Assessment Presentation
48
year old male with no known neurological history, complains of progressive
speech difficulties consisting of effortful speech with variable sound errors
Setting: It is most likely that this patient will be seen on an outpatient basis, or in a private clinical setting.
History: Provide case history form for patient to fill out prior to initial visit. This would include a complete medical history as well as documentation from any other professional services. Upon arrival, the following questions should supplement the case history form.
When did you first notice the problem?
Describe your speech problem and how has it changed over time? How does it sound to you and how does it feel?
Do you know the cause of your speech problems?
How do others describe your speech? Do they have problems understanding you and what do you do when this happens?
In what settings do you most notice the difficulty?
Do you have any difficulty with chewing or swallowing?
*How important is it to you that you improve your speech?
If there is a family member and/or caregiver present, ask for their input on the above questions.
Oral Mechanism Exam (D-COME)
Assessment of Motor Speech System (Darley, Aronson, and Brown)
Respiration: Have the patient take a deep breath and let it out as slowly and audibly as possible. Observe any signs of difficulty, and if necessary assess further.
Prosody: Have patient read the Grandfather Passage, and note rate, rhythm, and melody.
Resonance: Have patient produce different nasal sounds within conversational speech, observing nasal emission and hyper/hypo-nasality by holding a mirror under the nose and noting fog.
Articulation: Have patient perform diadochokinetic tasks (repeat /p/, /t/, /k/: 4 per second; /ptk/: 3 per second), observing effortful production of sounds.
Intelligibility: Will be assessed during the reading of the Grandfather Passage.
Apraxia Battery (Apraxia Battery for Adults, Dabul)
Articulation: Have patient perform DDKs of increasing complexity (V, CV, C1V1 C2V2). If patient has AOS, he will have more difficulty the more complex the task becomes.
Prosody: Have patient perform automatic speech tasks, such as counting, alphabet, and days of week. If prosodic errors disappear, then patient probably has AOS.
Repetition: Have patient repeat trials of the same words. If he has AOS, he will not say it the same way each time.
Volitionality: Will be assessed during automatic speech tasks and conversational speech.
Intelligibility: Will be assessed throughout session.
Aphasia Battery (Western Aphasia Battery)
Auditory Comprehension: Have patient identify common items upon request (household items, body parts, etc.)
Expression: Have patient describe his last vacation or a recent event of interest, observing for paraphasias, fluency, telegraphic speech, etc.
Reading/Writing: Have patient read aloud and to themselves at the single word, sentence, and paragraph levels. Patients with aphasia may not be able to read aloud, but may be able to read to themselves. Have patient write his name, his address, and DOB.
Non-language skills: Have patient imitate modeled rhythmic tapping.
Dysarthria Battery (Frenchay Dysarthria Assessment)
Strength of the Oral Musculature: Have patient blow air into cheeks, and hold for 15 seconds to assess lip strength.
Articulation: Will assess patient’s articulatory accuracy during single words, reading, and connected speech. Observe for distortions, omissions, additions, and trial-and-error groping.
Prosody: During patient’s connected speech and reading, assess speech rate and prosodic adequacy (ideal is 140-200 wpm).
Intelligibility: Will be assessed throughout session.
Observe positioning, alertness and responsiveness (eye contact, tracking), facial expression, ability to follow conversation, social appropriateness, hearing screening, stamina.
Estimated Length of Assessment: 2, 2-hour sessions. In order to prevent fatigue and ensure accuracy, it would be beneficial to have more than one session. We would assess the oral structure, the motor system, and AOS in the first session, completing the remainder of tasks in the second session. Depending on the patient’s performance, a full 4 hours may not be necessary, however, it is better to have more time than not enough.