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84 MOTOR SPEECH DISORDERS: DIAGNOSIS AND TREATMENT
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longer words that all start with the same consonant–vowel–
consonant (CVC) syllable. It should be extremely difcult
for an individual with apraxia of speech to complete this list
without numerous sequencing errors. Not only are most of
the words multisyllabic, most of them also are low-frequency
words, meaning that they do not occur often in everyday
conversations. Patients with apraxia usually have more
difculty pronouncing low-frequency words than high-
frequency words.
2. “Now these.” Individuals with apraxia of speech typically
have little difculty producing single-syllable words with
a simple CVC construction in which the initial and nal
consonants are identical. Words of this type are included in
the evaluation for two reasons. First, the patient should nd
them to be a successful change of pace from the difcult
previous task. Second, the words provide a strong indication
of severity if the patient makes many apraxic errors on these
words. Because these words should be fairly easy for most
individuals with apraxia of speech, a patient who has dif-
culty with them is probably severely affected by the apraxia.
3. “Now repeat these sentences after me.” The sentences on
this task should be difcult for individuals with apraxia of
speech. These items are uncommon sentences that contain
numerous multisyllabic words. They should evoke some
apraxic errors in most individuals suspected of having
apraxia of speech.
4. “Count from 1 to 20.” Because this is an overlearned, auto-
matic verbal task, many individuals with apraxia of speech
should be able to complete it with far fewer errors than they
will demonstrate on the next task.
5. “Now count backward from 20 to 1.” Most individuals with
apraxia of speech will make multiple errors on this task, if
they can complete it at all. Although they are producing the
same words as in the prior task, counting backward is not
an overlearned verbal activity. Consequently, this should be a
difcult task for most patients with apraxia of speech.
Analysis of Connected Speech
In this nal portion of the evaluation, the clinician should have
the patient read one of the standard reading passages such as the
Grandfather passage or the Rainbow passage. To ensure an accurate analysis of the patient’s connected speech, it is very important
3. EVALUATION OF MOTOR SPEECH DISORDERS 85
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to obtain a good quality audio or video recording of this task. Rate
the characteristics of the patient’s speech according to the questions listed at the end of the examination (Darley et al., 1975). A
complete analysis of connected speech should provide much of
the information needed to distinguish one dysarthria from another.
Summary of the Evaluation of Motor Speech Disorders
n Evaluating motor speech disorders can be a challenging task
for inexperienced clinicians. There are numerous elements of
speech production that must be assessed to make a proper
diagnosis. The clinician needs to evaluate a patient’s respiration, phonation, resonance, articulation, and prosody during a
motor speech examination.
n Instrumentation and perceptual analysis are the two primary
methods of assessing motor speech disorders. Most clinicians use perceptual analysis to make their diagnosis. With
this method, clinicians use their eyes and ears to determine
whether a motor speech disorder is present in a given patient.
n In addition to evaluating the elements of speech production
(e.g., respiration, phonation, etc.), a complete motor speech
examination will examine the six processes that are the foundation of all voluntary movements: muscle strength, speed of
movement, range of movement, accuracy of movement, motor
steadiness, and muscle tone.
n At the most basic level, a motor speech examination allows a
clinician to fully describe a patient’s speech production abilities. With this complete description of the patient’s abilities,
the clinician should be able to logically answer pertinent
questions about the patient’s decits and arrive at a correct
diagnosis.
Study Questions
1. What are the two basic methods of evaluating motor speech
2. According to Haynes and Pindzola, what are the two goals
3. What are the ve components of speech production?
disorders?
of any speech-language evaluation?
86 MOTOR SPEECH DISORDERS: DIAGNOSIS AND TREATMENT
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4. Dene dysarthria.
5. Dene apraxia of speech.
6. What are Darley, Aronson, and Brown’s salient features of
neuromuscular function, and why are they important?
7. Name two evaluation tasks that assess tongue strength.
8. What are AMRs and SMRs, and why are they important?
9. What might inhalation stridor indicate?
10. Why might an individual with apraxia of speech have dif-
culty counting backward from 20 to 1?
Motor Speech Examination
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Patient’s Name:
Date of Examination:
Patient’s Age:
Neurologic Diagnosis:
Relevant Personal Information:
Medical History:
Appendix 3–1
INSTRUCTIONS:
impairment as follows:
0 = no impairment
1 = mild impairment
2 = moderate impairment
3 = severe impairment
Also be sure to answer all other questions in the space indicated.
Answer each item yes or no and indicate the degree of
87
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I. STRUCTURAL-FUNCTIONAL SPEECH MECHANISM EXAMINATION
Yes No Degree
A.
Facial Musculature at Rest: CN VII
1. Is mouth symmetrical?
If no, describe:
2. Can patient resist examiner’s attempt to
force lips open?
Are eyes open?
3.
4. Are eyes partially closed?
5. Is facies rigid or masked?
6. Is there wrinkling of forehead (when
looking up without moving head?)
7. Is nose symmetrical?
If no, describe:
B. Facial Musculature During Voluntary Movement: CN VII
1. Is smile symmetrical?
If no, describe:
2. Is groping present?+
3. Can patient pucker the lips?
If no, describe:
4. Is groping present?+
5. Can patient puff out cheeks and maintain lip
seal when pressure is applied?
