Motor speech exam / Oral mech

Question 0

Steps of the Exam

Answer 0

1. introductions
2. patient/caregiver interview - start judging speech & gather primary concerns
3. physical exam - wash hands, gloves, good visual inspection, don’t apologize

Question 1

Salient features to look at

Answer 1

• strength
• speed of movements (slowness common in MSD)
• range of movement (influence on prosody & articulation)
• Steadiness (tremors, involuntary movements)
• Tone (can be excessive or reduced)
• Accuracy (perceived in articulation & prosody)

Question 2

What might facial asymmetry suggest?

Answer 2

• neuromuscular impairment

- craniofacial anomaly

Question 3

What might flaccidity suggest?

Answer 3

• atrophy

- paresis/paralysis (CN VII)

Question 4

What might spasticity suggest?

Answer 4

• hypertonic muscle activity

- damage to UMN fibres of pyramidal tract

Question 5

What might drooping lip on one or both sides suggest?

Answer 5

• Flaccidity (ipsi CN VII)

- Spasticity (contra pyramidal)

Question 6

What might drooling suggest?

Answer 6

• swallowing difficulties
• some medications
• nervousness
• lack of awareness

Question 7

What might abnormal/adventitious movements suggest?

Answer 7

• tics (localized spasmodic movements)

- chorea, dyskinesias, dystonias

Question 8

What might fasciulations suggest?

Answer 8

• can be benign
• may be loss of innervation of LMN
• if you see these, do a second look & take your time

Question 9

What might myoclonus suggest?

Answer 9

• Damage to CNS

Question 10

What might presence of path. reflexes suggest?

Answer 10

• CNS pathology (esp frontal lobes or subcortical regions)

- use caution interpreting these