Perceptual Assessment Flashcards
(92 cards)
1
Q
T/F
Before the ‘60s, there was a homogeneous view of dysarthria.
A
True
Dysarthria was lumped with aphasia.
2
Q
What is the Mayo Clinic system?
A
A classical system for the perceptual analysis of dysarthrias developed by Darley, Aronson and Brown in the ’60-‘70s.
3
Q
What advances were made in the study of dysarthria in the ‘80s and ‘90s?
A
‘80s – Netsell proposed a physiologic approach to dysarthria
Late ’80-‘90s – the study of the intelligibility of dysarthric speech began
4
Q
Presently, what kinds of studies of dysarthria are being advanced?
A
Kinematic and other physiological studies
5
Q
State the 4 tenets of the Mayo Clinic system.
A
- Dysarthrias are recognized by how they sound.
- They can be distinguished from normal speech and non-neurological speech disoders.
- Not all people with dysarthria sound the same, and the differences go beyond variations in severity.
- When they sound the same, similarities logically reflect lesion loci and common pathophysiology.
6
Q
What tasks were the 212 participants of the original DAB studies asked to do?
A
Vowel prolongations, reading a passage, AMR
7
Q
Darley, Aronson and Brown proposed that there are 38 deviant speech dimensions that can be categorized into what 7 categories?
A
Respiration, voice quality, pitch, prosody, articulation, loudness, overall
8
Q
In addition to the Mayo Clinic’s 38 deviant speech dimensions, 10 other relevant dimensions are:
A
Diplophonia, inhalatory stridor, flutter, myoclonus, weak pressure consonants, slow/fast AMRs, irregular AMRs, simple vocal tics, palilalia, coprolalia
9
Q
T/F
Flaccid dysarthria is a UMN disorder.
A
False – LMN disorder, resulting from damage to the cell, axon, neuromuscular junction, or muscle
10
Q
T/F
In flaccid dysarthria, only voluntary movements are impaired.
A
False – all types of movements (voluntary, automatic, reflexive) are impaired.
11
Q
What is flaccid dysarthria characterized by?
A
Weakness, flaccidity, reduced/absent reflexes, atrophy, fasciculations
12
Q
T/F
Most dysarthrias can result from specific damage to isolated nerves and muscles.
A
False – flaccid dysarthria is one of the onle dysarthrias that can result from this, as manifested in conditions like Bell’s palsy and unilateral vocal fold paralysis
13
Q
What condition might you have if you present with flaccid dysarthria and multiple peripheral nerves are affected?
A
Bulbar palsy
14
Q
Describe the respiratory features of flaccid dysarthria.
A
- Weakness of respiration
- rapid and shallow breathing
- flaring of nostrils
- inhalatory stridor (auditory inhalation)
- short phrases
- reduced maximum phonation time
- use of accessory muscles
15
Q
Describe the articulatory features of flaccid dysarthria.
A
Laboured, imprecise consonants
16
Q
Describe the resonance in speakers with flaccid dysarthria.
A
Hypernasality, nasal emission
17
Q
Describe the phonation of speakers with flaccid dysarthria.
A
- Phonatory incompetence
- hoarseness
- breathiness
- reduced loudness
- diplophonia with unilateral lesions
18
Q
The prosody in flaccid dysarthria is characterized by:
A
Monopitch, monoloudness, short phrases
19
Q
T/F
The rate of speech in flaccid dysarthria is abnormal.
A
False – rate of speech is usually within normal limits, but with reduced range of motion
20
Q
The most deviant speech characteristics encountered in flaccid dysarthria are:
A
- Hypernasality
- Imprecise consonants
- Breathiness
- Monopitch
- Nasal emission
- Auditory inhalation
- Harsh voice quality
- Short phrases
- Monoloudness
21
Q
Name the 3 deviant clusters of features associated with flaccid dysarthria.
A
- Phonatory incompetence (breathiness, short phrases, audible inspiration)
- Resonatory incompetence (hypernasality, imprecise consonants, nasal emissions, short phrases)
- Phonatory-prosodic insufficiency (harsh voice, monoloudness, monopitch)
22
Q
T/F
The following characteristics are more severely impaired in flaccid dysarthria than any other dysarthria type:
Hypernasality, breathiness, nasal emission, auditory inhalation, short phrases.
A
True
23
Q
T/F
Spastic dysarthria is a UMN disorder.
