Oral motor previous test questions

Palilalia is a ...

Neurological speech disorder

A dysphonia from vocal abuse is a ...

Nonneurologic speech disturbance

Auditory perceptual analysis can identify salient features through all of the following except: instrumental observations, tactile observations, auditory observations, or visual observations

Instrumental observations

Vascular interruption to the branches of the internal carotid artery will cause damage to most of the cerebral hemispheres. This could result in all of the following except: spastic dysarthria, aphasia, flaccid dysarthria, or apraxia of speech

Flaccid dysarthria

Instrumental analysis using visual imaging techniques for MSDs can include

Video-fluoroscopy

The oral mechanism examination task of asking the patient to move their tongue from side to side as fast as they can is primarily assessing

Rate and coordination

Normal aging can cause changes in all of the following except: fluency, speech breathing patterns, nonverbal communication, or pitch

Non-verbal communication

The final common pathway for speech is also called the

Lower motor neuron system

Clinical characteristics of flaccid dysarthria may consist of impairment movement relating to all of the following except: speed, accuracy, coordination, or range

Coordination

The anterior lobes of the cerebellum help regulate

Posture, gait, and truncal tone

The function of the indirect activation pathway is to...

Help maintain balance and govern posture

By having the patient relax and open their mouth slightly while swiping a tongue depressor from the corner of their mouth along and to the middle of their top lip, I can assess the patient's _____ reflex

Suck

The primary function of the skull is

Protection

The primary motor cortex has a ____ organization

Topographic

Damage to the spinal anatomical level could result in _____ dysarthria

Flaccid

The following cranial nerves originate in the medulla except: glossopharyngeal, vagus, facial, hypoglossal

Facial

Flaccid dysarthrias are due to an impairment of this system

Lower motor neuron

True or false: Motor speech disorders can occur due to damage in the meninges and in the meningeal spaces

True

True or false: Bilateral damage to the trigeminal nerve could result in lingual fasciculations

False

True or false: The flocculonodular lobe of the cerebellum modulates equilibrium and orientation of the head and eyes

True

True or false: fasciculations are jerky, flinging movements of the extremities

False

True or false: dopamine is a neurotransmitter that influences the sensitivity of neurons to excitatory and inhibitory input

True

True or false: spastic dysarthria may present in a patient that has a diagnosis of multiple sclerosis

True

True or false: ballismus can be produced by effects of hypokinesia

False

True or false: lesions to the indirect activation pathway at the level of the reticular formation most often lead to death

True

True or false: The term flaccid dysarthria is plural because a patient that has one flaccid dysarthria is likely to gain another in the course of their lifetime

False

True or false: the indirect activation pathway is also called the extrapyramidal tract

True

True or false: hyperkinesis results from damage to the indirect pathway of the basal ganglia control circuit

True

Match the etiologies with the example:

Neoplastic disease, degenerative disease, toxic-metabolic disease, inflammatory disease, trauma, and vascular disease

Dementia, encephalitis, hypoglycemia, CNS tumor, fall, stroke

Neoplastic disease-CNS tumor

Degenerative disease-dementia

Toxic-metabolic disease-Hypoglycemia

Inflammatory disease-encephalitis

Trauma-fall

Vascular disease-stroke

Outline the specific pathway of the direct activation pathway (AKA pyramidal tract)

Primary motor cortex, descend in the corona radiata, through internal capsule, through cerebral peduncle, brain stem and spinal cord

Describe the cerebellum control circuit's function in speech. Provide general effects of damage.

Function in speech: refines the temporal and prosodies properties after receiving=bing advance notice from the cortex; checks the adequacy of the outcome based on auditory and other feedback from speech muscles, tendons, and joints

General effects of damage: dysmetria, nystagmus, dysdidochokinesis, intention tremor, hypotonia, speech in coordination, ataxic dysarthria

Define differential diagnosis

The process of narrowing diagnostic possibilities and arriving at a specific diagnosis

Describe the role of the basal ganglia control circuit? What would damage to the direct and indirect pathways affect?

