Assesment: Acquired Motor Speech Disorders

Why interview the patient as well as the primary communication partner in a motor speech assessment?

Patient gives first-hand impact; partner adds daily-life and family context: The patient gives first-hand information about the nature and course of the impairment, their perceived functional limitations, participation restrictions, and the emotional impact. The partner adds their perceptions of the impairment, how it affects daily life, and family resources and social circles — which supports successful intervention.

What is ethnographic interviewing?

Learning how the client and family view the disorder through their own words: A method of learning how the client and family experience and view the disorder by asking the right questions in the right way (Westby et al., 2003). The client and family set the agenda, and the clinician recognizes they need to learn from the family's point of view.

How does an ethnographic interview differ from a traditional interview?

Client and family set the agenda; clinician learns their worldview: In a traditional interview the clinician sets the agenda and assumes they know what is best, aiming to gather information they think they need. In an ethnographic interview the client and family set the agenda, and the goal is to learn how they see the world.

What are descriptive questions in ethnographic interviewing?

Broad questions about daily life, routines and experiences: Broad questions that help the client describe daily life, routines, and experiences — e.g., "Tell me about a typical day for you" or "Give me an example of what happens when you can't make yourself understood."

What do structural questions help the clinician understand?

How the client organizes their thoughts and experiences. Subtypes include strict inclusion ("What kinds of memory problems do you have?"), cause-effect, rationale, and means-end questions.

Which social dimensions does ethnographic interviewing explore?

People, places, activities, events, objects, time, goals, feelings: People involved, places, activities, events, objects, time, goals, and feelings. These shape daily experience and help clinicians set meaningful, personalized treatment goals.

Which question follows the ethnographic interviewing tips?

ethnographic interviewing tips?Ask for examples rather than definitions, use open-ended questions, repeat the client's exact words, summarize key points, ask one question at a time, and avoid leading or 'why' questions. "Can you give me an example of something you forget?" asks for an example.

What is the purpose of the oral mechanism examination?

Assess speech system components and classify changes by cranial nerve: To assess each component of the speech system separately and classify notable changes by cranial nerves (V, VII, IX, X, XII). Face, lips, jaw, tongue, and palate are checked for strength, range of motion, tone, coordination, and speech, with an RPRAP screen included.

What does maximum phonation time assess?

Respiratory-phonatory function: sustaining voicing with breath support: Respiratory-phonatory function — how effectively a person coordinates respiratory support and laryngeal function to sustain voicing. The patient takes a deep breath and says /a/ as long, steadily, and clearly as possible.

What is the average maximum phonation time for adults and for school-age children?

15 seconds for adults, 10 seconds for children: About 15 seconds for adults and about 10 seconds for school-age children. Three trials are typically taken and averaged.

Why obtain maximal phonation times in a comprehensive motor speech protocol?

Why obtain maximal phonation times in a comprehensive motor speech protocol?It objectively indexes respiratory-phonatory support and voice qualityMPT gives an objective index of respiratory-phonatory support, and its duration and quality (latency, steadiness, breathiness, harshness, diplophonia, pitch, loudness) help characterize and compare dysarthria types and track change.

Which voice quality is described as two distinct pitches produced simultaneously, sounding rough or 'two-toned'?

distinct pitches produced simultaneously, sounding rough or 'two-toned'?Diplophonia — a laryngeal feature noted during maximum phonation time when quality is judged.

How does maximum phonation time present in flaccid dysarthria (e.g., myasthenia gravis)?

Reduced MPT with breathy voice and air wastage: Reduced MPT due to weakness in respiratory or phonatory muscles and poor glottal closure, with breathy voice, air wastage, and reduced loudness.

How does maximum phonation time present in ataxic dysarthria?

Variable MPT with unsteady, irregular voice qualityVariable MPT due to poor coordination of respiration and phonation, with unsteady, irregular voice quality.

How does maximum phonation time present in hyperkinetic dysarthria (e.g., Huntington's disease)?

How does maximum phonation time present in hyperkinetic dysarthria (e.g., Huntington's disease)?Fluctuating MPT with voice breaks and sudden loudness changesFluctuating MPT due to involuntary movements affecting breath support, with voice breaks and sudden changes in loudness.

