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Speech (Examination (Dysphonia impaired production of voice sounds (Cause…
Speech
Examination
Quick Screen
Ask: How did you get here today?
Listen to volume, rhythm, clarity and content
Any striking abnormality?
Extras
Dominant parietal lobe lesions
→ dyslexia, dysgraphia and dyscalcula
Read a paragraph
dyslexia
Write a sentence
dysgraphia
Dysarthria
impaired articulation of sound → words
Repetition
Yellow lorry
test lingual sounds
Baby hippopotamus
labial sounds
The Leith police dismisseth us
multiple processes
Count to thirty: muscle fatigue in MG
Lesion in tongue, lips, mouth or disruption of NM pathway
Pseudo-bulbar
Bilateral UMN lesions → spastic dysarthria
Difficulty w/ lingual sounds
“Hot Potato speech”
Brisk jaw jerk
Causes
CVA: e.g. bilateral internal capsule infarcts
MS
MND
Bulbar
Unilateral LMN weakness
Palatal weakness → nasal “Donald Duck” speech
Causes
Brainstem infarct
MND
GBS
Cerebellar
Slurred, drunken speech
Dysphonia
impaired production of voice sounds
Voice: quiet or hoarse
Cough: bovine
Say Ahh: vocal cord tension
Cause
Local cord pathology
laryngitis
tumour
nodule
Recurrent laryngeal N. palsy
Dysphasia
impairment of language
Name three objects
nominal dysphasia
Three stage command
Avoid visual clues by instructing from behind
receptive dysphasia
Repeat sentence:
Today is Thursday
conductive dysphasia
Types
Expressive
Broca’s area: frontal lobe
Non-fluent speech
Comprehension intact
Receptive
Wernicke’s Area: temporal lobe
Fluent but meaningless speech
Comprehension impaired
Conductive
Damage to arcuate fasciculus connecting Broca’s and Wernicke’s areas
Comprehension intact
Unable to repeat words or phrases