Associated with lower motor neuron (LMN) weakness [Flaccid dysarthria]
- Breathiness, hoarseness, diplophonia, short phrases, reduced maximum vowel duration, vocal flutter
- Confirmatory characteristics include: audible inspiration/inhalatory stridor, weak cough, weak glottal coup
- Deviation of tongue to left on protrusion and fasciculations
- Indicative of left lingual weakness
- Elevation of soft palate to right during phonation
- Indicative of left palatal weakness
Neurologic meaning: weakness secondary to left X and XII cranial nerve lesions (in this case, resulting from skull fracture)
- Can be associated with flaccid dysarthrias
- Right face (upper and lower)
- Droop of eyelid at rest
- Droop at corner of mouth with flat nasolabial fold
- Lack of upper and lower face movement during attempted movements
- Tongue is normal
Neurologic meaning: right cranial nerve VII paralysis (LMN)
Can be associated with flaccid dysarthrias
This includes a statement of the diagnosis of the motor speech disorder, describing the severity and type of disorder, secondary to an aetiology, and characterized by speech characteristics of the disorder. This should be followed by a statement of intelligibility level in a specific context, preferably with an additional context in which intelligibility is improved.
For example, “Mr. X presents with moderate hypokinetic dysarthria, secondary to Parkinson’s
disease, characterized by reduced vocal volume, monoloudness, low pitch, mono-pitch, hoarse
vocal quality, articulatory imprecision, and dysfluent initiation of utterances. Intelligibility in
the conversation was moderately impaired but improved for production of short phrases in response
the client’s characteristics of the motor speech disorder
Remember that you are reporting your interpretation of the client’s characteristics of the motor speech disorder in the Impression section, not scores/responses of assessment tasks, (e.g., don’t include duration of phonation or AMR/SMR results in the Impressions section).
Then discuss other concomitant deficits, secondary to their etiology,and their characteristics. For
example, describe aphasia, dysphagia,cognitive-linguistic deficits, or other deficits you would diagnose,and for each communication diagnosis, list its observed characteristics after naming the particular diagnosis. For example,“Mr. X also presents with moderate Broca’s aphasia, secondary to CVA, characterized by difficulty with word retrieval, nonfluent speech production, grammatical errors in verbal output, and mild difficulty with auditory comprehension of instructions.
Prognosis: Please describe factors that contribute to your determination of prognosis. For example,
“Prognosis is determined to be good for improvement of intelligibility based on…”
What are the speech characteristics of flaccid dysarthria?
1) Treatment: Treatment plan includes the following: frequency of treatment, duration of sessions and duration of overall recommended treatment, area(s) of deficit to address and the method planned to address it/them. At least two treatment objectives to address the client’s speech production must be included.
For example Individual speech treatment is recommended twice weekly for 30-minute sessions for 12 weeks. At that time, the client will be reassessed to determine if further treatment is recommended. The focus of treatment will include increasing respiratory support for increased loudness of speech production. Abdominal breath support and vocal loudness exercises will be addressed at the initiation of treatment. To improve respiratory support for speech production, the client will use abdominal breath support while reading short phrases with 80% accuracy.
2) Other recommendations: These could include medical referral for a concern noted during the
evaluation or reported during case history, referral to other professionals (OT, PT, psych, support group, etc.). Other recommendations can be included as appropriate. * Make a statement regarding counselling that you provided to the client and family regarding the diagnosis,
prognosis, and recommendations, and how they responded to that information (did they report
understanding? Did they demonstrate understanding by asking questions or by telling back various salient points?).