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Name the six "salient features" of neuromuscular function.
- 1. Muscle Strength
- 2. Speed of Movement
- 3. Range of Movement
- 4. Accuracy of Movement
- 5. Motor Steadiness
- 6. Muscle Tone
What can decreased muscle strength in the motor speech mechanism affect?
If a patient is asked to press his tongue against a tongue blade or asked to count out loud from 1 to 100 what is the SLP testing?
How is speed of movement assessed?
- alternate motion rates (AMR)
- sequential motion rates (SMR)
Asking the patient to repeat "puh, puh, puh" or "tuh, tuh, tuh" as rapidly as possible is what kind of task? And what is it accessing?
It is an alternate motion rates (AMR) task and it is assessing speed of movement.
Asking the patient to repeat "puh, tuh, kuh" on one breathe of air is what kind of task? And what is it accessing?
It is a sequential motions rate (SMR) task and it is assessing speed of movement.
How far the articulators can travel during the course of a movement.
Range of Movement
Inability to fully open the jaw or completely adduct the vocal folds are examples of what?
Reduced range of movement
Which speech process is especially affected by reduced range of movement?
The SLP has the patient hold a position or prolong a vowel, what is being assessed?
The most common disorder in which involuntary movements prevent motor steadiness.
Decreased muscle tone is associated with?
muscle weakness or paralysis
Increased muscle tone is associated with?
muscle spasticity or rigidity
How can the patient's muscle tone be assessed?
It is inferred by listening to the patient's speech or by looking at the affected body parts
Face and Jaw muscles at rest and during movement. What is the clinician looking for?
- any abnormal muscle tone or strength
- asymmetrical facial features
- restricted range of movement
Tongue at Rest and during Movement. What cranial nerve is responsible for the function of the tongue?
Hypoglossal cranial nerve XII-innervates the intrinsic and extrinsic muscles of the tongue.
Which cranial nerve is responsible for innervating most of the muscles of the velum and pharynx?
Vagus cranial nerve X
Can the function of the larynx be observed directly?
No, to actually observe the larynx, you need instrumentation such as a laryngeal mirror or a flexible nasoendoscope.
How can the clinician evaluate the strength and range of movement of the laryngeal adductor and abductor muscles?
By the following tasks:
- 1. Is the patient able to produce a sharp cough?
- 2. Can the patient produce a sharp glottal stop?
- 3. Is inhalatory stridor present?
What cranial nerve is responsible for the functioning of the facial muscles?
facial cranial nerve VII
What cranial nerve innervates the jaw?
The trigeminal cranial nerve V
In most cases what is the best instrument for evaluating deficits of the motor speech mechanism?
The clinician's experienced ear.
Weakened or paralyzed velar muscles result in what?
Incomplete velopharyngeal closure, which is heard as hypernasality
To assess the phonatory and respiratory components of the speech mechanism the clinician will have the patient take a deep breath and say /a/ as long, and steady as they can. What is the clinician listening for?
- the length of time the patient can prolong an /a/
What is a key evaluation task for motor speech disorders?
Alternate motion rate (AMR) tasks
What kind of dysarthias usually have slow and regular AMR's
Individuals with flaccid and spastic dysarthria
What kind of dysarthrias often have slow and irregular AMRs?
Individuals with ataxic and hyperkinetic dysarthia
Some individuals with hypokinetic dysarthria have AMR's that are?
more rapid than normal, some are so quick that the articulation of the phonemes is blurred
What is an AMR assessing?
The patient's ability to move the articulators rapidly yet smoothly in a repetitive motion.
What is a SMR task assessing?
The patient's ability to move the articulators in a rapid, smooth sequence of motions.
Typically which one is more difficult for the patient to perform: SMR or AMR?
Which task is useful for bringing out the symptoms of apraxia of speech?
- SMR, the symptoms can include:
- delays in the beginning the task
- phoneme substitutions
- incorrect sequencing of syllables
- articulatory groping for the correct phoneme placement
AMR is also know as the?
What does stress testing of the motor speech mechanism screen for?
Myasthenia gravis-a disorder that causes rapid fatigue of the muscles during a sustained motor activity.
If the patient demonstrates rapid deterioration of articulation, resonance or phonation while counting from 1 to 100, what would you suspect?
A disruption in the ability to voluntarily sequence complex movements accurately is?
Name the two types of apraxia that affect the speech musculature?
- nonverbal oral apraxia
- apraxia of speech
Examples of ______ include smiling, puckering the lips, protruding the tongue, and biting the lower lip.
Nonverbal oral movements
_______ is a problem in sequencing the steps of a complex movement that has already been planned by the higher centers of the brain.
T/F-It is possible for someone to have nonverbal oral apraxia but not have apraxia of speech.
Individuals with ______ often demonstrate numerous sequencing errors when they are attempting to speak, especially multisyllabic words.
Apraxia of speech
T/F- Automatic and emotional speech is usually free of apraxic errors.
True- tasks such as counting, uttering an expletive or replying to a social greeting are often produced correctly.
For a patient with apraxia of speech which task would be harder? Counting from 1-20 or counting backwards from 20-1?
Counting backwards (counting from 1-20 is easy, overlearned material)