Speech Disorders
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Expressive dysphasia

  • People understand commands, but are unable to find the words to respond appropriately.
  • To test for this, ask them to do basic motor tasks (e.g. close eyes), put hands on head. Then ask them what their name is – they might look to their name badge, or try to write it down.
  • 90% of people who are right handed have their language centre in the left side of the brain. So, look for peripheral signs: E.g. right spastic arm (stroke)

Causes

  • Stroke
  • Other brain lesions:
    • Trauma
    • Mass lesion

Receptive disorder

Bright, alert patient, who is not delirious or hallucinating. Not struggling to speak. Speaks fluently, but gives totally irrelevant answers. E.g.
  • What’s your name – ‘I’m looking forward to lunch’
  • What are you having for lunch – ‘Liverpool aren’t playing very well at the moment’
Often mistaken for confusionbut unlike confusion, there is not impaired consciousness/drowsiness.
They cannot obey motor commands.
They sometimes respond to written commands – but they can’t understand the spoken command about the written words!
Expressive disorders are more common than receptive disorders
Causes – Often similar to expressive speech disorder

Translocation disorders

Damage at the midpoint between Brocke’s and Wernick’es area.

Ataxic speech disorders – Cerebellar

  • Sound like they are drunk
  • But there is also another type of disorder associated with the cerebellum
  • Scanning speech (aka staccato speech)
  • Ask them to say “British constitution” and “west register street”. These are phrases that require a lot of co-ordination, and the patient may not be able to do it.
Emotionally labile / emotional incontinence
Emotion is not appropriate to behaviours. E.g might cry / laugh at inappropriate times. Suggest damage to frontal lobes, or damage to connections between frontal lobe and language centre. Often related to Pseudobulbar palsy.
  • Pseudobulbar palsy is a name for characteristic symptoms, and is NOT a diagnosis.
  • Hot potato /Donald duck speech
  • Very rigid, erect and stiff posture
  • Often looking a bit menacing – they don’t blink very often.

Bulbar palsyLMN

  • Very nasal
  • Might have nasal regurg in swallowing
  • Likely to aspirate

Causes

  • Gullian-Barre syndrome
  • MND
  • Can affect UMN and LMN – and to make the diagnosis you must have both. If the tongue is fasciculated and wasted and they have bulbar type speech symptoms – it is probably MND!
  • Myasthenia – fatigable
  • Myotonic dystrophy
Dystonia of the vocal chords
The intonation of his voice sounds like the Children’s TV program “The Clangers”
Dysphonia
A problem with speech volume, but normal articulation and normal language.
Often caused by Parkinsonism

References

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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