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Prior to DAB, dysarthria was considered one disorder. Viewed as an artic problem
Who developed the Mayo System for dysarthria? What was it a result of?
What kind of analysis?
What are the 6 dysarthria types?
- Darley, Aronson, Brown
- Research project
- Auditory-perceptual (gold standard)
- Flaccid, spastic, hypokinetic, hyperkinetic, ataxic, mixed, umn
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DAB invented clusters. Explain what a cluster is and how many. Name the clusters (but not the characteristics).
- Co-occurence=cluster
- Based on physiology (reflect underlying pathophysiology)
- 8 identified
- No 2 disorders had same set of clusters
- Articulatory inaccuracy, prosodic excess, prosodic insufficiency, articulatory-resonatory incompetence, phonatory stenosis, phonatory incompetence, resonatory incompetence, phonatory-prosodic insufficiency
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What is the neuromuscular basis for DAB clusters?
Tone, force, range, direction, rate
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What are some purposes of a clinical exam?
- 1. detect or confirm a suspected problem
- 2. establish differential dx
- 3. classify problem within specified disorder group
- 4. determine site of lesion or disease process
- 5. specify degree/severity of involvement
- 6. establish prognosis
- 7. specify more precisely the treatment focus
- 8. establish criteria for tx termination
- 9. measure any change in patient that accompanies tx, lack of tx, or exacerbation of original etiological factor
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Description and establishing are the two main components/goals of clinical exams. Describe them in detail.
- Description: characterizing features of speech & structures based on patient's history, description of problem, oral mech exam, perceptual characteristics of speech, standard clinical tests, instrumental analysis
- Establishing: diagnostic possibilities, diagnosis, implications for localization/disease dx, specifying severity
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General guidelines for assessment (clinical exam)
- 1. History (onset/course, deficits, patient's perception, consequences of condition, healthcare management, awareness of dx/prognosis)
- 2. Salient features
- 3. Confirmatory signs (atrophy, reflexes, etc.)
- 4. Interpretation (results should be stated relative to purpose of exam, help with localization, presence of MSD, severity, certainty)
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What are some consideration when doing a clinical exam?
- Cognitive status
- Intelligibility
- State of being, environmental, social info, cooperation, level of consciousness
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Physical exam (oral mech)
What to look for (General)?
Range, accuracy, tone, speed, strength, steadiness
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What are speech tasks during clinical exam? What about prosody? Intelligibility?
- Isolation, sentences, contextual speech (reading paragraph)
- Diadochokinetic tasks (speed & coordination), mention speed & steadiness (maybe accuracy)
- Rate, loudness, breath groups, articulatory precision
- Overall intelligibility
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Oral mech procedure
Examining face at rest--what to look for?
During sustained postures?
During movement
Also look for each structure in isolation, as well as non-speech movements
- Symmetry, adventitious movements, expressions, fasciculations
- Retracted lips, puffed cheeks, mouth opening
- Look for compensation in isolation (using jaw to compensate fr weak tongue movements)
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What are the most important structures to look at in a clinical exam?
Lips, jaw, tongue, velum, respiratory, phonatory
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Lips
Strength: Use tongue blade to see if lips can be moved when asked to maintain tight lips seal
ROM: Retraction, symmetry
Speech/coordination: Pucker/lip retraction-fast
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Jaw
ROM: Opening/closing
Strength: use resistance
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Tongue
At rest, look at fullness, symmetry, fasciculations, adventitious movements
Protrude: Sustained posture (stick tongue out)
Strength: Resist tongue blade, tongue in cheek on each side
Lateralization of tongue: ROM, speed, coordination
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VP mechanism
Symmetrical at rest?
Raise (loud, sustained ah)
Puh puh puh or pop pop pop
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Laryngeal mechanism
glottal coup: need vocal folds to approximate
Cough: need respiratory support; weak, strong? sharp?
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Respiration
SOB, listen for breath groups when speaking, rate loudness, audible inspiration?
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Phonation
Voice quality (hoarse)
appropriate pitch
stability
stridor
strength/speed/coordination: /i/ /i/ /i/
Loudness
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Reflexes
Gag: Important if only elicited on one side
Sucking: Draw tongue blade from corner of upper lip towards philtrum; positive=pursing of lips
Snout: light tap on philtrum; positive-pursing
Palmomental: Blade across palm of hand; positive: contraction of mentalis muscle
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Nonverbal oral apraxia:
Cough, click tongue, blow, bite lower lip, puff out cheeks, smack lips, stick out tongue, lick lips
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What are confirmatory signs of MSD? (but not necessary for dx of MSD)
- Muscle atrophy
- abnormal tone
- fasciculations
- poorly inhibited laughter or crying
- reflects-reduced or pathologic
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Other clinical exam tasks?
Difference between comprehensibility and efficiency?
- vowel prolongation, AMR, SMR, contextual speech, stress testing, multi-syllabic words/sentences
- How well the content of messages are understood vs. rate at which intelligible information is conveyed
- intelligibilty-impairment, comprehensibility-disabiltiy
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