. Independent
functioning may occasionally include the use of compensatory
techniques.

Front 67

Surgical treatments for phonation (3)

Back 67

• Laryngeal framework includes medialization
laryngoplasty used primarily for persons with
vocal fold paralysis
• Arytenoid adduction surgery repositions the
paralyzed vocal fold by rotating the arytenoid
medially
• Reinnervation of RLN using ansa cervicalis
with surgical anastamosis

Front 68

Injectables for phonation

Back 68

• Filler materials injected into the paralyzed vocal
fold to “bulk” the vocal fold and improve glottic
closure
• Unilateral or bilateral injection of botulinum toxin
(Botox) to the thyroarytenoid muscle in ADSD
• Botox may also be used in persons with essential
vocal tremor
• Some ABSD patients may benefit with Botox in
the PCA

Front 69

Prosthetic management for phonation

Back 69

• Voice amplifier‐speaker is located on the body,
chair or bed
• Artificial larynx in persons with aphonia
• Neck braces or cervical collars to stabilize head
and neck during speech in persons with
movement disorders or significant neck
weakness.
• Vocal intensity controller to provide feedback on
excessive or inadequate loudness

Front 70

Behavioral management of phonation

Back 70

• Voice therapy exercises to strengthen the
system
• Effort closure techniques and isometric
exercises in vocal fold paralysis/ paresis
• Head position and laryngeal manipulation for
glottic closure
• Relaxation exercises

Front 71

Lee Silverman Voice Treatment (LSVT) for persons with PD

Back 71

• Increased loudness to modify laryngeal
pathophysiology
• Emphasis on high effort, multiple repetitions
and intensity
• Trademarked and requires certification to use
with a patient

Front 72

Distinctive characteristics of LSVT (4)

Back 72

– Intensity (4 times/week for 4 weeks)
– High levels of physical effort
– Focus on respiratory‐phonatory effort
– Focus on increasing sensory awareness of
loudness and effort

Front 73

LSVT includes practice of...

Back 73

sustained vowels, pitch and functional phrases/sentences

Front 74

Respiration may be abnormal at rest but is...

Back 74

adequate for speech breathing and may not
need treatment

Front 75

Adequate speech breathing is necessary for...

Back 75

appropriate breath group length, variability
and prosody

Front 76

Treatment for respiration is primarily...

Back 76

prosthetic and/or behavioral

Front 77

Work to increase support for speech breathing
if... (3)

Back 77

– 5cm of water pressure on speech tasks cannot be sustained
– Respiratory pressure cannot support phonation
– More than one word per breath group cannot be produced during speech

Front 78

Respiratory exercises should be done during...

Back 78

speech

Front 79

DO NOT perform _________________ as a
treatment method

Back 79

oral motor exercises

Front 80

If patient is unable to generate subglottal air
pressure to support phonation, may need to
work on...

Back 80

breathing in isolation before speech
tasks

Front 81

Respiration nonspeech tasks (2)

Back 81

– using a water glass manometer with a goal of
sustaining “5 for 5”
– Air pressure transducer with a target cursor for
biofeedback

Front 82

Respiration speech tasks (2)

Back 82

– Maximum vowel prolongation (duration and
loudness), provide feedback
– Exhaling at a steady rate eventually with voicing

Front 83

Controlled exhalation tasks to...

Back 83

increase
respiratory capacity and enhance control of
exhalation for speech

Front 84

IMST, EMST

Back 84

Inspiratory or expiratory muscle strength
training

Front 85

IMST used to train inspiratory muscles using...

Back 85

a handheld device with a spring‐loaded valve
requiring the generation of a minimum
inspiratory pressure

Front 86

EMST has been studied more in persons with...

Back 86

neurological disease

Front 87

EMST

Back 87

Handheld pressure threshold device into which a
user must blow with sufficient force to overcome
resistance

Front 88

EMST resistance is set...

Back 88

at a level below the person’s
maximum expiratory pressure

Front 89

EMST - aim to...

Back 89

increase loudness, breath group, speaking
endurance, inspiratory speed

Front 90

Respiration Prosthetic assistance

Back 90

• Postural control using abdominal trussing can
also support weak abdominal muscles,
improve respiratory airflow
• Medical approval and supervision is critical
• Expiratory board/ paddle mounted on a
wheelchair to increase respiratory force for
speech

Front 91

Respiration behavioral compensation and control

Back 91

• Practice with deeper inhalation and/or using
more force during exhalation for speech
• “take a deep breath and let it out slowly when
speaking”
• Inhalation to approx. 50% of inspiratory capacity
• Seen to increase breath group and intelligibility
• Inspiratory checking

Front 92

Biofeedback has been useful...

Back 92

using various
software or instruments

Front 93

For speech breathing in persons with
flaccidity...

Back 93

neck breathing may be used with
medical clearance

Front 94

Reading paragraphs with marked breath
groups is...

Back 94

useful

Front 95

3 Parts of Velopharyngeal System

Back 95

1. Soft Palate

2. Nasal Cavity

3. Approximation portion of pharynx

Front 96

Velum is lowered when...

Back 96

Breathing

Front 97

Velum is raised when...

Back 97

Speaking (non-nasal sounds)

Front 98

Function of Levator Veli Palatini

Back 98

Elevate soft palate

Front 99

Innervator for Levator Veli Palatini

Back 99

Vagus Nerve (CN X)

Front 100

Function of Tensor Veli Palatini

Back 100

Broadens palate

Front 101

Innervator for Tensor Veli Palatini

Back 101

Trigeminal Nerve (CN V)

Front 102

Function of Palatoglossus

Back 102

Moves palate down

Front 103

Innervator of Palatoglossus

Back 103

Pharyngeal plexus

Front 104

Function of Uvular Muscle

Back 104

Provides bulk to palate

Front 105

Innervator for Uvular muscle

Back 105

Vagus nerve (CN X)

