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49 Cards in this Set

  • Front
  • Back
what are the two goals of motor speech evaluation
1. to understand a patient's problem-> leading to a diagnosis
2. to establish the beginning level of treatment (determining treatment focus)
7 questions to be answered by the evaluation
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
what are three reasons that the severity estimate is important
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
what are the five speech production components
1. respiration
2. phonation
3. resonance
4. articulation
5. prosody
respiration provides
subglottic air pressure-> vocal fold vibration
when respiration is impaired (3)
1. short phrase lenght
2. reduced loudness
3. breathy voice
phonation is production of ....and is dependent on
- production of voiced phonemes through VF vibration
- dependent on VF adduction and subglottic air pressure
when phonation is impaired (3)
1. breathy or harsh voice
2. strained- strangled voice
3. reduced ability to change pitch or loudness
resonance is proper placement of....
accomplished by...
- placement of oral or nasal tone onto phonemes
- accomplished by the movement of the velum
when resonance is impaired:
- velum not moving or moving slowly
- hypernasality
articulation is shaping of...
mannor and placement of articulation by....
- shaping of the vocal airstream into phonemes
- manner and placement of articulation by different articulators
impairment of articulation (3)
1. imprecise consonants
2. distorted vowels
3. irregular articulatory breakdowns

* seen in all types of disorders so not a good discriptor
prosody is:
melody of speech- stress and intonation
in prosody:
- stress is accomplished by..
- intonation is accomplished by...
- stress accomplished by changing the pitch, loudness, and duration
- intonation accomplished thru pitch change and stress
if prosody is impaired then (2)
- monopitch (monotone), monoloudness
- irregular pitch, loudness, or duration variations (b/c of unpredicted spasm of muscles
what are 6 salient neuromuscular features affecting speech production
1. muscle strength
2. speed of movement
3. range of moevement
4. motor steadiness
5. muscle tone
6. accuracy of movement
muscle strength characteristics...
task: (2)
-is reduced, usually consistently but sometimes progressively
-task: pushing, counting out loud (gets worse and worse)
speed of movement characteristic
task: (2)
reduced or variable (increased only in hypokinetic dysarthria)- don't move articulators to full potential (very few occurances)

-task: AMR and SMR
Range of movement
reduced or variable (predominatly excessive only in hyperkinetic dysarthria)
motor steadiness
- unsteady, either rhythmic or arrhythmic (ahhh/ holding body part steady)

- task: vowel prolongation
muscle tone:
increased, decreased, or variable
accuracy of movement
- all patients
- inaccurate, either consistently or inconsistently
-task: AMR, SMR, conversational speech (best test), spoken paragraph reading
what are confimatory signs definition
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.
6 examples of confirmatory signs within the speech system
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
5 examples of confirmatory signs in nonspeech motor speech
1. gait disturbances (discoordinated)
2. abnormal muscle stretch reflexes
3. limb atrophy and fasciculations
4. loss of automatic movements
5. difficulty initiating limb movements
5 parts to assessment process
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
6 parts of history
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
examination of hte speech mechanism during nonspeech activities includes
cranial nerve/ oral mechanism exam
what are the 5 Cranial nerves invovled in examination of the speech mechanism during nonspeech activities
1. CN V trigeminal
2. CN VII facial
3. CN IX glosopharyngeal
4. CN X Vagus
5. CN XII hypoglossal
examination of CN V trigeminal nerve for non speech tasks involves what 3 areas
1. observation of mandible during mouth opening and lateral movement
2. manipulation of mandible during resistance
3. note weakness, atrophy, groping, or deviation
examination of CN V trigeminal nerve for speech type tasks involves what characteristics of what task
diadochokinesis of /pa/
- observe # of repeated in 5 seconds (15-20 is normal)
- also observe articulatory accuracy and evenness of rate
examination of CN V trigeminal nerve for sensory involves what (2)
- inquire about numbness
- light touch on each side: look for symmetry
examination for CN VII facial nerve for nonspeech at rest and nonvolitional movement (laughing) look for (3)
1. symmetry
2. ptosis (eye drooping), masked face
3. weakness
examination of CN VII facial nerve for nonspeech tasks includes (4)
1. lip retraction
2. lip pucker/smile
3. lip compression against force
4. wrinkle forehead, when looking up
examination of CN VII facial nerve for speech tasks includes (3)
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
during examination of CN IX glossopharyngeal and CN X vagus nerve observation and inquires are related to
dysphagia and drooling
examination of CN IX glossopharyngeal and CN X vagus nerve for non speech includes (4)
1. velar movement-symmetry when repeating /a/
2. cough
3. glottal coup
4. inhalatory stridor (difficulty breathing) (VF paralysis)
examination of CN IX glossopharyngeal nerve and CN X vagus nerve for speech include (3)
1. observations for palatal movement during sustained phonation
2. observation of resonance
3. observations of voice quality
examination of CN XII hypoglossal nerve for non speech includes (2)
1. observe for atrophy or fasciculations of tongue- size, symmetry, stable
2. tongue protrusion, retracion, lateral movement and elevation with and without resistance
examination of CN XII hypoglossal nerve for speech includes
-AMR: 'ta' for tongue tip and 'ka' for tongue back
Inorder to evaluate repiratory adequacy for speech what 4 things should be looked at
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
what 5 tasks can be performed by the patient to test for nonverbal oral apraxia
1. blow
2. stick out your tongue
3. show me how you whistle
4. show me how you smile
5. click your tongue
when assessing perceptual analysis for speech what 5 areas need to be looked at
1. phonatory-respitory system
2. resonation system
3. testing combined components
4. stress testing
5. testing for apraxia of speech
what will the patient do for testing phonatory-respitory system and what 6 aspects will the clinician listen for
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
what 2 techniques are used to assess resonation system
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
As far as testing combined components- what are the 5 tasks assessed
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
which three of the testing combined components assess prosody and are more of comprehension tests
1. standard reading passage
2. narrative about picture scene
3. conversational sample
what are the 2 tasks used to asses stres testing
1. counting 1-100
2. a screening for myasthenia- a rapid fatigue of the muscles during a sustained motor activity
what are 5 aspects of testing for apraxia of speech
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)