Flashcards in Chapter 3 Motor Speech Disorders Exam Deck (28)
Purpose of Exam (5)
>Give a description of the patient's speech
>To establish diagnostic possibilities
>To establish a diagnosis
>To establish implications for localization and disease diagnosis
>To specify severity
Purpose of Exam: Giving a description
>Describes patient's speech and structures/functions associated with speech
>Determines if the descriptions are normal or abnormal
>Attempts differential diagnosis based on those descriptions
Purpose of Exam: Establishing diagnostic possibilities
>Attempts to determine possible diagnosis
>Type of disorder: Apraxia, Dysarthria, Aphasia
>Type of problem: Neurological, Developmental, Acquired
Purpose of Exam: Establishing diagnosis
>Attempt to make a specific diagnosis based on possibilites
>If undetermined than list possibilities in order of most likely to least likely
Purpose of Exam: Establishing implications for localization and disease diagnosis
>Clinician should state the diagnosis and localization associated with that diagnosis
>e.i. spastic dysarthria associated with UMN involvment
>e.i. ataxic dysarthria associated with cerebellar involvement
>State if the MSD findings are inconsistent with the previous disease diagnosis
>Uncertain diagnosis indicate possibilities
Purpose of Exam: Specifying severity
MILD, MODERATE, SEVERE
The SLP should always comment on severity in order to:
>Compare with the patient's complaints and determine possible psychogenic component or lack of patient insight
>Influences prognostic decision and how to manage the disorder
>Provides baseline information to compare progress or changes
General Guidelines for Exam (4)
>Interpretation of findings
General Guidelines for Exam: History
>Time of onset
>Course of development
>Patient's complaints and observations
>Provides an opportunity to listen to patient's speech and evaluate without them knowing
General Guidelines for Exam: Salient features
Features that most directly contribute to/influence the diagnosis
>Strength (muscle weakness most commonly associated with flaccid dysarthria)
>Speed (phasic movements controlled with UMN input) too much speed = Hypokinetic
>Range decrease ROM associated with slow/excessive speeds, varying ROM = Ataxic
>Steadiness lack of steady manifest as tremors or hyperkinesias and can affect phonation/prosody and vowel prolongation
>Tone (muscle tone, hyper or hypo)
>Accuracy associated with movements which can result in speech errors
General Guidelines for Exam: Confirmatory signs
Additional clues about the pathology in the nervous system which help support speech diagnosis
>In speech: atrophy and fasiculations, emotional liability, reduced tone
>Non speech: Gait, limb reflexes, pathological reflexes
General Guidelines for Exam: Interpretations of findings
Integrate information from the patient's history, salient features, confirmatory signs to make a diagnosis
Motor Speech Exam: History
>Intro and goal setting
>Basic demographic data
>Onset and course of deficit
>Associated deficits (swalliowing/drooling)
>Patient's perception of deficits
>Consequences (difficulty being understood)
>Management (how have compensated)
>Awareness of diagnosis and prognosis
Motor Speech Exam: Face at rest
>Symmetry and tone should be normal
>Shouldn't droop, be rigidly fixed, have extraneous movements or uncontrollable emotions
>Ask patient to relax and look ahead with mouth slightly open to breathe through
>Look at corners of mouth, lips, eyes, chin, nasolabial fold, expression, facial posture, movements
Motor Speech Exam: Face during sustained posture
>Have patient retract lips, round lips, puff cheeks, open mouth
>Can postures be held for several seconds?
>Is patient able to resist clinicians attempts change the posture?
>Note symmetry, ROM, sagging. tremors, drooping
Motor Speech Exam: Face during movement
During speech and non speech movements look for:
Compare in voluntary and involuntary movements
Motor Speech Exam: Jaw at rest
>Tightly closed or open at rest?
>Hanging lower than normal?
>Tremors or involuntary movements?
>Pulling to one side?
Motor Speech Exam: Jaw during sustained posture
>Observe jaw in sustained posture such as mouth opening and watch for deviations
>Attempt to open jaw with clenched teeth to check patient's resistance
> Palpate masseter/temporalis while clenching teeth to check for bulk
>Attempt to close the patients open mouth to check for resistance
Motor Speech Exam: Jaw in movement
Watch for symmetry and ROM in speech and spontaneous movements of jaw
>Have patient rapidly open and close mouth and not speed and regularity
Motor Speech Exam: Tongue at rest
Have patient open mouth and observe tongue inside (slight movement is okay)
>Is tongue symmetrical and of normal bulk and size?
>Is there atrophy/fasiculations?
>Is it wet or dry?
Motor Speech Exam: Tongue in sustained posture
Have patient protrude tongue and hold it
>Look for Deviations and have patient repeat task
>Look for ROM of tongue potrusion
>Can patient resist pushing tongue to each side?
>Can patient resist pushing on tongue tip?
>Can patient resist pushing on cheek?
Motor Speech Exam: Tongue during movement
>Ask patient to move tongue rapidly from side to side
>Look for speech regularity
>Look at ROM
Motor Speech Exam: Velopharynx at rest
Look at palate
Motor Speech Exam: Velopharynx during movement
Have patient say a prolonged "ah"
>look for palatal movement
>Look at symmetry of movement
Hold mirror under nose during "ah" and pressure consonants
>is there nasal airflow?
Hold patients nose during vowel
>is there a difference in resonance?
Have patient puff cheeks with air
>Can they resist pushing against cheeks?
Have patient puff up cheeks with tongue out
>Does air escape from nose?
If possible observe VP activity during videoflouroscopy
Motor Speech Exam: Larynx
Assess VF adduction through coughing
>Listen for cough sharpness not loudness
>Weakness indicates either poor VP closure or poor respiratory support
Glottal Coup requires little respiratory effort
>If cough is weak and coup is sharp then there is weak respiratory support
>If both are weak then there is definitely poor VF but may also have weak respiratory support
>Inhalatory stridor may indicate poor vocal fold abduction
Observe VF through Flex scope, rigid scope, video strobe, EGG
Motor Speech Exam: Respiration
>Note posture and possible affects on breathing
>Patient complaints with breathing at rest or active
>Is breath short, shallow, or rapid
>Clavicular breathing associated with respiratory weakness and reduced loudness
>Is breathing rate regular, flaring of nares, persistent hiccups (medulla)
>Contrast sharpness of cough to glottal coup
>Patient should be able to blow through a straw (placed at least 5cm deep) into a cup filled at least 12cm with water and produce and maintain a stream of bubbles for at least 5 seconds
Motor Speech Exam: Reflexes
Two types: Normal (normal nervous system0 and Pathological (present during infancy and and reappear due to CNS disease)
>Palmomental reflex (pathological)
Motor Speech Exam: Volitional vs. Automatic non speech movements
Nonverbal oral apraxia (NVOA) patients are able to do involuntary oral movements but may not able to upon command
>Often but not always associated with AOS
>Have the client attempt to imitated if unable to execute movements on command