Motor Speech Examination
Forms

Patient’s Name:
Date of Examination:
Patient’s Age:
Neurologic Diagnosis:

Relevant Personal Information:

Medical History:

Instructions: Answer each item YES or NO and indicate the degree of impairment as follows:
0=no impairment
1=mild impairment
2=moderate impairment
3-severe impairment

I. Structural-Functional Speech Mechanism Examination A. Facial Musculature at Rest: cranial nerve (CN) VII Task | Yes | No | Degree | 1)Is mouth symmetrical? If no, describe__________________________________________________________________________________________ | | | | 2) Can patient resist the examiner’s attempt to force lips open? | | | | 3) Are eyes open? | | | | 4) Are eyes partially closed? | | | | 5) Is facies rigid or masked? | | | | 6) Is there wrinkling of forehead (when looking up without moving head?) | | | | 7) Is nose symmetrical? If no, describe________________________________________________________________________________________________ | | | |

B. Facial Musculature during Voluntary Movement: CN VII

Summary of the Physical Examination of the Lips/ Yorkston Table 2.3
Symptom Checklist | Atrophy | | Adventitious Movement: | | Resting Asymmetry |
Function
| Range of Movement | Strength | Response to Instruction | Retraction | | | | Upper Left | | | | Upper Right | | | | Lower Left | | | | Lower Right | | | |

| Coordination of Movements | | Ability to Plose | | Ability to vary tension | | Precise labial consonants |

Task | Yes | No | Degree | 1)Is smile symmetrical? If no, describe: | | | | 2) Is groping present?*Any groping should be followed up with the completeapraxia battery | | | | 3) Can the patient pucker the lips? If no, describe: | | | | 4) Is groping present?* | | | | 5) Can the patient puff out the cheeks and maintain lip sealwhen pressure is applied? If no, describe: | | | |

C. Mandibular Musculature at Rest: CN V
Symptom Checklist/ Physical Examination of the Jaw (Table 2.2. Yorkston)

| Atrophy (temporalis/masseter) | | Reduced contraction [temporalis (L/R)] [masseter (L/R)] | | Structural Restrictions | | Adventitious movement:___________________________________________________ | | Fatigue with chewing | | Other (specify):___________________________________________________________ |

Does the mandible hang lower than normal Yes No Degree | | |

D. Mandibular Musculature during Voluntary Movement: CN V

Task | Yes | No | Degree | 1)When mouth is open as widely as possible, is there deviation to one side?If no, describe: | | | | 2) Is groping present* | | | | 3) Can patient move mandible voluntarily to the right or left? | | | | 4) Can the patient resist the examiner’s attempt to lower the jaw when the teeth are clenched? | | | | Can the patient keep mouth wide open as examiner attempts to force it Closed? | | | |

E. Tongue Musculature at Rest: CN XII

Summary of the Physical Examination of the Tongue
Symptom Checklist/ Structure (Yorkston, Table 2.4) | Atrophy | | Adventitious Movement: | | Ability to vary muscular tension | | Ability to plose | | Consonant precision | | Vowel differentiation | | Other (specify): |

Task | Yes | No | Degree | 1) Is tongue normal is size?If no, describe: | | | | 2) Does the tongue lie midline?If no, describe: | | | | 3) Is the tongue symmetrical in shape?If no, describe: | | | | 4) With tongue resting atop edges of lower incisor teeth, is fasciculationObservable? | | | | 5) Does tongue remain at rest?If no, describe: | | | |

F. Tongue Musculature during Voluntary Movement: CN XII Task | Yes | No | Degree | 1)Can the patient protrude tongue completely?If no, describe range and deviation: | | | | 2) Is groping present? * | | | | 3) With tongue protruded, can patient resist examiner’s attempt to forcetongue to other side? | | | | 4) With tip of tongue, can patient resist examiner’s attempt to force toone side or other? | | | | 5) With tip of tongue, can patient touch:Upper lip?Alveolar ridge?If no, describe: | | | | 6) With tongue in cheek, can patient resist examiner’s effort to forceTongue inward? | | | | 7) Can the patient move the tongue from side to side?If no, describe: | | | |

