COMDIS 711 PORTFOLIO PROJECT 2

Lauren Lanphere
Dysarthria Subtype:
Rewrite Case Number
9-6

Unilateral Upper Motor Neuron Dysarthria

Original: The patient is a 66-year-old man who exhibits mild
unilateral upper motor neuron dysarthria. Dysarthria is
characterized by imprecise articulation, repetition of the first
phoneme of words, mild hesitations, and increased rate. Vocal
quality is harsh and breathy. Additionally, a Central VII and right
hemiplegia were noted.
Rewrite: Patient is a 66-year-old man who exhibits mild unilateral
upper motor neuron dysarthria. Speech is characterized by
imprecise articulation, repetition of initial phonemes, mild
hesitations, and increased rate. Vocal quality is harsh and
breathy. Physical exam revealed a central VII and lateral tongue
movements were mildly slow.

New Case Number 9-1

Patient is a 55-year old male who presents with moderate

unilateral upper motor neuron dysarthria. Speech is characterized
by imprecise articulation and harsh vocal quality. AMRs were slow
and confirm imprecise articulation. Physical exam revealed right
central face weakness. Intelligibility was moderately reduced due
to errors in articulation.

Dysarthria Subtype:
Rewrite Case Number
4-4

Flaccid Dysarthria
Original: Patient is a 76-year-old male with a cognitive disability
who presents with mild/moderate flaccid dysarthria secondary to
myasthenia gravis. Dysarthria is characterized by articulatory
errors, reduced rate, and deviations in resonance and voice.
Articulatory errors are characterized by imprecise articulation and
weak pressure consonants. Resonance is characterized by
hypernasality and nasal emission during speech tasks, and voice
is characterized by inhalatory stridor. Results of the oral
mechanism exam revealed the face and tongue were weak
bilaterally, palatal movement decreased with repetitions, and
hypernasality and weak pressure consonants worsened over
speech tasks.
Rewrite: Patient is a 76-year-old male with a cognitive disability
who presents with mild-moderate flaccid dysarthria. Speech is
characterized by articulatory errors, reduced rate, and deviations
in resonance and voice. Articulatory errors are characterized by
imprecise articulation and weak pressure consonants. Resonance
is characterized by hypernasality and nasal emission during
speech tasks suggesting velopharyngeal insufficiency. Voice is
characterized by inhalatory stridor due to interrupted airflow.
Stress testing showed worsening weak pressure consonants and
increased hypernasality with fatigue, potentially indicating a
neuromuscular junction disease. Physical exam revealed
bilaterally weak face and tongue, and palatal movement
decreased with repetitions of ah.

COMDIS 711 PORTFOLIO PROJECT 2

New Case Number 4-7

Patient is a 62-year-old woman who presents with mild flaccid

dysarthria following an eight to ten year history of mild dysphagia
and 2-3 year history of speech problems. Speech is characterized
by imprecise articulation and slow rate of speech. Articulation is
imprecise particularly for lingual fricatives, liquids and bilabial
sounds. Physical exam revealed low tone in lower face and mildly
weak tongue bilaterally. Exaggerated lip movement during
articulation was noted as a compensation for weak tongue.
Speech is intelligible and functional.

Dysarthria Subtype:
Rewrite Case Number
6-2

Ataxic Dysarthria
Original: A 27-year-old woman presents with a history of
progressive gait balance, incoordination of the hands, and a 10year history of "slurred speech" which has not progressed
recently. According to the patient, her symptoms worsened during
pregnancy, menstrual periods, and when nervous or fatigued.
Neurologic exam revealed presence of ataxic gait, upper limb
ataxia, and nystagmus. Speech examination revealed the
presence of mild ataxic dysarthria. Speech is characterized by
irregular articulatory breakdowns and a mildly slow rate.
Multisyllabic words are produced with excess and equal stress
and voice is unsteady during prolongation of "ah". Speech AMRs
are slow. Speech intelligibility is normal.
Rewrite: A 27-year-old woman presents with moderate ataxic
dysarthria following a ten-year history of of "slurred speech"
which has not progressed recently. Symptoms reportedly
worsened during pregnancy, menstrual periods, and when
nervous or fatigued. Speech is characterized by irregular
articulatory breakdown, mildly slow rate, and equal and excess
stress. Equal and excess stress was particularly noticeable on
multisyllabic words. Sustained vowel prolongation was unsteady
and AMRs were slow. Physical exam did not reveal any
abnormalities.

New Case Number 6-4

Patient is a 63-year-old woman who presents with mild ataxic

dysarthria secondary to a right CVA. Speech is characterized by
irregular articulatory breakdown and vowel distortion. AMRs were
irregular due to articulatory breakdown. Physical exam did not
reveal abnormalities and speech intelligibility is functional.

