Motor Speech Exam 1: DAB Mayo Classification System & Clinical Examination
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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
DAB invented clusters. Explain what a cluster is and how many. Name the clusters (but not the characteristics).
- 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
What is the neuromuscular basis for DAB clusters?
Tone, force, range, direction, rate
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
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
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)
What are some consideration when doing a clinical exam?
- Cognitive status
- State of being, environmental, social info, cooperation, level of consciousness
Physical exam (oral mech)
What to look for (General)?
Range, accuracy, tone, speed, strength, steadiness
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
Oral mech procedure
Examining face at rest--what to look for?
During sustained postures?
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)
What are the most important structures to look at in a clinical exam?
Lips, jaw, tongue, velum, respiratory, phonatory
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
Strength: use resistance
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
Symmetrical at rest?
Raise (loud, sustained ah)
Puh puh puh or pop pop pop
glottal coup: need vocal folds to approximate
Cough: need respiratory support; weak, strong? sharp?
SOB, listen for breath groups when speaking, rate loudness, audible inspiration?
Voice quality (hoarse)
strength/speed/coordination: /i/ /i/ /i/
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
Nonverbal oral apraxia:
Cough, click tongue, blow, bite lower lip, puff out cheeks, smack lips, stick out tongue, lick lips
What are confirmatory signs of MSD? (but not necessary for dx of MSD)
- Muscle atrophy
- abnormal tone
- poorly inhibited laughter or crying
- reflects-reduced or pathologic
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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