Motor Speech Exam 1: DAB Mayo Classification System & Clinical Examination

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Motor Speech Exam 1: DAB Mayo Classification System & Clinical Examination
2014-09-29 20:56:51
motor speech classification system

DAB Mayo system
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  1. 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
  2. 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
  3. What is the neuromuscular basis for DAB clusters?
    Tone, force, range, direction, rate
  4. 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
  5. 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
  6. 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)
  7. What are some consideration when doing a clinical exam?
    • Cognitive status
    • Intelligibility
    • State of being, environmental, social info, cooperation, level of consciousness
  8. Physical exam (oral mech)
    What to look for (General)?
    Range, accuracy, tone, speed, strength, steadiness
  9. 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
  10. 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)
  11. What are the most important structures to look at in a clinical exam?
    Lips, jaw, tongue, velum, respiratory, phonatory
  12. 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
  13. Jaw
    ROM: Opening/closing
    Strength: use resistance
  14. 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
  15. VP mechanism
    Symmetrical at rest?
    Raise (loud, sustained ah)
    Puh puh puh or pop pop pop
  16. Laryngeal mechanism
    glottal coup: need vocal folds to approximate 
    Cough: need respiratory support; weak, strong? sharp?
  17. Respiration
    SOB, listen for breath groups when speaking, rate loudness, audible inspiration?
  18. Phonation
    Voice quality (hoarse)
    appropriate pitch
    strength/speed/coordination: /i/ /i/ /i/
  19. 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
  20. Nonverbal oral apraxia:
    Cough, click tongue, blow, bite lower lip, puff out cheeks, smack lips, stick out tongue, lick lips
  21. 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
  22. 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