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XXXAssess MotorSpch
XXXAssessment for Motor Speech
| Question | Answer |
|---|---|
| A motor speech assessment is conducted to | understand the patients problem in order to lead to a diagnosis and also to establish a beginning level of treatment; to determine the treatment focus. |
| Questions to be answered during the Motor Speech Evaluation: | Is there a problem with speech? Whatis the best way to describe it? Does the problem seem to be neurologic in origin? Did it appear suddenly or slowly? Is the problem related to speech PRODUCTION, or is it more of a language problem such as aphasia? |
| MORE questions to be answered during the Motor Speech Evaluation: | If it is a PRODUCTION speech problem, do most of the problems seem to be related to the sequencing of phonemes? This would be APRAXIA. |
| Apraxia | a neurogenic speech disorder resulting from inability to program sensorimotor commands for the positioning and movement of muscles for speech production; relates to sequencing of phonemes. |
| Dysarthria | impaired speech production due to disturbances in the muscular control of the speech mechanism. – Is neurologic in origin; associated with pathology of CNS or PNS structures involved in motor activities |
| Dysarthria | Problems due to paralysis, weakness, or incoordination of the speech muscles – May affect the speed, strength, range, timing, or accuracy of speech movement. |
| First process involved in speech production | ideation = communicative intent (cognitive) |
| 2nd process involved in speech production | Symbolization = word retrieval, phonological mapping, syntactic framing, stress assignment (linguistic) |
| 3rd process involved in speech production | Motor planning = specify movement parameters (motor) |
| 4th process involved in speech production | Neuromuscular execution = Move muscles involved = respiration, phonation, resonance articulation (motor) |
| Motor Speech Disorders | A collection of communication disorders, resulting from neurologic impairment, involving: – The retrieval and activation of motor plans for speech Or – The execution of movements for speech production |
| Why is it important to specify severity when doing a Motor Speech Evaluation? | You need to look for mismatch (psychogenic contributions, level of insight or level of concern about speech) also for prognosis and management decision making, and to determine BASELINE DATA against which future changes can be compared. |
| What are the five speech production components? | Respiration, phonation, articulation, resonance, and prosody. |
| Respiration provides: | the subglottal air pressure leading to vocal fold vibration. |
| When respiration is impaired it can lead to: | short phrase length reduced loudness breathy voice |
| Phonation is: | the production of voiced phonemes through vocal fold vibration. |
| Phonation is dependent upon: | Vocal fold adduction and subglottic air pressure. |
| When phonation is impaired: | breathy or harsh voice strained-strangled voice reduced ability to change pitch or loudness |
| Resonance is: | the proper placement of oral or nasal tone onto phonemes. |
| Resonance is dependent upon: | the movement of the velum. |
| When resonance is impaired: | Hypernasality |
| Articulation is: | the shaping of the vocal airstream into phonemes. |
| Articulation is dependent upon: | the manner and place of articulation by different articulators. |
| When articulation is impaired: | Imprecise consonants, distorted vowels, irregular articulatory breakdowns. |
| Prosody is: | the melody of speech; stress and intonation. |
| How is stress accomplished as it relates to prosody? | Stress accomplished by changing the pitch, loudness and duration. |
| How is intonation accomplished as it relates to prosody? | Intonation is accomplished through pitch change and stress. |
| To achieve prosody, a coordination of various components is needed including: | pitch, loudnss, and duration |
| If prosody is impaired: | Monopitch & monoloudness Irregular pitch, loudness or durations |
| What are some salient neuromuscular features that affect speech production? | Muscle strength, speed of movement, range of movement, motor steadiness, muscle tone, and accuracy of movement. These are salient and are used to confirm the diagnosis. |
