Speech Disturbance

Question 1

3 major categories of speech disturbance

Answer 1

1. Dysphasia (difficulty generating of comprehending content of speech) - can be expressive, receptive or mixed
2. Dysarthria - bulbar, pseudobulbar it mixed
3. Dysphonia (difficulty producing sound)

Question 2

Examination

Answer 2

• ask a few simple questions and note:
  1. Quality of speech (slurred, nasal or hoarse)
  2. Rate of speech- slow and deliberate? Explosive or telegraphic?
  3. Volume of speech - quiet or monotonous? Fatiguing?
  4. Content of speech: correct grammar or syntax? Makes sense? Fluent?
• say la la la (lingual consanants)
• mm mm mm (labial consonants)
• ga ga ga (gutteral consanants)
• baby hippopotamus and west register street (cerebellar speech)
• ask to perform command (receptive dysphasia)
• repeat a phrase or sentence
• cough and say ahhhhh
• read and write a sentence
• right or left handed? (All right handed have left dominance, 75% of left handed have right dominance)

Question 3

Dysphasia

Answer 3

• expressive vs receptive vs conduction dysphasia (problems with repetition of phrase or sentence)
• check for other signs of dominant hemisphere damage: visual agnosia prosopagnosia (inability to recognise faces)
• gerstmanns syndrome
• limb apraxias (ask to copy hand generates and pretend to brush teeth or comb hair
• suggest full neurological exam for other UMN signs

Question 4

Causes of dysphasia

Answer 4

• any lesion of Broca’s area (expressive), wernickes (receptive) or arcuate fasciculus (conductive) (this connects the other two areas.
• MCA occlusion, SOL, neurodegenerative disorder

Question 5

Pseudobulbar (UMN/spastic dysarthria) signs

Answer 5

Slow, effortful and harsh speech

Associated UMN facial weakness (forehead sparing)

Donald Duck speech due to spastic tongue held in back of mouth (labial consanants most affected)

Slow tongue movements and difficult to protrude tongue

Tongue fasciculations or wasting due to LMN pathology of MND

Exaggerated facial reflexes

Emotional lability

Question 6

Causes of pseudobulbar dysarthria

Answer 6

Bilateral damage to corticobulbar tracts

Bilateral internal capsule infarcts/ small vessel disease

MND

Demyelination disorder

Neuro syphilus

Traumatic brain injury

High brain stem tumours

Question 7

Bulbar (LMN dysarthria) signs

Answer 7

Due to lack of tone in tongue, may be nasal if soft palate weak

LMN facial weakness

Tongue may be wasted or fasciculated

Poor palate movements

Associated nasal regurgitation, dysphagia, dysphonia

Poor jaw jerk

Fatiguability suggests MG

Cough may be poor, meaning high risk of aspiration

Question 8

Causes of bulbar dysarthria

Answer 8

MG
GBS
MND
Brainstem infarcts affecting bulbar nuclei
Polio
Brainstem tumour
Syringobulbia

Question 9

Ataxic dysarthria signs

Answer 9

Slurred speech

Explosive volume

Scanning speech (emphasis on making each syllable)

Other signs of cerebellar problems