Front 106

3 types of velopharyngeal disorder

Back 106

1. Velopharyngeal Insufficiency

2. Velopharyngeal Incompetence

3. Velopharyngeal Mislearning

Front 107

Velopharyngeal Insufficiency

Back 107

Insufficient velopharyngeal closure due to an
anatomical or structural defect

Front 108

Velopharyngeal Incompetence

Back 108

Poor velopharyngeal function resulting from a
neuromotor or physiological disorder

Front 109

Velopharyngeal Mislearning

Back 109

Velopharyngeal closure physically possible, but
aberrant pattern has been learned

Front 110

Main causes of velopharyngeal incompetence (4)

Back 110

1. Stroke

2. Trauma

3. Physical Stress

4. Degenerative disease

Front 111

Velopharyngeal Incompetence (VPI)
and Speech

Back 111

Reduced respiratory support
Reduced intelligibility—distorted speech
sounds, even with correct articulation
Reduced oral air pressure

Front 112

VPI reduced oral pressure for... (3)

Back 112

1. Plosives

2. Fricatives

3. Affricates

Front 113

Hypernasality

Back 113

Excessive Nasality

Front 114

Hypernasality due to...

Back 114

Poor VP closure

Front 115

Causes of poor VP closure

Back 115

Dysarthria, cleft palate, anatomical
differences

Front 116

5 Main Categories of Velopharyngeal Dysfunction

Back 116

1. Consistent, appropriate closure

2. Consistent, inadequate closure with extensive VP dysfunction

3. Consistent, inadequate closure with minimal VP dysfunction

4. Delayed VP Closure

5. Inconsistent VP Closure

Front 117

Consistent, appropriate closure

Back 117

◦ Neurotypical—no dysfunction

Front 118

Consistent, inadequate closure with
extensive VP dysfunction

Back 118

◦ Severe flaccid dysarthria
◦ Little or no movement of VP structures for
speech or otherwise

Front 119

Consistent, inadequate closure with
minimal VP dysfunction

Back 119

◦ Consistently inadequate function
◦ Mild when in optimal speaking conditions
◦ Worse when fatigued

Front 120

Delayed VP closure

Back 120

◦ Timing is the issue
◦ Often caused by stiffness in muscle

Front 121

Inconsistent VP closure

Back 121

◦ Caused by incoordination and fatigue
◦ Hypokinetic dysarthria
◦ Ataxic dysarthria
◦ Slowing rate may improve consistency of
closure

Front 122

Nasal emission

Back 122

Airflow through nasal passage during
production of nonnasal consonants

Front 123

Is nasal emission audible?

Back 123

Sometimes

Front 124

Hyponasality

Back 124

Reduced nasal resonance

Front 125

Hyponasality due to...

Back 125

Inadequate VP opening

Front 126

Hyponasality is present with...

Back 126

Colds, obstructing pharyngeal flap,
hypertrophied turbinate

Front 127

Hypertrophied Turbinate

Back 127

Swelling of the nasal concha that causes obstruction

Front 128

Assessment Steps (4)

Back 128

1. Medical History

2. Oral Mechanism Exam

3. Perceptual Speech Evaluation

4. Instrumental Assessment

Front 129

Medical history

Back 129

Onset of symptoms and medical/dental history
Nature, duration, and course of VPI
Reports of previous treatment
Level of concern about the problem
Motivation for treatment

Front 130

Oral Mechanism Exam

Back 130

Velopharynx at rest and during movement
Modified tongue-anchor test
Dental occlusion
Sensitivity of the gag reflex
Swallowing ability
Saliva management

Front 131

Perceptual Speech Evaluation is a judgment of... (4)

Back 131

1. Hypernasal resonance

2. Audible nasal emission

3. Loudness

4. Precision of pressure consonants

Front 132

Perceptual speech eval - Listener ratings

Back 132

◦ Specific passages (Grandfather, Rainbow, Zoo)
◦ Sentence level (Pittsburgh sentences)

Front 133

Perceptual speech eval - 7 point equal appearing interval scale

Back 133

connected speech with ratings across
audiences

Front 134

Nasal emissions testing

Back 134

Air paddle (Bzoch, 1989)
Mirror testing

Front 135

Performance on articulation tests

Back 135

◦ Differences in the accurate production of
nasals and pressure consonants
◦ Stops, fricatives, and affricates = significant
differences
◦ Nasals = no differences

Front 136

Nares occluded versus Unoccluded

Back 136

◦ Intelligibility
◦ Pressure consonants
◦ Speaking effort
◦ Syllables per breath group

Front 137

Perceptual assessment - no __________ necessary

Back 137

tools

Front 138

________________ context of speech sample influences perception of hypernasality

Back 138

phonetic

Front 139

Factors influencing listener perceptions (3)

Back 139

1. Training

2. Experience

3. Educational background

Front 140

Dialectical Differences

Back 140

Consider both for speaker and listener

Front 141

Evidence that dialect can affect __________

Back 141

nasality

Front 142

3 purposes of instrumental assessment

Back 142

◦ Precise measurement of nasalance, nasal
emission, system dysfunction
◦ Quantify disorder
◦ Detailed description of dysfunction

Front 143

Nasometry

Back 143

◦ Numerical rating of nasal acoustic energy
◦ Oral and nasal components of speech sensed by microphones on either side of a sound separator
◦ Ratio of nasal to nasal-plus-oral acoustic energy multiplied by 100 = nasalance score

Front 144

Suggested Utterances for
Aerodynamic Assessment

Back 144

/ta/, /da/, /na/
/atada/
/adata/
/andantan/
/antandan/
/atana/
/adana/
/anata/
/anada/

Front 145

Endoscopy Assessment

Back 145

Direct visualization technique
Insert endoscope through nose until soft
palate and pharyngeal wall are visible
Especially helpful when fitting a palatal lift

Front 146

Instrumental Assessment Issues

Back 146

Equipment necessary
Training to use equipment
Can NEVER replace perceptual analysis!

