Name: Olivia Spears CD 630 Fall 2020: MSD Chart Assignment

Part I (Duffy, 2013)

Motor Speech Disorder Lesion / Co-occurring Characteristics – Physical and Speech Likely Swallowing / Feeding Issues Assessment Methods / Diagnostic Potential
Type Impairments related to MSD Markers Treatment Methods

Flaccid Lower Motor Neuron (final
common pathway, motor unit)
Spastic Bilateral Upper Motor Neuron
(direct and indirect activation
pathways)
Physical: Hypotonia and Weakness 1. Nasal Regurgitation Assessment Methods: 1. Postural
Speech: 2. Anterior spillage 1. Non-speech activities (i.e. face at rest, adjustments
1.Slow Rate/short Phrases 3. Pocketing face during movement, face sustained 2. Inhale more
2. Imprecise Consonant sounds (sounds affected vary postures, jaw at rest and moving, tongue deeply before speech
depending of cranial nerve affected (V, VII, X, XII)) at rest/sustained postures/movement), 3. Increase phrase
velopharynx during movement, volitional length
vs. automatic. 4. LSVT
2. Speech Tasks: vowel prolongation, 5. Increase loudness
AMRs, SMRs, contextual speech, stress 6. Exaggerate jaw
testing, and assessing motor speech movements
planning/programming capacity.
3. The Assessment of Intelligibility in
Dysarthric Speakers (AIDS), Sentence
Intelligibility Test (SIT), Frenchay
Dysarthria Assessment (FDA-2), A Word
Intelligibility Test, Munich Intelligibility
profile
Diagnostic Markers:
1. Hypernasal
2. Breathiness
3. Short Phrases
4. Speaking on inhalation
5. Audible inspiration
6. Rapid deterioration and recovery with
rest
7. Diplophonia
8. Nasal Emission (audible)
Physical: Bilateral Spasticity and Weakness 1. Drooling (decreased swallowing Assessment Methods: 1. Exaggerate
Speech: frequency and /or poor control of Refer to section under Flaccid section as consonants
1. Impaired movement patterns not associated with secretions) it is applicable to all dysarthria 2. Relaxation
individual muscles 2. Range of lip retraction decreased assessments. exercise
2. Usually associated with deficits at all of the speech 3. ROM of tongue movement decreased Diagnostic Markers: 3. Breathy Onset
valves and all components of the speech system and weakness 1. Harshness 4. Stretching
3. Reduced range of individual and repetitive movements 4. Gag reflex hyperactive 2. Low Pitch 5. Visual/auditory
4. Reduced force of movement 5. Oral reflexes common: sucking, 3. Slow rate feedback
5. Imprecise consonants/Distorted vowels snout, palmomnetal, and jaw jerk 4. Strained-strangled quality
reflexes 5. Pitch breaks
6. Slow/regular AMRs

Unilateral Upper Motor Unilateral Upper Motor Neuron Physical: Unilateral spasticity and Weakness 1. Difficulty propelling the bolus Assessment Methods: 1. Shorten Phrases
Neuro Speech: posteriority during oral transit phase Refer to section under Flaccid section as 2. Strengthening
1. Imprecise articulation 2. Unilateral facial weakness (at rest and it is applicable to all dysarthria exercises
2. Irregular articulatory breakdowns during movement) assessments. 3. Conservation of
3. Imprecise consonants 3. Unilateral Central Diagnostic Markers: strength
4. Speech AMRs (Slow/Imprecise/Irregular) 1. Slow rate 4. Biofeedback

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 Name: Olivia Spears CD 630 Fall 2020: MSD Chart Assignment

