CSDS 213: Exam 1 Unit 3

Speech production components

respiration, phonation, resonation, articulation, and prosody.

Purpose of a motor speech evaluation

To detect and describe a problem

Questions you want to answer during a motor speech evaluation

Is there a problem with the patient’s speech?

If there is a problem, what is the best way to describe it?

Does the problem seem to be the result of a neurologic disorder?

If it seems to be neurologic in origin, did it appear suddenly or slowly?

Is the problem related strictly to speech production, or is it more of a problem with language such as aphasia?

If it is a problem of speech production, do most of the problems seem to be related to the sequencing of phonemes (i.e., apraxia of speech)?

If there are no phoneme sequencing errors, what are the characteristics of the patient’s speech errors and any associated motor problems?

Dysarthria

neuromotor damage to PNS or CNS causing muscle tonicity issues

Apraxia of Speech (AOS)

deficit in the ability to create accurate phoneme sequences with correct articulatory timing and placement, causing distorted articulation and prosody issues.

Respiration

Speech is dependent on a good supply of air; it is needed to activate our vocal folds and support smooth and continuous speech

Problems with respiration

If the nerves that innervate our respiratory muscles are damaged, we are going to have less air for speech

Speech with these problems usually has a lack of loudness, decreased phonation time, and restricted intonation, causing choppy speech

Phonation

Normal phonation requires approximation/adduction of the vocal folds with good breath support to vibrate them

Problems with phonation

If the nerves that innervate our vocal fold adductors are damaged then we can have weak or incomplete adduction (phonatory incompetence)

Causes breathiness, going to run out of air sooner, short phonation time, choppy speech

If we have spasticity in the vocal folds - too much tension could cause a strained vocal quality

Impact pitch and loudness

Resonance

the proper placement of oral or nasal tonality on phonemes during speech

accomplished by raising and lowering the velum

Problems with Resonance

When nerves innervation the velum muscles are damage the movements are going to be slow or weak

Causes hypernasality

If air is leaking out of your nose could impact phonation time

Articulation

Proper articulation requires good movement of articulators - tongue, lips,

Have to move with good strength, timing, accurate placement

Problems with articulation

Damage to the nerves that innervate these muscles could cause imprecise consonants, distorted vowels, inappropriate silences, and irregular articulatory breakdowns

Prosody

The use of stress and intonation to convey meaning

Stress is defined as changing pitch and loudness or the duration of syllables to give words added importance or clarify meanings

Intonation is the use of pitch change or stress to communicate if a sentence is a question or a statement etc.

Problems with prosody

if damage causes weakness or slowness speech could have a monopitch and monoloud quality

If damage causes involuntary movements of vocal tract muscles speech might have irregular pitch variations, sudden increases or decreases in loudness, and prolonged intervals between syllables/words

Standardized Tests for Dysarthria

Assessment of Intelligibility of Dysarthric Speakers (AIDS)

Franchay Dysarthria Assessment 2 (page 63 in text)

Speech Intelligibility Test for Windows - Upload the sample to the computer, and it’ll help with analysis

Assessment of Intelligibility of Dysarthric Speech (page 64)

Standardized Tests for Apraxia of Speech

Apraxia Battery for Adults-2

Apraxia of Speech Rating Scale (ASRS)

Motor Speech Evaluation assesses

6 salient features of neuromuscular functioning:

Muscle strength

Speed of movement

Range of movement

Accuracy of movement

Motor steadiness

Muscle tone

Components of the Evaluation

Case Hx and Interview

Oral mechanism exam

Speech characteristics (perceptual assessment of their speech production), including a calculation of percent intelligibility

Standardized test results, if there are any

Instrumental analysis, if available

Evaluation attempts to answer what questions

Is speech normal or abnormal?

If abnormal, what are the diagnostic possibilities?

Is it organic, psychologic, neurologic in origin?

Is it recent or long-standing? (acute or degenerative?)

If it is neurologic, is it a motor speech disorder or something else (ie., aphasia or dementia)?

If it is a MSD, is it dysarthria or apraxia?

If it is dysarthria, what kind?

Make the diagnosis

Describe/explain the implications of localization

Estimate severity

Site of lesion: lower motor neuron

flaccid dysarthria

Site of lesion: Bilateral Upper Motor Neuron

Spastic dysarthria

Site of lesion: Unilateral UMN

Unilateral UMN dysarthria

Site of lesion: Cerebellum

Ataxic dysarthria

Site of lesion: Basal Ganglia

Hypokinetic Dysarthria OR Hyperkinetic dysarthria

Site of lesion: multiple areas

Mixed dysarthria

Site of lesion: left frontal lobe (generally)

Apraxia of speech