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11/28/16
AssessmentofMotor
SpeechDisorders
CHAPTER14
Diagnostic Plan
for
Motor Speech
Disorders
Case History/Interview Info
Medical DX/ Other factors
Standardized
Motor Speech Assessment
InformalMeasures
In-depth OME
Hearing screening
Speech sample
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I
II
III
IV
V
VI
VII
VIII
IX
X
XI
XII
Ooh
Ooh
Ooh
To
Touch
And
Feel
Very
Green
Vegs
A(h)
H
S = sensory
Olfactory
M = motor
Optic
B = both
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Vestibulocochlear
Glossopharyngeal
Vagus
Accessory (spinal)
Hypoglossal
CN3
(S)ome
(S)ay
(M)arry
(M)oney
(B)ut
(M)y
(B)rother
(S)ays
(B)ig
(B)rains
(M)atter
(M)ore
Superior
Rectus
CN3
Medial
Rectus
Inferior
Oblique
CN3
Lateral
Rectus
Superior
Oblique
Inferior
Rectus
Anosmia
-loss of smell
-often can still smell “painful” stimuli
like ammonia
CN6
CN4
I. Olfactory (S)
CN3
-smell
left CN II lesion
Blindness in eye on affected
side (mimicked by closing
an eye)
II. Optic (S)
right CN II lesion
- sight
III. Oculomotor (M)
-sensorineural deafness
-balance problems
-may be diminished by
adaptation if onset is slow
-difficulty
swallowing
-lack of taste
in post. 1/3
of tongue
-uvula
deviates
away from
lesion
a. 4 of 6 eye muscles
-inferior oblique
-superior rectus
-medial rectus
-inferior rectus
b. constriction of iris (PS)
c. upper eyelid
VIII. Vestibulocochlear (S)
-balance and hearing
IX. Glossopharyngeal (B)
right CN III lesion
-(S) taste of post. 1/3 of tongue
-(M) pharynx
-(M) salivation (PS)
IV. Trochlear (M)
-superior oblique
X. Vagus (B)
-if a major lesion...death
-minor lesions
- nasal speech
- lack of taste in throat
- parasympathetic problems
- may impair swallowing
-fixed dilated pupil
-paralysis of eye
-outward deviation of eye
-drooping eyelid
-(S) taste deep in throat
-(M)PS of heart, lungs,
kidneys, viscera
-(M) pharyx, larynx
(swallowing)
V. Trigeminal (B)
(S) sensation of face
(M) muscles of mastication
VI. Abducens (M)
-weak neck and
back muscles
-may impair
swallowing
- pharynx, larynx
(swallowing)
- sternocleidomastoid
-trapezius
Neurohonors.wordpress.com
- numbness of face
(dyasthesia)
-paralysis and deviation
of the jaw to the side
of the lesion
-cannot look laterally
-eye deviates medially
-lateral rectus
XI. Spinal Accessory (M)
right CN XI lesion
(note the lack of tone on the right
and the shoulder droops slightly))
Try to group CNs by function. Which nerves together serve...
Taste ______________
Others?
PS function ______________
Eye movement ______________
Swallowing ______________
Speech ______________
-weak down and out vision
-head tilt
-doublevision
XII. Hypoglossal (M)
- tongue weakness
- tongue protrudes to
the side of the lesion
-difficulty swallowing
right CN VI lesion
VII. Facial (B)
- intrinsic tongue muscles
- shape tongue
- extrinsic tongue
- moves tongue
-(S) taste of ant. 2/3
of tongue
-(M) facial expressions
-(M) glands (PS)
-left CN XII
lesion
(try to hold your
tongue and swallow)
-facial weakness
-emotion is not voluntary
so face may move with surprise
-lack of taste in ant. 2/3 of tongue
-dry mouth
-Bell’s Palsey
left CN VII (she is attempting to smile
but the L side of her face is paralyze
AmorecomprehensiveOME
https://www.youtube.com/watch?v=girup5Hs4CE
https://www.youtube.com/watch?v=uS0aU3Pmhy4
DysarthriaExamVideo
ApraxiaExamhttps://www.youtube.com/watch?v=961P3unPCWY&t=81s
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InformalAssessmentMeasure
§AutomaticSpeech(days,numbers,months,rhymes)
§Spontaneousspeechsample
§Oralreading
Multipleerrorstypicallypresentinspontaneousspeech
andoralreading
Apraxia
Automaticspeecherrors Dysarthria
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Dysarthria
Motor speechdisorder duetomuscleweakness,
slownessorpoor coordination
Typicallyaffectsarticulation,voice,resonance,
fluency
6subtypes- manyhavesimilarcharacteristics
Etiology- CVA,trauma,infection, neurodegenerative,
congenital
WhattypeofDysarthria?(Table14-3,Form14-1)
Flaccid- Hypernasal, inprecision,breathy,monopitch,nasal
emission
Spastic- Harshvoicequality,strained-strangled,shortphrases
Mixed- Hypernasal,imprecision, slowrate,harshvoice,vowel
distortion
Ataxic-inconsistentloudness,variable nasality,irregular artic
Hypokinetic- reducedstress,breathy,rushofspeech,
imprecision, harshvoice,monopitch,longsilences
Hyperkinetic- Imprecision,distortedvowels,harshvoice,
irregular artic breakdowns,strained-strangled
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PerceptualDiagnostics- Type
Case1)Strangled-strainedvoice,harshvoice,inprecise
consonants
Case2)variablenasality,irregularstress,loudnesscontrol
difficulty
Case3)breathy,monopitch,harshvoicetension,rushesof
speech
VideoExamples- Dysarthria
Huntington’s ChoreaA.L.S.MyastheniaGravis-
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Apraxia
AKA;AcquiredApraxia,verbalapraxia,dyspraxia
CASinchildren
Motorspeechdisorderduetoinabilitytoexecutevolitional
movements(normalmuscletone/coordination)
Programmingofbrainfrommotorstriptomusclesnot
executingprecise,purposefulmotororspeechmovements
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Apraxia
Etiology:CVA,TBI,Tumor, neurodegenerative
diseases
Subtypes:Limb, oral
Verbal- problems positioning, sequencing muscles
forspeechmovements
https://www.youtube.com/watch?v=bZ7pnmd9UHI
DifferentialDiagnosis:
Apraxia
vs
Dysarthria
Articulation difficulty, abnormal prosody
Difficultywithmotorplanning, muscletoneintact
Involuntary tasks(swallowing,chewing,etc.)not
affected
Errorsduetodisruptionofmessagefrommotor
striptooralmuscles
Inconsistent,unpredictablespeech,variesfrom
cleartopoorspeech
Primarily substitutions,repetitions,additions,
transpositions,prolongations,omissions,
distortions,attemptsarecloseapproximations
Intelligibility may increaseasrateincreases
Increaseincomplexityreducedarticulation
Moreerrorsascomplexityincreases.
Ex: consonantsvs.vowels,blendsvs.singles
Difficultywith;Articulation, phonation,resonance,
respiration,prosody
Difficultywithmuscletone,involuntary&
voluntary motor tasks
Errorsduetodisruptionofcentralandperipheral
nervoussystemthatcoordinatesmusclecontrol
Consistentandpredictablespeecherrors
Primarily distortions/omissions,Slowrate,
strained,tense,poorbreathsupport
Intelligibility reducedasspeechrateincreases
Increaseincomplexityreducedarticulation
Consonants areinprecise butconsistent,vowels
neutral
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IdentificationVideos
Noticeablecharacteristicsduring;
◦Automaticspeechtasks
◦Readingpassage
◦Spontaneous speech/Conversation
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