Speech Exam – dysphasia 7.

Reading
8. Writing
1. Engage in free speech – describe their job, a picture
2. Decide fluent vs non fluent
Speech Repetition Comprehension Associated
 In non-fluent aphasia the patient leaves out filler words with
Type signs
high information content speech but no melody
o Frontal lobe lesions Non-fluent
Broca’s ↓/ N N Weakness R
 In fluent aphasia words flow freely with normal length
arm
sentences normal melody but incorrectly used words & low
Global ↓ ↓ R hemi
info content
o Parietal or temporal lobe lesions Fluent Hemianopia
o Phenomic paraphasia – consonant is substituted for Wernicke’s ↓ ↓
another ‘sing’ instead of ‘sink’ Conduction ↓ N
o Semantic paraphrasia – word is changed for similar word, Isolation N ↓
‘knife’ instead of ‘fork’ Nominal N N
o Neologism if – non-existent word is substituted, ‘boof’
instead of room Random stuff
o Suggests posterior speech area lesion  STRIFE – superior temporal receptive, inferior frontal expressive
3. “British Constitution” or “West Register street” – test for dysarthria  Fluent dysphasia – receptive, conductive or nominal
4. Name objects  Non-fluent dysphasia – expressive
5. Repetition
 When describing speech:
 No ands if or buts o Fluent or non-fluent
6. Comprehension o Paraphasic errors
 Use “yes” or “no” questions o Repetition
o “Are we in your house?”, “Is your dress red?”, “Are your
o Comprehension
shoes on?”
 More complex
o “Do you put your shoes on before your socks?”
o “Do you shut the car door before getting into the car?”
 Obey commands:
o Touch your nose
o Touch your nose with your left hand
o Touch your nose with your left hand then touch your ear
Speech Exam – Dysarthria  Paralysis of facial MMs
 No disorder of speech content  Difficulty swallowing & chewing
 Ask pts to say – “British Constitution” or “West Register  ↑ jaw jerk
street”, “Peter piper picked a peck of pickled peppers”  Cause: infarction of both internal capsules
 Testing for weakness of different articulation MMs  Pts with bilateral CN IX & X lesions – risk of aspiration
o Lips – puh puh puh
o Tongue – tuh tuh tuh Bulbar palsy (CN IX-XII)
o Palate – kuh kuh kuh  Nasal speech
 Examine motor system to determine level  LMN lesion
o UMN – brisk jaw jerk, exaggerated gag, hemiparesis  Facial MM weakness causes slurred speech
o LMN – facial weakness, wasting, weakness
/fasciculation of tongue, loss of gag, palatal palsy Extrapyramidal lesions
o Extrapyramidal – check for parkinson’s or other  Monotonous speech due to bradykinesia & MM rigidity
involuntary movt
o Cerebellar – nystagmus, intention tremor in arms, gait Other causes of slurred speech
disturbance  EtOH
 Check cough  Cerebellar disease
o Bovine - vocal cord paralysis o Slow slurred & explosive speech
 In ‘pure’ dysarthria, sentence structure, repetition & o Speech broken up in to syllables
comprehension will be normal  Check for mouth ulceration

Pseudo bulbar (CN IX-XII)

 UMN
 Spastic speech - sound sliek pt trying to squeeze words
out of tight lips
Ask Simple Questions: Abbreviated Mental Test:
-Ask: Name, age, occupation, address, handedness -Recall an address: “42 West Street”
-Ask to describe a scene or job -Name of monarch or PM, Year of WW I or WW II
Test Language areas -Count backwards 20 to 1, serial 7s
-Ask to repeat a phrase “no ifs ands or buts Test Primitive Reflexes:
-Test ability to Read -Snout reflex
-Test ability to write -Palmomental reflex
Test Comprehension: -Sucking reflex
-Put tongue out, Shut eyes, Touch nose, Smile -Grasp reflex
-Two-stage commands (touch your left ear with right hand) -Jaw jerk
Test Orientation:
Dysarthria or dysphonia
-Time&Date, place
-Ability to name objects – pen, watch
Dysphasia
-Stutter -Nominal, conductive or receptive aphasia name poorly,
Test Articulation:
-Paralysis of cranial nerves VII, IX, X, XI expressive aphasia names better than spontaneous speech
-Say: “British Constitution”, “West register street”, “Baby
-Cerebellar disease – staccato, scanning speech -Lesion in dominant posterior temporparietal OR
hippopotamus”, “Biblical criticism”, “Artillery”
-Scanning – more common in MS encephalopathy OR increased ICP
-Check lips function “me, me, me”
-Staccato – more common in Freidreich’s ataxia -Conductive and receptive aphasia can’t repeat & conductive
-Check tongue function “la, la, la”
-Parkinson’s speech – slow, quiet, slurred, monotnous aphasia will have impaired writing
-Check pharynx “Kuh, gut”
-Pseudobulbar palsy – monotonous, high-pitched speech -Lesion in arcuate fasciculus
-Check palate, larynx, expiratory muscles – “ah”
-Progressive bulbar palsy – nasal speech -Only receptive aphasia can’t follow any commands
-Early childhood deafness -Lesion in Wernicke’s area
-Structural lesions of lips, tongue, palate, pharynx, larynx -Not impaired only in nominal aphasia
-Ill fitting dentures -Receptive aphasia  Impaired content of writing
-Expressive Aphasia – Lesion in Broca’s area