Chapter 15 Differential Diagnosis

Question 1

What is different diagnosis?

Answer 1

The process of narrowing possibilities and reaching conclusions about the nature of a deficit.

Question 2

When doing a speech evaluation always try to:

Answer 2

Make a diagnosis

Question 3

If you can’t make a definitive diagnosis then:

Answer 3

> Describe what you find
State why you couldn’t make a diagnosis
State what it’s not definitely not
Do not offer a definitive diagnosis, use words like undetermined, equivocal, probably possible

Question 4

Make a speech diagnosis related to:

Answer 4

The suspected neurological diagnosis or suspected site of lesion and state whether the speech signs are consistent or inconsistent with them

Question 5

Just because a person is diagnosed with a type of disease doesn’t mean that they:

Answer 5

Have deviant speech at the time of the evaluation due to the severity and the level of progression of a disease

Question 6

Etiologies and differential diagnosis:

Answer 6

Some etiologies help determine what to expect in terms of speech deficits

Question 7

Vascular Etiologies:

Answer 7

> Can cause any type of dysarthria
Most commonly associated with Spastic, UUMN, and Ataxic dysarthria
Hemorrhagic stroke is the most common cause of dysarthrias

Question 8

Degenerative Diseases:

Answer 8

> Can cause any type of dysarthria

> Most commonly causes Spastic, Ataxic, Hypokinetic, Flaccid dysarthria

Question 9

Parkinson’s Disease only associated with:

Answer 9

Hypokinetic dysarthria

Question 10

ALS only associated with:

Answer 10

Mixed Flaccid-Spastic dysarthria

Question 11

TBI etiologies in general:

Answer 11

> Can cause any type of dysarthria

Question 12

TBI close head injury etiologies:

Answer 12

Most commonly associated with Spastic dysarthria

Question 13

TBI open head injury etiologies:

Answer 13

Most commonly associated with Spastic, Ataxic, and UUMN dysarthria (the CNS dysarthrias)

Question 14

TBI skull fractures and neck trauma etiologies:

Answer 14

Flaccid dysarthria only

Question 15

Surgical Trauma etiologies:

Answer 15

> Can cause ANY type of dysarthria EXCEPT Hypokinetic
ENT, chest/cardiac surgeries are ONLY associated with Flaccid dysarthria
Neurosurgery is associated CNS dysarthrias and Flaccid dysarthria

Question 16

CNS dysarthrias

Answer 16

Ataxic, Spastic, & UUMN

Question 17

Toxic/Metabolic etiologies

Answer 17

> Most commonly associated with Hyperkinetic and Ataxic dysarthrias

Question 18

Infectious and inflammatory conditions:

Answer 18

Rarely causes dysarthrias and is dependent on the condition

Question 19

Demyelinating diseases:

Answer 19

> Can cause ANY type of dysarthria
RARELY associated with Hypokinetic
Dependent on the disease

Question 20

Guillain Barre

Answer 20

Associated with Flaccid dysarthria

Question 21

MS

Answer 21

Associated with Ataxic dysarthria

Question 22

Anatomic Malformation (of the brain Arnold-Chiari)

Answer 22

Associated with Flaccid dysarthria

Question 23

Neuromotor Junction Disorder etiologies (PNS diseases)

Answer 23

Only associated with Flaccid dysarthria

Question 24

Dysarthrias that can (most commonly) be presented without a neurological diagnosis:

Answer 24

Hyperkinetic, Spastic, & Ataxic

Question 25

Oral Mechanism Findings

Answer 25

certain findings in the oral mechanism are not required for Motor Speech Disorders but are used as confirmatory signs

Question 26

FLACCID Oral Mechanism Findings

Answer 26

>Atrophy and fasiculations >Hypoactive gag reflex most often occur >Nasal regurgitation may be seen >Rapid loss of intelligibility = Myasthenia Gravis

Question 27

SPASTIC Oral Mechanism Findings

Answer 27

>Pathological oral reflexes >Hyperactive gag reflex >Pseudobalbar effect >Problems w/ drooling and swallowing

Question 28

ATAXIC Oral Mechanism Findings

Answer 28

>Dysmetria in non speech jaw/face/tongue movements

Question 29

HYPOKINETIC Oral Mechanism Findings

Answer 29

>Orofacial tremors | >Masked face is common

Question 30

HYPERKINETIC Oral Mechanism Findings

Answer 30

>Abnormal movements at rest and in speech

Question 31

UUMN Oral Mechanism Findings

Answer 31

>Unilateral facial and lingual weakness w/o atrophy or fasciculations

Question 32

Speech characteristics of Flaccid dysarthria

Answer 32

``` >Phonatory/Resonatory abnormalities are the most common characteristics: >Breathiness (with greater hoarseness) >Diplophonia >Audible inspiration >Short phrases >Rapid deterioration of speech= MG ```

Question 33

Speech characteristics of Spastic dysarthria

Answer 33

>Slow rate >Slow regular AMRs >Strained voice quality >All three above not typical in any other

Question 34

Speech characteristics of Ataxic dysarthria

Answer 34

>Irregular articulatory breakdowns >Irregular AMRs >Dysprosody

Question 35

Speech characteristics of Hypokinetic dysarthria

Answer 35

>Rapid blurred speech >Rapid blurred AMRs may occur >Palilalia does not occur with any other

Question 36

Speech characteristics of Hyperkinetic dysarthria

Answer 36

>Abnormal movements

Question 37

Speech characteristics of UUMN dysarthria

Answer 37

>Mildness (irregular AMRs, strain) | >Transient duration