5. Slow rate 4. Weakness (tongue to the weak side on 2. Irregular articulatory breakdowns 5. Exaggerate
protrusion) 3. Irregular AMRs consonants
5. Dysphonia (helpful indicator of 4. Reduced loudness
dysphagia)
Ataxic Cerebellum and its Connections Physical: Incoordination of Muscles 1. Non-speech AMRs of the jaw, lips, Assessment Methods: 1. Optimal Breath
(Cerebellar Control) Speech: and tongue may be irregular (lateral Refer to section under Flaccid section as group
1. Particularly a prosodic and articulatory disorder wagging of the tongue or retraction and it is applicable to all dysarthria 2. Increase phrase
2. Imprecise consonants pursing of the lips) assessments. length
3. Irregular Articulatory Breakdowns Diagnostic Markers: 3. Exaggerate
4. Distorted Vowels 1. Excess and equal stress Consonants
5. Prolonged phonemes 2. Irregular articulatory breakdowns 4. Rate modification
6. Prolonged intervals 3. Irregular AMRs 5. Modify syllable
7. Slow Rate 4. Distorted vowels duration and pause
5. Excess Loudness Variation time
6. Prolonged phonemes
7. Telescoping of syllables
8. Inconsistent articulatory errors
Hyperkinetic Basal Ganglia and its Physical: Extra and Abnormal Movements Hyperkinetic Chorea: Assessment Methods: 1. Shorten phrases
Connections Hyperkinetic Chorea: 1. Drooling Occasional Refer to section under Flaccid section as 2. Biofeedback
(Extrapyramidal) 1. Hypernasal 2. Swallowing difficulties common it is applicable to all dysarthria 3. Reduce rate
2. Distortions/Irregular breakdowns’ slow and irregular 3. At rest orofacial postures quick, assessments. 4. Relaxation
AMRs unpredictable, involuntary movements Diagnostic Markers: exercises
3. Prolonged intervals and phonemes, variable rate, Hyperkinetic Dystonia: 1. Hypernasal 5. Sensory tricks
inappropriate silences, excessive-inefficient variables of 1. Food sticks in the throat/chewing is 2. Irregular AMRs 6. Postural
stress difficult because of involuntary 3. Distorted vowels adjustments
Hyperkinetic of action myoclonus: jaw/tongue movements 4. Excess loudness variation
1. Occasional adductor voice arrests Hyperkinetic Spasmodic Dysphonia: 5. Prolonged intervals
Slow Rate, decreased precision with increased rate N/A 6. Sudden/forced inspiration/expiration
Hyperkinetic Dystonia Hyperkinetic Spasmodic Torticollis: 7. Voice stoppage/arrests
1. Strained, harsh vocal quality, voice stoppages, audible 1. PM (Palatal Tremor) present at rest, 8. Transient Breathiness
inspiration, excess loudness variations, alternating during sustained postures and 9. Voice Tremor
loudness, voice tremors, movement, and during sleep 10. Myoclonic vowel prolongation
2. Hypernasality 2. Pharyngeal contractions 11. Intermittent hypernasality
3. Distorted vowels, irregular articulatory breakdowns, 3. Myoclonic movements of larynx, 12. Slow/irregular AMRs
slow irregular AMRs external neck, lips, and nares 13. Marked deterioration with decreased
4. Inappropriate silences, excess loudness variations, Hyperkinetic rate
excessive inefficient variable patterns of stress Palatopharyngolaryngeal: 14. Inappropriate vocal noises
Hyperkinetic Spasmodic Torticollis: 1. Lingual Tremor at rest or on 15. Coprolalia
1. Reduced pitch and variability protrusion
2. Dysphonia 2. Tremor of jaw and lips at rest, during
3. Reduced rate, delayed speech initiation, slow AMRs sustained postures, and during vowel
Hyperkinetic of Palatopharyngeal Myoclonus: prolongation
1. Voice arrests of myoclonic beats at 60 to 140 Hz during 3. Palatal/pharyngeal tremor (evident
vowel prolongation during sustained “AH”)
Hyperkinetic Voice Tremor: 4. Rhythmic vertical laryngeal
1. Quavering, rhythmic, waxing, waning tremor, most movements
evident on vowel prolongation, at a rate of 4 to 7 Hz. 5. Adductor/abductor oscillation of VFs
2. Rhythmic, vertical laryngeal movements and adductor (seen during FEES and vowel
and abductor oscillators of the vocal folds synchronous prolongation)
with voice tremor

