PORTFOLIO PART 1: CLINICAL ASSESSMENT COMDIS 711

Part One: Clinical Assessment Section

PP 1 Objective: Demonstrate ability to conduct an oromotor examination (physical

examination and speech examination).
Methods
A. Subjects
MSD subject: LH is a 91-year-old female who presents with a moderate apraxia of speech.
Age matched subject: AP is an 86-year-old female with no diagnosis of a motor speech disorder.
B. Procedure
1. COMPARATIVE PARAGRAPH OF RESULTS BETWEEN THE PHYSICAL DIFFERENCES
Physical exams for the MSD and age-matched subject revealed similar results. A mild asymmetry was
noted on the MSD subjects right side of mouth during retraction, while no facial asymmetries were
noted in the age-matched subject. A mild reduction in strength of the right and left masseter was noted
in both subjects. In the MSD subject, moderate incoordination during lingual protrusion, mild lingual
reduction in strength against resistance, and moderate lingual reduction in strength against resistance
with elevation were noted. The only abnormal finding in the age-matched subject was a mild lingual
reduction in strength against resistance.
2. COMPARATIVE PARAGRAPH OF RESULTS BETWEEN THE SPEECH EXAM DIFFERENCES
NORMS CITED RELEVANT TO YOUR AGE GROUPS AND ACCOUNT FOR PERFORMANCES

Diadochokinetic rates were tested in both subjects. The MSD subject performed considerably
lower than average on repetitions of /puh/ (2.2 times per second; norm 5.0-7.1). She
substituted sounds of incorrect articulatory placement for productions of /tuh/ and /kuh/,
therefore data for these two productions was not compared to norms. The age-matched
subject performed slightly lower than the norms for repetitions of /puh/ (4.4 times per second;
norm 5.0-7.1) and /tuh/ (4.3 times per second; norm 4.8-7.1) and in the minimum norm range
for repetitions of /kuh/ (4.4 times per second; norm 4.4-6.4) (Duffy, 2013, p. 81). During testing
of sequential motion rates, both subjects performed considerably lower than norm scores. The
MSD subject produced repetitions of /puh/ /tuh/ /kuh/ 0.5 times per second, although it should
be noted that she substituted buttercup and butterchup for /puh/ /tuh/ /kuh/. The agematched subject produced /puh/ /tuh/ /kuh/ 1.9 times per second (norm 3.6-7.5) (Duffy, 2013,
p. 81). Both subjects are elderly females (LH = 91 y.o.; AP = 86 y.o.) which is a factor that may
affect their performances, in conjunction with a diagnosis of apraxia of speech in the MSD
subject. Maximum phonation duration was also tested in both subjects. The MSD subject
performed better on this task, with an average time of 27.99 seconds while the age-matched
subject had an average time of 5.93 seconds (norm 10.0-15.4 seconds) (Duffy, 2013, p. 80). This
data suggests that the MSD subject has more efficient respiration for speech in comparison to
the age-matched subject. The age-matched subjects performance on this task is likely due to
her sedentary lifestyle and poor physical fitness.
[Source: Duffy, J. R. (2013). Motor speech disorders: Substrates, differential diagnosis, and management.
Elsevier Health Sciences.]

