PORTFOLIO PART 1: CLINICAL ASSESSMENT COMDIS 711

Kim Caron
PP1 Revisions

Part One: Clinical Assessment Section

PP 1 Objective: Demonstrate ability to conduct an oromotor examination (physical examination
and speech examination).
I. Methods
A. Subjects
FC is a 78-year-old male. He is diagnosed with moderate expressive aphasia and mild
dysarthria secondary to left cerebrovascular accident. JC is a 66-year-old male. He has no
diagnosis of a motor speech disorder.

B. Procedure
1. Physical Exam
During the physical exam with FC, a mild facial droop was noted on the lower right side at
rest. He had mildly poor control when asked to compress his lips. He had complete, accurate
movement during the retraction of the lips, retraction against resistance, protrusion of the lips,
and protrusion against resistance. He showed poor control when asked to move his lips from
side to side. When examining his muscles of mastication, FC displayed moderately poor control
when lateralizing his jaw, but no other signs of limitation or weakness were evident. His tongue
was symmetrical at rest and no deviation was noted during protrusion. FC had moderate
reduction in lingual strength during lingual protrusion against resistance and tongue tip elevation
with resistance. Limited movement of his tongue root was noted when instructed to repeat ga,
ga, ga. He exhibited poor control during anterior and posterior lateral movements of the
tongue. A mild-moderate lingual weakness was noted during anterior lateral movement against
resistance and posterior lateral movement against resistance.
There was no evidence of limitation or weakness of labial, mandibular, and lingual
structures during the physical exam with JC. He showed mildly poor control when asked to
lateralize his lips to the right side.
2. Speech Exam
FCs speech alternate motion rates (AMRs) and sequential motion rates (SMRs) were
slow, yet regular. Inconsistent vowel substitutions were present (i.e., // for // and // for //).
Difficulty initiating productions was noted. Due to fatigue, FC only completed two trials of tuh
and kuh, as well as SMRs. According to Duffy (2013), the median performance of puh for
elderly adults is 6.3 syllables per second, tuh is 6.2 syllables per second, and kuh is 5.8
syllables per second. The median SMR performance for elderly adults is 5.0 syllables per second
(Duffy). Although FC did not complete three trials of each, it is anticipated that he falls below
normal limits in both AMR and SMR performance. JCs speech AMRs and SMRs were steady and
regular. His performance was just below normal limits for puh and kuh. Speech SMR
performance was below normal limits, averaging 2.2 syllables per second. Results of FCs
diadochokinetic performance and maximum phonation duration are included in the tables
below.
During the maximum phonation duration task, FC sustained /a/ for three trials; his
average time was 2.84 seconds. According to Duffy (2013), the median value of maximum
phonation duration for the vowel /a/ for an elderly male (generally over the age 65) is 13.8

PORTFOLIO PART 1: CLINICAL ASSESSMENT COMDIS 711

seconds. FCs average time of 2.84 seconds was significantly below the norm for a male of his
age. Difficulty initiating productions and inadequate breath support were noted. His vocal
quality during this task was characterized by moderate-severe strain, mild-moderate roughness,
and mild breathiness. His ability to modulate volume was severely limited. JCs average score of
24.01 seconds was above normal limits for a male over the age of 65. His vocal quality was
characterized by mild roughness. Pitch was normal.
DIRECTIONS

NORMAL RANGE (cite

age appropriate norms)
Set watch to 10 seconds

TRIAL 1

TRIAL 2

Take a deep breath and repeat

the sound(s) ___ as accurately
and quickly as possible.
(Model and train behavior)
Diadochokinesis: Alternate and Sequential Motion Rates [AMRs and SMRs]
Alternate Motion Rates
/puh/
6.3/sec
0.7
/tuh/
6.2/sec
0.7
/kuh/
5.8/sec
0.7
Sequential Motion Rates
/puh/ /tuh/
0.6
/tuh/ /kuh/
0.7
/puh/ /tuh/ /kuh/
5.0/sec
0.3

TRIAL 3

0.8
0.7
0.8

0.6
-

0.6
0.7
0.4

Maximum Phonation Duration (MPD):

[check age norms] = 13.8 sec
Sustaining Steady Phonation, # of Seconds
[10-25 seconds]
(Take a deep breath and say ah for as long as you can until you run out of breath)
Trial 1: ___2.34_____ Trial 2: ____1.51______ Trial 3: ___2.84_______
Quality:
___ steady and even
___ clear
___ hypernasality
_X_ breathiness
_X_ harshness
___ diplophonia

Pitch:
___ too high
___ too low
_X_ normal

Loudness:
___ excessive
_X_ inadequate
___ normal

CAPE V assessment: A good time to practice this.

http://www.asha.org/uploadedFiles/members/divs/D3CAPEVprocedures.pdf
3. Video Link: https://www.youtube.com/watch?v=HDaQXXmCbUI

PORTFOLIO PART 1: CLINICAL ASSESSMENT COMDIS 711

II. Medical report section

FC is a 78-year-old male who exhibits mild dysarthria. Speech is characterized by slow overall
speech rate, monoloudness, and inconsistent vowel substitutions. Speech AMRs and SMRs
were regular, but reduced in rate. Physical exam revealed a mild lower facial droop (i.e.,
Central VII). Reduced range of movement was noted during right labial and jaw
lateralization. Posterior tongue movement was reduced during repeated gah production.
Tongue strength was moderately reduced during lingual protrusion, elevation, and intra-oral
lateralization (buccal) against resistance. Voice was significantly reduced in loudness
suggesting poor respiratory support for speech. He had difficulty modulating phonation from
a whisper to a shout. Vowel prolongation was significantly below expectations (2.84 secs).
Based on the Cape-V assessment, overall vocal quality was moderately deviant (44/100).
Voice was moderately reduced in loudness (52/100) with mild-moderate roughness (33/100),
inconsistent mild breathiness (25/100), and mild strain (14/100).
III. Reflection on performance
I found it very beneficial recording the oral motor physical examination with FC. After
reviewing the video, I realized there are many aspects I can improve on. I realize how
important clear and concise instructions are to a successful performance by the client. There
was one point in the video where I said, Say puh as quickly and as clearly as you can and I
will time you for 10 seconds. When FC only said puh one time very quickly, I realized that
my instructions were not clear. I was sure to fix my mistake by explaining to him that he
needed to repeat the syllable as many times as he can in 10 seconds; I then gave him a
model.
I also noted that during the physical exam, there were times that even when my
instructions were clear, FC did not understand what I was asking. When he looked confused,
he benefitted from a model. His confusion may be attributed to his aphasia.
I also learned how important it is to understand the needs of the client and recognize
when they become too overwhelmed or overworked. During the maximum phonation
duration and diadochokinesis tasks, FC was becoming tired and short of breath. I was sure to
give him as many breaks as he wanted. I also decided to only do two trials of the AMRs and
SMRs. FC has a history of two heart attacks, and it was obvious that using so much breath
support during the tasks was really fatiguing him.
Looking back at the video, I realized I was too far from my client during the physical
exam. At times, it was difficult to see the structures and judge the symmetry, range of
motion, and weakness. I also should have had my client sit in a firmer chair; his posture
would have been better resulting in better productions.