Hypokinetic Basal Ganglia and its Physical: Reduced movement and range of motion 1. Swallows Infrequently Assessment Methods: 1. Increase phrase
Connections (Extrapyramidal) Speech: 2. Drooling length

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 Name: Olivia Spears CD 630 Fall 2020: MSD Chart Assignment

1. Short Phrases 3. Tremor of jaw/lips Refer to section under Flaccid section as 2. LSVT
2. Variable Rate 4. Non-speech alternating motion rates it is applicable to all dysarthria 3. Intense, high level
3. Short rushes of speech of the jaw, lips, and tongue may be assessments. phonatory affect
4. Imprecise consonants slowly initiated and completed or rapid Diagnostic Markers: 4. Minimal contrasts
and restricted 1. Monopitch 5. Modify syllable
2. Monoloudness duration and pause
3. Reduced Loudness time
4. Inappropriate silences 6. Exaggerate
5. Short rushes of speech consonants
6. Variable rate
7. Increased rate in segments
8. Increased overall rate
9. Rapid “Blurred” AMRs
10. Repeated phonemes
11. Palilalia
Mixed Variable; any mix of the above Physical: Variable; depends on what type of dysarthria If spastic is involved: Assessment Methods: 1. Contrastive stress
places damage mix. 1. Pathologic oral reflexes Refer to section under Flaccid section as tasks
Speech: 2. Hyperactive gag reflex it is applicable to all dysarthria 2. Modify Pauses
1. Imprecise consonants 3. Slow orofacial movements assessments. 3.Visual/auditory
2. Short Phrases 4. Pseudobulbar affect Diagnostic Markers feedback
3. Prolonged Intervals 1. Imprecise consonants 4. Reduce rate
4. Prolonged Phonemes IF LMN affected: 2. Monopitch 5. Intelligibility drills
1.Reduced gag 3. Short Phrases
2. Cough weak 4. Prolonged Intervals
3. Lack of tone in face 5. Prolonged Phonemes
6. Inappropriate silences
Audible reflexive dry swallow 7. Harshness (often wet/gurgly)
8. Breathiness
9. Strained or strangled vocal quality
10. Audible inhalation
11. Abnormally high or low pitch

Apraxia of Speech Left hemisphere Physical: 1. Inconsistent motor planning for Assessment Methods:
1. Right sided weakness volitional components of a swallow Refer to section under Flaccid section as
2. Spasticity it is applicable to all dysarthria
3. Limb Apraxia assessments.
Speech: Diagnostic Markers:
1. Distorted sound substitutions and additions 1. Poorly sequenced SMRs
2. Decreased phonemic accuracy with increased rate 2. Articulatory groping
3. Attempt to correct articulatory errors 3. Distorted substitutions
4. Groping 4. Attempts of self-correction
5. Highly inconsistent pattern of speech errors 5. Articulatory additions/complications
6. Automatic speech
7. Inconsistent articulatory errors
8. Increased errors with increased length

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Name: Olivia Spears CD 630 Fall 2020: MSD Chart Assignment

Part II

Oral Mechanism Examination/Cranial Nerve Assessment: Key: + WNL - Problem/Concern (Groher & Crary, 2016) & (MUSHC, 2020)
Lips

Symmetry: + / - Range: + / - Strength: + / -

Control: + / - Please Note Presence of Involuntary Movement
Pucker: + / - Retraction: + / - Alternating Pucker/Retraction: + / -
Tongue

Symmetry: + / - Range: + / - Strength: + / -

Control: + / -
Protrusion: + / - Retraction: + / - Lateralization: + / -
Jaw

Symmetry: + / - Range: + / - Strength: + / - Additional Comments:

Control: + / -
Opening/Closing: + / - Lateralization: + / - Protrusion: + / -
Retraction: + / -
Palate (Hard and Soft)