Front 147

Treatment ofVelopharyngeal
Dysfunction (4)

Back 147

Behavioral Therapy
Surgical Intervention
Palatal Lift
Nasal Obturation

Front 148

The grandfather passage and rainbow passage are ________________

Back 148

phonetically balanced

Front 149

Techniques to assess stimulability:

Back 149

◦ Change speaking rate (slower)
◦ Modify effort level
Mild VP weakness = increasing effort
Ataxia with excess effort = decreasing effort
◦ Increased exaggeration of articulatory
movements

Front 150

Perceptual assessment could in certain cases be problematic because...

Back 150

of the influence of other speech issues

Front 151

____________ is still the gold standard of assessment

Back 151

perception

Front 152

Most common treatment of VPI for dysarthria

Back 152

behavioral intervention

Front 153

Most behavioral interventions are from ____________________ rather than _________________

Back 153

expert opinion

research findings

Front 154

Behavioral intervention - Little evidence or expert opinion regarding ________________

Back 154

duration of treatment

Front 155

Modifying the Pattern of Speaking (3)

Back 155

◦ Producing speech with increased effort

◦ Reduced rate

◦ Overarticulation

Front 156

Overarticulation (4)

Back 156

Open your mouth more
Speak more clearly
Overarticulate
Talk slowly

Front 157

Continuous Positive Airway Pressure
(CPAP)

Back 157

◦ Resistance treatment during speech
◦ Resistance against muscles of velopharyngeal
closure must work

Front 158

CPAP is designed to...

Back 158

strengthen muscles of velopharyngeal closure to reduce hypernasality

Front 159

CPAP steps

Back 159

Client sits upright
Positive air pressure into nasal passages via mask while speaking
◦ Words with movement from nasal to pressure consonant
◦ List of 50 words then 6 short sentences
Starting pressure low (4 cm H2O)
Gradually increased over the course of treatment

Front 160

Current research situation on CPAP

Back 160

Need more
evidence but
promising results
on initial testing

Front 161

Nonspeech exercises are not endorsed because... (2)

Back 161

◦ (a) speech and nonspeech velopharyngeal
closure involves different underlying
mechanisms
◦ (b) no evidence that increasing soft palate
strength improves speech performance

Front 162

Examples of nonspeech exercises

Back 162

◦ Pushing techniques
◦ Strengthening exercises, such as blowing and
sucking
◦ Tasks that encourage airstream control using
whistles, candles, straws paper, bubbles, etc.
◦ Inhibition techniques
prolonged icing, ,pressure to muscle insertion
points, slow and irregular stroking and brushing, desensitization

Front 163

Purpose of palatal lift

Back 163

◦ Lifts soft palate to impedes airflow to the nasal cavity

Front 164

2 types of palatal lifts

Back 164

Trial palatal lift

Definitive palatal lift

Front 165

Favorable Palatal Lift Candidacy (8)

Back 165

Flaccid soft palate
Slow rate of change
Resonance change with occlusion
Absent or controllable gag reflex
Adequate dentition
Adequate cognition
Adequate or improving respiration,
articulation, and phonation
Dexterity

Front 166

Potential Challenges to Palatal Lifts (6)

Back 166

Edentulous clients
Very young children
Speakers with rapidly changing neuro
status
Poor salivary control
Clients with cognitive impairment
Strong gag reflex

Front 167

Palatal lift desensitization - Palatal massage

Back 167

◦ Move index finger posteriorly starting at alveolar ridge
◦ Firm, continuous pressure
◦ Patient phonates with urge to gag
◦ Stop progressing posteriorly and move lateral (30 sec.)
◦ Rest (15 sec.) and continue
◦ 5 minutes—4x/day for 2-3 weeks

Front 168

Palatal lift desensitization options

Back 168

Desensitization during toothbrushing
routine (Yorkston, Beukelman, Strand, & Hakel, 2010)
OR
Insert lift 2-3 sec.—double time after
each successful wear (Yorkston et al., 2010)
OR
No desensitization process (Hardy, 1983)

Front 169

Team approach for palatal lift fitting and delivery - Members of team (3)

Back 169

1. Dentist

2. SLP

3. Prosthodontist

Front 170

Ways to design and and fabricate palatal lifts

Back 170

Dental exam
◦ Determine method of retention
Wire clasps
Orthodontic brackets
Crown
Acrylic bonded to teeth
Wax cast of maxillary arch
Cast used to create acrylic resin lift—
metal reinforcement throughout

Front 171

Effectiveness of Palatal Lift (8)

Back 171

- Velopharyngeal closure during production
of pressure consonants
- Velopharyngeal opening for nasal sounds
- Painless and efficient swallow
- Able to breathe through nose

- Improved speech intelligibility
- Increased loudness
- Decreased/eliminate nasal emission
- Longer breath groupings

Front 172

2 VPI Surgical Interventions

Back 172

- Pharyngeal flap surgery
- Injections

Front 173

A nasal obturator is a _____________ that __________________

Back 173

prothesis

occludes nares

Front 174

What does the nasal obturator accomplish?

Back 174

Decreases nasal airflow for people with velopharygeal insufficiency and velopharygeal incompetence

Front 175

Nasal obturator interim intervention

Back 175

◦ While palatal lift is being fabricated and fitted

Front 176

Nasal obturator long term intervention

Back 176

◦ Reduced dexterity limiting use of palatal lift
◦ Inadequate retention/support for palatal lift
◦ Incomplete or comprised closure of velopharyngeal port when using a palatal lift

Front 177

Pharyngeal Flap Surgery

Back 177

Soft tissue “flap” cut from the pharynx and attached to velum

Front 178

Purpose of pharyngeal flap surgery

Back 178

create a functional seal between oral and nasal cavities

Front 179

Injections - what substances used as filler?

Back 179

Teflon, collagen, or fat

Front 180

Injections are injected into...

Back 180

posterior pharyngeal wall to bulk the area and increase closure

Front 181

Injections are uncommon with dysarthria, more evidence for...

Back 181

cleft palate

Front 182

VPI can affect _________________ and _______________

Back 182

articulation

respiration

Front 183

Perceptual assessment must be completed
—even when...

Back 183

you’ve done instrumental testing

Front 184

Avoid _________________ —no
evidence!

