Oral Peripheral Neuromotor Speech Examinations

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Oral Peripheral Neuromotor SpeechExaminationsby:Mary V. Andrianopoulos, Ph.D.

Examining the Speech Mechanism Clinical observations are judged orquantified to determine normality orabnormality of motor speech andphonatory mechanisms. To date, there are no psychometricallystable tests to differentially diagnosethe motor speech and phonatorymechanisms.

Differential Diagnosis Voice Æ Phonatory MechanismsArticulation Æ Sensorimotor SystemsCognition Æ IQ: verbal non-verbalLanguage Æ Cognitive-Linguistic Processes– Phonology, semantics, syntax, etc.– Receptive vs. expressive abilities Subjective Objective Measurements Clinician Judgment Quantitative measurement

Assessment of the SpeechMechanism is a two-fold process1. Determine the Structural Integrity ofthe speech mechanism:– administer an oral peripheral exam– determine size, shape, and adequacy ofstructures for non-speech speechrelated purposes

2. Determine the Functional Integrity ofthe Speech Mechanism:– administer the neuromotor speech exam– determine adequacy of system to producenon-speech and speech-relatedmovements– articulatory phonatory systems

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

Exam the following: teeth and occlusionhard palatesoft palatetongueface, nose, mouthneck, shouldersoverall body and posturelungs or respiratory systemmuscular processes associated with abovestructures

Neuromotor Examination assess sensori-neuromotor mechanisms assess cranial nerves related to speech– and articulatory components assess phonatory mechanisms

Assess CNS PNS Integrity Inventory signs symptoms Determine salient confirmatory signs Interpret signs symptoms withlocalization of lesion of breakdown Form a differential diagnosis– pattern recognition associations– Rule-out/rule-in problems Confirm diagnosis

Relevant Cranial Nerves Cranial V: jaw Cranial VII: face– (lower face contralateral UMN input)– (upper face Æ bilateral UMN input) Cranial VIII: auditoryCranial IX: pharynxCranial X: soft palate, vocal folds, larynxCranial XI: shoulders, neck– (some muscles contralateral) Cranial XII: tongue ( contralateral UMN input)

Facial Asymmetry

Eyelid Weakness

Lingual Weakness

Check for Neuropathological Reflexes Suck reflex Æ bilateral UMN involvement Gag reflex ÆAbsent or reduced reflex See list of primitive reflexes for developingchildren and neonates

Phonatory Mechanisms Respiration: breathingPhonation: vocal qualityResonance: air flowPitch: fundamental frequency (Hz)Loudness: volume (dB)Rate of speech: speed

Respiration General breathing pattern forspeech/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

Voice Assessment Instrumentation Computerized Speech Lab oscopyFlexible Endoscopic Evaluation ofSwallowing with Sensory Testing– (FEESST)

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.

Resonation nasal resonatory– hyper- or hyponasality Subjective measurements: mirror clouding Objective measurements: Nasometer

Loudness Subjective measurements: volume Objective measurements:– SLM, dB measurement

Speech Rate AMRs (alternate motion rates) Æ norms– Diadochokinetic rates SMRs (sequential motor rates) WPM (words per minute) SPS (syllables per second)

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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