DYSARTHRIA/APRAXIA SCREENING

 

Oral Mechanism Exam

INTELLIGIBILITY

Observation: conversational speech

          Characteristics:

Spontaneous Speech: "Tell me about this picture."
(Disability/Perceptual)

 

RESPIRATION

Observation:

Bubble Test: Materials: glass of water with straw submerged at 5 cm and paper clipped to side
(Impairment/Perceptual) Ability to sustain /s/:
(Impairment/Perceptual)
    "Take a deep breath then exhale, making the /s/ sound for as long as you can."
    ________ seconds  
PHONATION

Observation: vocal quality

Ability to sustain /a/:
(Impairment/Perceptual)
    "Take a deep breath, then make the /a/ sound for as long as you can."
    ___________seconds Ability to increase volume:
(Impairment/Perceptual)
    "Take a deep breath, then make the /a/ sound again, but start at a whisper then get
    louder." Ability to glide up and down a scale:
(Impairment/Perceptual)
    "Begin at your conversational level of speech, say /a/ and sing up a scale, then sing
    down the scale." (provide a model)

PROSODY

Observation: Ability to vary:

Ability to imitate different stress patterns:
(Impairment/Perceptual)
    "Say these sentences exactly the way I say them using the same stress."  

RESONATION

Observation: Nasality:

Velar Movement
(Disability/Perceptual)
    "Say /a/, /a/, /a/." Nasal Emission: mirror
(Impairment/Perceptual)
    "I am going to hold this mirror under your nose, say 'may may may', now say, 'pay, pay,
    pay'."  

ARTICULATORY

Observation:

Rate of Movement:
(Disability/Perceptual)
    "Say 'buttercup' as fast as you can until I tell you to stop." model (5 seconds) Word Length:
(Impairment/Perceptual)
    "Repeat each word after me."   Repetition:
(Impairment/Perceptual)
    "Repeat each word 3 times." (Judge whether productions get better after repetitions)  
 
Norms adapted from the Dysarthria Profile (Robertson, 1987)

REFERENCES

    Dabul, Barbara L. (1979). Apraxia Battery for Adults. Austin, Texas: PRO-ED, Inc.
    Duffy, J. R. (1995). Motor Speech Disorders: Substrates, Differential Diagnosis, and Management. St. Louis: Mosby - Year Book Inc.
    Enderby, Pamela M. (1983). Frenchay Dysarthria Assessment. Austin, Texas: PRO-ED, Inc.
    Hartman, D.E. & Dworkin, J. P. (1994). Aphasia, Apraxia of Speech, and Dysarthria. San Diego: Singular Publishing Group, Inc.
    Robertson, S.J. (1987). Dysarthria Profile. Tuscon, Arizona: Communication Skill Builders, Inc.
 


 
SUBSYSTEM INVOLVEMENT OF MOTOR SPEECH DISORDERS
DISORDER SITE OF LESION ARTICULATION PHONATION RESONATION RESPIRATION PROSODY
APRAXIA Unilateral 
Cerebelar
X
      
X
UUMN Unilateral  
Cortico-Bulbar Tracts
X
        
SPASTIC Bilateral Cortico-Bulbar 
Tracts
X
X
X
  
X
HYPOKINETIC Substantia -Nigra
X
X
    
X
HYPERKINETIC Basal Ganglia
X
X
X
X
X
ATAXIC Cerebellum
X
      
X
FLACCID Cranial-Spinal Nerves/Muscles
X
X
X
X
X
MIXED Central-Peripheral 
Nervous System
X
X
X
X
X
 

* Adapted from Hartman & Dworkin, 1994
 
 


 

Motor Speech Disorders and Related Characteristics

 
Apraxia of Speech:  Inability to perform volitional motor movements in the presence of normal comprehension, muscle strength, sensation, attention, and coordination (White, 1997)
          1.  Inconsistent Errors: Repetitions, Substitutions, Simplifications, Distortions
               Additions, Deletions               6.  Meaningful utterances better than non meaningful utterances

 

Dysarthria: A specific disorder of speech in which the muscles controlling articulation,
            respiration, phonation, prosody, and resonation are affected, while basic language remains
            in tact (White, 1997).

                Ataxic Dysarthria: Damage of bilateral or unilateral cerebellar hemispheric lesions or
                damage to the cerebellar outflow tracts produce discoordination and dysmetria in the oral
                speech musculature as well as the muscles of the axial and appendicular skeleton.