Back 184

non-speech exercises

Front 185

Reducing speaking rate is considered a __________ technique

Back 185

global

Front 186

Rate can affect (4)

Back 186

Respiration
Resonance
Intelligibility
Articulation
Etc.

Front 187

Rate reduction is not always...

Back 187

effective

Front 188

Even though people with dysarthria already are speaking slow, we still...

Back 188

want to have them decrease it even more

Front 189

With rate reduction, there are always...

Back 189

trade-offs

Front 190

Reducing speaking rate may increase
intelligibility because: (3)

Back 190

◦ More time to achieve accurate articulation
◦ Reduces number of irregular articulation
breakdowns
◦ Allows listeners more processing time

Front 191

Normal Speech Rate
Task dependent
◦ Reading:

Back 191

Paragraph—160-170 wpm
Sentence—190 wpm

Front 192

Normal Speech Rate
Task dependent

◦ Conversational speech:

Back 192

150-250 wpm
4.4-5.9 syllables/second

Front 193

Factors Influencing Speaking Rate (4)

Back 193

1. Familiarity with words (rehearsal effect)
2. Complexity of message
3. Communication partner
4. Task

Front 194

Measuring speaking rate

Speaking time =

Back 194

Articulation Time + Pause Time = Speaking Time

Front 195

WPM formula

Back 195

Total words/speaking time = rate in words per
minute (WPM)

Front 196

Pause time is more flexible than...

Back 196

actual rate of articulation

Front 197

Articulatory movement relatively...

Back 197

consistent

Front 198

Slowing speech =

Back 198

working on pause time

Front 199

Distribution of Pauses

Not...

Back 199

Not random
Typically not tied to respiration

Front 200

Distribution of Pauses

Related to...

Back 200

syntactic boundaries

Front 201

People with dysarthria generally speak ________ than neurotypicals

Back 201

slower

Front 202

Mayo Clinic Study about speaking rate and dysarthria

Back 202

◦ 212 people with dysarthria
◦ 170 = deviant speaking rate
◦ Of 170, all but small subset spoke with slower
than average rate

Front 203

Fairly strong relationship between rate
and _____________

Back 203

intelligibility

Front 204

Need research on who __________ from rate reduction

Back 204

benefits

Front 205

Assessment of Speaking Rate
Perceptual assessment

Back 205

◦ Listen to speaker
◦ Is speaking rate excessively rapid?
◦ Excessively slow?

Front 206

Assessment of Speaking Rate
Perceptual Assessment Limitations (3)

Back 206

◦ Difficult to assess with reduced articulatory
precision
◦ Need for objective analysis
◦ Listener variability

Front 207

Assessment of Speaking Rate
Objective/Computerized Measures (2)

Back 207

◦ Sentence level assessment
◦ Paragraph level assessment

Front 208

◦ Sentence level assessment

Back 208

Assess rate and intelligibility at the same time

Front 209

◦ Paragraph level assessment

Back 209

More common for dysarthria
Read paragraph and software analyzes rate

Front 210

Speech Software
Pacer/Tally

Back 210

◦ Pacer
variable rate control
word-by-word rate manipulation
five signaling strategies
◦ Tally
oral reading or spontaneous speech measurement

Front 211

Speech software

Apps

Back 211

They exist

Front 212

Assessment of Speaking Rate
Objective/Hand Calculation Measurement

Back 212

Record a speech sample
Count words and divide by time
= Rate in WPM

Front 213

Speech Rate Treatment (6)

Back 213

- Pacing board strategies
- Alphabet board supplementation
- Metronome
- Delayed Auditory Feedback
- Computer training
- Rhythmic cueing

Front 214

Pacing Board

Back 214

- Rigid rate control technique
- Person taps on a multi-celled board while
producing each word or syllable
- Increases pause time between words

Front 215

Evidence for pacing board with _____________

Back 215

Parkinson’s disease

Front 216

Pacing for Parkinson’s disease patient (1983 study)

Back 216

◦ Rapid speech, palilalia, and lengthy hesitations
◦ Intelligibility increased from 30% to 63%

Front 217

Pacing Board
Pros

Back 217

◦ Inexpensive
◦ Requires little training

Front 218

Pacing Board

Cons

Back 218

◦ Physical ability
◦ Unnatural
◦ Speech can be too slow

Front 219

Alphabet Board Supplementation

Back 219

- Rigid rate control technique
- Person points to first letter of each word while speaking
◦ Slows rate
◦ Provides cues to listener
- Spell out whole word if necessary

Front 220

Alphabet Board Supplementation
Word intelligibility

Back 220

◦ Doesn’t reduce speed but provides context

Front 221

Alphabet Board Supplementation

Sentence intelligibility

Back 221

◦ Reduces speed AND provides context
◦ Pause time increased

Front 222

Alphabet Board Supplementation
Pros:

Back 222

◦ Relatively minimal training required
◦ Listener context cues
◦ Large reductions in speech rate

Front 223

Alphabet Board Supplementation

Cons:

Back 223

◦ Rigid rate control
◦ Unnatural
◦ Requires some physical control
◦ Literacy skills

Front 224

Metronome

Back 224

- Auditory rhythmic cueing
- Person with dysarthria produces a word
or a syllable with every beat
- Variable speed = rate set to level for
optimal intelligibility

Front 225

Metronome
Evidence:

Back 225

◦ Few studies conducted for dysarthria
◦ Available evidence suggests that method is
better for severe dysarthria
◦ Little effect for mild impairment

Front 226

Delayed Auditory Feedback

Back 226

Speaker must prolong each syllable until the
feedback catches up to the speech production

Front 227

Delayed Auditory Feedback

If effective:

Back 227

◦ Slow, fluent speech
◦ Prolonged vowels
◦ Smooth transitions between syllables
◦ Relatively stable syllable duration

Front 228

Delayed Auditory Feedback
Pros:

Back 228

◦ Easy to adjust
◦ Easily faded
gradually reduce delay interval
gradually reduce loudness of the signal
◦ Good for speakers with poor generalization
of behavioral strategies

Front 229

DAF on rate and intensity of dysarthric
speech (study)