G. The Velum and Pharynx at Rest and during Movement: CN X

Summary of the Physical Examination of Velopharyngeal Function (Table 2.5 Yorkston)
Symptom Checklist/Function | Nasal Emission | | Hypernasality | | Perceptual changes with occlusion | | Nasal Reflux | | Inability to use a straw | | Resting asymmetry in palate | | Adventitious Movements: | | Other (specify): | FUNCTION | During a strong, sustained phonation or /pop/ sound | | Initial Elevation | | Asymmetry (______weaker than______) | | Ability to sustain (fatigue)-look at repeated elevations. |

Task | Yes | No | Degree | 1) Does the Velum rise symmetrically each time patient says /a/ ?If no, describe: | | | | 2) Is there a gag reflex when the back wall of the pharynx is touched? | | | |

H. The Function of the Larynx: CN X Task | Yes | No | Degree | 1) Is the patient able to produce a sharp cough? | | | | 2)Can the patient produce a sharp glottal stop?If no, describe: | | | | 3) Is inhalatory stridor present?If yes, describe: | | | |

II. Acoustic Motor Speech Examination A. Phonatory-Respiratory System:

Summary of the Physical Examination of Respiration and Phonation
Symptom Checklist (perceptual features of the voice)- (Table 2.6 Yorkston) | Abnormal Loudness (reduced/ excessive) | | Loudness Variation | | Complaints of fatigue | | Shortness of breath | | Abnormal Quality (breathy/hoarse/harsh/strained-strangled)-on sustained phonation | | Phonatory breaks | | Instability (mild/moderate/severe) | | Stridor (inspiratory/expiratory) | | Wet Phonation (on a strong, voluntary cough) | | Abnormal Voluntary cough (weak, absent) | | Other (Specify): |
Vital Capacity (seated): (how much air can they breath in using a handheld respirometer)

Vital Capacity (supine):

Sustained phonation time (seconds): 1. Directions to patient: “Take a deep breath and say /a:/ as long, steadily, and clearly as you can.”
a.Duration: Trial 1:_______________ Trial 2:______________ Trial 3:______________ Trial 4:______________ Average:____________ (average is 15 seconds for adults and 10 seconds for school-aged children)

b. Latency: Is there a latency period between signal to say /a:/ and initiation of phonation? Yes No Degree | | |

c. Quality | Steady and Smooth | | | | | Smooth and Clear | | | | | Hypernasality | | | | | Breathiness | | | | | Harshness | | | | | Diplophonia | | | | d. Pitch | Too High | | | | | Too Low | | | | | Normal | | | | | Tremor | | | | | Pitch Breaks | | | | e. Loudness | Excessive Loudness | | | | | Inadequate Loudness | | | | | Normal Loudness | | | |
f. Describe Abnormalities:

B. Resonatory System: 1) Directions to patients: “Take a deep breath and say /u:/ for as long as you can.” Hold a (laryngeal) mirror beneath one nostril and then the other.

Is there any leakage from (left/right/both) nostrils. (include YES, NO, DEGREE)

2) Directions to patient: “Now I want you to do the same thing, but this time I’m going to squeeze your nose. Don’t let it bother you; just keep the /u:/ going.” | Yes | No | Degree | Change in resonance when occluding (left/right/both) nostrils | | | | Connected Speech without nasal. | | | |

C. Combined Systems (Phonatory, Respiratory, Resonatory, and Articulatory) 1. Alternate Motion Rate (AMR) (diadochokinetic)
Directions to patient: “Take a deep breath and say (e.g puh, puh, puh) as long, and as fast, and as evenly as you can.”

