Speech disorders

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  • Created by: z
  • Created on: 14-03-16 19:36

Speech examination

  • look for defects in:
    • speech content
      • dysphasia > cortical problem
    • articulation
      • dysathria > nv/muscle
    • phonation
      • dysphina > larynx
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Dysphasia

  • examine:
    • fluency
    • comprehension
    • naming
    • repetition, reading. writing
  • introduce self + consent 
    • proves they can hear and understand (rules out receptive dysphasia)
  • expression of speech - ask pt tell you what they have done today (tests for motor or expressive dysphasia - common in stroke pts)
  • understanding spoken word - ask pt to perform verbal commands (e.g. close your eyes)
    • tests for receptive dysphasia - may get some degree in expressive dysphasia too
    • need a chain of command snot just one
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Expressive vs receptive aphasia

  • Expressive  (Broca's)
    • lesion of inferior portion of left frontal gyrus
    • speech understood, but production distorted
    • poor fluency
    • telegraphic speech
    • may have UMN R facial and hand weakness
    • may have problems w/ naming
  • Receptive (Wernicke's)
    • lesion of posterior portion of superior temporal gyrus
    • copious speech but incorrect word and syllable choice
    • speech not understood (own or others)
    • may have contralateral sensory loss or homonymous visual field deficit
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Dysathria

  • diffuclties w/ speech production
  • look for additional signs
    • bulbar function- flaccid/*******/ataxic
    • NB bulbar=medulla oblongata involved
  • causes:
    • bulbar palsy - GBS, MG, MND, brainstem stroke
    • pseudobulbar palsy - MS, MND, bilateral stroke involving corticobulbar tracts
  • also- cerebellar/ataxic dysathria- get scanning dysathria (explosive, staccato)
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Dysphonia

  • difficulty w/ phonation
  • problems w/ pharyngeal/laryngeal action
  • look for quiet voice and bovine (hollow) cough
  • causes:
    • often due to local pathology - ENT referra
    • tumour
    • MND
    • CN IX, XI problems
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