Neuromuscular Impairment

Assessment Strategies

Clinical Signs

Weakness: reduced ability to produce force

Strength: The client pushes against resistance provided by the examiner. May also be assessed objectively.

Endurance: The client pushes repeatedly against resistance or sustains a continual contraction against resistance. May also be assessed objectively.

*Range of motion (ROM) tasks (e.g., moving the tongue as far as possible without application of resistance) do not measure strength

Reduced ability to exert force either in isolation and/or during endurance tasks

Reduced ROM of proximal articulators (e.g., velum, pharynx, larynx) often interpreted as reflecting weakness

Altered Tone

Muscle tone: resistance to passive stretch

Hypotonia: reduced resistance to passive stretch (often associated with peripheral nervous system lesions)

Hypertonia: increased resistance to passive stretch (often associated with central nervous system lesions)

In the limbs: Examiner passively moves an articulator while judging the amount of resistance.

No standardized clinical method for assessing tone of the speech/swallowing musculature is available.

Hypotonicity often inferred from unilateral facial or velar droop

Hypertonicity often inferred from symmetrical weakness and slowness of movements

(Site of lesion information may serve to support judgments of tone alterations)