Perception Quiz 1

Abnormal pitch

pitch is consistently too low or too high for age and sex

Pitch breaks

pitch shows sudden and uncontrolled variation (e.g., falsetto breaks).

Monopitch

voice is characterized by monopitch or monotone. Voice lacks normal pitch variation

Monoloudness

Voice shows monotony of loudness. It lacks normal variations in loudness.

Voice tremor

voice shows fairly regular tremor, usually in 4-7 Hz range.

Excess loudness variation

Voice shows sudden, uncontrolled alternations in loudness, sometimes becoming too loud, sometimes too quiet.

Loudness decay

Progressive diminution or decay of loudness within an utterance

Alternating loudness

Alternating changes in loudness within an utterance

Loudness level (overall)

Voice is insufficiently or excessively loud

Harsh voice

Voice is harsh, rough, and raspy.

Hoarse (wet) voice

There is wet, "liquid-sounding" hoarseness.

Breathy voice, or breathiness (continuous)

Voice is continuously breathy

Breathy voice, or breathiness (transient)

breathiness is transient or intermittent

Strained (stained-strangled) voice

Voice quality sounds strained or strangled (an apparently effortful squeezing of voice through glottis)

Voice stoppages (interruptions/arrests)

There are sudden stoppages of voice, as if airflow has been impeded

Hypernasality

resonance is excessively nasal

Hyponasality

resonance is hyponasal/denasal

Increased rate in segments (accelerated rate)

Rate increases progressively within given segments of connected speech.

Increased rate overall (rapid rate)

Rate increases progressively from beginning to end of sample

Reduced stress

Speech shows reduction of proper stress or emphasis patterns.

Variable Rate

Rate varies within or across utterances.

Prolonged intervals

There is prolongation of interword or intersyllable intervals.

Inappropriate silences

There are inappropriate silent intervals.

Short rushes of speech

There are short, rapid rushes of speech separated by pauses.

Excess and equal stress

There is excess stress on usually unstressed syllables or parts of speech.

Imprecise consonants/articulation

Consonants lack precision. They show inadequate sharpness, distortions, and lack crispness.

Prolonged phonemes

Phonemes are prolonged

Repeated phonemes or syllables

There are slow or rapid repetitions of phonemes

Laryngeal (oral mech exam)

· vocal fold paralysis (breathy voice); weak cough (lacking sharpness) and coup (lacking sharpness); stridor; audible inhalation

· possible unilateral paresis or paralysis

· Stridor/audible inhalation: both features can reflect abductor vocal fold weakness

· Immobile (paralyzed vocal fold): indication of unilateral Vagus nerve lesion. Associated with flaccid dysarthria (breathy)

Facial (oral mech exam)

Asymmetry at rest and during movement; Reduced or asymmetric smile, rounding, puffing; Chin fasciculations (LMN involvement, CN VII, can be associated with flaccid dysarthria)

-Synkinesis

Upper + lower face weakness on one side + tongue normal

cranial nerve (VII paralysis (LMN) of one side (can be associated with flaccid dysarthria)

Bilateral lingual fasciculations, chin fasciculations, reduced lip retraction and rounding, vocal flutter (associated with laryngeal weakness)

LMN involvement (CN VII, X, and XII) can be associated with flaccid dysarthrias

Synkinesis

-abnormal contraction of muscle adjacent to normally contraction muscle

-Such as when eye blinking causes simultaneous movement of lower facial muscles

-It reflects aberrant branching of regenerating axons or abnormal activity of residual motor units

-Commonly seen after recovery from Bell's (VIIth nerve) palsy

Characteristics: right face (lower): droop at corner of mouth with flat nasolabial fold, reduced right face retraction on smiling, retraction rounding, upper lip arch reduced on right on mouth opening (no drop of eyelid or forehead, tongue grossly normal)

neurological meaning: right CNS face weakness indicative of left UMN lesion

Right CNS face weakness; indicative of left UMN lesion

Observe: Right face (lower)

o Right face droop and flat nasolabial fold at rest (A)

o Reduced right face retraction on volitional lip retraction (B)

o Reduced volitional lip rounding on right (C)

o Relatively symmetric emotional smile (D)

Lingual (oral mech exam)

· Deviation on protrusion (same side as sight of lesion. EX: right deviation = right lingual weakness); Fasciculations; Weak or reduced lingual movements

· Fasciculations and atrophy are indicators of weather weakness is UMN or LMN

· Elevation of soft palate to one side during phonation indicative of palatal weakness

Elevation of soft palate to one side during phonation indicative of palatal weakness

-elevation of soft palate to the right = left palatal weakness

-elevation of soft palate to the left = right palatal weakness

Velopharyngeal (asymmetry)

Pathologic oral reflexes

· Sucking reflex

· Snout reflex

· Palmomental reflex: contraction of right and left mentalis or lower lip (In response to brisk stroking of right and left palms)

· when response is prominent and easily elicited, suggestive of CNS pathology

· present more often in spastic than in other dysarthria types

Pseudobulbar affect

· Poorly inhibited, fairly stereotypic laughter reflecting pseudobulbar affect (Smiling, crying, and verge-of-tears facial expression are other manifestations of this form of labile affect)

· Neurologic meaning: usually occurs with bilateral UMN involvement, not unlike pathologic reflexes

· not uncommon in people with spastic dysarthria

Involuntary movements

· Essential tremor

· Tongue and chin tremor

· Chorea

· Palatal-pharyngeal tremor

Essential tremor

o head tremor

o markedly severe voice tremor with voice interruptions

o probably involving cerebellar control circuit

Tongue and chin tremor

Relatively rhythmic chin and tongue tremor, most evident during static postures (mouth opening and tongue protrusion) and movement

Chorea

o Relatively quick, unsustained movements of shoulders, head, and lips; difficulty sustaining steady posture

o reflecting basal ganglia control circuit pathology

o Ex: Huntington's disease

Palatal-pharyngeal tremor

o Laryngeal tremor is reflected in fluctuations during vowel prolongation

o Right face weakness is present but is a problem distinct from the beating tremor

o lesion in Guillain-Mollaret triangle (dentate nucleus, inferior olive, red nucleus)

Nonverbal oral apraxia

· Groping, off-target efforts to achieve postures and movements

· Vocalization or verbalization as part of, or in place of, target

· Neurologic meaning: left (dominant) hemisphere localization

o Often but not always associated with AOS and aphasia

o Rare in dysarthria without AOS or aphasia