Demonstrate: | Yes | No | Degree | Is AMR slow? | | | | Is AMR excessively fast? | | | | Is AMR dysrythemic? | | | | Is AMR uneven in loudness? | | | | Is AMR uneven in pitch? | | | | Is there a tremor? | | | | Is there equal spacing between syllables? | | | | Is there blurring (lack of differentiation between syllables)? | | | | Is there hypernasality? | | | | Is there nasal emission? | | | | Is there restriction in amplitude of motion of lips and jaw? | | | | Are there imprecise or distorted consonants? | | | |

Indicate rate per 5-second intervals on this table: | Puh | Tuh | Kuh | Puh, tuh, kuh | Trial 1 | | | | | Trial 2 | | | | | Trial 3 | | | | | Average | | | | |

Average rate for “puh” and “tuh” is about 30 to 35 repetitions for 5 seconds; “kuh” is somewhat slower.

2)Sequential Motion Rate
Directions to patient: “Now I want you to make those three sounds, puh, tuh, kuh together”.
Demonstrate. (Note: Record the results [per 5-second trial] in the table above.

| Yes | No | Degree | a.) Is patient able to move smoothly from syllable to syllable? | | | | b) Are sounds blocked, transposed or omitted?If yes, describe: | | | |

3) Stress Testing of the Motor Speech Mechanism (screening for Myasthenia Gravis)
Instruct the patient to count rapidly (approximately two numbers per second) at least up to 100.
Demonstrate 1-10.

Is there audible deterioration of phonation or articulations?
If yes, describe:

III. Testing for Nonverbal Oral Apraxia A. Tests for Nonverbal Oral Apraxia
Directions to patient: “Now I want you to do some things. Listen closely and do everything as completely and as well as you can. Are you ready?”

Graded Response (scale below) | Test Item | | 1) Stick out your tongue | | 2) Show me how you blow out a match | | 3) Show me your teeth. | | 4) Round your lips. | | 5) Touch your nose with the tip of your tongue. | | 6) Bite your lower lip. | | 7) Show me how well you whistle. | | 8) Lick your lips all around. | | 9) Clear your throat. | | 10) Move your tongue in and out. | | 11) Click your teeth together once. | | 12) Show me how you smile. | | 13) Click your tongue. | | 14) Chatter your teeth as if you were cold. | | 15) Touch your chin with the tip of your tongue. | | 16) Show me how you cough. | | 17) Puff out your cheeks. | | 18) Wiggle your tongue from side to side. | | 19) Pucker your lips. | | 20) Alternately pucker and smile. |

Graded Response Scale 1) Accurate and immediate response with no hesitation. 2) Accurate after trial-and-error searching movement on command. 3) Crude, defective in amplitude, accuracy, or speed on command. 4) Partial response (an important part missing) on command. 5) Same as (1) after demonstration 6) Same as (2) after demonstration. 7) Same as (3) after demonstration. 8) Same as (4) after demonstration. 9) Perseverative response. 10) Irrelevant response. 11) No oral performance.

IV. Testing for Apraxia of Speech (Oral Verbal Apraxia)
A. Directions to patient: “Say these words for me.” If patient is unable to repeat to verbal stimuli, present words as printed on cards. As patient reads of repeats the following, tape record and transcribe errors.

1) Slowpoke 2) Conference 3) Tahiti 4) Dressmaker 5) Annapolis 6) Kindergarten 7) Condominium 8) Industrial revolution 9) Winnie-the-Pooh and Tigger too 10) Stiff-stiffer-stiffening 11) Base-baseball-baseball cap 12) Fan-fancy-fantastic 13) Glow-glowing-glistening-glamourously 14) Rid-riddle-ridicule-ridiculous

“Now these.” 1) mime 2) George 3) Pipe 4) Babe 5) Shush 6) Dude 7) Tent 8) Nan

“Now repeat these sentences for me.” 1) The beautiful girl was dancing. 2) Open this birthday present first. 3) The stranger walked into the store. 4) The birdwatcher saw a Norweigian Blue parrot.