A
True – it involves bilateral damage to the pyramidal and extrapyramidal systems under UMN control.
24
Q
T/F
Spastic dysarthria results in a loss of all types of movements.
A
False – loss of skilled voluntary movements
25
Spastic dysarthria is characterized by:
Spasticity, exaggerated reflexes, pseudobulbar affect, weakness (but not to the extent of flaccid dysarthria), effortful and slow movement
26
T/F
| Atrophy is a characteristic of both flaccid and spastic dysarthria.
False – just flaccid, not spastic
27
Describe the effects of spastic dysarthria on the jaw.
The jaw is typically unaffected.
28
T/F
| In spastic dysarthria, lower facial weakness is not as pronounced as in flaccid dysarthria.
True
29
Describe the effects of spastic dysarthria on the tongue.
Full bulk, symmetric, slow DDKs with reduced range of motion
30
What are the features of phonation in spastic dysarthria?
- Laryngeal/phonatory stenosis (laryngeal valve hyperadduction)
- Harsh voice quality (strained/strangled)
- Low pitch, reduced pitch range, pitch breaks
- Monoloudness
31
What are the respiratory features in spastic dysarthria?
- reduced inhalatory and exhalatory respiratory volumes
- shallow breathing
- paradoxical breathing (antagonistic contraction of abdominal musculature)
- reduced utterance length per breath group
32
Articulation in spastic dysarthria is:
Slow, laboured, imprecise
33
Resonance in spastic dysarthria is:
Hypernasal
34
Prosody in spastic dysarthria is characterized by:
- Monopitch
- monoloudness
- intermittent voice arrests
- short phrases
- equal and excess stress on syllables
35
The most deviant characteristics in spastic dysarthria are:
- Imprecise consonants
- Monopitch
- Reduce stress
- Harshness
- Monoloudness
- Low pitch
- Slow rate
- Hypernasality
- Strained-strangled voice quality
- Short phrases
- Distorted vowels
- Pitch breaks
- Breathy voice
- Excess and equal stress
36
What deviant characteristics are more severely impaired in spastic dysarthria than any other type of dysarthria?
Imprecise consonants, harshness, low pitch, slow rate, strained-strangled quality, short phrases, pitch breaks
37
What are the 4 deviant clusters associated with spastic dysarthria?
- Prosodic excess (excess and equal stress, slow rate)
- Articulatory/resonatory incompetence (imprecise consonants, distorted vowels, hypernasality)
- Prosodic insufficiency (monopitch, monoloudness, reduced stress, short phrases)
- Phonatory stenosis (low pitch, harshness, strained-strangled voice, pitch breaks, short phrases, slow rate)
38
Unilateral upper motor neuron dysarthria is related to which other type of dysarthria?
Spastic
39
T/F
| Unilateral UMN dysarthria is more severe than spastic dysarthria.
False – Unilateral UMN dysarthria is less severe and often transient.
40
The characteristics of unilateral UMN dysarthria are:
- central weakness and paresis on facial and lingual musculature on the side opposite to the lesion
- slow articulators with reduced ROM
- tongue movement is slow and clumsy
- imprecise consonants
41
T/F
| Hypokinetic dysarthria results from lesions to the indirect loop of the basal ganglia.
False – direct loop, resulting in reduced movement
42
T/F
| In hypokinetic dysarthria, size, strength and symmetry of the jaw and tongue may be normal as evaluated by an OME.
True
43
Characteristics of hypokinetic dysarthria are:
Masked face, difficulty initiating, rapid rate (sometimes with festinations), decreased ROM, stuttering
44
Hypokinetic dysarthria is often associated with which condition?
Parkinson’s
45
How is respiration impacted in hypokinetic dysarthria?
Reduced vital capacity and amplitude of chest movement
46
How is phonation impacted in hypokinetic dysarthria?
Dysphonia, breathiness, harshness, reduced loudness
47
How is articulation impacted in hypokinetic dysarthria?
Imprecise consonants, repeated phonemes (dysfluencies), palilalia
48
How is rate impacted in hypokinetic dysarthria?
Increased overall rate, variable (festinating) rate, increased rate in segments
49
How is prosody impacted in hypokinetic dysarthria?
Inappropriate silences, reduced stress, monopitch, monoloudness, short rushes of speech
50
How is resonance impacted in hypokinetic dysarthria?