Back 229

◦ 12 sentences
◦ With and without DAF (180 msec.)
◦ Results
DAF = slower speech rate and increased vocal
intensity

Front 230

DAF and Parkinson’s disease (study)

Back 230

◦ DAF (50msec.) resulted in dramatic
improvement in rate and intelligibility
◦ Disease progression = increase delay for max
benefit (50msec to 200 msec)
◦ No maintenance effect noted—need machine
for effect

Front 231

Supranuclear palsy (associated with
parkinson’s disease) and DAF (study)

Back 231

◦ 8 month of failed attempts at behavioral
therapy for rate reduction
◦ DAF (100msec) = effective rate reduction and
increased intensity

Front 232

Delayed Auditory Feedback
Pros

Back 232

◦ Proven effective for patients with dysarthria
◦ Very minimal training
◦ Adjustable for disease progression

Front 233

Delayed Auditory Feedback
Cons

Back 233

Requires constant and continuous use of prosethetic

Front 234

Computer Rate Control

Back 234

- Computer programs present text word
by word
- Client reads text at a specified rate
- Several programs available
◦ Pacer
◦ Apps

Front 235

Computerized Rate Control
Yorkston, Hammen, Beukelman, & Trainor, 1990

4 computerized rate control methods for
adults with ataxic and hypokinetic dysarthria

Back 235

1. Additive Metered
◦ One word appeared at a time on computer
screen—equal duration between words
2. Additive Rhythmic
◦ One word appeared at a time on computer
screen—duration between words set to
simulate natural speech patterns--inconsistent
Computerized Rate Control
3. Cued Metered
◦ Whole passage presented on screen—words
underlined—equal duration between words
4. Cued Rhythmic
◦ Whole passage presented on screen—words
underlined—duration between words set to
simulate natural speech patterns—inconsistent

Front 236

Behavioral Instruction (2 components)

Back 236

Rhythmic cueing
◦ Clinician points to written words at
appropriate speed while client reads
◦ Clinician inserts appropriate pauses to
encourage naturalness

Breath grouping
◦ Clinician trains client to speak with
appropriate breath groups

Front 237

Rate Reduction and Training
Less training required for...

Back 237

rigid rate control techniques (alphabet supplementation and pacing boards) and DAF

Front 238

Cognition and Rate Control
Rate control strategies may require...

Back 238

◦ Attention
◦ Memory
◦ Executive function
- When do I need to use my strategy?
◦ New learning

Front 239

Physical Disability and Rate Control

Back 239

- Many rate control techniques require
physical movement
◦ Tapping/pacing
◦ Alphabet supplementation
- Severe physical disabilities may reduce
ability to use rigid rate control
- May need to consider alternative
strategies

Front 240

Segmental speech features

Back 240

◦ Alter the identity of phonemes

◦ Therapy focuses on ability to produce speechsounds—Articulation

Front 241

Suprasegmental speech features

Back 241

◦ Prosodic aspects of speech Stress patterns, intonation, rate and rhythm

◦ Beyond the boundaries of individual speechsounds

Front 242

Active Speech Articulators (3)

Back 242

◦ Lips◦ Jaw◦ Tongue Velum too (and teeth)

Front 243

Assessment of Articulation

Perceptual Assessment

Back 243

◦ Is there an oral articulation impairment?

◦ How severe is it?

◦ How does the severity of this impairment compare to other impairments?

Respiration

Phonation

Velopharyngeal function

Front 244

Oral Mech Exam

Back 244

◦ Observe system as rest and system in motion

◦ ROM

◦ Strength and control of tongue movements

◦ Strength and control of lip movements

◦ Facial symmetry

◦ Open and close mouth—jaw movement

◦ Etc.

Front 245

Diadochokinetic Assessment

Back 245

/papapa/ /tatata/ /pataka/

Front 246

Informal assessment of artic

Back 246

◦ Observe articulators in motion

◦ Listen for articulation errors—you can’t seeeverything!

Front 247

Articulation Inventories◦ Potentially useful clinical tool

Back 247

Compare pre and post treatment articulation Assess changes with palatal lift placement Monitor changes associated with degenerative or improving progression

Front 248

_____________ is dependent upon other speech processes/subsystems

Back 248

Articulation

Front 249

Artic is often considered late in treatment for dysarthria. Why?

Back 249

Attempt to remediate other subsystems first

Front 250

Intelligibility Assessment

Back 250

◦ Objective measurement

◦ Not a direct measure of articulation

Must also consider other aspects of speech production

Front 251

Articulation inventories are not used to assess ___________

Back 251

dysarthria

Front 252

Speech Intelligibility Test

Shown to be effective for:

Back 252

motor speech disorders

laryngeal and oral cancer

foreign dialect

cleft palate

Front 253

Speech Intelligibility Test (SIT)

Back 253

1. Speaker read series of single words or sentences while being recorded

2. Recordings played for unfamiliar listener who transcribe what they hear

3. Calculation completed to determine % of speech intelligibility

Front 254

Phonetic Contrasts List Procedures (4)

Back 254

1. Speaker with dysarthria recorded reading list of words

2. Listeners given corresponding list with the target and 3 foils

3. Listeners select the one they believe the person said

4. Measure of speaker’s word transmission

Front 255

Sentence Intelligibility vs. Word intelligibility

Back 255

know the difference

Front 256

Respiration versus Articulation

Back 256

◦ Assess respiratory drive

Inadequate drive to produce pressure consonants,fricative, etc.?

Mouth words/sounds better than when producedaloud?

◦ If no, focus on respiratory support—articulation could improve as a result

Front 257

Resonance versus articulation

Back 257

◦ Assess nasality

◦ Production of pressure consonants?

◦ Is speech hyper/hype nasal?

Speech with plugged nose and unplugged nose

◦ If so, consider resonance treatment

Front 258

Phonation versus Articulation

Back 258

◦ Assess voiced and voiceless cognates

/pa/ versus /ba/

◦ Can person turn voice on and off as necessary?◦ If not, focus on phonation and articulation may improve

Front 259

Prioritizing Treatment

Back 259

Necessary to rank severity of impairment◦ Determine which is most deviant and affecting speech signal most severely◦ Intervention should focus on most deviant aspect of speech

Front 260

Pharmacological intervention

Back 260

◦ Botox and whole body spasticity medication

Front 261

Rate reduction

Back 261

◦ Pacing board, DAF, metronome, etc.