Symmetry: + / - Range: + / - Strength: + / - Cranial Nerve Assessment

Elevation: + / - Sustained Elevation: + / - Alternating Elevation/Relaxation: +
/ - Trigeminal Nerve (CN V) Jaw Movement + / -
Teeth Facial Nerve (CN VII) Lips and Facial Symmetry + / -
Vagus Nerve (CN X) Hard and Soft Palate + / -
Arrangement: Occlusion (Molar Incisor Relationship: + / -
Pharyngeal Plexus (CN X and XI) Hard and Soft Palate + / -
Relationship): + / -
Hypoglossal Nerve (CN XII) Lingual Movement + / -
Alternating Motion Rates

/p/: + / - /t/: + / - /l/: + / - /k/: + / -

Sequential Motion Rates

“puh-tuh-kuh”: + / - “buttercup”: + / -

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Name: Olivia Spears CD 630 Fall 2020: MSD Chart Assignment

Respiration/Phonation (ASHA, 2020)

Activity Stimulus Quality Duration Loudness

Phonation Hold “ahh” for 15-20 seconds WNL WNL WNL
Breathy Mildly Impaired Monoloudness
Hoarse Moderately Impaired Excessive Loudness
Harsh Severely Impaired Variable Loudness
Strained
Sentence The client will repeat: WNL WNL WNL
“I am getting a swallowing evaluation Breathy Mildly Impaired Monoloudness
today” Hoarse Moderately Impaired Excessive Loudness
Harsh Severely Impaired Variable Loudness
Strained
Conversation This will be observed throughout the WNL WNL WNL
session Breathy Mildly Impaired Monoloudness
Hoarse Moderately Impaired Excessive Loudness
Harsh Severely Impaired Variable Loudness
Strained
What is the current Oxygen Saturation? ___________ How long can the patient hold their breath? __________

Dysarthria Type (Circle): N/A, Ataxic, Hypokinetic, Spastic, Flaccid, Mixed, UUMN

Speech Intelligibility (ASHA, 2020)

Stimulus Comments Awareness/Strategy Use Findings

Phoneme Limited Awareness of Motor Speech impairment WNL
Evaluate Aware of impairment, unable to use strategies to improve intelligibility AOS
according to /p/, Uses strategies intermittently to improve intelligibility or listener’s understanding of the message Mild/Mild-Mod/Mod/Mod-Severe/Severe
/t/, /k/ addressed Uses strategies effectively and consistently to improve intelligibility or listener’s understanding of the message Dysarthria
in the OME Mild/Mild-Mod/Mod/Mod-Severe/Severe
Word Limited Awareness of Motor Speech impairment WNL
Mom Aware of impairment, unable to use strategies to improve intelligibility AOS
House Uses strategies intermittently to improve intelligibility or listener’s understanding of the message Mild/Mild-Mod/Mod/Mod-Severe/Severe
Load Uses strategies effectively and consistently to improve intelligibility or listener’s understanding of the message Dysarthria
Clean Mild/Mild-Mod/Mod/Mod-Severe/Severe
Tip-Top
Organize
Potato

Conversation Limited Awareness of Motor Speech impairment WNL

Evaluate Aware of impairment, unable to use strategies to improve intelligibility AOS
according to Uses strategies intermittently to improve intelligibility or listener’s understanding of the message Mild/Mild-Mod/Mod/Mod-Severe/Severe
conversation Uses strategies effectively and consistently to improve intelligibility or listener’s understanding of the message Dysarthria
throughout Mild/Mild-Mod/Mod/Mod-Severe/Severe
evaluation

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Name: Olivia Spears CD 630 Fall 2020: MSD Chart Assignment

Part III

Co-morbidity Analysis

Motor Speech Disorder Type

Flaccid Barriers: Fatigue, strength of articulators, hyponasality, limited palliative movement; weakness of articulators will make speech lack precision.
Solutions: Speech Generating Device and Palatal Lift
Could try oral motor exercises with resistance and additional reps when possible, in conjunction with other modalities.