| What are some CONFIRMATORY SIGNS? | Signs other than deviant speech and the salient neuromuscular features that were used to help confirm the diagnosis. |
| List of confirmatory signs: | Atrophy, fasciculations, reduced normal reflexes, pathologic reflexes, strength of cough and coup de glotte, gait disturbances, abnormal muscle stretch reflexes, limb atrophy and fasciculations, loss of automatic movements, difficulty initiating movements |
| We do NOT diagnose from: | confirmatory signs. |
| Confirmatory signs within the speech system: | Do NOT diagnose from these! Speech Confirmatories: Atrophy, fasciculations, reduced normal reflexes, pathologic reflexes, strength of cough and coup de glotte. |
| Confirmatory signs in NON speech motor system: | We do NOT diagnose from these either! Gait disturbances, abnormal muscle stretch reflexes, limb atrophy and fasciculations, loss of automatic movements, difficulty initiating limb movements |
| Assessment Process: | History. Oral Mechanism Exam during NONspeech activities, Perceptual Analysis of Speech Characteristics, Intelligibility Assessment, Acoustic and Physiologic Analysis if possible. |
| History: | Primary and secondary medical diagnosis? Facts about onset and course? Associated deficits? Site of lesion? Patients awareness of symptoms and perception of the deficit? Degree of disability it causes? |
| Examination of the speech mechanism during NONSPEECH ACTIVITIES is known as the: | Cranial nerve / Oral Mechanism Exam |
| observation of the mandible during mouth opening and lateral movement, manipulation of mandible during resistance, note weakness, atrophy, groping or deviation. | Cranial nerve / Oral Mechanism Exam Looking at CN V / Trigeminal NON SPEECH TYPE TASKS |
| Diadochokinesis of /pa/, observe if repeated in 5 seconds 15-20 times = normal, and observe articulatory accuracy and evenness of rate. | Cranial nerve / Oral Mechanism Exam Looking at CN V / Trigeminal SPEECH TYPE TASKS |
| Inquire about numbness, Light touch on each side, look for symmetry. | Cranial nerve / Oral Mechanism Exam Looking at CN V / Trigeminal SENSORY TASKS |
| Look at face at rest and during non violitional movement (laughing) and look for symmetry, ptosis, masked face, and weakness. | Cranial nerve / Oral Mechanism Exam Looking at CN VII / Facial NON SPEECH AT REST TYPE TASKS and NON VIOLITIONAL MOVEMENT |
| Observe for lip retraction, lip pucker/smile, lip compression against force, wrinkle forehead while looking up. | Cranial nerve / Oral Mechanism Exam Looking at CN VII / Facial NON-SPEECH TYPE TASKS |
| Observe production of /pa/ with BITE BLOCK to remove participation of the jaw and compare to number of times with NO bite block. | Cranial nerve / Oral Mechanism Exam Looking at CN VII / Facial SPEECH TYPE TASKS |
| When you observe production of /pa/ with BITE BLOCK to remove participation of the jaw and compare to number of times with NO bite block you are: | Cranial nerve / Oral Mechanism Exam Looking to see if the person needs the jaw to help; if they do this may indicate a problem with lip movement and a problem with CN VII Facial Nerve. |
| Ask about and observe for dysphagia and drooling... | Cranial nerve / Oral Mechanism Exam This will provide information about potential damage to CN IX (glossopharyngeal) and CN X (Vagus) |
| Observe velar movement during the repetition of /a/, cough, glottal coup, and listen for inhalatory stridor. | Cranial nerve / Oral Mechanism Exam Looking at CN IX and CN X NON-SPEECH TYPE TASKS |
| Observe for palatal movement during sustained phonation of /a/, observe for resonance, observe for voice quality | Cranial nerve / Oral Mechanism Exam Looking at CN IX and CN X SPEECH TYPE TASKS. |
| Observe for atrophy or fasciculations of the tongue and note Size, Stability, and Symmetry. Note abilities in protrusion, retraction, lateral movement, and elevation both with and without resistance. | Cranial nerve / Oral Mechanism Exam Looking at CN XII Hypoglossal NON SPEECH TYPE TASKS. |
| Observe during the production of /ta/ and /ka/ | Cranial nerve / Oral Mechanism Exam Looking at tongue tip /ta/ and tongue back /ka/ during SPEECH TYPE TASKS for CN XII Hypoglossal. |
