Case history
- introduction and goal setting; discuss with client why they are at therapy/what they want to get out of it
- background information; social support, daily routine
- onset and course; sudden vs gradual, improving/deteriorating
- current status and perceptions; what helps? When is it better/worse - any pattern?
- clients/carers perception of the problem, consequences of the dysarthria
- observe posture, mood, hearing and vision during case history
- listen to intelligibility and respiration
The dysarthria impact profile (Walshe et al, 2009)
- psychosocial impact of dysarthria from speakers perspective
- four sections; the effect of dysarthria on me as a person, accepting my dysarthria, how i feel others react to my speech, how dysarthria affects my communication with others
Frenchay Dysarthria Assessment (FDA-2) (Enderby, P., Palmer, R. 2008. Frenchay dysarthria assessment - second edition)
- assesses oromotor movements
Why is it important to assess
- reach a diagnosis, establish severity, rate intelligibility and comprehensibility
- assess the impact that the impairment has on their life (activity limitations and participations)
- guide intervention and treatment focus
- enable goal setting
- to measure change (outcome measures)
- make prognosis and potential long term intervention
What to assess
- take holistic approach - encompassing a range of variables
- development of ICF has moved therapy away from impairment based analysis of speech deficits - consider participation and activity
Assessing body function (ICF)
- breath support
- laryngeal performance
- oromotor performance
- prosody
- cognitive functioning
- other concomitant problems; dysphagia, visual impairment, auditory processing disorder
Oromotor exam
- assesses articulation (tongue and lip movement)
Assessment of intelligibility of dysarthric speech (Yorkston & Beukelman, 1984)
- obtains an estimate of overall severity
- speaker reads 50 one or two syllable words, one at a time
- limits learning effects selecting target words at random from a larger set of potential words
Grandfather passage (Aronson and brown 1975)
Use (Dobinson, 2009) 9 point scale to assess intelligibility
Respiration
Speech is breathy and person can only speak in short sentences or phrases
Volume also decreased
Assessment tasks for respiration
- say /a/ for as long as possible (norm 10-15 secs)
- s-z ratio to differentiate from vocal cord dysfunction
- count 1-5 getting louder each time
- listen to vocal volume in connected speech
- utterance length
Phonation
Production of voice through vocal fold vibration in the larynx
Phonation - assessment tasks
- cough
- say /a/ as long as possible, listen to voice quality
- loudness and pitch during connected speech
Resonance
- placement of tones (oral or nasal) in phonemes during speech
- can be reduced nasal airflow; hyponasal speech
- excessive nasal airflow; hypernasal
Resonance assessment tasks
- observe the velum at rest, does it rise symmetrically on phonation of /a/ and series of /a/
Articulation
Needs articulators (lips, jaw, tongue, velum, larynx) to perform movements required for each phoneme with appropriate timing, direction, force, speed, placement
Assessment tasks - articulation
- OME; tongue and lip movement, blow out cheeks
- DDK tasks
