COMDIS 711 PORTFOLIO PART 2: Differential Motor Speech Disorder Diagnostic Writing

Jenna Sargent

Dysarthria Subtype:
Rewrite Case Number 5.1

Spastic Dysarthria
65-year-old female exhibits a mild spastic dysarthria reportedly following a 6-month
progression of worsening speech and dysphagia. Patient reported biting her cheek when
chewing and compensating by chewing slower and eating smaller portions. Speech is
primarily characterized by imprecise articulation and reduced rate. Speech AMRs are slow
but regular. Additionally, vocal quality is characterized by monopitch, monoloudness, and a
strained-harsh-groaning quality with occasional pitch breaks. Resonance is characterized by
hyper-nasality. Physical exam revealed mild bilateral facial weakness, decreased lip
retraction, slow lateral tongue movements, and bilateral tongue weakness which could
contribute to imprecise articulation. Speech intelligibility is normal but mildly compromised
by noise. Suspected dysphagia associated with tongue, lip, and jaw control.

New Case Number 5.3

71-year-old female exhibits a moderately-severe spastic dysarthria reportedly following a 3month history of lost voice. Patient reported a 15-month history of progressing speech
difficulty. Speech is primarily characterized by imprecise articulation, and reduced rate.
Speech AMRs are slow but regular. Additionally, vocal quality is characterized by
monopitch, monoloudness, and a strained-harsh-groaning voice. Resonance is
characterized by hyper-nasality. Physical exam revealed unilateral lingual weakness, a slight
right facial droop and subtle snarl of the left upper lip at rest. Despite the presence of
imprecise articulation and lingual weakness, the patient demonstrates the ability to
compensate and produce intelligible speech. Patient reported a normal diet with occasional
choking on liquids and infrequent nasal regurgitation.

Dysarthria Subtype:
Rewrite Case Number 4.6

Flaccid Dysarthria
Patient exhibits a mild flaccid dysarthria secondary to a bilateral cranial nerve VII paralyses
resulting from a TBI. Speech is primarily characterized by distorted productions of bilabial
and labiodental sounds and fricatives and affricates. Physical exam revealed bilateral facial
paresis, reduced bilateral facial range of motion and labial weakness during compression
against resistance which could contribute to imprecise labial consonant productions.
Patient reported anterior leakage of liquids due to labial weakness during compression.
Speech intelligibility is normal but reduced under adverse environmental conditions.

New Case Number 4.7

62-year-old female exhibits mild flaccid dysarthria reportedly following an 8- to 10-year

history of mild swallowing problems and a 2- to 3- year history of speech problems
associated with radiation treatment to the face at age 13. Speech is primarily characterized
by slow rate and imprecise articulation of fricatives, liquids, and bilabial sounds. Physical
exam revealed bilateral facial and lingual weakness. Despite the presence of imprecise
articulation, weakness, and associated reduced tongue movement, the patient
demonstrates the ability to compensate and produce intelligible speech. At this time, she
did not report any difficulty with swallowing.

Dysarthria Subtype:
Rewrite Case Number 6.7

Ataxic Dysarthria
45-year-old female exhibits a mild dysarthria reportedly following a 5-month history of
slurred speech. Speech is characterized by irregular articulatory breakdowns and
occasional pitch breaks. Speech AMRs are irregular. Physical exam revealed reduced range
of motion during labial rounding, mild lingual weakness on lateral strength testing, and
equivocal lingual weakness during lateralization. Subtle bilateral lingual fasciculations are
present. Reflexes are hyperactive. Patient reported occasionally coughing, choking, or
gagging when swallowing and occasionally gagging when brushing her teeth.

COMDIS 711 PORTFOLIO PART 2: Differential Motor Speech Disorder Diagnostic Writing

Jenna Sargent

New Case Number 6.5

53-year-old female exhibits a moderately-severe ataxic dysarthria reportedly following a 9month history of slurred speech which has gradually worsened. Patient reported biting
her tongue when eating and occasional drooling when laughing or crying. Speech is
primarily characterized by irregular articulatory breakdowns and dysprosody. Dysprosody is
noted with excess and equal stress and varied inappropriate loudness. Speech AMRs are
irregular and slow. Vowel prolongation was breathy and unsteady. Although speech is
reduced, the reduced rate appears to be a compensatory strategy for increasing speech
intelligibility. Speech intelligibility is normal but reduced when emotionally upset.

Dysarthria Subtype:
Rewrite Case Number 7.2

Hypokinetic Dysarthria
68-year-old male exhibits mild hypokinetic dysarthria reportedly following a 5-year history
of voice difficulties. Patient reported difficulty initiating speech within the past year, along
with reduced rate and loudness after extended speech. Speech is primarily characterized by
reduced loudness, accelerated speech rate, and inconsistent repetitions or prolongations of
initial phonemes. Additionally, nasal emission is noted during pressure sound-filled words.
During vowel prolongation, voice was breathy and hoarse with reduced loudness relative to
hypokinetic vocal cord function. Speech did not deteriorate during stress testing, despite
the subjective complain of speech changes with extended speaking.

New Case Number 7.3

72-year-old female exhibits mild-moderate hypokinetic dysarthria following a recent

complaint of slurred speech and difficulty initiating speech. Speech is primarily
characterized by imprecise articulation, accelerated rate, harsh vocal quality, and
dysfluencies. Disfluencies are characterized by whole word repetitions and syllable
repetitions that are palilalic in nature. These dysfluencies interrupt normal prosody or
rhythm of speech. Due to a concern of myasthenia gravis, stress testing was conducted but
no evidence of speech deterioration was noted.

Dysarthria Subtype:
Rewrite Case Number 8.4

Hyperkinetic Dysarthria
35-year-old female exhibits a moderate hyperkinetic dysarthria following a 2-year history of
speech difficulty. A familial history of Huntingtons disease was reported. Speech is
primarily characterized by imprecise articulation with irregular articulatory breakdowns and
dysprosody. Dysprosody is characterized by accelerated rate and inappropriate assignment
of pitch and loudness. Speech AMRs are irregular. Low-amplitude tremor was noted during
vowel prolongation. Delayed initiation of speech and continuation of speech was noted
secondary to choreic-like movements of the lower face, jaw, and tongue. Patient had
difficulty maintaining a protruded tongue, lip retraction, and open mouth postures. Speech
intelligibility is mildly reduced; however, patient compensated by reducing her speaking
rate.

New Case Number 8.6

73-year-old female exhibits moderate adductor spasmodic dysphonia following a 10-year

history of voice difficulties. Patient reported that voice difficulties began during a period of
psychological stress. Her voice worsens when she is anxious or speaks in groups. Speech is
characterized by a tremor that interrupts her voice and a reduced speech rate. Consistent,
irregular and strained voice interruptions were noted during vowel prolongation. Tremors
were apparent at higher pitches but absent during prolongations of voiceless fricatives.
Botox injections were recommended and provided. After several weeks of a weak-breathy
dysphonia and mild swallowing difficulties, vocal quality improved and characterized by a
mild voice tremor.