Bedside Approach to Speech and Language Disorders

Question 1

Aphrasia vs Dysarthria

Answer 1

Aphasia

Definition: impairment of language, affecting the production or comprehension of speech and the ability to read and write

Investigations: 6 bedside tests- observation of fluency, comprehension, repetition, naming, writing, reading + cognitive testing (MOCA) Management: speech therapy, support groups +/- neuropsychology

Dysarthria

Definition: impairment of articulation, phonation, resonance, rhythm, rate and/or volume of speech production

Symptoms: slurred speech, slow speech, inability to speak louder than a whisper, or speaking too loudly, rapid speech, nasal.raspy/ strained voice, uneven/abnormal speech rhythm, uneven speech volume, monotone speech, difficulty moving tongue or facial muscles

Etiology: stroke, ALS, MS, myasthenia gravis, parkinsons’, brainstem tumours, meds, alcohol.

Question 2

Broca’s Aphasia

Definition: damage to the __ ___ frontal lobe region responsible for speech production

Symptoms: word content sparse, effortful production, hesitancy, word searching, impaired repetition, intact comprehension +/- R face and hand weakness

Wernicke’s Aphasia

Definition: damage to posterior superior temporal lobe region responsible for speech comprehension

Symptoms: fluent non-sensical communication, frequent jargon usage, impaired comprehension of simple commands, impaired repetition, anosognosia (lack of insight/awareness of dysfunction), +/- right superior quadrantanopia

“Word salad”

Answer 2

Broca’s Aphasia

Definition: damage to the posterior inferior frontal lobe region responsible for speech production

Symptoms: word content sparse, effortful production, hesitancy, word searching, impaired repetition, intact comprehension +/- R face and hand weakness

Wernicke’s Aphasia

Definition: damage to posterior superior temporal lobe region responsible for speech comprehension

Symptoms: fluent non-sensical communication, frequent jargon usage, impaired comprehension of simple commands, impaired repetition, anosognosia (lack of insight/awareness of dysfunction), +/- right superior quadrantanopia

“Word salad”

Question 3

Non-Fluent Primary Progressive Aphasia (PPA)

• Etiology: ___pathy
• Symptoms: slow onset __ Aphasia

Semantic Progressive Aphasia:Surface __

Logopenic progressive aphasia: associated with dementia and ___ disease.

Answer 3

Non-Fluent Primary Progressive Aphasia (PPA)

• Etiology: Tauopathy
• Symptoms: slow onset Broca’s Aphasia

Semantic Progressive Aphasia: surface Dyslexia

Logopenic progressive aphasia: associated with dementia and alzheimers disease.

Question 4

type of dysarthria seen in brainstem, stroke or MS (UMN in the corticobulbar tract)

Answer 4

spastic UMN

Seen in brainstem, stroke, or MS. Lesion to UMN in the corticobulbar track

Emotional Incontinence: bouts of laughter or crying without the underlying emotions

Phonation: harsh quality, sound strangled

Resonance: hypernasality

Prosody: burst of loudness

Articulation: reduce movement, tongue strength and speech rate

Question 5

type of dysarthria seen in parkinsons

Answer 5

Hypokinetic

Seen in Parkinsons/extra-pyramedal disorders

Phonation: hoarse, low volume

• Prosody: monopitch, monoloudness +/- palilalia (compulsive repetition of syllables)
• Articulation: difficulty initiating speech, freezing

Question 6

type of dysarthria seen in huntingtons

Answer 6

Hyperkinetic

Seen in Huntingtons

• Phonation: harsh, voice stoppages +/- dystonia
• Resonance: hypernasality
• Speech: voluntary speech movements on top of involuntary movements. Speech can either be mildly affected or completely unintelligible

Question 7

type of dysarthria seen in cases of cerebellar invovelemtn.

Answer 7

Ataxic

Definition: dysarthria due to cerebellar involvement→ ex cerebellar involvement

• Phonation: harsh, excessively lough, effortful, explosive
• Prosody: equal and excessive stress on all syllables
• Articulation: slurred, slowed, inaccurate range, force or timing

Staccato speech

Question 8

Damage to the ___ hemisphere can cause language disorders (usually __ hemisphere). If you damage the non-dominant hemisphere, most likely will not affect speech __.

__ (rhythm and intonation of speech), nonverbal communication, implied meaning, situational context, humor, inferences all affect speech and are controlled by the ___ HEMISPHERE.

Answer 8

Damage to the dominant hemisphere can cause language disorders (usually left hemisphere). If you damage the non-dominant hemisphere, most likely will not affect speech production.

prosody (rhythm and intonation of speech), nonverbal communication, implied meaning, situational context, humor, inferences all affect speech and are controlled by the RIGHT HEMISPHERE.