Role: helps to move muscles and not move muscles. Need balance between them

Damage to direct- hypokinesia, bradykinesia, akinesia, possible resting tremor, hypokinesia dysarthria

damage to indirect- hyperkinesia, dyskinesia, ballismus, hemiballismus, chorea, athetosis, hyperkinetic dysarthria

What might contribute to your diagnosis of spastic dysarthria? What speech characteristics will be present? What confirmatory signs would you see in your assessment?

Speech characteristics: slowness, reduced ROM, reduced force of movement, excessive tone could all lead to imprecise consonants, harsh, strained-strangled vocal quality, hypernasality, mono pitch, and monoloudness

Confirmatory signs: pseudobulbar affect, impairment in fine, skilled movements, hypertonia, hyper reflexes, Babinski reflex present

Taking into account the 5 speech subsystems, describe how a flaccid dysarthria might present for each. In other words, where would the specific damage be within that motor system and what speech characteristics would be present with that subsystem being affected?

Flaccid dysarthria is due to lower motor neuron damage:

Respiration: spinal nerve damage could cause diaphragm weakness which would lead to reduced breath support/vital capacity- short phrase length

Phonation: vagus nerve damage could cause vocal fold paresis/paralysis which would lead to dysphonia, aphonia

Resonance: vagus nerve damage could cause velopharyngeal insufficiency which would lead to hypernasality

Articulation: hypoglossal nerve damage could cause lingual weakness which would lead to imprecise articulation

Prosody: vagus nerve damage could cause vocal fold paresis/paralysis which would lead to mono pitch or monoloudness

Provide an example of a functional outcome rating scale. Why would this be important information to gather as a part of the assessment process?

ASHA NOMS, communication effectiveness survey, dysarthria impact profile, living with dysarthria, communicative participation item bank

Helps to understand how their communication disorder is affecting them in a more natural and relevant setting. This is completed by the clinician, pt, or loved one and serves as a good reference for improvement over time.

What is one assessment task that could determine at what level the motor system is involved for a facial nerve paralysis? Describe the inner action of cranial nerve VII to explain this task.

One assessment task to determine the motor system level involvement for a facial nerve paralysis would be raising eyebrows, squinting. The facial nerve is connected to the motor strip via UMNs. If the UMNs are damaged, the contra lateral lower face will be affected, because they are bilaterally innervated for the upper face and contralaterally innervated for the lower face. If the facial nerve itself is damaged (LMN level), the ipsilateral full face will be affected.

A good history is important to the motor speech evaluation process. List 8 questions that are relevant and necessary to ask.

Onset/course, associated deficits, introduction and goal setting, patient perception, patient awareness, consequences, management, and assessment of perceptual speech characteristics

An individual diagnosed with unilateral upper motor neuron type dysarthria might present with all of the following clinical characteristics except.. weakness initially, hemiplegia, spasticity later, nystagmus

Nystagmus

Hyperkinetic dysarthria is likely to be caused by all of the following except.. dementia, Huntington's chorea, multiple sclerosis, or antipsychotic drugs

Multiple sclerosis

Which motor speech disorder is most likely to result from damage to the left cerebral hemisphere (frontal lobe)?

apraxia of speech

Which of the following would be least helpful in diagnosing apraxia of speech? Conversational speech sample, strength testing of oral musculature, repetitions of single syllables, or diadochokinetic rates

Strength testing of oral musculature

A person with Parkinson's may describe their speech like this

Mumbling

An oral mechanism examination finding that is common for ataxic dysarthria is

Normal gag

All of the following are clinical characteristics of Parkinsonism except... reduced arm swing, hypomimia, pseudobulbar affect, festination

Pseudobulbar affect

Unilateral upper motor neuron type dysarthria can be caused by all of the following except... brain tumor, stroke, cranial nerve X damage, brain trauma

Cranial nerve X damage

The following are acceptable prognoses to include in a motor speech diagnostic statement except... fair, positive, guarded, poor

Positive

Facial masking, festination, and reduced loudness are characteristic of:

Hypokinetic dysarthria

Which of the following best describes palilalia?

