MSD Final Exam

CD 5732 Neurogenic Disorders II
Motor Speech Disorders
Final Exam
Summer 2005

Name ____________________________________________ Score _______/100

PART I: Review the Motor Speech Disorders Post-Test videotape. Respond to each of the questions below. (14)

Case #1

1. What is the most prominent deviant feature of this patient's speech?
breathiness
accelerated rate
slow rate
phonemic substitutions

2. This patient's voice quality is best described as:
strained
diplophonic
myoclonic
continuously breathy

3. This patient's motor speech disorder is:
flaccid dysarthria
spastic dysarthria
hypokinetic dysarthria
hyperkinetic dysarthria

Case #2

4. What is the most prominent visible abnormality in this sample?
frequent inappropriate smiling
facial tics
involuntary facial retraction
facial fasciculations

5. Which of the following best describes this patient's motor speech disorder? (bonus)
chorea
myoclonus
tremor
dystonia

6. This patient's motor speech disorder is:
spastic dysarthria
ataxic dysarthria
unilateral upper motor neuron dysarthria
hyperkinetic dysarthria

Case #3

7. This patient's speech difficulties are primarily:
respiratory and phonatory
articulatory and prosodic
phonatory and resonatory
articulatory and resonatory

8. This patient's AMR's are predominantly:
slow
rapid
loud
irregular

9. This patient's motor speech disorder is:
flaccid dysarthria
spastic dysarthria
ataxic dysarthria
apraxia of speech

Case #4

10. The most striking characteristic of this patient's speech is:
deterioration during continuous speaking
accelerated rate
articulatory substitutions and groping
monopitch and monoloudness

11. The nervous system abnormality causing this speech disturbance is most likely in the:
cerebral cortex
cerebellum
basal ganglia
neuromuscular junction

12. This patient's motor speech disorder is:
flaccid dysarthria
spastic dysarthria
hypokinetic dysarthria
ataxic dysarthria

Case #5

13. Which one of these speech abnormalities is the most important to differential diagnosis of this patient?
dysphonia
articulatory substitutions and groping
slow rate
monopitch and monoloudness

14. The lesion causing this motor speech disorder is most likely in the
left cerebral hemisphere
right cerebral hemisphere
upper motor neuron system, bilateral
cerebellum

15. This patient's speech disorder is
spastic dysarthria
ataxic dysarthria
unilateral upper motor neuron dysarthria
apraxia of speech

Part II: Assessment Essay: Assessment of motor speech disorders involves several steps and observations at many levels. Discuss the levels/methods of assessment that should be included in a complete motor speech evaluation and identify how the various information obtained will be used. (20)

Part III: Differential Diagnosis. Provide the most likely diagnosis or diagnoses given the assessment findings. If more information is needed to make a definitive diagnosis, identify the potential diagnoses and the additional information needed to narrow the diagnosis. Be sure to consider language disorders as well as motor speech disorders. (20)

Assessment Information	Differential Diagnosis	Additional Information Needed
Oral mech exam normal Nonfluent Speech Good auditory comprehension
Right sided facial weakness Mildly imprecise productions of labial and lingual consonants Slightly slow rate of speech
Pt unable to produce movements upon request for oral mech exam No apparent weakness noted during spontaneous oral movements Hyperfluent speech Very poor auditory comprehension and repetition
Reduced range of motion noted during oral motor exam Speech is characterized by fast rate, monopitch, and imprecise consonants Mild auditory comprehension deficits
Speech slow and labored Auditory comprehension normal
Oral mech exam shows normal strength, tone & ROM, but movements are dyscoordinated Primary speech characteristics include articulatory and prosodic errors
Oral mech exam shows general weakness and slow movements Speech is slow and imprecise, with strained vocal quality
Oral mech exam normal Speech characterized by breathiness and diplophonia
Oral mech exam normal (given visual model) Speech is fluent but limited to echolalic utterances Auditory comprehension poor

Part IV: Treatment Essay. Compare and contrast treatment for the motor speech disorders listed below. Consider issues of impairment-level treatments as well as principles of motor learning.

A. flaccid dysarthria (multiple cranial nerves) and hypokinetic dysarthria (10)
B. spastic dysarthria and apraxia of speech (10)

PART V: Treatment Planning (20)

For each patient listed below:

Develop a prognosis and a treatment plan, identifying the frequency and duration of treatment, the setting in which treatment will take place, and the functional goals treatment will address.
Develop a lesson plan for 60 minutes of therapy (note: this may involve more than one session). The plan should state explicitly
- the treatment activities that will be conducted
- the target of those activities (i.e., the goal the activity addresses)
- rationale for why the activity is appropriate
- identify the nature of the stimuli that will be used (if any)
- describe the type of instruction and/or feedback that is likely to be required

Patient A: 35 year old male 2 years s/p viral encephalitis with resultant spastic quadriplegia and severe spastic dysarthria. Current speech functioning: undifferentiated vowels, maximum sustained phonation 1.5 seconds.

Patient B: 58 year old female 7 days post onset brainstem stroke resulting in flaccid dysarthria impacting multiple cranial nerves.

Part VI: Integration (10). OK, you made it to the end of Neuro I and Neuro II (whew!). Without stressing too much, respond to one of the following reflection prompts:

Is evidence-based practice really possible in the management of neurogenic communication and swallowing disorders?
Discuss the significance of SLPs managing both communication and swallowing disorders.
What should ASHA, NIH, and other funding agencies consider the highest priority in terms of clinical research and how will such research influence clinical practice?
Consider your broader education in the areas of language, phonology/artic, voice and fluency disorders. What key concepts from your other classes have been most applicable/helpful in your learning about neurogenic disorders (or vise versa) and why?