Front 262

Speech supplementation

Back 262

◦ Alphabet and topic supplementation

Front 263

Types of Treatment

Back 263

Pharmacological intervention

Rate reduction

Speech supplementation

Strengthening exercises

Vocal effort

Drill and practice techniques

Front 264

Botox

Back 264

Injection into spastic muscles of speech

Limited evidence of efficacy

More research needed

Front 265

◦ Baclofen pump

Back 265

Surgically inserted pump that releases baclofen

Some evidence of improvement in speech intelligibility/articulation

Front 266

Rate control techniques

Back 266

◦ Pacing◦ DAF◦ Metronome training◦ Etc.

Front 267

Reduced rate for artic impairment

Back 267

Reduced rate = more time to articulate and ability to separate words = increased intelligibility

Front 268

Strengthening Exercises Examples

Back 268

◦ Bilabial closure

◦ Lip rounding

◦ Tongue protrusion

Front 269

Strengthening exercises are highly ___________

Back 269

controversial and have limited evidence

Front 270

Why are strengthening exercises ineffective? (4)

Back 270

1. Not focusing on speech

2. Weakness is not always the issue

3. Speech requires limited strength

4. Strength training may be contraindicated

Front 271

Is Strength Training Ever Warranted?

Back 271

Possibly, IF:

1. Weakness is the main speech issue

2. Interfering with speech intelligibility

3. Strengthening WILL improve speech production

4. Strengthening is not contraindicated

Front 272

Increased vocal effort training

Back 272

◦ Similar to Lee Silverman Voice Therapy (LSVT)

◦ Increase loudness of speech

Front 273

Contrastive Productions

Back 273

◦ Drill and practice task

◦ Produce two words with one sound distinction e.g., /ban/ and /pan/

◦ Goal = make sounds as distinct as possible

Front 274

Intelligibility Drills - Steps (5)

Back 274

1. Each word printed on a card and cards shuffled

2. Person with dysarthria reads each word

3. Clinician repeats what they heard

4. If correct, move on to next word

5. If incorrect, try one more time and if still incorrect, speaker must find a way to fix the communication breakdown

Front 275

Benefits of intelligibility drills

Back 275

◦ Speaker compensates in any way possible to approximate the appropriate sounds

Clinician does not teach how sounds are produced

◦ Knowledge of results is the natural feedback

◦ Speaker learns how to resolve communication breakdowns

Front 276

Articulation Summary

Back 276

- Common issue associated with dysarthria

- Affected by other speech subsystems

- Often best approach is to target other deviant speech subsystems

- Intelligibility is measure of all speech subsystems combined

Front 277

Prosody - Suprasegmental speech features

Back 277

◦ Stress patterning

◦ Intonation

◦ Rate and Rhythm

Front 278

Prosodic signals distinguish _____________ from __________

Back 278

statements

questions

Front 279

Prosody is important for ____________ and __________

Back 279

intelligibility

naturalness

Front 280

Severe dysarthria - prosody

Back 280

Prosody can signal stress patterns and syntactic boundaries -> increased intelligibility

Front 281

Mild dysarthria - Prosody

Back 281

Prosody can improve naturalness -> decreased handicap associated with dysarthria

Front 282

3 Prosodic Correlates

Back 282

- Perceptual

- Acoustic

- Physiologic

Front 283

Perceptual

Back 283

What the listener perceives

Front 284

Acoustic

Back 284

Objective, measurable features

Front 285

Physiologic

Back 285

What the speaker is doing

Front 286

Stress patterning issues in dysarthria

Back 286

◦ Monoloudness

◦ Monopitch

◦ Excessive loudness variation

◦ Loudness decay

◦ Alternating loudness

◦ Reduced stress

◦ Excess and equal stress

Front 287

Intonation issues in dysarthria

Back 287

◦ Pitch level fluctuations

◦ Monopitch

◦ Short phrases

Front 288

Rate-Rhythm issues in dysarthria

Back 288

◦ Rate disturbances

◦ Increased rate in segments

◦ Increased overall rate

◦ Variable rate

◦ Prolonged intervals

◦ Inappropriate silences

◦ Short rushes of speech

Front 289

Many different prosodic features Often grouped into two patterns

Back 289

1. Excessiveness

2. Reductions

Front 290

Speech Naturalness

Back 290

Perceptual term Overall description of prosodic adequacy Speech should conform to normal rate,stress patterning, and intonation

Front 291

Dysarthric Features that Reduce Speech Naturalness (3)

Back 291

1. Monotomy

2. Syntactic Mismatches

3. Inconsistency Across Features

Front 292

Assessment of Prosody Rating of Naturalness

Back 292

◦ Naturalness is perceived

◦ Listeners rate speech naturalness on 7-pointequally appearing interval scale

Front 293

Assess the importance of naturalness based on _____________

Back 293

social roles

Front 294

Go back and look at assessment of communicative function

Back 294

04.13.15 lecture, toward the end

Front 295

Instrumental Assessment of Prosody - Changes

Back 295

Becoming easier to access instrumental assessment equipment

Used to need expensive equipment

Now have spectrogram apps

Front 296

Instrumental Assessment of Prosody - Asses:

Back 296

◦ Fundamental frequency

◦ Duration

◦ Amplitude = loudness

Front 297

Assess Stimulability: Breath Grouping

Back 297

Client exhibits odd breath grouping patterns

◦ Inadequate respiratory drive?

◦ Adequate respiratory drive but poor control?

◦ Can identify appropriate places for pauses/breath?