| Evaluate the Respiratory Adequacy needed for Speech. How do you do this? | Observe posture, style of breathing (abdominal, thoracic versus clavicular breathing.) Evaluate breathing rate (16-18 cycles per minute = normal,) Evaluate regularity of breathing, Evaluate respiratory driving pressure using water glass manometer. |
| How do you use a water glass manometer and what do you use if for? | You use it to evaluate the Respiratory Adequacy needed for Speech - they need to blow bubbles into a water glass through a straw at a depth of 5 cm for 5 seconds. |
| What is apraxia? | a neurogenic speech disorder resulting from inability to program sensorimotor commands for the positioning and movement of muscles for speech production – Can occur without weakness and without aphasia |
| How do you test for Non-Verbal Oral Apraxia? | Blow, stick out your tongue, show me how you whistle, show me how you smile, click your tongue. |
| How do you collect data for the perceptual analysis of speech? | Grandfather Passage or Rainbow Passage - get these speech samples on audio and/or video tape for analysis purposes. |
| How do you evalulate the phonatory / respiratory systems - what are you listening FOR? | Prolonged production of /a/. Listen for these: Hypernasality Breathiness Harshness Diplophonia Pitch Loudness |
| How do you do an evaluation of the Resonation System? | Do the Mirror Test while the patient is producing /u/. They should NOT fog up a mirror held under their nose. Squeeze one nostril at a time to check to see if there is any improvement in resonance. |
| Testing Combined Components? | AMR SMR Standard Reading Passage Narrative About Picture Scene Conversational Sample |
| AMR | Alternative Motion Rate /p/ then later on /t/ then later on /k/ |
| SMR | Sequential Motion Rate repeat /p//t//k/ /p//t//k/ |
| SMR is a good test for what? | Apraxia of speech because it can help evaluate the patients ability to inability to program sensorimotor commands for the positioning and movement of muscles for speech. |
| How do you conduct Stress Testing and what is it a test FOR? | Have the patient count 1 - 100. Listen for a rapid fatigue of the muscles during this sustained motor activity. Could be myasthenia gravis if after rest the patient's voice then returns to normal sounding production on a second attempt at this task. |
| How do you test for Apraxia of Speech? | SMR, repeating or reading a list of words rom 2 to multi-syllabic words with the same CVC syllable, sentences with multisyllabic words, sing familiar tune, count 1-20 back and forth, picture description, sentence repetition. |
| Motor speech problems exist in the ears of the | listener |
| If you can understand someone they do NOT have | a speech disorder. |
| Be careful to consider motor problems separately from | language problems. |
| Signs other than deviant speech characteristics and the salient neuromuscular features are known as | Confirmatory Signs. These are NOT speech signs! We cannot diagnose from them. They are only used to CONFIRM the diagnosis that was already made based on speech characteristics! |
| If someone has atrophy of the tongue, can you diagnose from this? | No because atrophy is a CONFIRMATORY SIGN and we do not diagnose from confirmatory signs! You can only diagnose from speech characteristics. |
| First Order Neuron and its axon = | UMN |
| 2nd Order Neuron and it's process = | LMN |
| UMN starts from where? | The motor cortex for the pyramidal system. |
| Both the pyramidal and extrapyramidal systems are considered to be part of what? | The UMN. |
| What do you look for in an oral exam when you are looking at someone's tongue at rest? | Size, stability, symmetry. |
| Which is the most useful task for evaluating integrated task of speech conduction? | CONNECTED SPEECH |
| When conducting a perceptual analysis 5 components are: | respiratory, phonation, articulation, resonance, and prosody |
| Remember that someone may have motor deficit but | having a motor deficit does not necessarily mean someone has a motor speech disorder also. |
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MayaMayaAlejandra
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