How does maximum phonation time present in mixed dysarthria (e.g., ALS)?

How does maximum phonation time present in mixed dysarthria (e.g., ALS)?Severely reduced MPT with harsh, strained, weak voiceSeverely reduced MPT if both respiration and phonation are affected, with a harsh, strained, weak voice and breath support deficits.

What does speech intelligibility refer to?

How much of the speaker's message a listener can correctly understandHow much of a speaker's message a listener can correctly understand. In a motor speech evaluation it describes how speech production difficulties affect clarity and documents functional impact and change over time.

What is the purpose of intelligibility testing such as the Frenchay Intelligibility Test?

What is the purpose of intelligibility testing such as the Frenchay Intelligibility Test?Describe functional impact and document change over timeTo describe the functional impact of a motor speech disorder — how accurately speech is understood in structured tasks and how performance differs between word- and sentence-level material — and to help document change over time.

Why does the Frenchay Intelligibility Test include both single words and short sentences?

Words give little context; sentences add context but more complexity: Single words give listeners little context to work with, while sentences provide more context but involve longer, more complex speech. Comparing the two shows how intelligibility varies across speaking tasks.

What can intelligibility testing NOT tell you?

It cannot diagnose the disorder or identify the underlying mechanism: It cannot by itself diagnose a particular motor speech disorder, identify the underlying speech mechanism, or capture the person's full communication experience in everyday settings. Listener familiarity, context, and listening conditions also matter.

If groping is seen in the oral mechanism exam, which two apraxia areas would an SLP test?

Nonverbal oral apraxia and apraxia of speechNonverbal oral apraxia and verbal apraxia (apraxia of speech). Groping suggests a movement planning/programming problem, so both nonspeech and speech planning tasks are examined.

What does a nonverbal oral apraxia task examine?

Planning of intentional nonspeech mouth and facial movements: The planning of intentional mouth and facial movements that are not speech — for example, pretending to cough or blow out a match. It may help identify a co-occurring nonspeech motor-planning difficulty.

What does an apraxia of speech (verbal apraxia) task examine?

Planning and programming of movements for speech: The planning and programming of movements needed for speech, including sound sequences, transitions, timing, and stress.

How do nonverbal oral apraxia and apraxia of speech differ?

One is nonspeech movement planning; the other is speech movement planning: Nonverbal oral apraxia concerns planning of intentional nonspeech mouth and facial movements; AOS concerns planning and programming of speech movements — sequences, transitions, timing, and stress. They may co-occur but are distinct.

Which verbal apraxia task uses words of increasing length such as slowpoke, kindergarten, and industrial revolution?

Words of different complexity: A word-complexity task — it asks whether speech production becomes more difficult as words get longer or more complex.

What does the word-sequence task (fan → fancy → fantastic) illustrate?

How well the speaker organizes increasingly complex sound sequences — it probes sequencing and transitions rather than word length alone.

Why compare spontaneous and repeated speech in a verbal apraxia task?

To see if self-generated and imitated speech differ: To see whether performance differs depending on whether speech is self-generated or imitated — imitation can be easier because the plan is provided by the clinician.

What might an SLP notice on verbal apraxia tasks?

Variable errors, groping, disrupted timing and stress: Speech sound distortions or variable errors, effortful starts or visible groping, disrupted timing, pauses or syllable stress, and changes in performance as the task becomes more complex. No single feature or task diagnoses AOS.

What does the SLP need to consider beyond apraxia testing?

Aphasia, dysarthria, oral motor function and communication needs: Aphasia, dysarthria, oral motor function, conversation, and the person's communication needs. AOS and nonverbal oral apraxia may co-occur but are distinct, and the goal is to understand the underlying difficulty and its functional impact.

What is the overall goal of a comprehensive motor speech assessment?

Describe functional impact, characterize the difficulty, document change: To describe how speech production difficulties affect clarity and daily communication, characterize the underlying difficulty, and document change — using chart review, patient and partner interviews, oral mechanism exam, MPT, intelligibility testing, and apraxia tasks together.