Assessment Plan

Question 1

Case history

Answer 1

• introduction and goal setting; discuss with client why they are at therapy/what they want to get out of it
• background information; social support, daily routine
• onset and course; sudden vs gradual, improving/deteriorating
• current status and perceptions; what helps? When is it better/worse - any pattern?
• clients/carers perception of the problem, consequences of the dysarthria
• observe posture, mood, hearing and vision during case history
• listen to intelligibility and respiration

Question 2

The dysarthria impact profile (Walshe et al, 2009)

Answer 2

• psychosocial impact of dysarthria from speakers perspective
• four sections; the effect of dysarthria on me as a person, accepting my dysarthria, how i feel others react to my speech, how dysarthria affects my communication with others

Question 3

Frenchay Dysarthria Assessment (FDA-2) (Enderby, P., Palmer, R. 2008. Frenchay dysarthria assessment - second edition)

Answer 3

• assesses oromotor movements

Question 4

Why is it important to assess

Answer 4

• reach a diagnosis, establish severity, rate intelligibility and comprehensibility
• assess the impact that the impairment has on their life (activity limitations and participations)
• guide intervention and treatment focus
• enable goal setting
• to measure change (outcome measures)
• make prognosis and potential long term intervention

Question 5

What to assess

Answer 5

• take holistic approach - encompassing a range of variables
• development of ICF has moved therapy away from impairment based analysis of speech deficits - consider participation and activity

Question 6

Assessing body function (ICF)

Answer 6

• breath support
• laryngeal performance
• oromotor performance
• prosody
• cognitive functioning
• other concomitant problems; dysphagia, visual impairment, auditory processing disorder

Question 7

Oromotor exam

Answer 7

• assesses articulation (tongue and lip movement)

Question 8

Assessment of intelligibility of dysarthric speech (Yorkston & Beukelman, 1984)

Answer 8

• obtains an estimate of overall severity
• speaker reads 50 one or two syllable words, one at a time
• limits learning effects selecting target words at random from a larger set of potential words

Question 9

Grandfather passage (Aronson and brown 1975)

Answer 9

Use (Dobinson, 2009) 9 point scale to assess intelligibility

Question 10

Respiration

Answer 10

Speech is breathy and person can only speak in short sentences or phrases
Volume also decreased

Question 11

Assessment tasks for respiration

Answer 11

• say /a/ for as long as possible (norm 10-15 secs)
• s-z ratio to differentiate from vocal cord dysfunction
• count 1-5 getting louder each time
• listen to vocal volume in connected speech
• utterance length

Question 12

Phonation

Answer 12

Production of voice through vocal fold vibration in the larynx

Question 13

Phonation - assessment tasks

Answer 13

• cough
• say /a/ as long as possible, listen to voice quality
• loudness and pitch during connected speech

Question 14

Resonance

Answer 14

• placement of tones (oral or nasal) in phonemes during speech
• can be reduced nasal airflow; hyponasal speech
• excessive nasal airflow; hypernasal

Question 15

Resonance assessment tasks

Answer 15

• observe the velum at rest, does it rise symmetrically on phonation of /a/ and series of /a/

Question 16

Articulation

Answer 16

Needs articulators (lips, jaw, tongue, velum, larynx) to perform movements required for each phoneme with appropriate timing, direction, force, speed, placement

Question 17

Assessment tasks - articulation

Answer 17

• OME; tongue and lip movement, blow out cheeks
• DDK tasks