COMDIS 711 PORTFOLIO PROJECT 2

A. Submit your ten written samples from the Duffy book. Include the case numbers.
Dysarthria Subtype:
Rewrite Case Number

New Case Number

Dysarthria Subtype:
Rewrite Case Number

Cortical
(Case 5-4) Spastic
Original:
XX exhibits a moderate spastic dysarthria characterized by
imprecise articulation, reduced loudness, monopitch,
monoloudness, hypernasality, and hoarse-strained vocal quality,
and reduced speech intelligibility. Performance on alternate
motion rates is slow and regular. There is no evidence of aphasia
or apraxia of speech. Physical exam revealed bilateral lower
facial weakness and reduced range of motion when smiling, lip
rounding, and lip puffing. Limited range of motion was also
noted during tongue protrusion and lateralization. Gag reflex is
hypoactive.
Rewrite:
An 80-year-old patient exhibits a moderate spastic dysarthria
with a reported 1-year history of sudden onset dysphagia and
dysarthria that resolved within 10 days. While the dysphagia and
dysarthria remitted, the dysarthria is present today. Speech is
characterized by imprecise articulation and reduced loudness.
Prosody is characterized by monopitch and monoloudness.
Resonance is hypernasal. Vocal quality is hoarse-strained.
Speech intelligibility is reduced. Alternate motion rates were
slow and regular. Physical exam revealed bilateral lower facial
weakness and reduced range of motion when smiling, lip
rounding, and lip puffing. Limited range of motion was also
noted during tongue protrusion and lateralization. Gag reflex is
hypoactive. Aphasia and apraxia of speech were ruled out.
Despite the reported presence of dysphagia 1 year ago,
dysphagia was ruled out at this time.
(Case 9-6) UUMN
A 66-year-old male presents with a moderate flaccid UUMN
dysarthria. Speech is characterized by imprecise articulation,
repetition of initial phoneme of words, and mild hesitations.
Vocal quality is breathy and harsh. Physical exam revealed
lateral lingual movements are mildly slowed. A right lower facial
droop (central VII) was noted.
Flaccid
(Case 4-3)
Original:
A 40-year-old patient presents with mild-moderate dysphagia
and mild-moderate flaccid dysarthria secondary to right vocal
fold paralysis in the paramedian position. Dysphagia is
characterized by occasional coughing or choking and frequent

COMDIS 711 PORTFOLIO PROJECT 2

throat clearing post-swallow. Cough and glottal coup are weak.
Speech is characterized by short utterances. Vocal quality is
breathy and hoarse with moderately reduced loudness. An
abnormal s/z ratio is present (12/2).

New Case Number

Dysarthria Subtype:
Rewrite Case Number

Rewrite:
Patient presents with mild-moderate dysphagia and mildmoderate flaccid dysarthria. Dysphagia is characterized by
occasional coughing or choking and frequent throat clearing post
swallow. Speech is characterized by short utterances. Vocal
quality is breathy and hoarse with moderately reduced loudness.
Laryngeal exam revealed right vocal fold paralysis in the
paramedian position possibly due to surgical trauma of the
recurrent laryngeal nerve. S/Z ratio is abnormal (12/2). Cough
and glottal coup are weak.
(Case 4-7)
A 62-year-old woman presented with an 8-10 year history of mild
dysphagia and a 2-3 year history of speech problems reportedly
associated with radiation treatment to the face at age 13. She
currently presents with mild flaccid dysarthria. Speech is
characterized by reduced rate and imprecise articulation,
particularly with anterior lingual fricatives, liquids, and bilabial
sounds. Speech AMRs and SMRs are normal. Vocal quality is
normal. Physical exam revealed bilateral facial and lingual
weakness against resistance. Lateral lingual nonspeech AMRs
are slow with noted fluttering of the cheeks during production of
bilabials. No pathologic oral reflexes are present. Despite the
presence of weakness and reduced tongue movement, the
patient is able to compensate and produce intelligible speech. At
this time the patient does not report any difficulty with
swallowing.
Ataxic
(Case 6-1)
Original:
A 41-year-old woman with a reported 1-year history of change in
speech presents with mild ataxic dysarthria. Speech is
characterized by reduced rate and irregular articulatory
breakdowns and is reported to worsen under stress or fatigue.
Voice is mildly hoarse with reduced pitch and vocal quality
during vowel prolongation is unsteady. Prosody is abnormal
with occasional excess and equal stress. AMRs are slow and
irregular. Speech intelligibility remains functional. Physical exam
results were within functional limits and no pathologic oral
reflexes were present. A neurologic evaluation completed at a
later date revealed a pronounced gait and balance difficulties.
CT scan and MRI results identified cerebellar atrophy bilaterally
and in the vermis.

