Assessment of Motor Speech Disorders- Lecture 4
Reasons for Assessment
Understand the problem.
Understand the impact.
Inform decision-making.
Track change.
Expected Outcome of Assessment - The ICF (International Classification of Functioning, Disability and Health) Framework
Health condition (disorder or disease).
Body functions/Body structures.
Activities.
Participation.
Environmental factors.
Personal factors.
Assessment Methods
Assessment is not limited to just using a test; it is a systematic information gathering process to answer a clinical question.
Case History: Gather person's background and context.
Observation: Informal examination of speech behaviors.
Formal Assessment: Standardized tests to evaluate specific aspects of speech.
Informal Assessment: Adapted evaluations based on clinical judgment.
Patient-Reported Outcome Measures (PROMs): Subjective evaluations from the client about their condition.
Instrumental Measures: Use of technology to measure speech characteristics.
Assessment Decision-Making Framework
WHY are we assessing? Establish the purpose and clinical question.
WHEN do we assess? Identify if it is an initial assessment, follow-up, or outcome measurement.
WHAT do we assess? Determine subsystems, severity, impact, and context of the speech disorder.
HOW do we assess? Decide on the tools, methods, and administration processes to be used.
Assessment Toolbox
Case History and Interview: Essential for gathering background info.
Informal Observation: Analyze patient speech in everyday situations.
Formal Standardized Assessment: Objective tests for comparability and reliability.
Patient-Reported Outcome Measures: Understand the patient's perspective regarding their condition.
Instrumental Measures: Use of technology for objective data gathering.
Case History Components
Medical diagnosis and history.
Review of auditory, visual, motor, cognitive, language, and emotional status (if not included as part of the assessment).
Education, vocation, and cultural/linguistic backgrounds.
Reports from the patient and family regarding their condition.
Identification of facilitators and barriers to communication.
Formal Assessments Materials
ABA-2 (Apraxia Battery for Adults, Second Edition): Assesses apraxia in adults, developed by Barbara Dabul.
FDA-2 (Frenchay Dysarthria Assessment, Second Edition): Developed by Pamela Enderby and Rebecca Palmer; a critical tool for assessing dysarthria.
Dysarthria Profile (Revised) - Scoring Form
Measures various speech functions:
Respiration: Vital for speech production.
Phonation: Analysis of voice including pitch and quality.
Facial Musculature: Checks for symmetry and tone during simple expressions.
Frenchay Dysarthria Assessment-2 (FDA-2)
Purpose: Assess physical components of speech production across multiple speech subsystems.
Target Group: Adults with suspected dysarthria.
Time Estimated: Approximately 20-30 minutes.
Key Feature: Employs a rating scale from typical to no function to quantify speech impairment.
What Gets Assessed
Reflexes.
Respiration.
Lips.
Palate.
Laryngeal function.
Tongue movement.
Intelligibility.
Administration – Key Points
Each patient allowed two attempts; the second attempt scores.
Clear and simple instructions are crucial.
Detailed observation of the patient's attempts is essential for assessment reliability.
Scoring Best-Fit Descriptors
a = normal function for age.
b = mild abnormality noted by a skilled observer.
c = obvious abnormality, perform task reasonably well.
d = partial completion but poor quality.
e = unable to complete the task.
Half steps are permitted in scoring.
FDA-2 Interpretation
What it tells you: Identifies affected subsystems and severity of impairment.
What it does NOT tell you: The functional impact, reasons for impairment, or effects on specific tasks in context.
Evaluation Limitations
Strengths: No frequency effect on reliability, standardized across various populations, short administration time, minimal resources needed.
Weaknesses: Subjectivity in interpretation and a reliance on visual/reading skills for intelligibility assessment.
Differential Diagnosis – AOS vs Dysarthria
Apraxia of Speech (AoS):
Increased errors with word length and complexity.
Muscle range, motion, tone, coordination, and strength within normal limits (WNL).
Primarily affects articulation and prosody; speech errors are consistent across tasks.
Damage typically in the perisylvian area of the dominant hemisphere.
Dysarthria:
Consistent errors regardless of word length or complexity.
Impairment in at least one muscle quality in nearly all cases.
Effortful searching for speech is uncommon; damage could originate from CNS or PNS.
Clinical Reasoning in Action
Scenario: "Client presents with slow, effortful speech. Errors increase with longer words. Automatic speech (e.g., counting) is better than voluntary speech. Muscle strength is normal. Written language intact." This suggests differential diagnosis possibilities, requiring further targeted assessments.
Other Assessment Tools
Apraxia Battery for Adults (ABA2): Purpose to verify presence of AOS and estimate severity (approx. 20 minutes).
Apraxia Rating Scale 3.5 (ARS): High reliability, used as a diagnostic tool for AOS.
Instrumental Measures: For objective data (acoustic measures, physiologic measures, visual imaging).
Person Reported Outcome Measures (PROMs)
Highlights the impact of communication disorders on an individual.
Provides individual perception of deficits and may help delineate between impairment and its impact.
Key Takeaways
Assessment is a systematic gathering of information across impairment, activity, participation, and contextual factors.
Tool selection is crucial, as formal assessments are beneficial but not comprehensive.
Differential diagnosis gears towards identifying patterns in presentation.
Emphasize that impairment ≠ impact; contextual information is essential.
Interdisciplinary collaboration enhances comprehensive patient care.