Motor Speech Quiz #4

what is the primary purpose of a motor speech disorder (MSD) evaluation?

determine if the patient has dysarthria

what are the components of the speech mechanism?

• tongue

• movement of mandible

• lungs

• vocal folds

• velum

• diaphragm

an MSD evaluation should differentiate:

dysarthria from apraxia

MSD evaluations describe…

features of speech and integrity of structure and function of the speech mechanism

an MSD evaluation should specify:

severity

MSD evaluation establishes

diagnosis possibilities and a diagnois

a MSD evaluation determines

goals for treatment

determining whether speech characteristics are normal or abnormal requires:

evaluation of each speech subsystem

differential diagnosis is used to:

narrow diagnostic possibilites and arrive at a specific diagnosis

what examination helps determine structural adequacy for speech?

oral peripheral examination

the oral peripheral exam assesses structures for:

speech and nonspeech activities

to determine structural integrity of the speech mechanism tasks are given to assess:

nonverbal oral movement control and sequencing

when assessing nonverbal oral movement control and movement you are looking for disorders like…

apraxia

functional integrity is primarily assessed using:

neuromotor speech examination

the neuromotor speech exam tasks for:

assessing speech planning or programming capacity

the functional integrity of the speech mechanism determines:

adequacy of musculature for speech movements

what speech systems are evaluated for deficits in a neuromotor speech exam?

• articulatory

• phonatory

• laryngeal

• resonance

• prosody

when considering diagnosis, the clinician should first determine whether the disorder is:

• neurologic

• organic

• chronic

• acute

if a neurologic disorder is present, the clinician should determine:

whether it is a motor speech disorder (or other related disorder)

diagnosis is based on:

interpretation of findings

a diagnosis may sometimes:

not always be stated with certainty

true or false: people with Parkinson’s can also have a stroke

true

why should severity always be estimated?

to establish prognosis, therapy goals, and ensure patient complaints match

severity ratings help establish:

a baseline

if a patient is saying their voice gets strained after a longer period of time what should the speech therapist do during assessment?

have them talk more to assess speech and their concerns

treatment planning should identify:

characteristics amendable to treatment

treatment goals should consider:

functional impact of dysarthria/apraxia on patient’s functional activities

what is a goal for dysarthria or apraxia?

for the patient to be more intelligible (will always be a goal surrounding communication)

what are the three essential components to evaluation?

history, identification of salient speech features, and identification of confirmatory signs

case history helps reveal:

time course of disorder and patient observations of the problem

oral responses during case history taking provide:

a sample of typical speech conditions for the client

what are the six salient features that influence speech production?

• strength of the muscle

• speed at which they can move the muscle

• range of movement

• steadiness

• time

• accuracy

muscles typically have ______ strength

reserve

weakness is most apparent in:

LMN lesions

weakness can affect:

laryngeal, velopharyngeal, and articulatory musculature

weakness of the laryngeal, velopharyngeal, and articulatory musculature causes weak:

vocal cords, velum, tongue muscles, etc

weakness can be exhibited in all:

5 components of the speech mechanism

true or false: we use all of our muscle strength when we talk

false

phasic movements

quick, unsustained, discrete movements

phasic movements are required for:

speech

phasic movements are mediated through:

direct activation UMN pathway to alpha motor neurons

true or false: excessive speed is uncommon in MSDs

true

excessive speech speed is most commonly associated with:

hypokinetic dysarthria

excessive speech rate is usually due to:

decreased range of motion

slow speech rate is most common in:

spa*tic dysarthria

slow speech rate has the greatest effect on:

prosody

flaccid dysarthria causes:

muscle paresis and muscle paralysis

spa*stic dysarthria causes:

tight muscles that make it harder to move

in hypokinetic dysarthria, range of motion is typically:

decreased

abnormal range has a major impact on:

prosody (restrictive or excessive)

range of speech affects all:

speech mechanisms, not just one

true or false: problems usually include decreased range of motion, not increased

true

hyperkinesia is the result of:

neurologic disease affecting steadiness

tremor is an example of impaired:

steadiness

tremors commonly affect:

phonation, and possibly prosdoy

tremor can be heard during:

vowel production

tremor may be seen on:

an oral mechanism exam

examples of steadiness include:

dystonia, dyskinesia, chorea, athetosis

random, unpredictable movements can affect:

any component of speech

hyperkinetic

decreased accuracy and altered prosody

tone can be:

excessive or reduced

tone is known to:

fluctuate

abnormal tone can affect:

any of the speech mechanisms

what type of tone does flaccid dysarthria have?

