Speech

Question 1

Categories of speech impairment

Answer 1

Dysphonia: impaired production of voice sounds
Dysarthria: impaired articulation of sound to words
Dysphasia: impairment of language

Question 2

Examination for dysarthria

Answer 2

Repetition:
“Red lorry yellow lorry” - lingual sounds
Baby hippopotamus - labial sounds
Count to thirty - muscle fatigue in myasthenia gravis

Question 3

Examination for dysphonia

Answer 3

Ask patient: “How did you get here today?”
Voice - quiet or hoarse
Cough - bovine
Say ahh - vocal cord tension

Question 4

Examination for dysphasia

Answer 4

Name three objects: nominal dysphasia
Three stage command: receptive dysphasia (avoid visual clues by instructing from behind)
Repeat sentence: today is thursday (conduction dysphasia)

Question 5

Screen for dyslexia

Answer 5

Ask patient to read a paragraph

Question 6

Screen for dysgraphia

Answer 6

Ask patient to write a sentence

Question 7

Causes of dysarthria

Answer 7

Lesion in tongue, lips, or mouth, or disruption of neuromuscular pathway.
Pseudobulbar: spastic dysarthria. Difficulty with 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, drunked speech.

Question 8

Causes of dysphonia

Answer 8

Local vocal cord pathology: laryngitis, tumour, nodule.

Recurrent laryngeal nerve palsy.

Question 9

Causes of Dysphasia

Answer 9

Expressive:
Damage to Broca’s area in frontal lobe, non-fluent speech, comprehension intact.
Receptive:
Damage to Wernicke’s area in temporal lobe, fluent but meaningless speech, comprehension impaired.
Conduction:
Damage to arcuate fasciculus connecting Broca’s and Wernicke’s areas. Comprehension intact, unable to repeat words or phrases.