“Count from 1 to 20.” (Note: Indicate pauses for breath by a slash (/) after the appropriate number.
1___ 2___ 3___ 4___ 5___ 6___ 7___ 8___ 9___ 10___ 11___ 12___ 13___ 14___ 15___ 16___ 17___ 18___ 19___ 20___

“Now count backward from 20 to 1.”
20___ 19___ 18___ 17___ 16___ 15___ 14___ 13___ 12___ 11___ 10___ 9___ 8___ 7___ 6___ 5___ 4___ 3___ 2___ 1___

B.“ Tell me what is happening in this picture.” Use the Boston’s “Cookie Theft” picture to evoke at least 1 minute on ongoing speech. If necessary, point out neglected features of the picture by asking ,”What is happening here?

Write down any four sentences that the patient says, If the patient provides an insufficient speech sample here, use any (four) sentences produced at any point in the evaluation.
1)___________________________________________________________________________________________________
2)___________________________________________________________________________________________________
3)___________________________________________________________________________________________________
4)___________________________________________________________________________________________________

“Say these sentences after me.” Use the sentences just written above. Write down (and if necessary, phonetically transcribe) the patient’s imitations.
1)___________________________________________________________________________________________________
2)___________________________________________________________________________________________________
3)___________________________________________________________________________________________________
4)___________________________________________________________________________________________________

C. Temporal Relationship Between the Stimulus and the Response
To determine the severity the Apraxic delay. Speakers with Apraxia of Speech benefit from cues from the examiner.
They do better when they are able to hear and see the utterance being produced by someone else and are immediately given the opportunity to reproduce the utterance. Examiner must make note of the cueing strategies used for a starting point for treatment, and to determine how much and how quickly improvement may occur. Examiner must determine what level of cueing is needed for individual with Apraxia to say utterance successfully.

A Cueing Hierarchy that Varies the Temporal Relationship Between the Stimulus and the Response for Speakers with Apraxia of Speech (Table 2.9-Yorkston)
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(listed from most powerful strategies to least powerful strategies) A. Simultaneous production with cueing: Speakers say the utterance with the clinician, but only after tactile and visual cues are provided. The speaker is allowed to stay in the initial articulatory configuration for a second or two before production in order to take full advantage or proprioceptive feedback. B. Simultaneous production: Speakers say the utterance with the clinician. Rate is slowed as needed to improve accuracy. C. Immediate repetition: Speakers imitate the productions of the clinician immediately after they see and hear it. D. Repetition with Delay: The clinician imposes a 2-4 second delay between modeling the utterance and requesting a response from the speaker. E. Spontaneous production: The utterance is produced in response to questions. F.

V. Connected Speech Sample
Have the patient read “My Grandfather” or another standard reading passage and rate the following questions. (included in files).

| Yes | No | Degree | 1) Are vowels and consonants produced clearly? | | | | 2) Is the patient’s rate of speech too slow? | | | | Or is it too fast? | | | | 3) Does the patient show inappropriate silent intervals between words? | | | | 4) Does the patient show hypernasality? | | | | 5) Is nasal emission present? | | | | 6) Does the patient vary loudness normally? | | | | 7) If not, is there evidence of monoloudness? | | | | 8) Is there evidence of tremor in the patient’s voice? | | | | 9) Does the patient show abnormal pitch variations? | | | | 10) Does the patient’s voice have a harsh vocal quality? | | | | 11) Does the patient’s voice have a strained-strangled vocal quality? | | | | 12) Does the patient’s voice have a breathy voice quality? | | | | 13) Does the patient speak in abnormally short phrases? | | | | 14) Are there moments of involuntary inhalation or exhalation? | | | | 15) Is inhalatory stridor present? | | | | 16) Does the patient use normal stress on the appropriate syllables or words? | | | | 17) If not, is there a reduction in normal stress? | | | | 18) Or is there excess and equal stress? | | | |