If no, describe:
C. Mandibular Musculature at Rest: CN V
Does mandible hang lower than normal?
+Any groping should be followed up with the complete apraxia battery.
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Yes No Degree
D. Mandibular Musculature During Voluntary Movement: CN V
1. When mouth is open as widely as possible, is
there deviation to one side?
If no, describe:
2. Is groping present?+
3. Can patient move mandible voluntarily to
the right or left?
Can patient resist examiner’s attempt to open
4.
lower jaw when teeth are clenched?
5. Can patient keep mouth wide open as examiner
attempts to force it closed?
Tongue Musculature at Rest: CN XII
E.
1. Is tongue normal in size?
If no, describe:
2. Does tongue lie midline?
If no, describe:
3. Is tongue symmetrical in shape?
If no, describe:
4. With tongue resting atop edges of lower incisor
teeth, is fasciculation observable?
5. Does tongue remain at rest?
If no, describe:
F. Tongue Musculature During Voluntary Movement: CN XII
1. Can patient protrude tongue completely?
If no, describe range and deviation:
*Any groping should be followed up with the complete apraxia battery.
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Yes No Degree
2. Is groping present?+
3. With tongue protruded, can patient resist
examiner’s attempt to force tongue to other
side?
4.
With tip of tongue, can patient resist
examiner’s attempt to force tongue to one
side or other?
5.
With tip of tongue, can patient touch:
upper lip?
alveolar ridge?
If no, describe:
6. With tongue in cheek, can patient resist
examiner’s effort to force tongue inward?
7. Can the patient move the tongue from side
to side?
If no, describe:
G. The Velum and Pharynx at Rest and During Movement: CN X
1. Does the velum rise symmetrically each time
the patient says /a/?
If no, describe:
2. Is there a gag reex when the back wall of the
pharynx is touched?
H. The Function of the Larynx: CN X
1. Is the patient able to produce a sharp cough?
2. Can the patient produce a sharp glottal stop?
If no, describe:
3. Is inhalatory stridor present?
If yes, describe:
3. EVALUATION OF MOTOR SPEECH DISORDERS 91
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II. ACOUSTIC MOTOR SPEECH EXAMINATION
Yes No Degree
A.
Phonatory-Respiratory System:
1. Directions to patient: “Take a deep breath and say /a:/ as long, steadily,
and clearly as you can.”
a. Duration: Trial 1:
Trial 2:
Trial 3:
Average:
(average is 15 s for adults & 10 s for school-aged children)
b. Latency: Is there a latency period
between signal to say /a:/ and initiation
of phonation?
c.
Quality:
Steady and even
Smooth and clear
Hypernasality
Breathiness
Harshness
Diplophonia
Pitch
d.
Too high
Too low
Normal
Tremor
Pitch breaks
e. Loudness
Excessive loudness
Inadequate loudness
Normal loudness
f. Describe Abnormalities:
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Yes No Degree
B.
Resonatory System:
1. Directions to patient: “Take a deep breath
and say /u:/ for as long as you can.” Hold a
(laryngeal) mirror beneath one nostril and
then the other.
Leakage from (L. R. Both) nostrils.
2. Directions to patient: “Now I want you to do the
same thing, but this time I’m going to squeeze
your nose. Don’t let it bother you; just keep the
/u:/ going.”
Change in resonance when occluding (L. R. Both)
nostrils.
Connected speech without nasal.
Combined Systems (Phonatory, Respiratory, Resonatory, and Articulatory)
C.
1. Alternate Motion Rate (diadochokinetic)
Directions to patient: “Take a deep breath and
say (e.g. /p
evenly as you can.”
Demonstrate.
öpöpö/) as long, and as fast, and as
Is AMR slow?
Is AMR excessively fast?
Is AMR dysrhythmic?
Is AMR uneven in loudness?
Is AMR uneven in pitch?
Is there a tremor?
Is there equal spacing between syllables?
Is there blurring (lack of differentiation
between syllables)?
Is there hypernasality?
Is there nasal emission?
Is there restriction in amplitude of motion of
lips and jaw?
Are there imprecise or distorted consonants?
3. EVALUATION OF MOTOR SPEECH DISORDERS 93
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Indicate rate per 5-s intervals on this table:
/pö/ /tö/ /kö/ /pötökö/
Trial 1
Trial 2
Trial 3
Average
Average rate for /p
ö/ is somewhat slower.
/k
2.
Sequential Motion Rate
Directions to patient:
ö/ and /tö/ is about 30–35 repetitions for 5 s;
“Now I want you to make those three
sounds, ‘puh,’ ‘tuh,’ and ‘kuh’ together.”
Demonstrate. Note: Record the results (per 5-s trial) on the table
above.
Yes No Degree
a. Is patient able to move smoothly from
syllable to syllable?
b. Are sounds blocked, transposed, or omitted?
If yes, describe:
3. Stress Testing of the Motor Speech Mechanism
(screening for myasthenia gravis)
Instruct the patient to count rapidly (approximately
two numbers per second) at least up through 100.
Demonstrate 1 through 10.
Is there audible deterioration of phonation or
articulation?
If yes, describe:
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