Mild hypernasality
51
What are the most deviant characteristics in hypokinetic dysarthria?
- monopitch
- reduced stress
- monoloudness
- imprecise consonants
- inappropriate silences
- short rushes of speech
- harsh voice
- breathy voice
- low pitch
- variable rate
- increased rate of segments
- increased overall rate
- repeated
52
What deviant characteristics are more severely impaired in hypokinetic dysarthria than other types?
Monopitch, monoloudness, reduced stress, inappropriate silences, short rushes of speech, increased rate in segments, increased rate overall, repeated phonemes
53
What deviant cluster is associated with hypokinetic dysarthria?
Prosodic insufficiency (monopitch, monoloudness, reduced stress, short phrases, variable rate, short rushes of speech, imprecise consonants)
54
T/F
Variable rate and short rushes of speech are considered components of prosodic insufficiency in hypokinetic dysarthria, but not other dysarthria types.
True
55
Where is the lesion in hyperkinetic dysarthria?
Indirect loop of the basal ganglia
56
What possible mechanisms contribute to the damage in the indirect loop of the basal ganglia in hyperkinetic dysarthria?
- destruction of subthalamic nucleus, causing increased thalamic and cortical excitatory firing
- loss of striatal neurons
- imbalance between excitatory cholinergic and inhibitory dopaminergic neurotransmitters
57
What types of involuntary movements might be seen in hyperkinetic dysarthria? Define them.
- Chorea: rapid, random dance-like movements that can be subtle or relatively large. May be present at rest and during sustained movement.
- Dystonia: slow hyperkinesia, excessive co-contraction of antagonistic muscles
58
How is respiration impacted in hyperkinetic dysarthria?
- Sudden involuntary inspirations
or expirations
- Sniffing/grunting/throat
clearing, etc.
59
How is phonation impacted in hyperkinetic dysarthria?
```
- Irregular variations in loudness
and voice quality
- Harsh, strained-strangled quality
- Random hyperadductions of the
vocal cords: voice arrest
- Transient breathiness
```
60
How is resonance impacted in hyperkinetic dysarthria?
Irregular velopharyngeal incompetence
61
How is articulation impacted in hyperkinetic dysarthria?
- Unpredictable (irregular)
articulatory breakdowns
- Imprecise articulation
- Vowel distortions
62
How is rate impacted in hyperkinetic dysarthria?
Irregular, variable rate
63
How is prosody impacted in hyperkinetic dysarthria?
- Irregular breakdowns
- Prolonged, inappropriate silences
- Irregular prosodic excess
- Excess and equal stress
64
What would you expect to observe in the DDKs of a hyperkinetic dysarthric speaker?
- Irregular, unpredictable interruptions
- rapid or variable rate
- dropped movement segments
- unexpected pauses
65
An example of a condition involving hyperkinetic dysarthria is:
Spasmodic dysphonia
66
Ataxic dysarthria occurs as a result of damage to what structure?
Cerebellum
67
Characteristics of ataxic dysarthria are:
- incoordination and reduced ROM
- slowness and inaccuracy in force, timing, direction of a muscle movement
- hypotonia
- dysmetria
- movement decomposition (sequencing errors)
68
Common complaints in ataxic dysarthria are:
Sounding drunk, difficulty coordinating speech and breathing, biting tongue during speech or eating
69
T/F
| In ataxic dysarthria, the size, strength and symmetry of the jaw, face, tongue and palate are always abnormal at rest.
False – often normal
70
T/F
In the speech of someone with ataxic dysarthria, overshoot or undershoot of movements and spatial articulatory targets may be missed, resulting in errors or distortions.
True
71
Describe DDKs in ataxic dysarthria.
May be irregular in timing, speed, ROM, accuracy, direction
72
Describe respiration in ataxic dysarthria.
excess loudness variation – explosive
73
Describe phonation in ataxic dysarthria.
- hoarse and breathy or harsh, even to strain-strangled
- voice tremor
- monotony
- pitch breaks
74
Describe articulation in ataxic dysarthria.
- Imprecise due to articulatory breakdowns
- Inconsistent problems
- Prolongation of phonemes
- telescoping - syllable or series of syllables run
together with transient acceleration
75
Describe resonance in ataxic dysarthria.
Resonance problems are rare; however, intermittent hypo-hyper nasality is
possible
76
Describe prosody in ataxic dysarthria.
