Neuromuscular Features Affecting Speech
     Strength
     Speed
     Range
     Steadiness
     Tone
     Accuracy

 Confirmatory signs
     Signs other than the deviant speech characteristics and
     features of speech muscles during speech that can help
     confirm a speech diagnosis

    Can be found in speech or nonspeech muscles

 Examples of confirmatory signs within the speech system
     Atrophy
      Fasciculations
     Emotional lability
     Reduced reflexes
     Presence of pathologic reflexes
     Strength of cough and coup de glotte

 Examples of confirmatory signs in nonspeech motor system
     Gait disturbances
     Abnormal muscle stretch reflexes
     Limb atrophy and fasciculations
     Loss of automatic movements
     Difficulty initiating limb movements
     Abnormalities of strength speed, accuracy, tone, steadiness and ROM
        at rest or during nonspeech tasks

 Assessment Process
     History
     Assessment of nonspeech function
     Perceptual analysis of speech
     Intelligibility assessment
     Acoustic and physiologic analyses
 

PROTOCOL FOR EXAMINATION OF MOTOR SPEECH DISORDERS

1.  History
        *  facts about onset and course
        *  associated deficits
        *  patient's awareness of the symptoms/perception of the deficit
        * degree of disability or handicap caused by the problem i.e.
           consequences of the problem
        *  what kinds of things have been tried to manage the problems
        *  suggestions of questions pp.68-69
2. Assessment of nonspeech function

 A.   cranial nerve/oral mechanism exam e.g. Dworkin-Culatta Oral Mechanism Examination
        or other commercial or non-commercial format

   trigeminal (Vth) nerve

  * look for weakness, asymmetry and incoordination of the
     muscles controlling jaw movement
  * evaluate sequential motion rates (SMRs) using /p p p / and
     /m m m /- listening for pace and rate of production, articulatory
     precision, weak intensity, disintegration of rate or production and/or
     uneven loudness or pitch
  * also do sensory testing of facial area

  * evaluate muscles controlling lip and facial movements with a
     number of nonspeech tasks
  * repeat SMRs described above with bite block to restrict
    contribution of jaw movement and look at lip movement in isolation

  * as they apply to speech affect the integrity of pharyngeal, palatal
     and laryngeal musculature
  * look for evidence of dysphagia, drooling
  * examine palatal musculature at rest and during forceful phonation
     of /a/ paying special attention to uvula, asymmetry of palatal
     movement, fatigue on extended phonation
  * evaluate resonance features with and without nasal clip,
     mirror test for nasal air flow

  * look for tongue atrophy, fasiculations or other abnormal involuntary movements
  * check range, speed strength and symmetry of nonspeech tongue movements
  * evaluate integrity of tongue movements for SMRs using  /t t t / for tongue tip and
     /k k k / for tongue back both with and without bite block
  * alternating motion rates (AMRs) using /p t k /
  * as with other speech testing looking for blurring of articulation,
     pace or rate abnormalities, unevenness in loudness or pitch etc.

3. Perceptual analysis of speech
   A.   gather the following speech samples audio and/or video tape for analysis a
            * vowel prolongation
            * alternating motion rates (AMR) and sequential motion rates (SMR)
               using speech syllables and or words such as "puppy" "buttercup"
            * standard reading passage
            * narrative about pictured scene
            * conversation sample
            * stress test (counting for 2-4 minutes)
            * complex multisyllabic words and sentences
            * repeat days of week, months, CVC syllables with identical initial
               and final consonants, sing familiar tune

   B.   identify and rate deviant speech characteristics (pg 82 text)

4. Intelligibility assessment
    rate intelligibility using one of following scales
        * Assessment of Intelligibility of Dysarthric Speech
        * Frenchay Dysarthria Assessment
        * Word Intelligibility Test (Kent et. al, 1989)
        * Tikofsky Test of Intelligibility
        * Situational Intelligibility Survey (Berry and Sanders, 1983)

5. Acoustic and Physiologic Measures

       *  Perceptually based clinical assessment will probably always be
            most important component of clinical diagnosis
       *  As expense of instrumentation decreases, many acoustic and physiologic measures
            that have been used extensively in research have potential value for clinical diagnosis
            (and management - but we will deal with this later)
      *    Lack of instrumental use clinically may also reflect a lack of knowledge on the part
            of current clinicians - "phobias" about using instrumentation - or lack of clearly demonstrated
            clinical value
 

        Examples of  instrumental measures relevant to motor speech evaluations;
                Magnitude and timing of F2 movements
                F2 slope
                Diadochokinetic rate - average rate, variation of rate, intensity variations during repetitions
                VOT
                Pitch and intensity magnitude and variations during speech and sustained vowels
                Measures of nasal resonance (Nasometer)