With the Frenchay dysarthria examination, the doctor specifies a speech disorder related to damage to the brain or facial nerves by having the patient perform specific movements or utterances with the lips, soft palate, jaw, or tongue in ten individual areas. He also assesses voice, respiration (breathing), reflexes, and intelligibility on a scale of one to nine in the testing procedure, with the results recorded as a bar chart, allowing closer classification of the cause of paralysis and the form of dysarthria. The diagnostic tool thus enables the decision for a specific speech therapy and progress monitoring during therapy.
What is the Frenchay dysarthria examination?
With the Frenchay dysarthria exam, the doctor specifies a speech disorder related to damage to the brain or facial nerves. The Frenchay dysarthria examination is a test used to assess all types of dysarthria. Dysarthria is defined by the medical profession as any speech disorder associated with damage to the brain or facial nerves. The test procedure is primarily a diagnostic instrument that describes the respective disorder in a differentiated manner and thus classifies it into a subform of the collective term dysarthria. Through this differentiated classification, the strengths and weaknesses of the patient are documented so that the speech therapist can select a suitable therapy method to improve the speech picture. The test was developed by Pamela M. Enderby at Frenchay Hospital in England and translated and tested by a speech therapist in Hamburg. In 1991, Gustav Fischer Verlag published a first edition of the examination procedure in German.
Function, effect, and goals
The diagnostic Frenchay dysarthria examination consists of a total of ten sub-areas and is used for closer differentiation, as well as for therapy progress monitoring of any type of dysarthria. The tester scores the dysarthria patient’s ten individual performances on a point scale with a maximum of nine points, and the test results are recorded in the form of a bar chart. Individual test areas of the procedure include reflexes, respiration, lip movement, jaw, soft palate, voice, tongue, intelligibility, influencing factors, and otherwise. In addition to hand instructions, a form sheet, and a spatula, the tester needs a stopwatch, a glass of water, cookies, and word and phrase cards to perform. He uses a recording device to record the results. The physician performs the test according to a manual. This manual includes specific instructions that use scaling to document the degree of performance differences. Heterogeneous subtests are recorded in a table, so that from the patient’s non-linguistic motor performance to visual observations of the patient, many individual observations can be recorded and possibly added to the form. To check reflexes, the physician has the patient cough and swallow, for example. Respiration is assessed on a scale of one to nine using the patient’s breathing during speech and also at rest. When assessing lip movements, the physician has the patient draw the lips wide and perform alternating lip movements, for example. The motor function of the jaw is assessed at rest as well as during speech. For an assessment of the soft palate motor function, the patient must also eat in addition to speaking. In the area of the voice, particular attention is paid to vocal strength, tone retention and tone differentiation. During the test, the tongue is stuck out, lifted, moved in alternating and lateral movements and observed while speaking. In order to include intelligibility in the test results, the doctor also assesses spontaneous pronunciation and the ability to express words and whole sentences. Influencing factors during the examination include hearing, teeth, and posture, in addition to general constitution. Other factors can be the speech rate or kinesthetic perception. Based on the created bar chart, the physician classifies the respective disorder into one of five dysarthria areas, which allows him to draw conclusions about the cause of the paralysis. For example, he may suspect lesions of the upper motor neurons if the test procedure has revealed spastic dysarthria.Mixed lesions of upper and lower motor neurons, on the other hand, suggest mixed dysarthria. Extrapyramidal disorders, on the other hand, are often related to hypokinetic dysarthria. If the dysarthria is classified as ataxia, cerebellar dysfunction may be assumed, whereas flaccid dysarthria is more likely to involve lesions of the lower motor neurons.
Risks, side effects, and hazards
The Frenchay dysarthria examination usually takes less than half an hour, making it a rapid test that carries almost no risks for the patient. Only in the case of swallowing paralysis can swallowing occur under certain circumstances during the drinking subtest. Since the test is based on standard values from the English-speaking world, the original procedure is not suitable as a diagnostic instrument for the German-speaking world. Within Germany, physicians tend to use the Aachener Materialien zur Diagnostik Neurogener Sprechstörungen (Aachen Materials for the Diagnosis of Neurogenic Speech Disorders), which was developed for use in this country. The advantages of the Frenchay Dysarthria Test are described as tested test quality criteria encompassing reliability as well as validity and clinical validity. In addition, the procedure is said to allow profiling and to include evidence of additional observations that provide an overall picture of the patient. However, because the test is based on etiological as well as symptomatic principles, it has come under criticism in some quarters. In the clinic, for example, a purely symptomatic classification according to actual movement disorders would be more appropriate. Apart from this, the fact that the test pays much less attention to respiration and phonation than to prosody, oral motor activity and reflexes is worthy of criticism. Although the examination thus primarily checks nonspeech disorders, only this procedure is named in the German remedy guidelines for dysarthria diagnostics.