                Speech Characteristics: Consonantal imprecision, omissions, and distortions particularly
                at word, phrase, and sentence endings.  Speech has an intoxicated quality.
                Diadichokinesis is slow and irregular, speaking rate and intonation patterns
                are irregular, and voice quality is harsh.
 
                Non-Speech Characteristics Signs of cerebellar disease include intention tremor, broad
                based gait, nystagmus, and dysphagia.
                 
 
                Unilateral Upper Motor Neuron (UUMN) Dysarthria: Damage resulting from a focal
                corticobulbar tract lesion of an isolated lacunar, internal capsule.

                Speech Characteristics:  Imprecise consonants, decreased loudness, limited pitch
                range, low pitch, short phrases and slow rate.

                Non-Speech Characteristics:  Contralateral central facial and tongue weakness,
                hemiparesis, and hyperreflexia.
 

                Spastic Dysarthria: Damage resulting from bilateral corticibulbar tract lesion,
                bihemispheric disease along with involvement of periventricular white matter and
                internal capsules.

                Speech Characteristics: Imprecise articulation, slow diadochokinesis, variable
                hypernasality, nasal emissions, strain-strangled phonation, frequent lapses of laughing or
                crying, decreased rate, and reduced breath support.

                Non-Speech Characteristics:  Hypertonicity, weakness, slowness of movement,
                hyperreflexia, "primitive" signs of sucking, jaw jerk, biting, grasping, increased palatal
                reflexes, and Babinski responses.  Weak oropharyngeal musculature places patient at
                risk for dysphagia and aspiration.
 

                Hypokinetic Dysarthria:  Damage caused by unilateral or bilateral lesions of the
                substantia nigra or its projections.  Characteristic of Parkinson's Disease

                Speech Characteristics:  Decreased loudness, reduced pitch inflections, and
                breathy-harsh voice.  Variable articulatory precision and rapid diadochokinesis,
                decreased loudness, silent intervals or inappropriate pausing followed by short rushes
                of rapid speech.

                Non-Speech Characteristics: Masked facial expression, positive glabellar tap, resting
                tremor, festinating bradykinteic gait, and flexed truncal posture.  Dysphagia is an early
                sign and dementia is a later one.
 

                Hyperkinetic Dysarthria:  Results from a lesion in the basal ganglia or biochemical
                imbalance.

                Speech Characteristics:  Imprecise articulation, irregular diadochokinesis, inappropriate
                prolongations of sounds, inappropriate silences between and among words, variable or
                fast rate, vocal harshness, reduced pitch and loudness variations, phonatory arrest, and
                tremor.  When there is velopharyngeal and respiratory involvement, variable
                hypernasality with nasal emission, and reduced and discoordinated respiratory support
                is also evident.

                Non-Speech Characteristics:  Uncontrolled quick, slow, or tremulous movements
                of the orofacial, trunk, and limb musculature.  Palatopharyngeal myoclonus  presented
                in strap muscles of the neck, base of the tongue, posterior pharyngeal wall, soft palate,
                and laryngeal musculature.
 

                Flaccid Dysarthria:  Damage caused by neuropathy (e.g., progressive bulbar palsy,
                infarct, trauma), myoneuropathy (e.g., myastenia gravis, Eaton-Lambert syndrome), or
                myopathy (e.g., myotonis dystrophy, polymyositis).
 
                Speech Characteristics: Severity and extent of speech involvement depends
                on the number of and degree to which the cranial nerves/ muscles and spinal
                nerves/muscles are involved.
 
                        Bilateral IX and X nerve lesions - continuous hypernasality and nasal emission due
                        to velopharyngeal involvement; hoarse, gurgly voice, weak or absent cough,
                        dysphonia, decreased loudness and unstable pitch, short phrases, reduced
                        stress, decreased respiratory support for speech, inspiratory and/or expiratory
                        stridor.
 
                        V, VII, and XII nerve lesions - imprecise, slow-labored articulation, reduced
                        diadochokinesis.

                   Non-Speech Characteristics:   muscle atrophy, fasciculations, diminished or absent
                   reflexes, paralysis, paresis and limitation of movements.
 

                   Mixed Dysarthria:  There are various combinations of dysarthria.  Listed below are
                   some disorders/diseases and the resultant mixed dysarthrias:

                   Amyotrophic Lateral Schlerosis                   flaccid-spastic
                   Multiple Schlerosis                                      spastic-ataxic
                   Wilson's Disease                                         ataxic-spastic and hypokinetic
                   Progressive Supranuclear Palsy                   spastic-hypokinetic-ataxic and flaccid
 

 
  Acquired AOS is aphasic adults
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