- Language allows communication and elaboration of thoughts and experiences by linking them to words
- Speech is the oral production of language
- Perisylvian region of the left hemisphere in 95 – 99% of right-handed and 60 – 70% of left-handed people
- Posterior pole: Wernicke’s area, transforms sensory inputs into their lexical representations (gives meaning)
- Anterior pole: Broca’s area, transforms lexical representations into their articulatory sequences
- Also involved in the construction of meaning-appropriate syntax (grammar)
- Speech deficits
- Dysphonia: inability to properly formulate sound from the larynx
- Patients characteristically have a bovine cough (lacking the sharp, explosive onset)
- Dysarthria: inability to shape noise into recognisable words
- May have slurred and slow pronunciation
- Especially evident on speaking words with many consonants (such as university, Episcopal, constitution or “West Register Street”)
- Bulbar speech – nasal speech which lacks tonal modulation
- Pseudobulbar (Donald Duck) – monotonous, slurred, high-pitched speech (sounds forced)
- Cerebellar – staccato, scanning speech
- Dysphasia: inability to understand or generate language
- Wernicke’s (sensory / receptive) dysphasia: cannot understand and execute a simple three-stage command, e.g. “when I clap my hand, touch your right ear with your left index finger
- Broca’s (motor / expressive) dysphasia: slower word production and word-finding difficulties
- Conductive dysphasia: loss of repetition, with preserved comprehension and expression.
- Dysphonia: inability to properly formulate sound from the larynx
- Expression
- Fluency: maintains appropriate output volume, phrase length and melody (prosody)
- Paraphasia: when a patient uses a word which approximates the desired one phonetically (for example, “plentil” for “pencil”). Occurs in damage to anterior language areas
- Semantic paraphasia: when a patient offers an incorrect but legitimate word instead of the desired one (for example, “pen” for “pencil”). Occurs in semantic memory impairment
- Fluency: maintains appropriate output volume, phrase length and melody (prosody)
- Naming (anomia is the single most common defect in aphasic patients)
- Circumlocutious description of the object
- Paraphasia
- Mild anomia: naming parts of objects (for example watch, watch face, watch strap, hands, and crown) is more sensitive
- Most anomias are retrieval-based (anomia, but can point object out if the examiner asks him to)
- Two-way anomia implies comprehension deficit
- Comprehension
- Simple: “can a dog fly?” or “point to the source of light”
- Complex syntax: “if a tiger is eaten by a lion, which animal stays alive?” or “if I take my shoes and socks off, then put my socks on, what am I wearing?”
- Execute a three-stage command: “when I clap my hand, touch your right ear with your left hand”
- Repetition: repeat “no ifs, ands or buts”
- Reading
- Ask the patient to read aloud from a bedside newspaper or magazine
- Ask the patient to summarise what he has just read to test reading comprehension
- In patients with an expressive dysphasia, ask them to read and execute “close your eyes”
- Writing
- Screen for the presence of dysgraphia (acquired deficit in spelling or grammar of written language)
- Ask the patient to write a few sentences, and inspect them for spelling and grammar
Examination of Speech
jenweiying
2018-01-30T16:37:22+00:00