reduced tone

spastic and hypokinetic dysarthria have what kind of tone?

consistently increased tone

hyperkinetic has what kind of tone?

variable tone

myasthenia gravis becomes more ______ over time.

flaccid

those with hyperkinetic dysarthria have _____ tone AT FIRST, but as they move it changes.

normal

excessive force and tone results in:

overshooting targets

decrased force and tone results in:

undershooting targets

accuracy in speech can be consistent or inconsistent depending on consistency of:

strength, speed, range, steadiness, and tone

accuracy problems are generally perceived more easily in:

articulation and prosody (but can occur within any of the components)

in ataxic dysarthria, inaccuracy is primarily due to:

impaired timing and coordination

in hyperkinetic dysarthria inaccuracy results from:

involuntary movements

true or false: confirmatory signs can be related to the speech mechanism or not

true

confirmatory signs that:

assist with confirmation of the diagnosis

confirmatory signs are NOT:

diagnosis of MSDs (do not need to be present)

examples of non-speech signs within the speech system include:

• atrophy

• reduced tone

• fasciculations

• emotional lability

• reduced reflexes and/or presence of pathologic reflexes

an example of reduced tone includes:

dropping of face

an example of fasciculations includes:

flaccid dysarthria

emotional lability is the:

unpredictable outburst of emotion

non-speech signs outside of the speech system include:

• gait disturbances

• abnormal muscle reflexes (Babinski Reflex)

• loss of automatic or volitional movement (limb apraxia)

• difficulty initiating limb movements

• abnormalities of strength, speed, accuracy, tone, steadiness, and range of movement of muscles

what information should be collected during history?

• basic background data (including any premorbid speech problems)

• introduction and goal setting

• basic demographics

• time course of complaints

• association of deficits

• patients awareness of symptoms/perception of deficit

• degree of disability or handicap caused by the problem

• what kind of things have been tried to manage the problems?

• awareness of medical diagnosis and prognosis

during examination of the face, the clinician should assess for:

• symmetry

• dentures/edentulous

• espressionless/masklike

• abnormal involuntary movements

• mild facial symmetries relatively normal

• forehead wrinkling

• eyebrow raising

• pucker and retraction of lips

during examination of the jaw, the clinician should assess for:

• lightly closed or slightly open

• involuntary movements

• opened or closed against resistance

during examination of the tongue, the clinician should assess for:

• full or symmetric at rest

• abnormal movements at rest? excessively moist or dry?

• deviation to one side during protrusion

• able to push out cheek on the other side (with tongue)

• speed, range, and regularity of tongue during lateralization

during examination of the palate, the clinician should assess for:

• using tongue depressor, is palate symmetrical? does it hang low?

• during phonation of /ah/ (long a) is palate symmetrical? sustained elevation for 6-8 seconds? repeated elevation - differences?

• evidence of nasal airflow on mirror during vowel prolongation

• change with nares occluded

• can they protrude tongue and puff cheeks simultaneously

during examination of the larynx, the clinician should assess for:

• sharp cough (not loud, but sharp) and glottal coup on command?

• presence of inhalation stridor on rapid and/or deep inhalation

during examination of respiration (during quiet breathing), the clinician should assess for:

• posture control

• shortness of breath (16 to 18 breathing cycles/min; 2-3 sec per cycle)

• chest wall and shoulders during breathing

• hiccups

hiccups are what kind of movement?

hyperkinetic

inhalation order

vocal folds are vibrating as the air is going through

edentulous

no teeth

what does water glass manometer for determining:

the ability to generate and sustain respiratory driving pressure sufficient for speech

for the water glass manometer you must:

maintain a stream of bubbles for 5 seconds with a straw at a depth of 5 cm

typical vital capacity at age 10 is approximately:

2 liters

why should the absence of normal reflexes be interpreted cautiously?

they may or may not be present in the general population (interpret with caution)

the gag reflex is elicited by stroking what structures:

back of tongue, faucial arches, or posterior pharyngeal wall on both sides

a normal gag reflex response includes:

elevation of the palate, retraction of tongue, and contraction of posterior and lateral pharyngeal walls

an elicited gag reflex is considered clinically significant when:

it is asymmetrical

if the gag reflex is asymmetircal, the clincian should:

ask the patient if it feels different on each side