- scanning speech - excess and equal
- intermittent periods of explosive inflection
- poorly modulated pitch and loudness
- prolonged phonemes
77
The most common deviant characteristics in ataxic dysarthria are:
Imprecise consonants, excess and equal stress, irregular articulatory breakdowns, distorted vowels, harsh voice, prolonged phonemes, prolonged intervals, monopitch, monoloudness, slow rate, excess loudness variations, voice tremor
78
The deviant speech characteristics most severely impaired in ataxic dysarthria compared to other types are:
Excess and equal stress, irregular articulatory breakdowns, distorted vowels, prolonged phonemes, excess loudness variations
79
The 3 deviant clusters associated with ataxic dysarthria are:
- articulatory inaccuracy (imprecise consonants, irregular articulatory breakdowns)
- prosodic excess (distorted vowels, excess and equal stress, prolonged phonemes, prolonged intervals)
- phonatory-prosodic insufficiency (harshness, monopitch, monoloudness)
80
T/F
| 35% of all dysarthrias have a mixed presentation.
True
81
What is the etiology of mixed dysarthria?
Co-occurrence of more than one neurologic event/disease, such as TBI, ALS, multiple sclerosis, progressive supranuclear palsy, multiple system atrophy
82
What are the characteristics of a spastic + ataxic mixed dysarthria presentation?
- Impaired loudness control
- harsh voice quality
- imprecise articulation
- excess and equal stress (scanning speech)
- impaired pitch control
- decreased vital capacity
- hypernasality
83
In progressive supranuclear palsy, the mixed dysarthria presentation is comprised of features from what individual dysarthrias?
Hypokinetic, spastic, ataxic
84
Describe progressive supranuclear palsy.
- Massive cell loss in the motor system, frontal
lobes, BG, cerebellum
- Survival 6-7 years
- Paralysis of vertical gaze
- No tremor
- Prominent frontal lobe dysfunction
- Does not respond to antiparkinsonism drugs
85
List 4 other diseases, besides PSP, ALS and MS, with a mixed dysarthria presentation.
- Multiple system atrophy (hypokinetic + spastic + ataxic)
- striatoniagral degeneration
- olivopontocerebellar atrophy
- Shy-Drager syndrome
86
The mixed presentation in ALS is comprised of features from which individual dysarthria types?
Spastic and flaccid
87
In what ways is the Mayo Clinic approach useful?
- Helps to think about differential diagnosis,
neurologic localization
- Provides framework (structure, terminology) for
clinic and research in motor speech disorders
- May bear relevance to treatment
- Does not have to be perceptual-only framework -
encourages us to think across domains (perception,
physiology, neurophysiology)
88
What are the issues with the Mayo Clinic approach?
- From recognizing a pattern to breaking it into 38 pieces/ dimensions –methodological issue?
- Dimensions are non-unique, psychometric
properties are unknown
- No further research on the relationship b/w dysarthria type and side of lesion/ pathophysiologic characteristics - clinical tool with minimal scientific backup
- Representation of etiologies in the original dysarthria groups not representative
- How many subtypes are needed?
- Questionable relevance for determining treatment (treatment is subsystem-based)
- Cannot be applied to developmental dysarthria
- Independent of the course of the disease
- Does not deal with severity
- intra- and inter-rater reliability issues
89
With regards to the Mayo Clinic system, Bunton et al concluded the following:
Mayo Clinic system cannot be a sole tool for clinical
differential diagnosis, ways to improve perceptual judgments must be identified, identification of “the pattern” instead of specific dimensions might produce different results
90
State 5 reasons why we use perceptual judgments.
- Gold standard
- validity
- cheap
- easy to perform
- robustness
91
What are problems with perceptual judgment?
- reliability
- Perception is tricky by nature (e.g., phonemic restoration, discrimination vs. identification, prosodic effects, McGurk, errors tend to be distortions but often judged as substitutions)
- Multidimensional nature of speech/ voice & interdependency of dimensions
- Different reference for normality
- Lack of agreement on what descriptors are most important
- Depends on method of judgment (broad, narrow transcription)
- Depends on who the judge and the speaker are
92
What are solutions that address issues with perceptual judgment?
- Know what your analysis is for
- Simplify (reduce dimensions)
- Train judges
- Use reference samples
- Use the same assessment samples within and across patients
- Stay tuned to research -- expect new ways of using multidimensional methods
- Explore correspondence between instrumental and perceptual analyses