Perceptual Characteristics of Speech-Patterns (Yorkston Table 2.8)

Audio-recording of a standard passage of reading and rate the 38 perceptual dimensions present (Mayo Clinic Studies}. This information may be used to identify clusters of deviant dimensions of specific types of dysarthria or may be used to guide the motor speech exam. Check all that apply:

| Pitch Characteristics | | | Pitch Level | -Pitch of voice sounds consistently too low or too high for individual’sage and sex. | | Pitch Breaks | -Pitch of voice shows sudden and uncontrolled variation(falsetto breaks). | | Monopitch | -Voice is characterized by a monopitch or monotone. Voice lacks normalpitch and inflectional changes. It tends to stay at one pitch level. | | Voice Tremor | -Voice shows monotony of loudness, lacking normal variations in loudness. | | Loudness | | | Monoloudness | -Voice shows monotony of loudness, lacking normal variations in loudness. | | Excess loudness variation | -voice shows sudden, uncontrolled alternations in loudness, sometimesbecoming too loud, sometimes too weak. | | Loudness decay | -There is progressive diminution or decay of loudness. | | Alternating loudness | -There are alternating changes in loudness. | | Loudness (overall) | -Voice is insufficiently or excessively loud. | | Voice Quality | | | Harsh Voice | -voice is harsh, rough & raspy. | | Hoarse (wet) voice | -There is “liquid sounding” hoarseness. | | Breathy Voice (continuous) | -continuous breathy, weak, and thin. | | Breathy Voice (transient) | -breathiness is transient, periodic, intermittent. | | Strained-Strangled voice | -voice (phonation) sounds strained or strangled (an apparently effortfulsqueezing of voice through glottis). | | Voice Stoppages | -There are sudden stoppages of voiced airstream (as if some obstacle alongvocal tract momentarily impedes flow of air). | | Hypernasality | -voice sounds excessively nasal. Excessive amount of air is resonated by nasal cavities. | | Hyponasality | -voice is denasal. | | Nasal Emission | -There is nasal emission of airstream. | | Respiration | | | Forced inspiration-expiration | -speech is interrupted by sudden, forced inspiration and expiration sighs. | | Audible inspiration | -audible, breathy inspiration. | | Grunt at end of expiration | -grunt occurs at end of expiration. | | Prosody | | | Rate | -rate of actual speech is abnormally slow or rapid. | | Phrases Short | -Phrases are short (possibly due to fact that inspirations occur more oftenthan normal). Speaker may sound as if he has run out of air. He may producea gasp at the end of a phrase. | | Increase of rate in segments | -rate increases progressively within given segments of connected speech. | | Increase of rate overall | -rate increases progressively from beginning to end of sample. | | Reduced Stress | -speech slows reduction of proper stress or emphasis patterns. | | Variable rate | -rate alternately changes from slow to fast. | | Intervals prolonged | -prolongation of interword or intersyllable intervals. | | Inappropriate silences | -there are inappropriate silent intervals. | | Short rushes of speech | -there are short rushes of speech separated by pauses. | | Excess & Equal Stress | -Excess stress on usually unstressed parts of speech, e.g. (1) monosyllabicwords, and (2) unstressed syllables of polysyllabic words. | | Articulation | | | Imprecise consonants | -consonant sounds lack precision. They show slurring, inadequate sharpnessdistortions, and lack of crispness. There is clumsiness in going from one consonant sound to another. | | Phonemes prolonged | -there are prolongation of phonemes. | | Phonemes repeated | -there are repetitions of phonemes. | | Irregular articulatory breakdown | -Intermittent non-systemic breakdown in accuracy of articulation. | | Vowels distorted | -Vowel sounds are distorted throughout their total duration. | | | | | Overall | | | Intelligibility (overall) | -Rating of overall intelligibility or understandability of speech | | Bizareness (overall) | -Rating of degree to which overall speech calls attention to itself because ofunusual, peculiar, or bizarre characteristics. |