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Part One: Clinical Assessment Section

Portfolio Project - 1 Objective: Demonstrate ability to conduct an oromotor examination


(physical examination and speech examination).

I.

Methods
A. Subjects

Motor Speech Disorder (MSD) Subject: 53-year old male diagnosed with cerebral palsy (CP).
Age-Match Subject: 56-year old male with no motor speech disorder diagnosis.
B. Procedure
1.) Comparative Physical Exam
For the MSD subject, a mild lingual deviation to the right and a moderate right facial droop were
present at rest. Mild reduction in range of motion to the right was present during labial retraction
and lateral labial movements. Mild reduction in lingual strength on the right side was present
during anterior lateral movement against resistance. The physical examination revealed no
abnormalities for the age-matched subject.
2) Comparative Speech Exam:
Diadochokinesis:
Norms
(Duffy, p.81)
Alternate Motion Rates (AMRs)
/puh/
6.3
/tuh/
6.2
/kuh/
5.8
Sequential Motion Rates (SMRs)
/puh/ /tuh/
N/A
/tuh/ /kuh/
N/A
/puh/ /tuh/ /kuh/
5.0

MSD Subject

Age-Matched Subject

Trial
1
4.6
3.8
4.1

Trial
2
4.2
4.1
3.8

Trial
3
4.2
4.2
3.9

Trial
1
3.6
4.6
3.3

Trial
2
3.8
4.4
3.8

Trial
3
3.8
4.6
3.5

2.4
2.5
1.6

2.2
2.4
1.4

2.3
2.5
1.4

2.1
2.1
1.2

2.3
2.3
1.2

2.3
2.5
1.6

For both the MSD and age-matched subjects the AMRs and SMRs were slow but regular.
However, SMRs were significantly slower than AMRs relative to the normative data for both
subjects. No articulatory errors were noted in either the MSD or age-matched subjects.
Maximum Phonation Duration (MPD):

Norms: Between 13.8 (elderly man) to 28.5 (young male) - (Duffy, p.80)
Take a deep breath and say ah for as long as you can until you run out of breath
MSD Subject
Age-Matched Subject
Trial 1
Trial 2
Trial 3
Trial 1
Trial 2
Trial 3
16
13
9
15
12
9
The MSD subjects average MPD score of 12.67 seconds and the age-matched subjects average
MPD of 12 seconds were just below the average of 13.8 seconds for an elderly male. However,
anything greater than 9 seconds is considered within functional limits (Duffy, p.80). Hypo
nasality, roughness, and vocal tremor were present in the MSD subject. No deviations in vocal
quality were noted for the age match subject.
Consensus Auditory Perceptual Evaluation of Voice (CAPE-V)
Perceptual Attribute
Degree of Dysphonia
Overall
Mild-Moderate dysphonia
(30/100)
Breathiness
Normal (0/100)
Strain
Normal (0/100)
Roughness
Mild Roughness (10/100)
Pitch
Loudness
Resonance

Normal (0/100)
Normal (0/100)
Mild-Moderate Hypo Nasal
(25/100)

Presence
Consistent
Consistent
Consistent
Only noted on sustained
vowels
Consistent
Consistent
Consistent

Results from the CAPE-V analysis revealed a mild dysphonia (30/100) overall for the MSD
subject. Vocal quality was mildly rough (10/100) on sustained vowels and resonance was
consistently characterized by mild hypo nasality (25/100). No deviations in vocal quality were
noted for the age match subject.
II.

Medical Report

Subject is a 53 year old male who exhibits a mild dysarthria secondary to cerebral palsy.
Articulation is characterized by imprecise consonants and distorted vowels (e.g., sod of ma
body for side of my body). Prosody is characterized by mildly slow rate (120wpm), equal
stress across syllables and words, monopitch, and monoloudness. A mild vocal tremor and mild
roughness (10/100) were present on sustained vowels. Resonance is characterized by mildmoderate hypo nasality (25/100). Speech intelligibility remains intact. Diadokhokinesis revealed
mildly slow and regular AMRs (~ 4/s) and significantly slow and regular SMRs (1.5/s).
Maximum phonation duration was mildly reduced (12.67s). The physical exam revealed mild
reduction in lingual strength and range of motion and a mild lower right facial droop.
III.

Video Link

https://drive.google.com/open?id=0B11uFvXI6miqM0V1MnZnbGNsb0k

IV.

Video Reflection

Overall the physical and speech exams were relatively easy to conduct. Since my subject does
not have any language or intellectual impairments, he easily understood my directions. I could
benefit from more instruction on how to elicit the infantile reflexes. Though neither of my
subjects displayed the reflexes, I was not sure if this was the result of me not eliciting them
properly.
During the physical exam I should have sat closer to the subject so I could have braced his head
with my hand. I think I was reluctant to sit so close because I did not know my subject and this
is a very intimate exam. With experience I am confident that I will develop the level of comfort
required to properly conduct a physical exam.
Though I am not able to record my students, I have been performing physical and speech exams
on the students that I suspect have a motor speech disorder, either apraxia of speech or a
dysarthria. Each student experiences difficulty with a different aspect of the exam. It is eye
opening to see firsthand how varied motor speech disorders can be. I have also noticed that it is
significantly more difficult to perform the exam on my students because many of them have
concomitant language impairments and/or intellectual disabilities. I need to be very aware of my
instructions. If a student is not able to perform a task I need to be sure it is related to the motor
speech disorder and not due to them not understanding the task.