Rapid, irregular repetition of syllables or words

Which of the following is most characteristic of speech in ataxic dysarthria?

Excess and equal stress

This dysarthria type is the most frequent within mixed dysarthria

Spastic

A general term used to refer to abnormal, involuntary movements, regardless of etiology is...

Dyskinesia

Most hypokinetic dysarthrias are due to

Parkinson's disease

Apraxia of speech can often be accompanied by this type of aphasia

Broca's

All of the following are considered Parkinson's plus syndromes except... multiple system atrophy, corticobasal syndrome, amyotrophic lateral sclerosis, progressive supranuclear palsy syndrome

Amyotrophic lateral sclerosis

This is a common finding of an oral mechanism examination with a person who has Parkinson's disease

Masked faces

A likely finding of an oral mech exam with a person who has unilateral upper motor neuron type dysarthria would be

Unilateral central facial droop

This could be expected finding on an oral mech exam with a person who has hyperkinetic dysarthria

Facial grimacing

Match the mixed dysarthria types with the degenerative disease

mixed spastic hypokinetic dysarthria, mixed flaccid-spastic dysarthria, mixed spastic-ataxic dysarthria

ALS, MS, PSPS

Mixed spastic-hypokinetic: PSPS

Mixed flaccid-spastic: ALS

Mixed spastic-ataxic: MS

What is involuntary single respective brief jerks? Slow, writhing movements? Violent, uncontrolled movement? Rapid horizontal eye movements? Rhythmic tremor of the body or head?

Tics, athetosis, ballismus, nystagmus, titubation

Choose the most appropriate speech characteristic for the dysarthria type.

Articulatory/phonatory interruptions; short rushes of speech; slow rate

Hypokinetic, hyperkinetic, ataxic

Hypokinetic: short rushes of speech

Hyperkinetic: articulatory/phonatory interruptions

Ataxic: slow rate

True or false: patients with hyperkinetic dysarthria may present with unpredictable interruptions in speech due to involuntary movements

True

True or false: a person with a unilateral upper motor neuron type dysarthria may or may not have a hoarse vocal quality

True

True or false: All people who have MS will have dysarthria

False

True or false: The primary speech subsystem affected by unilateral upper motor neuron type dysarthria is articulation

True

True or false: When mutism occurs due to apraxia of speech or aphasia, it is usually long-term

False

True or false: Unilateral upper motor neuron dysarthria is usually severe

False

True or false: The clinical characteristic of a cognitive disturbance may be present in an individual with ataxic dysarthria

True

True or false: Apraxia of speech typically improves significantly when using automatic speech tasks like counting or singing

True

True or false: Intelligibility is usually not affected with mixed dysarthria

False

True or false: Damage to the cerebellum is the primary cause of flaccid dysarthria

False

True or false: Apraxia of speech is always accompanied by non-verbal oral apraxia

False

True or false: It is possible to identify the salient speech features of ataxic dysarthria when the patient is speaking a different language just based on the perceptual judgements of speech AMRs, as well as the rate and prosodic characteristics of conversational speech

True

True or false: ALS can affect both upper and lower motor neurons

True

True or false: Apraxia of speech has clearly defined and agreed upon discriminative characteristics

False

True or false: The term Parkinson's diseases is for Parkinsonism that is responsive to levodopa treatment, like the drug Sinemet

True

Describe the elements important to include in a motor speech diagnostic statement

Type of MSD, speech characteristics, severity, prognosis, etiology

Describe how prosody may be affected in ataxic dysarthria and provide one example of how this might sound during connected speech

Prolonged phonemes, prolonged intervals, excess and equal stress, and slow rate; "I'm going to the store" might sound like "I'm GO-ing TO the STORE" with equal emphasis on each syllable