Spastic Barriers: All of the speech valves and speech system is affected if the individual has spastic dysarthria making it difficult to know what symptoms should be treated first and
where to start.
Solutions: Start with the most prevalent symptom and/or the symptom that bothers the client the most and tailor treatment to their immediate needs.

Unilateral Upper Motor Neuron Barriers: The unilateral spasticity will make speech imprecise which will affect overall intelligibility.
Solutions: The best solution would be to target articulation by exaggerating those consonants and providing biofeedback to the client. Also working on increasing the rate of
speech would also aid in overall intelligibility. Like with flaccid, perhaps using strengthening exercises in conjunction with the other methods could be beneficial as well.

Ataxic Barriers: The articulation errors (distorted vowels/imprecise consonants/prolonged phonemes) as well as inappropriate prosody and excess loudness will impact overall speech
intelligibility and may affect the client socially.
Solutions: Address breathing, exaggerate consonants to improve intelligibility in words, work on using an appropriate rate through finger tapping or by providing feedback as
to how they can modify their rate. Then address the loudness by working on speaking with intent.
Hyperkinetic Barriers: The excess movements can affect all speech systems (i.e. articulation, phonation, respiration, and resonance) and it can be difficult to determine how to target in
treatment and what treatments would be most appropriate.
Solutions: You could breakdown the systems and target one at a time, but then build on what has been targeted (i.e. start with postural adjustments for better breath control then
try to shorten phrases). You could also do exercises that address all systems and symptoms throughout the session (i.e. do all of the above: postural adjustments, shorten
phrases, reduce rate, etc.)

Hypokinetic Barriers: Reduced rate and motion will affect speech precision and length as well as speech rate. Swallowing can also be negatively affected as it is infrequent which could
cause issues determining what food consistencies are the most appropriate for the client.
Solutions: Target speech precision by having the client exaggerate consonants. Then modify speech length by increasing phrase length and by modifying syllable
duration/pause time. Regarding swallowing, if a full swallowing evaluation has not been conducted to determine appropriate diet, the clinician should do a full swallowing
evaluation. If a swallowing evaluation has been done, have the client keep a food journal so you know what they are eating and have them report when events such as
coughing/choking occur and monitor their symptoms.

Mixed Barriers: Making decisions (i.e. knowing which dysarthria to teach first). Also, knowing what to do if one dysarthria type overtakes the other, we must figure out what to do
and be able to explain why we are doing it.
Solutions: Treat one at a time, figure out a treatment that might treat both dysarthria types/symptoms (biggest bang for buck), work where you will see the most improvements
the fastest.

Apraxia of Speech Barriers: Inconsistency of articulatory errors will make it difficult to determine what sounds to target first and maybe even the level at which articulation needs to be targeted
(i.e. isolation, syllable, word, phrase, sentence).
Solutions: A trend that is noticed with AOS is decreased phonemic accuracy with increased rate, meaning that the inconsistent errors may also be attributed to rate of speech,
therefore, working on slowing down their rate and using fluency styled treatment may be beneficial and help improve overall intelligibility.

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Name: Olivia Spears CD 630 Fall 2020: MSD Chart Assignment

References

ASHA (n.d.) Adult assessment template: motor speech disorders evaluation [PDF file]. Retrieved from https://www.asha.org/uploadedFiles/slp/healthcare/AATMotorSpeech.pdf

Duffy, J. R. (2013). Motor speech disorders: Substrates, differential diagnosis, and management. St. Louis, MO: Elsevier Mosby.

Groher, M. E., & Crary, M. A. (2016). Dysphagia: Clinical management in adults and children. St. Louis, MO: Elsevier.

Marshall University Speech and Hearing Center (2020). Oral Mechanism Examination Form. [Class Handout]. Retrieved from MUSHC

Rouse, M. H. (2019). Neuroanatomy for Speech-Language Pathology and Audiology. Jones & Bartlett Learning.