Assessment for Motor Speech Disorder in Parkinson's Disease
Assessment Plan(s):
Assessment can include:
Assessment can include:
- A speech sample from the individual reading 'My Grandfather' passage can be completed to assess for perceptual ratings of breathiness, roughness, strain-strangled vocal quality, vocal tremors, loudness, pitch, prosody, speech rate, articulation, phonation breaks and intelligibility. The clinician will also have a copy of the passage to compare the patient's speech to what is written. The clinician will mark when inappropriate breaths are taken, when the phrases become rushed, and assess the prosody while the patient reads the passage. Since the first indicator of Parkinson's disease is vocal quality, this will be a good assessment to perform to observe what areas are impacted at the present moment. To help assess the productions made by the patient, the clinician can use the GRBAS (Grade [degree of deviance], Roughness, Breathiness, Aesthenia [weakness of voice], Strain) which is a voice rating scale of 0 - 3. The scale corresponds as the following: 0=normal, 1= slight impairment, 2= moderate impairment, 3= severe impairment.
- An Oral Mechanism Exam will be completed to assess the range of motion, movement of the articulators, and facial expressions of the patient. The oral mechanism will assess lip movement by the clinician asking the patient to pucker their lips, smack their lips together and seal their lips together to assess the movement of the lips and if they are able to move to the appropriate area for particular speech sounds. The next area to assess will be the tongue and its symmetry, whether the patient can stick their tongue out of their mouth (protrusion), if the patient can elevate the tongue, or push against a tongue depressor, and movement of the tongue in a lateral motion. The tongue will be important for articulating and creating intelligible speech. Upon observation, the clinician will take note of the facial expression the patient currently has. A masked like facial expression is a characteristic of Parkinson's disease, and is demonstrated by an emotionless appearance.
- Breath support of the patient will be assessed by the clinician by asking the patient to hold a prolonged vowel, /ah/. This will help the clinician use this information of how long the patient can hold a prolonged /ah/ along with the breath support the patient demonstrated during the reading of the Grandfather passage.
- The clinician will ask the patient to complete various vocal glides or vocal pitch sweeps. The clinician will ask the patient to attempt to produce the highest and lowest pitch levels with producing /ah/ or /i/. The clinician will demonstrate this pitch sweep to the patient to provide an auditory cue.
- Diadochokinetic (DDK) rate can also be used to assess the quality of voice of the patient. DDKs consist of repetitious sounds such as /pʌ-pʌ-pʌ,/ (puh-puh-puh) /kʌ-kʌ-kʌ/ (kuh-kuh-kuh), and /tʌ-tʌ-tʌ/ (tuh-tuh-tuh) which are alternating motion rate of sounds and sequential motion rates of sounds /pʌ-tʌ-kʌ / pʌ-tʌ-kʌ /pʌ-tʌ-kʌ/ (which sounds like puh-tuh-kuh) to help assess the breath support, loudness, pitch, prosody, speech rate, articulation, vocal quality, and intelligibility of the patient. The information obtained through DDKs will help further the clinician's findings of the area to try and begin working on strategies to help the patient with increasing intelligibility.
- A formal assessment that can be done is the Assessment of Intelligibility of Dysarthric Speech (ASSIDS). This assessment can be used to to measure speech intelligibility at the single word and sentence level. This assessment also will tell the clinician information regarding communication efficiency of the patient.
The subsystems that are most impacted by Parkinson's disease are respiration, prosody, articulation, and phonation. Simple assessment of Respiration, Prosody, Articulation, and Phonation can be completed during conversation and simple speech tasks to collect information on the following:
Respiration
Reduced Loudness |
Prosody
Monopitch Low pitch Reduced Stress Monoloudness Variable rate Short rushes of speech |
Articulation
Imprecise consonants DDK’s |
Phonation
Harshness Breathiness GRBAS S/Z ratio |
Regardless of treatment method being used, usually target areas are:
• increasing speech intensity
• improving speech prosody
• reducing rapid speech
• increasing articulatory mobility and precision
• increasing speech intensity
• improving speech prosody
• reducing rapid speech
• increasing articulatory mobility and precision