Quiz 2 Info For Motor Speech- Assessment

Front 1

what are the two goals of motor speech evaluation

Back 1

1. to understand a patient's problem-> leading to a diagnosis
2. to establish the beginning level of treatment (determining treatment focus)

Front 2

7 questions to be answered by the evaluation

Back 2

1. is there a problem with the paitent's speech
2. if yes, what is the best way to describe it
3. does the problem seem to be the result of a neurological disorder
4. if so did it appear suddenly or slowly
5. is the problem related strictlly to speech production or is it more of a problem with language, such as aphasia
6. if it is a speech production problem, do most of the problems seem to be related to the sequencing of phonemes (apraxic in nature)
7. if there are not phoneme sequencing errors, what are the characteristics of the patient's speech errors and any associated motor problems

Front 3

what are three reasons that the severity estimate is important

Back 3

1. psycogenic contributions, level of insight, or level of concern about speech, if mismatch
2. prognosis and management decision making
3. can serve as baseline data against which future changes can be compared

Front 4

what are the five speech production components

Back 4

1. respiration
2. phonation
3. resonance
4. articulation
5. prosody

Front 5

respiration provides

Back 5

subglottic air pressure-> vocal fold vibration

Front 6

when respiration is impaired (3)

Back 6

1. short phrase lenght
2. reduced loudness
3. breathy voice

Front 7

phonation is production of ....and is dependent on

Back 7

- production of voiced phonemes through VF vibration
- dependent on VF adduction and subglottic air pressure

Front 8

when phonation is impaired (3)

Back 8

1. breathy or harsh voice
2. strained- strangled voice
3. reduced ability to change pitch or loudness

Front 9

resonance is proper placement of....
accomplished by...

Back 9

- placement of oral or nasal tone onto phonemes
- accomplished by the movement of the velum

Front 10

when resonance is impaired:

Back 10

- velum not moving or moving slowly
- hypernasality

Front 11

articulation is shaping of...
mannor and placement of articulation by....

Back 11

- shaping of the vocal airstream into phonemes
- manner and placement of articulation by different articulators

Front 12

impairment of articulation (3)

Back 12

1. imprecise consonants
2. distorted vowels
3. irregular articulatory breakdowns

* seen in all types of disorders so not a good discriptor

Front 13

prosody is:

Back 13

melody of speech- stress and intonation

Front 14

in prosody:
- stress is accomplished by..
- intonation is accomplished by...

Back 14

- stress accomplished by changing the pitch, loudness, and duration
- intonation accomplished thru pitch change and stress

Front 15

if prosody is impaired then (2)

Back 15

- monopitch (monotone), monoloudness
- irregular pitch, loudness, or duration variations (b/c of unpredicted spasm of muscles

Front 16

what are 6 salient neuromuscular features affecting speech production

Back 16

1. muscle strength
2. speed of movement
3. range of moevement
4. motor steadiness
5. muscle tone
6. accuracy of movement

Front 17

muscle strength characteristics...
task: (2)

Back 17

-is reduced, usually consistently but sometimes progressively
-task: pushing, counting out loud (gets worse and worse)

Front 18

speed of movement characteristic
task: (2)

Back 18

reduced or variable (increased only in hypokinetic dysarthria)- don't move articulators to full potential (very few occurances)

-task: AMR and SMR

Front 19

Range of movement

Back 19

reduced or variable (predominatly excessive only in hyperkinetic dysarthria)

Front 20

motor steadiness
task:

Back 20

- unsteady, either rhythmic or arrhythmic (ahhh/ holding body part steady)

- task: vowel prolongation

Front 21

muscle tone:

Back 21

increased, decreased, or variable

Front 22

accuracy of movement
task:

Back 22

- all patients
- inaccurate, either consistently or inconsistently
-task: AMR, SMR, conversational speech (best test), spoken paragraph reading

Front 23

what are confimatory signs definition

Back 23

signs other than deviant speech characteristics and the salient neuromuscular featrues that help confim the speech diagnosis
- can be found in speech or nonspeech muscles
- something other than speech related-> only used to help confirm diagnosis.
- not necessary for diagnosis
- not diagnostic of motor speech prblems
- used to support conclusion already drawn.

Front 24

6 examples of confirmatory signs within the speech system

Back 24

1. atrophy
2. fasciculations
3. emotional ability (no control)( laugh when nothing funny)
4. reduced normal reflexes
5. presence of pathologic reflexes
6. strength of cough and coup de glotte

Front 25

5 examples of confirmatory signs in nonspeech motor speech

Back 25

1. gait disturbances (discoordinated)
2. abnormal muscle stretch reflexes
3. limb atrophy and fasciculations
4. loss of automatic movements
5. difficulty initiating limb movements

Front 26

5 parts to assessment process

Back 26

1. history (patient's account of what happened and how)
2. examination of the oral mechanism during nonspeech activities
3. perceptual analysis of speech characteristics
4. intelligibility assessment
5. acoustic and physiologic analyses, if possible

Front 27

6 parts of history

Back 27

1. primary and secondary medical diagnosis
2. facts about onset and course
3. associated deficits (drooling, swallowing, chewing, emotional problems)
4. site of lesion
5. patient's awareness of the symptoms/perception of the deficit
6. degree of disability or handicap caused by the problem (consequences of the problem)- goal is always for person to be functional communicator