Front 298

Assess Stimulability: Communicative Function

Back 298

Assess:

Knowledge of appropriate stress patterns

Ability to add stress to specific words

◦ Reading

◦ Conversation

Front 299

Prosody Wrap Up

Back 299

- Do not overlook prosody! - Crucial for naturalness and for intelligibility - Can be assessed perceptually and through instrumentation

Front 300

Apraxia of Speech--Definition

Back 300

A neurological speech disorder that reflects an impaired capacity to plan or program sensorimotor commands necessary for directing movements that result in phonetically and prosodically normal speech.

Front 301

Apraxia of speech can occur...

Back 301

in the absence of physiological disturbance associated with the dysarthrias and in the absence of a disturbance in any component of language

Front 302

Apraxia—Many Different Disorders (7)

Back 302

- Buccofacial/orofacial apraxia = most common - - Limb-kinetic apraxia

- Ideomotor apraxia

- Ideational apraxia

- Constructional apraxia

- Oculomotor apraxia

- Verbal apraxia

Front 303

Acquired Apraxia of Speech - What % of all motor speech disorders

Back 303

6.9%

Front 304

AOS often co-occurs with __________

Back 304

aphasia

Front 305

When did we get the terminology for AOS?

Back 305

Darley (1969) ASHA talk:

“The Classification of Output Disturbances in Neurological Communication Disorders”

Front 306

Motor planning

Back 306

Action strategy—when, where, and how to move

Front 307

Motor programming

Back 307

Assembly of simple and complex sequences of movements

Front 308

Motor Execution (Dysarthria)

Back 308

◦ Initiation of the motor sequences

◦ Controlling the course of movement

Front 309

Primary cause of AOS

Back 309

◦ Left hemisphere CVA (middle cerebral artery)

◦ Anterior perisylvian region

Front 310

Other potential causes of AOS (3)

Back 310

◦ TBI

◦ Brain tumor

◦ Neurodegenerative diseases (primary progressive aphasia)

Front 311

AOS - Primary Clinical Characteristics (5)

Back 311

1. Slow speech rate

2. Sound distortions

3. Sound substitutions

4. Errors are relatively consistent in type(omission, substitution, distortion) and location

◦ CONTROVERSIAL!!

5. Prosodic abnormalities

Front 312

AOS - Slow speech rate

Back 312

◦ Lengthened vowel and consonant productions

◦ Lengthened intersegment duration

- Time between sounds

- Time between syllables

- Time between words & phrases

Front 313

Voice Onset Time

Back 313

Time between articulatory start of a consonant and onset of voice for vowel

Front 314

◦ Voiced sounds - VOT

Back 314

Voice onset slightly before to slightly after start of consonant

Front 315

Voiceless sounds - VOT

Back 315

Voice onset after production of the consonant—on for vowel that follows

Front 316

VOT is _____________ in AOS

Back 316

variable

Front 317

AOS - Phonetic Errors

Back 317

◦ Small distortions

◦ Imprecise

Front 318

AOS - Phonological errors

Back 318

◦ Substitutions

Fate-----Gate

◦ Additions

Loom-----Gloom

◦ Deletions

Chair------air

Front 319

AOS - Sequencing errors

Back 319

- Anticipations

Doorknob-----Noorknob

- Perseverations

Pet-----Pep

- Transpositions

Africa-----Arfica

Front 320

Prosodic Abnormalities (3)

Back 320

◦ Explosive speech

Syllable segregation

Equal stress on all syllables

◦ Articulatory Prolongation

Lengthening of sounds

Unusually long transition times between sounds

◦ Speech flow disruption

Groping

Self correction attempts

Pausing

Front 321

Compensatory behavior = prosodic impairment - 2 kinds

Back 321

1. Conscious—reduced speech rate to prevent errors

2. Unconscious—consequence of articulatory groping and self-correction

Front 322

Nondiscriminative Clinical Characteristics - AOS (7)

Back 322

1. Articulatory groping

2. Perseverative errors

3. Errors increasing with increased word length 4. Speech initiation issues

5. Awareness of deficits

6. Automatic speech is better than propositional speech

7. Islands of error-free speech

Front 323

Assessment of Apraxia of Speech (3 main things)

Back 323

Formal testing

◦ Apraxia Battery for Adults-2nd edition(ABA-2)

Informal testing

Observation

Front 324

ABA-2 Structure

Back 324

◦ 6 subtests

1. Diadochokinetic Rate

2. Increasing Word Length

3. Limb Apraxia and Oral Apraxia

4. Latency Time and Utterance Time for Polysyllabic Words

5. Repeated Trials

6. Inventory of Articulation Characteristics of Apraxia

Front 325

Subtest 1—Diadochokinetic Rate

Back 325

Rapid production of /p∧/, /t∧ /, /k∧ /

3 trials

◦ /p∧t∧ /

◦ /t∧ k∧ /

5 trials

◦ /p∧t∧ k∧ /

Count number of correct trials

Assesses

◦ Tongue movement from front to back

◦ Speech rate

◦ Sequencing errors

◦ Perseveration, etc.

Front 326

No real significant difference between genders in diadochokinetic rate for younger adults, but...

Back 326

Geriatric norms are decreased

Front 327

Subtest 2—Increasing Word Length

Back 327

Word repetition

◦ Thick…..Thicken…..Thickening

Assesses

◦ Repetition skills

◦ Syllable number

◦ Self correction skills

◦ Groping behaviors

◦ Sequencing errors

Front 328

Subtest 3—Limb Apraxia and Oral Apraxia

Back 328

Focuses on identification of limb and oral apraxia—NOT verbal apraxia

- Limb Apraxia—Gestures◦ e.g., wave goodbye

- Oral Apraxia—Oral motor tasks◦ e.g., lick lips, stick out tongue

Front 329

Subtest 4—Latency Time and Utterance Time for Polysyllabic Words

Back 329

- Picture naming task

- Measure

◦ Latency time—time to first speech attempt

◦ Utterance time—time from start to finish of word production

- Assesses

◦ Speech rate Production duration

◦ Intersegment duration

Front 330

Subtest 5—Repeated Trials

Back 330

Repeated production of multisyllabic words Example:

◦ Examiner: “flashlight”

◦ Examinee: “flashlight, flashlight, flashlight”

Assesses

◦ Variability in production (consistency of production)

◦ Production of multisyllabic words

Front 331

Subtest 6—Inventory of Articulation Characteristics of Apraxia

Back 331

- Picture description task

- Read aloud “Grandfather” passage

- Counting task

- Complete all tasks while examiner assesses for several speech behaviors

Front 332

Apraxia without aphasia is __________________ than Aphasia without apraxia

Back 332

less common

Front 333

Aphasic (linguistic) errors can resemble...

