Lecture 4 Flashcards by Melanie Riva

What are the goals of Ax in MSD?

diagnosis
determining severity of speech impairment (speech intelligibility)
determining underlying reasons for reduced intelligibility and perceptual abnormalities
determining Tx targets
documenting progress

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What are the 6 components of Ax for MSD?

History (chart review & interview)
Oral motor & sensory exam
Intelligibility testing
Perceptual evaluation of speech
Instrumental assessment
Diagnostic therapy probes

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What are some questions to ask during an interview?

-Pt description of problem
-date of onset
-pattern of onset
-nature of symptoms
-medical/surgical history
-medications
-impact on daily functions
etc.

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What information do we get from an OME?

Info on

structural integrity (presence of structures, inflammation, changes in colour, proportionality)
severity of physical change/damage
localization of damage (UMN vs. LMN, CN)
symmetry
NO INFO ABOUT SPEECH

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What is one way we can slightly decrease subjectivity of OMEs?

you create protocols that you follow for each person every time. This consistency allows us to understand the range of severities and symptoms

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What are 3 ways you can organize an OME?

by cranial nerve
by structure
by subsystem

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Which parameters of muscle function do we assess during an OME?

strength of muscle contractions
range of non-speech movements
speed of NS movements
accuracy of NS movement
muscle tone
symmetry
coordination of rapid, repeated, NS movements

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Which structures do we assess for CN V?

Jaw

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In regards to the jaw, what do we look at during an OME?

• Rest Position (skin over masseter & temporalis)
• Clench jaw – palpate masseter & temporalis for asymmetry, volume and tone.
• On opening – observe size & deviation of mandible
• During movement
• Test opening and closing of jaw against
resistance
• Elicit jaw-jerk

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CN V has __________ innervation for UMNs

bilateral

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What happens if there is unilateral UMN damage to CN V?

no effect

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What happens if there is bilateral UMN damage to CN V?

open jaw,

positive jaw jerk

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What happens if there is unilateral LMN damage to CN V?

jaw deviates towards WEAK side on opening
(felt as asymmetry during
clenching)

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What happens if there is bilateral LMN damage to CN V?

open jaw, absent

(normal) jaw jerk

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What structures do we assess for CN VII?

face and lips

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In regards to the face and lips, what do we look at during an OME while they are at rest?

-Symmetry at angles of mouth
• Flattening of nasolabial folds
• Drooling
• Eyelids partially closed
• Eyes shut involuntarily or not at all
• “Masked face”
• Absence of wrinkling on forehead

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In regards to the face and lips, what non-speech movements do we look at during an OME?

• Smile, pucker, rounding, pout
• Alternating smile-pucker
• Labial seal: puff cheeks, clinician pushes
air out
• AMR - /ba-ba/

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What is special about the UMN supplying the face?

It has bilateral innervation for the forehead and the lower face has unilateral - contralateral innervation

What happens if there is unilateral UMN damage to CN VII?

lower face ONLY is affected (on pucker, lips deviate toward the weak side; contra- to the side of damage)

What happens if there is unilateral LMN damage to CN VII?

affects upper

and lower face. On pucker, lips deviate towards the weak side (ipsi to side of damage)

What happens if there is bilateral LMN damage to CN VII?

complete facial paralysis

List the signs of facial nerve paralysis

Paralysis of all the muscles of facial expression:
Facial asymmetry
Eyebrow droop
Loss of forehead & nasolabial folds
Drooping of corner of mouth
Uncontrolled tearing
Inability to close eye
Lips cannot be held tightly together
Facial muscle atrophy (late stage)

What are 3 diseases that affect CN VII

bell’s palsy
acoustic neuroma
lyme disease

Which structures do we assess for CN IX and X?

soft palate, pharynx and larynx

What do we look for in the soft palate & pharynx

• Velar symmetry at rest • Velar symmetry on phonation – look for elevation & movement of faucial pillars • Nasal emissions (using mirror) – during cheek-puff, modified tongue anchor test, and non-nasal speech samples • Gag reflex

What do we look for in the larynx

* Prolongation of /a/: maximum phonation time, quality, pitch, pitch breaks, diplophonia, tremor or WOW (slow) or flutter (fast), voice arrest, fluctuation in loudness * Inhalatory stridor * Cough on demand, clear throat on demand * Glottal coup

The UMNs of CNs IX & X have _____________ innervation

bilateral

What happens if there is unilateral UMN damage to CN IX & X?

-no effect on velum & pharynx or the larynx

What happens if there is bilateral UMN damage to CN IX & X?

- symmetrically weak soft palate | - complete VF paralysis

What happens if there is unilateral LMN damage to CN IX & X?

-during phonation, soft palate deviates towards the STRONG side -unilateral VF paralysis

What happens if there is bilateral LMN damage to CN IX & X?

-symmetrically weak soft palate -complete VF paralysis

For CN IX & X LMN lesions, the lower the lesion the more _________ the damage

isolated

Which structures do we assess for CN XII?

tongue

What do we assess when looking at the tongue?

• Symmetry at rest and on protrusion • Tremor? at rest and with movements • Fasciculations? at rest, and on lateralization • ROM: protrusion, lateralization (internal & external), elevation to alveolar ridge, elevation external, depression external, lip-lick, tongue wag, DDK • Strength: against resistance (tongue depressor & inside cheek)

The UMN of CN XII has __________ innervation

bilateral innervation, with the exception that the genioglossus has contralateral innervation

What happens if there is unilateral UMN damage to CN XII?

tongue deviates to the weak side on protrusion

What happens if there is unilateral LMN damage to CN XII

tongue deviates to the weak side on protrusion

What happens if there is bilateral LMN damage to CN XII

bilateral tongue | weakness. Observe fasciculations and atrophy -> LMN lesion

T or F: based purely on tongue deviation, we cannot distinguish between UMN unilateral damage and LMN unilateral damage

true

What do we observe during an OME in terms of respiration?

``` • Posture • Shortness of breath • Rapid, shallow, labored, noisy • Nasal flare on inhalation • Clavicular movement • Listen for changes in loudness, breath group duration, reduced phrase and word stress ```

What reflexes should be measured during an OME?

- gag | - pathological reflexes: jaw jerk, suck, root, snout

In terms of sensory modalities, what do we need to assess?

- vision - hearing - light-touch discrimination - two-point discrimination

What are 4 formal tests related to OMEs?

- Frenchay Dysarthria Assessment (FDA) - Oral Speech Mechanism Screening Examination (OSMSE-R) - Robbins & Klee - Verbal motor production assessment for children (VMPAC)