PORTFOLIO PART 1: CLINICAL ASSESSMENT COMDIS 711

Diadochokinesis: Alternate and Sequential Motion Rates (AMRs and SMRs)
Alternate Motion Rates
Normal
Trial 1
Trial 2
Trial 3
Average
Range
AP
LH
AP
LH
AP
LH
AP
LH
/puh/
5.0-7.1
3.4
2.8
4.8
1.9
5.2
1.9
4.4
2.2
/tuh/
4.8-7.1
4.4
0
3.8
0
4.8
0
4.3
0
/kuh/
4.4-6.4
3.8
0
5.2
0
4.2
0
4.4
0
Sequential Motion Rates
Normal
Trial 1
Trial 2
Trial 3
Average
Range
AP
LH
AP
LH
AP
LH
AP
LH
/puh/ /tuh/
3
0
2.8
0
2.4
0
2.7
0
/tuh/ /kuh/
2.5
0
2.9
0
2.8
0
2.7
0
/puh/ /tuh/ /kuh/
3.6-7.5
1.9
0.6
1.9
0.5
2
0.5
1.9
0.53
*MSD subject substituted /puh/ for /tuh/and /wuh/ for /kuh/ in alternate motion rates
*MSD subject substituted /bwuf/ /wuf/ for /puh/ /tuh/, /wuf/ /wuh/ for /tuh/ /kuh/, and butterchup for
buttercup.
Maximum Phonation Duration
Trial 1
Trial 2
Trial 3
Average
AP
LH
AP
LH
AP
LH
AP
LH
7.68
35.30
4.57
27.18
5.56
21.49
5.93
27.99
Video link: https://youtu.be/IVJFRpgUR5c

Norms
10.0-15.4

II. Medical report section (disorder subject only) IMPRESSIONS STATEMENT ONLY
LH is a 91-year old female who exhibits moderate apraxia of speech and a mild residual UUMN
dysarthria. Speech is characterized by reduced rate, syllable segregation, and imprecise articulation.
Articulatory groping frequently accompanies speech attempts. LH exhibits mild-moderate vocal
roughness and mild-moderate strain with moderate-severe reduction in loudness. Performance on
diadochokinetic rates was slow with consonant substitutions. Maximum phonation duration was
above normal limits for her age. Physical examination revealed a mild right asymmetry during labial
retraction and a right asymmetry of the soft palate, which is evidence of a central VII. A mild bilateral
reduction in strength of the masseter, mild reduction in lingual strength against resistance during
protrusion, and moderate reduction in lingual strength against resistance during elevation was noted.
In addition, a moderate incoordination during lingual protrusion was noted.

III. Reflection on performance

After reviewing my video recording for this project, I recognize that there are many things I can
improve upon in the future. I expect that conducting these exams will become more natural as I gain
more experience. Through the entire exam I frequently used fillers (i.e., um, alright) when I was
trying to gather my thoughts and formulate concise directions to give to my client and in the future I
should not use as many fillers. When testing tongue strength against resistance, I did not put my
hand behind my clients head to stabilize it, which I should have done in order to more accurately
assess strength. During the entire tongue portion I was sitting farther away from her than I realized
and I should have been sitting closer. I found it challenging to provide directions without providing a
visual model because it feels natural to provide a model as I am telling someone what to do, but I
stayed conscious of this throughout testing and was careful to not give models when not necessary.
In the very beginning I did provide a model after I asked her to stick out her tongue and she stuck it
out and downwards. At the time I thought she had trouble following the command and needed a

PORTFOLIO PART 1: CLINICAL ASSESSMENT COMDIS 711

model, however after re-watching this part I realize that I should have tried to give a more clear
direction (i.e., Stick your tongue straight out, not upwards or downwards) before providing a model.
Before testing maximum phonation duration I did not tell my client the purpose of this task. It may
not be essential but it is always good to tell clients why we are having them do things that might seem
strange to them. During this task my directions were not as clear as they could have been and as a
result she began going before I was ready to time her.
When testing diadochokinetic rates, I initially started out using an app on my phone that counts
syllables for me. This app is very useful for subjects with fast AMR rates, such as the age-matched
subject that I used, however as I was using it with my MSD subject it became apparent that her rates
were slow enough for me to keep track of easily and using the app seemed to be adding even more
for her to think about during an already difficult task, so I decided to discontinue use of it. As I tested
AMRs and SMRs, I recognized that my client was unable to produce the correct sounds for some
targets but I thought I needed to have her do the best that she could do anyways. I know now that I
could have discontinued the productions once I determined that she was unable to produce them in
the correct articulatory position.