Front 28

examination of hte speech mechanism during nonspeech activities includes

Back 28

cranial nerve/ oral mechanism exam

Front 29

what are the 5 Cranial nerves invovled in examination of the speech mechanism during nonspeech activities

Back 29

1. CN V trigeminal
2. CN VII facial
3. CN IX glosopharyngeal
4. CN X Vagus
5. CN XII hypoglossal

Front 30

examination of CN V trigeminal nerve for non speech tasks involves what 3 areas

Back 30

1. observation of mandible during mouth opening and lateral movement
2. manipulation of mandible during resistance
3. note weakness, atrophy, groping, or deviation

Front 31

examination of CN V trigeminal nerve for speech type tasks involves what characteristics of what task

Back 31

diadochokinesis of /pa/
- observe # of repeated in 5 seconds (15-20 is normal)
- also observe articulatory accuracy and evenness of rate

Front 32

examination of CN V trigeminal nerve for sensory involves what (2)

Back 32

- inquire about numbness
- light touch on each side: look for symmetry

Front 33

examination for CN VII facial nerve for nonspeech at rest and nonvolitional movement (laughing) look for (3)

Back 33

1. symmetry
2. ptosis (eye drooping), masked face
3. weakness

Front 34

examination of CN VII facial nerve for nonspeech tasks includes (4)

Back 34

1. lip retraction
2. lip pucker/smile
3. lip compression against force
4. wrinkle forehead, when looking up

Front 35

examination of CN VII facial nerve for speech tasks includes (3)

Back 35

1. repetitive /pa/ with bite block to remove participation of the jaw
2. compare # of times per second with no bite block condition
3. if person needs the jaw to help, this may indicate some trouble with lip movement

Front 36

during examination of CN IX glossopharyngeal and CN X vagus nerve observation and inquires are related to

Back 36

dysphagia and drooling

Front 37

examination of CN IX glossopharyngeal and CN X vagus nerve for non speech includes (4)

Back 37

1. velar movement-symmetry when repeating /a/
2. cough
3. glottal coup
4. inhalatory stridor (difficulty breathing) (VF paralysis)

Front 38

examination of CN IX glossopharyngeal nerve and CN X vagus nerve for speech include (3)

Back 38

1. observations for palatal movement during sustained phonation
2. observation of resonance
3. observations of voice quality

Front 39

examination of CN XII hypoglossal nerve for non speech includes (2)

Back 39

1. observe for atrophy or fasciculations of tongue- size, symmetry, stable
2. tongue protrusion, retracion, lateral movement and elevation with and without resistance

Front 40

examination of CN XII hypoglossal nerve for speech includes

Back 40

-AMR: 'ta' for tongue tip and 'ka' for tongue back

Front 41

Inorder to evaluate repiratory adequacy for speech what 4 things should be looked at

Back 41

1. observation of posture;abdominal, thoracic vs. clavicular breathing
2. Evaluate breathing rate (16-18 cycles/minute is the norm)
3. evaluate regularity of breathing
4. evaluate respiratory driving pressure (water glass manometer)- goal= 5 secs with straw depth of 5 cm

Front 42

what 5 tasks can be performed by the patient to test for nonverbal oral apraxia

Back 42

1. blow
2. stick out your tongue
3. show me how you whistle
4. show me how you smile
5. click your tongue

Front 43

when assessing perceptual analysis for speech what 5 areas need to be looked at

Back 43

1. phonatory-respitory system
2. resonation system
3. testing combined components
4. stress testing
5. testing for apraxia of speech

Front 44

what will the patient do for testing phonatory-respitory system and what 6 aspects will the clinician listen for

Back 44

vowel prolongation /a/: listen for
1. hypernasality
2. breathiness
3. harshness (vf not completely closed
4. diplophonia (having two tones one low and one high, happens bc one VF paralyed and is thicker- lower pitch)
5. pitch
6. loudness

Front 45

what 2 techniques are used to assess resonation system

Back 45

1. mirro test while patient is producting/u/- see if mirror fogs up
2. squeeze one nostril at a time to check if any improvement in resonance

Front 46

As far as testing combined components- what are the 5 tasks assessed

Back 46

1. alternate motion rate (AMR): diadochokinetic rate(papapa)- speed, articuation, rhythm
2. sequential motion rate (SMR) (patakapataka)- good test for apraxia of speech
3. standard reading passage
4. narrative about picture scene
5. conversational sample

Front 47

which three of the testing combined components assess prosody and are more of comprehension tests

Back 47

1. standard reading passage
2. narrative about picture scene
3. conversational sample

Front 48

what are the 2 tasks used to asses stres testing

Back 48

1. counting 1-100
2. a screening for myasthenia- a rapid fatigue of the muscles during a sustained motor activity

Front 49

what are 5 aspects of testing for apraxia of speech

Back 49

1. repeating of reading a list of words, from 2-multi-syllabic words with same CVC syllable (please, pleasing, pleasingly)
2. sentences with multi-syllabic words
3. repeat days of week, months, CVC syllables with identical initial and final consonants, sing familiar tune
4. counting 1-20 forward and backward (overlearned vs not overlearned)
5. picture description and sentence repetition (picture descrition is easier- difficulty with on command tasks/ spontaneous tasks easier)