Assessment of Motor Speech Disorders
Goals of Assessment
Identification
Description
Diagnosis
Severity determination
Prognosis
Treatment planning
Levels of Assessment
Body Structure & Function
Activity
Participation
General approach:
"problem solving"
Consider the assessment process as on-going
Can assess using perceptual, acoustic, kinematic, or physiologic observations
Must assess several speech subsystems, keeping in mind that the
subsystems are very interdependent and impairments in one speech
subsystem may affect functioning in another
Obtaining Pertinent History
Medical Record Review & Interview
• Relevant information
– What information do you need?
– How will the information be used?
Other sources of information?
Tools to assist in history gathering
Assessing body structure and function
Structural integrity
S y m m et r y
Strength
ROM
Tone
Coordination
Assessing strength
Peripheral muscle groups
• Usually gauged by judging ability to produce force against resistance
– Subjective
– Objective
Subjective measures of strength
Examples
• Press against tongue blade
• Move jaw, lips against hand/fingers
Live demo/practice
Issues
• Subjectivity
• Must include movements in all appropriate directions
• No norms available
Objective measures of strength
Examples
• Iowa Oral Performance Instrument (IOPI)
– Video demo
• Kay Swallowing Signals Lab
Issues
• Limited variety of directional movements
• May be more sensitive to subtle changes/differences in strength
Assessing Strength
Proximal muscle groups
• Examples
– Velum
– Larynx
– Pharynx
• Issues
– Usually inferred from function
– ROM
– Coup de glotte
Assessing ROM
Active
• Single motion
• Alternating or sequential motion
Assessing Tone
Issues
• Tone of individual muscles may be difficult to ascertain because of overlap
in structure and function
• Impairments in tone may not be manifest in the same way in the muscles
innervated by cranial nerves as observed in limbs
Assessing Tone
Strategies: Peripheral Muscle Groups
• Gauging tone during passive movement (Example: D-COME)
– “Use gloved fingers of both hands to pull down the patient’s lower lip toward the chin
(at least three times) to appraise muscle tone/elasticity”
– “Hold gauze between the thumb and index finger of both hands and then grasp and
gently pull the tongue-tip in various directions: forward, right and left, and up and own,
at least three times in each direction”
D-COME Cont
Rating Scale
• 1. Normal (passive) resistance
• 2. Hypotonic (flaccidity) resistance
• 3. Hypertonic (rigidity) resistance
Practice
No norms exist regarding “normal” amount of resistance
Does not rate tone of jaw, articulator most likely to exhibit hypertonicity
Other strategies for assessing tone
Fast passive movement
– Generally intended to elicit stretch reflex
– Lips and tongue do not demonstrate stretch reflexes
Facial droop (signals weakness and hypotonia)
Assessing Tone
Proximal muscle groups
• Velum and pharynx
– Slow, symmetrical movements may indicate hypertonia
– Droop, often asymmetrical, may indicate hypotonia
• Larynx
– Hypertonicity typically has bias for hyperadduction (strained, strangled vocal quality)
Assessing Coordination
Nonspeech
Speech
• AMR
• SMR
• Words of increasing complexity
Structure/Function Assessment: Speech Subsystems
identifies differential affects on different subsystems
focuses perceptual observations
allows for observations at the impairment level
directs treatment at the impairment level
Respiratory
Examples from dysarthria batteries
Other measures
• pressure
– blow bubbles (5 x 5 rule)
– Water manometer
– Pressure transducer
• volume: spirometer
• flow
– pneumotachometer
– respirometer
Phonatory
Examples from dysarthria batteries
Other Physiologic measures:
• flow (can indicate breathiness)
• electroglottograph (temporal patterns of vocal cord closure)
• electromyography (muscle activities)
• stroboscopy (visually examine vocal cord functioning)
Articulatory
Examples from dysarthria and apraxia batteries
Oral Motor Exam
Other Tools
– Dworkin-Culatta Deep Test
– IOPI
– E MG
– Force and movement transduction
Assessment of Speech Activity
Critical to differential diagnosis
• Type of motor speech disorder
• Nature and severity
Darley, Aronson, Brown perceptual characteristics
primary diagnostic criteria for diagnosis and classification of
dysarthrias
if a person doesn’t sound dysarthric, he/she doesn’t have dysarthria!
phonatory/respiratory
low pitch
pitch breaks
monopitch, monoloudness
excessive loudness variation
loudness decay
alternating loudness
overall loudness
harsh voice
wet hoarseness
continuous breathy voice
transient breathy voice
strained-strangled voice
voice stoppages
forced inspiration/expirations
audible inspiration
grunt at end of expiration
resonance
hypernasality
hyponasality
nasal emission
prosodic/respiratory
rate increases/decreases
short phrases
increased rate in segments
variable rate
reduced stress
prolonged intervals
inappropriate silences
short rushes of speech
excess and equal stress
repeated phonemes
articulatory
imprecise consonants
prolonged phonemes
irregular articulatory breakdown
distorted vowels
o t he r
overall reduced intelligibility
overall speech bizarreness
naturalness
normalcy
acceptability
bizarreness
Assessment of speech subsystems during speech
Examples from dysarthria/apraxia batteries
Prosody
Types
• Linguistic
• Emotional
Can alter prosody with pitch, intensity, or duration (not everyone uses
the same strategies)
Intelligibility
One of the main indexes of disability
Intelligibility plus speech rate can give you a give estimate of the
severity
Intelligibility involves the speaker, the listener, and the environment
Assessment of Intelligibility of Dysarthric Speech
Special Assessment Issues with AOS
Key features of AOS
• groping of the articulators
• variable errors
• increased difficulty with volitionality and complexity
• difficulty with repetition
• usually articulatory and prosodic errors
Tasks to include in AOS assessment:
• automatic speech”
• DDK of increasing complexity
• words of increasing complexity
• repeated trials of the same words
• nonverbal tasks of increasing complexity (oral apraxia)
• right handed tasks upon verbal command (limb apraxia)
Differential Diagnosis
Lesion detection
Treatment planning
Refer to Duffy charts