Back 333

apraxic (motoric) errors

Front 334

Aphasia and Apraxia have the same basic region of...

Back 334

Damage

◦ Aphasia and Apraxia = Left Hemisphere

Middle Cerebral Artery

◦ Aphasia = Temporoparietal more than Frontal

◦ Apraxia = Frontal more than temporoparietal

Front 335

“Pure” Apraxia

Back 335

Assess all facets of language◦ Verbal expression is deficient◦ All other facets of language are within normal limits Auditory comprehension Reading comprehension Written expression

Front 336

Assessing Apraxia and Aphasia across all modalities - Apraxia likely when:

Back 336

◦ Deficits in some or all language modalities

◦ Speech is disproportionately deficient compared to other modalities

Front 337

Differential Diagnosis: Apraxia and Dysarthria Damage Localization

Back 337

Apraxia

◦ Left hemisphere

◦ Supratentorial

◦ Middle cerebral artery

Dysarthria

◦ Right and/or left hemisphere

◦ Supratentorial, posterior fossa, spinal and peripheral regions

◦ Many vascular sources

Front 338

Apraxia and Dysarthria Shared etiologies

Back 338

◦ Stroke, TBI, tumors

Front 339

Etiologies unique to dysarthria

Back 339

◦ Degenerative diseases e.g., Parkinson’s, MS

Front 340

Differential Diagnosis: Apraxia and Dysarthria Oral Mech Exam

Back 340

◦ Often normal for AOS

- Oral-facial apraxia must be considered

◦ Rarely normal for Dysarthria

- Excluding ataxic and hyperkinetic dysarthria

- Issues with strength, ROM, tone, etc.

Front 341

Dysarthria affects

Back 341

Respiration, phonation, resonance,articulation, & prosody

Front 342

AOS affects (as opposed to dysarthria)

Back 342

◦ Articulation & prosody only

Front 343

Dysarthria + Aphasia =

Back 343

Rare

Front 344

AOS + Aphasia =

Back 344

Common

Front 345

Differential Diagnosis: Apraxia and Dysarthria - Utterance Length

Back 345

- Dysarthria

◦ Consistent errors across utterances

◦ Little change based on length of utterance

- AOS

◦ Variable errors possible

◦ Utterance length and complexity affect production

Front 346

Treatment of AOS (3 main things)

Back 346

1. Articulatory/Kinematic

2. Rate and/or Rhythm

3. Augmentative and Alternative Communication

Front 347

Articulatory/Kinematic Treatment Focus on

Back 347

improved movement and/or positioning of articulators

Front 348

Most researched treatment method for AOS is...

Back 348

Articulatory/Kinematic Treatment

Front 349

Rationale for artic/kinematic treatment

Back 349

◦ AOS is a sensorimotor disorder of articulation.

◦ Therapy should focus on improving articulation,specifically sequencing of movements

Front 350

Commonalities in Artic/Kinematic treatments

Back 350

◦ Motor practice of speech targets

◦ Modeling and repetition

◦ Integral stimulation

- “Watch me, listen to me, say it with me”

Front 351

Examples of Articulatory/Kinematic Treatments

Back 351

1. PROMPT

2. Sound production Therapy

Front 352

Articulatory/Kinematic Treatment Placement cues (5)

Back 352

◦ Drawings (Raymer et al., 2002)

◦ Videotaped models (Aten, 1986)

◦ Verbal instruction (Wambaugh et al., 1999)

◦ Visual modeling (Wambaugh et al., 1999)

◦ Shaping (Knock et al., 2000)

Front 353

PROMPT stands for...

Back 353

Prompts for Restructuring Oral and Muscular Phonetic Targets

Front 354

PROMPT is a system of...

Back 354

finger cues

Front 355

PROMPT Originally used for

Back 355

CAS

Front 356

PROMPT - client must be able to...

Back 356

◦ Phonate for vowels

◦ Allow clinician to “take control”

◦ Basic comprehension skills

Front 357

PROMPT Clinician cues client on: (7)

Back 357

◦ Place of contact

◦ Mandibular excursion

◦ Resonance and phonation

◦ Number of muscles contracted

◦ Duration of segments

◦ Manner of production

◦ Coarticulation

Front 358

PROMPT Coarticulation

Back 358

◦ Focus on phrase level rather than phoneme level

◦ Back to syllable or phoneme only when necessary

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Contrastive Drills

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With other targets or nontargets

Lack of consensus

Start with maximal opposition and move toward minimal pairs (Wertz, 1984)

Emphasis on minimal pairs (Square-Storer &Hayden, 1989;Wambaugh et al., 1998, 2004)

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Articulatory/Kinematic Treatment - Sound Production Therapy

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Series of steps to train production of minimal pairs

Correct production = stop

Incorrect production = go to next step

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SPT - Step 1

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Modeling/Imitation

◦ Repeat minimal contrast pair (pie/die)

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SPT - Step 1 - Correct production

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◦ Feedback provided

◦ Repeat production

◦ Move on to next pair

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SPT - Step 1 - Incorrect production

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◦ Practice each member of pair separately

◦ Either sound incorrect -> Step 2

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SPT - Step 2

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Modeling & Written Word Cue/Imitation

◦ Therapist point to printed letters (Die/Pie) while modeling correct production

◦ Speaker must repeat

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SPT - Step 2 - Correct

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Repeat again

Move on to next pair

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SPT - Step 2 - Incorrect

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◦ Either sound incorrect -> Step 3

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Look back at SPT steps

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04/20/15

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Target Selection (4 considerations)

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- Phrases, words, syllables, or sounds

- Real words or nonsense words

- Functional words or sound specific words

- Sounds in isolation or clusters