COMDIS 711 PORTFOLIO PROJECT 2

Rewrite:
A 41-year-old woman with a reported 1-year history of change in
speech presents with mild ataxic dysarthria. Speech is
characterized by irregular articulatory breakdowns and is
reported to worsen under stress or fatigue. Prosody is
characterized by reduced speech rate and occasional excess and
equal stress. Voice is mildly hoarse with reduced pitch. Vocal
quality during vowel prolongation is unsteady. Alternate motion
rates are slow and irregular. Speech intelligibility remains
functional. Physical exam results were within functional limits
and no pathologic oral reflexes were present.
New Case Number

(Case 6-3)
A 56-year-old woman presents with moderate ataxic dysarthria
following a reported 8-month progression of speech difficulty.
Speech is characterized by irregular articulatory breakdowns.
Vowel prolongation is unsteady. Speech AMRs are irregular.
Physical exam results were normal. Due to irregular articulatory
breakdowns, speech intelligibility is mild-moderately reduced.

Dysarthria Subtype:
Rewrite Case Number

Hypokinetic
(Case 7-2)
Original:
A 68-year-old man presents with mild hypokinetic dysarthria
following a reported 5-year history of voice difficulty. A 1-year
history of uncertainty if words would come out, quieter and
slower speech in the evening or following extended speaking,
and occasional difficulty getting going with speech was also
reported. Speech is characterized by accelerated rate, nasal
emission during production of pressure-sound filled sentences,
and rapid repetitions or prolongations of initial phonemes.
Performance on speech AMRs was normal. Speech did not
deteriorate during stress testing. Vocal quality is breathy-hoarse
with reduced loudness. Vocal quality during vowel prolongation
is breathy-hoarse. Physical exam revealed a masked facial
expression and mildly tremulous jaw, lips, and tongue during
sustained postures.
Rewrite:
A 68-year-old male presents with mild hypokinetic dysarthria
following a reported 5-year history of voice difficulty. Patient
reported experiencing hesitancies initiating speech within the
past year, along with reduced rate and loudness after extended
speaking. Upon examination, speech is characterized by
accelerated rate, nasal emission during production of pressuresound filled sentences, and palilalia. Vocal quality is breathyhoarse with reduced loudness, substantiating the patients

COMDIS 711 PORTFOLIO PROJECT 2

New Case Number

Dysarthria Subtype:
Rewrite Case Number

New Case Number

subjective complaint of reduced loudness after extended

speaking. Performance on speech AMRs was normal. Speech
did not deteriorate during stress testing, despite the subjective
complaint of speech changes with extended speaking. Physical
exam revealed a masked facial expression and mildly tremulous
jaw, lips, and tongue during sustained postures.
(Case 7-3)
A 72-year-old female presents with mild-moderate hypokinetic
dysarthria. Speech is primarily characterized by mildly
accelerated rate and mildly imprecise articulation. Vocal quality
is harsh. Dysfluencies including palilalia and prolonged silent
intervals are present in conversational speech. Speech did not
deteriorate during stress testing despite suggestion of
myasthenia gravis; therefore, myasthenia gravis was ruled out.
Hyperkinetic
(Case 8-2)
Original:
A 53-year-old male with an 18-month history of gradual speech
difficulty presents with mild-moderate hyperkinetic dysarthria
secondary to basal ganglia disorder of unknown etiology. Patient
reports that speech tends to worsen when he is anxious, excited,
or has consumed alcohol and improves in the morning, after
relaxation exercises, and when writing or drawing while
speaking. Intermittent jaw opening and tongue retraction were
noted during speech and are associated with open vowels and
velar consonants. Speech improves when the patient whispers,
clenches his jaw while speaking, or writes while speaking.
Physical exam findings were normal.
Rewrite:
A 53-year old male with an 18-month progression of speech
difficulty presents with mild-moderate hyperkinetic dysarthria
secondary to basal ganglia disorder of unknown etiology. Patient
exhibits dystonic movements, which are characterized as
intermittent jaw opening and tongue retraction and are
triggered by phoneme-specific movements that require jaw
opening or posterior lingual elevation (i.e., open vowels and
velar consonants). Patient reports that speech tends to worsen
when he is anxious, excited, or has consumed alcohol and that it
improves in the morning, after relaxation exercises, and when
writing or drawing while speaking. Whispering, clenching jaw
while speaking, and writing while speaking are compensatory
strategies that were trialed and resulted in improved speech.
Physical exam findings were normal.
(Case 8-5)

COMDIS 711 PORTFOLIO PROJECT 2

A 70-year-old female presents with moderate hyperkinetic
dysarthria of organic voice tremor following a reported 1-year
history of voice difficulty that worsened with stress and fatigue.
Speech is characterized by vocal tremor and voice arrests. A
vocal tremor, as well as mandibular, lingual, palatal, and
pharyngeal tremor were noted during vowel prolongation.
Physical exam revealed low-amplitude labial tremor at rest. All
other aspects of the physical exam were normal.
B. Identify and recognize areas for improvement in your writing and as observed in peer samples.
My ability to write impressions statements has improved over the course of this semester,
however there are still areas that I plan to improve upon in the future. In the beginning of the semester
my impressions statements were short and did not always include all salient information from the case
studies. While I have become better at identifying which information is necessary to include and which
information is not (i.e., is not relevant to the speech diagnosis), I still find this challenging at times when
working with complex cases so this is an area that I still would like to see myself improve upon. In
addition, as I gain more experience writing impressions statements I plan to work towards making my
writing more cohesive.