This woman presents with a moderately-severe dysarthria, with 85% intelligibility in known contexts and 80% intelligibility in unknown contexts. Primary characteristics of the dysarthria are forced audible inspiration, forced inspiration-expiration, strained-strangled voice, voice stoppages, imprecise consonants, inappropriate silence, reduced stress, and slow rate. The client’s overall intelligibility was not greatly affected, since her single word and phrase productions were understood by the listener.
Although the client presents with a moderately-severe dysarthria, with 80-85% intelligibility, her naturalness and comprehensibility are tremendously reduced, due to deficits in the various subsystems for speech and observable neurological deficits contributing to her dysarthria. The woman demonstrates a lack of facial expression, eye contact, volitional, postural, and muscular deficits at rest and during speech production. She exhibits imprecise volitional and automatic movements, abnormal and irregular posture, abnormal, irregular, and involuntary muscle contractions.
These neuromuscular abnormalities or deficits could also be occurring in the speech subsystems. The woman’s speech production is characterized by forced audible inspiration, forced inspiration-expiration sighs, strained-strangled voice, voice stoppages, and changes in loudness variation demonstrating deficits in respiration and phonation. These deficits may be attributed to reduced vital capacity and subglottal air pressure, deficits in laryngeal function, control of the respiratory and phonatory subsystem, and possibly alluded to the client’s abnormal postural control.
During the Diadochokinetic (DDK) task, the client demonstrated alternating loudness variations, voice stoppages, and a strained-strangled voice after she was provided with a model and instructions (i. e. , “repeat fast and steady”). Additionally, during a sustained phonation task of the vowel /a/, the client was provided instructions to hold and sustain the vowel (i. e. , “take a breath and say /a/, hold that out for long and steadily as you can”) which also revealed alternating loudness variations, voice stoppages, and a strained-strangled voice.
Her maximum phonation time (MPT) was 13 seconds, which could signify respiratory and phonatory deficits. The client’s voice quality suggests difficulties in initiating and sustaining speech. Furthermore, the client presented with articulation deficits, characterized by imprecise consonant production. In the DDK speech task (i. e. , /pa/, /ta/, /ka), the client’s productions were slow and laborious, particularly for the production of /ka/, in which she also exhibited incoordination of the subglottal pressure. In addition, she produced “wilt” for the word wild, demonstrating uncoordinated articulatory precision for the consonant /d/ (i. . , devoicing to /t/).
She also presented with breakdowns in multisyllabic words due to co-articulation, which indicate deficits in lingual, mandibular, facial muscle, and laryngeal function. Although she presented with breakdowns in multisyllabic words, she was intelligible in the monosyllabic word level. The client’s speech production is also affected by her prosody. Her prosody is characterized as having reduced stress, slow rate, and inappropriate silences between words. Prosody is affected by all or a combination of the speech subsystems, which makes her pitch and loudness variation more prominent.
During the counting task (i. e. , 1-10), she demonstrated an increase in the length of pauses between each production, rising from three-to-six seconds. Additionally, during a phrase repetition task, it took the client twenty-two seconds to produce the entire phrase. The client inserted inappropriate silences after monosyllabic or multisyllabic words (i. e. , we saw…several…wild…animals). Consequently, in the picture description task, the client produced ten words in twelve seconds (i. e. , the mother…is…washing…dishes…and…the water…is overflowing).
The client’s prosodic deficits contributed to the overall naturalness and comprehensibility, due the listener’s processing of individual words as oppose to continuous speech; however, the articulatory production of each word was considered intelligible. These prosodic changes during counting, phrase repetition, and picture description tasks were not consistent with the sustained phonation and DDK task. The client’s prosodic features varied, and were affected by vocal fold abduction and adduction, sustained phonation, loudness and voice quality.
The client also demonstrated mandible and tongue movement variations in the limited oral motor examination when compared to speech tasks. The client was asked to depress her mandible, protrude her tongue, and to rapidly lateralize her tongue. She demonstrated a decreased range in motion and tone, and reduced ease of alternating movement; however, these results were not easily detectable during speech tasks. In order to further understand the client’s dysarthria and begin treatment planning, I would need prepare a thorough assessment. I ould initiate the assessment procedure by completing a comprehensive medical and personal case history, as well as a client-self assessment.
The clinician will obtain vital information of the client’s personal views of their auditory-perceptual deficits, awareness, and concerns. Additionally, obtaining a complete oral-motor examination, of the face, mandible, tongue, velum, larynx, dentition, and hard palate, would provide the clinician an understanding of the structural and functional adequacy of the oral mechanisms, and the importance of each muscle for speech production.
Moreover, observations or results from the oral motor exam will provide initial hypotheses that will lead to further testing and by elicitation of additional behaviors. Similarly, performing comprehensive DDK task with /pa/ /ta/ /ka/ and /buttercup/ would provide results of nonsense syllables and real words. The word /buttercup/ would resemble continuous speech, and have a stronger linguistic value than the nonsense syllables. The DDK task would assess the client’s ability to make rapid speech movements using all the structures in the oral motor examination.
Additionally, a DDK task will provide further information of the resonance (e. g. , velopharyngeal elevation or retraction) respirator, and phonation subsystems. In addition to the oral motor examination and DDK task, connected speech and repetition tasks are also fundamental for a thorough assessment. The client’s speech production will be assessed in known and unknown contexts, such as a reading passage, in conversation, and in repetition tasks, which range from monosyllabic, to multisyllabic words, to short phrases, and sentences.
A larger sample of the client’s speech production will help assess or confirm the hypothesis from the video; that the client’s spontaneous speech production improves during spontaneous speech production as oppose to repetition tasks. Furthermore, all the subsystems will be assessed, especially prosody. These tasks will provide the clinician results for a differential diagnosis and a direction for treatment. Together the client and clinician will create and modify treatment goals, based on the client’s awareness, strengths, and weaknesses.