Dysarthria Subtype:

Hypokinetic Dysarthria

COMDIS 711 PORTFOLIO PROJECT 2

Rewrite Case Number

7-6

New Case Number 7-3

Dysarthria Subtype:
Rewrite Case Number
8-2

Original: Patient is a 51-year-old male who presents with

moderate hyopkinetic dysarthria. Patient reported a 3 year history
of myocardial infarcts. Dysarthria is characterized by impaired
speech, prosody, and voice. Speech is characterized by imprecise
articulation, initial phoneme and syllable repetitions, in addition
to word and phrase repetitions. Prosody is characterized by
increased rate, monopitch and monoloudness. Vocal quality was
breathy, harsh, and strained. AMRs were imprecise and blurry and
intelligibility was significantly reduced. Physical exam revealed a
mask-like face, reduced range of movement in the jaw, lips, and
tongue, and mild left tongue weakness. Reduced rate and hand
taping were successfully implemented to increase intelligibility.
Rewrite: Patient is a 51-year-old male who presents with
moderate hypokinetic dysarthria. Speech is characterized by
impaired articulation, prosody, and voice. Articulation is imprecise
and consisted palilalia, which is characterized by initial phoneme
and syllable repetitions, in addition to word and phrase
repetitions. Palilalia significantly decreased speech intelligibility
and prosody. Prosody is characterized by increased rate with
equal and excess stress. Vocal quality was breathy, harsh, and
strained. AMRs were imprecise and blurry due to increased rate
and errors in articulation. Physical exam revealed a mask-like
face, reduced range of movement in the jaw, lips, and tongue,
and mild left tongue weakness. Reduced rate and hand taping
were successfully implemented to increase intelligibility.
Patient is a 72-year-old woman who presents with mild-moderate
hypokinetic dysarthria. Speech is characterized by impaired
articulation, prosody, and vocal quality. Articulation is imprecise
and characterized by hesitations and occasional whole and part
word repetitions synonymous with palilalia. Rate was mildly
accelerated and vocal quality was harsh. Physical exam was
normal.
Hyperkinetic Dysarthria
Original: Patient is a 53-year-old male who presents with a mildmoderate hyperkinetic dysarthria following an 18-month history
of worsening speech difficulty with reportedly worsened speech
with anxiety or excitement. Speech is characterized by imprecise
articulation and arrests during speech. Imprecise articulation and
arrests are due to involuntary, intermittent jaw opening and
tongue retraction synonymous to dystonia. Dystonia is strongly
associated with open vowels and velar consonants. Speech
improved during whispering and while clenching his jaw. Physical
examination is normal.
Rewrite: Patient is a 53-year-old male who presents with a mildmoderate hyperkinetic dysarthria following an eighteen-month
history of speech difficulty that worsened with anxiety,
excitement and alcohol use. Speech is characterized by imprecise
articulation and arrests during speech due involuntary,

COMDIS 711 PORTFOLIO PROJECT 2

intermittent jaw opening and tongue retraction synonymous to

dystonia. Dystonia is observed during open vowels and velar
consonants due to tongue and jaw involvement. Physical
examination is normal. Speech improved during whispering and
while clenching his jaw.

New Case Number 8-5

Patient is a 70-year-old woman who presents with a mild

hyperkinetic dysarthria following a year of voice difficulty
worsening under stress and fatigue, in addition to a family history
of parkinsonism. Speech is characterized by a vocal tremor with
occasional voice interruptions. Voice interruptions are due to
interruption of airflow during phonation. During vowel
prolongation, vocal tremor was particularly evident and jaw,
tongue, palate, and pharyngeal tremor were noted. Physical exam
revealed a subtle low amplitude tremor of the lips at rest.

Reflection:
Over the course of the semester, I feel my impressions statements have improved.
At first, it was difficult for me to determine what information was important to convey in a
report. As I wrote impressions statements, it became clearer what information I needed
to include. It helped me to think about myself reading a report on a patient. What
information would I need to know if I received the report and needed to start treatment
on the patient? Based on that, I could include relevant information about a patient.
Additionally, I believe my writing became more concise. Through peer and professor
feedback, I was able to combine sentences that were redundant and make my point
clearer. Again, it helped me to think of myself as the clinician reading the report. More
often than not, clinicians do not have a lot of time to read reports before the meet a
patient so I wanted to convey my impressions as succinctly as possible.
By the end of the semester, I also feel understood why certain speech attributes
were occurring in a patients speech. In the beginning, it was easy to copy Duffys
perceptual attributes (i.e., imprecise articulation, harsh voice) without knowing why it
was occurring. By the end of the semester, I saw the bigger picture. I am now able to
understand that intermittent voice stopping might be due to involuntary adduction of the
vocal folds or imprecise articulation might be due to involuntary tongue protrusion and I
can add that to the impressions statement. Not only does this make the impressions
statement more meaningful, I have a better grasp on what a patient might look like if
they walked through my door with a motor speech disorder. Overall, I do not think my
impressions statements are perfect yet, but I do feel I have come a long way with
understanding what information to include and why perceptual attributes are occurring.