oral peripheral + neuromotor speech examinationspeople.umass.edu/mva/pdf/oral periph neuromotor...
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Oral Peripheral + Neuromotor Speech Examinations
by:Mary V. Andrianopoulos, Ph.D.
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Examining the Speech Mechanism
• Clinical observations are judged or quantified to determine normality or abnormality of motor speech and phonatory mechanisms.
• To date, there are no psychometrically stable tests to differentially diagnose the motor speech and phonatory mechanisms.
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Differential Diagnosis• Voice Phonatory Mechanisms• Articulation Sensorimotor Systems• Cognition IQ: verbal + non-verbal• Language Cognitive-Linguistic Processes
– Phonology, semantics, syntax, etc.– Receptive vs. expressive abilities
• Subjective + Objective Measurements• Clinician Judgment + Quantitative measurement
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Assessment of the Speech Mechanism is a two-fold process
1. Determine the Structural Integrity of the speech mechanism:
– administer an oral peripheral exam– determine size, shape, and adequacy of
structures for non-speech + speech-related purposes
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2. Determine the Functional Integrity of the Speech Mechanism:– administer the neuromotor speech exam– determine adequacy of system to produce
non-speech and speech-related movements
– articulatory + phonatory systems
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Oral Peripheral Examination• Assess the:
– Size, shape, and adequacy of:– oral, lingual structures– resonatory, laryngeal structures– respiratory structures
• Determine if they perform their functions for:– non-speech + speech-related purposes
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Exam the following:• teeth and occlusion• hard palate• soft palate• tongue• face, nose, mouth• neck, shoulders• overall body and posture• lungs or respiratory system• muscular processes associated with above
structures
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Neuromotor Examination• assess sensori-neuromotor mechanisms• assess cranial nerves related to speech
– and articulatory components• assess phonatory mechanisms
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Assess CNS + PNS Integrity
• Inventory signs + symptoms• Determine salient + confirmatory signs• Interpret signs + symptoms with
localization of lesion of breakdown• Form a differential diagnosis
– pattern recognition + associations– Rule-out/rule-in problems
• Confirm diagnosis
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Relevant Cranial Nerves• Cranial V: jaw• Cranial VII: face
– (lower face > contralateral UMN input)– (upper face bilateral UMN input)
• Cranial VIII: auditory• Cranial IX: pharynx• Cranial X: soft palate, vocal folds, larynx• Cranial XI: shoulders, neck
– (some muscles > contralateral)
• Cranial XII: tongue (> contralateral UMN input)
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Facial Asymmetry
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Eyelid Weakness
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Lingual Weakness
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Check for Neuropathological Reflexes
• Suck reflex bilateral UMN involvement• Gag reflex Absent or reduced reflex
• See list of primitive reflexes for developing children and neonates
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Phonatory Mechanisms
• Respiration: breathing• Phonation: vocal quality• Resonance: air flow• Pitch: fundamental frequency (Hz)• Loudness: volume (dB)• Rate of speech: speed
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Respiration
• General breathing pattern for speech/nonspeech
• s/z ratio, 1:1 ratio, 1:4 abnormal• MPT: modal /a/ maximum in seconds
– Maximum phonation time• Pulmonary function studies (PFTs)• Spirometry, pneumotachograph
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Voice Assessment Instrumentation
• Computerized Speech Lab (CSL)• Multispeech• Visi-pitch• Largyno-strobo-video-endoscopy• Flexible Endoscopic Evaluation of
Swallowing with Sensory Testing– (FEESST)
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Phonation and Pitch
• Subjective rating scale– Clinician-based:
• GRBAS, CAPE-V, Buffallo III, Duffy book– Patient-based:
• V-RQOL, VHI-10, VHI-30• Objective measurements:
– Visi-pitch, CSL/MDVP, MultiSpeech, etc.
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Resonation
• nasal resonatory– hyper- or hyponasality
• Subjective measurements: mirror clouding• Objective measurements: Nasometer
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Loudness
• Subjective measurements: volume• Objective measurements:
– SLM, dB measurement
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Speech Rate
• AMRs (alternate motion rates) norms– Diadochokinetic rates
• SMRs (sequential motor rates)• WPM (words per minute)• SPS (syllables per second)