Examination of Speech

Speech

• Fluency• Comprehension• Repetition• Naming and Word Finding• Reading• Writing

1. Fluency

• Word Output (nl 50-150)• Word finding difficulty• Initiation difficulty• Circumlocution• Grammar• Prosody• Paraphasias• Neologisms

Circumlocution

• Circumlocution is using many words to describe something simple

• Eg: "a tool used for cutting things such as paper and hair - scissors"

Agrammatism

• Agrammatism is a form of expressive aphasia that refers to the inability to speak in a grammatically correct fashion.

• People with agrammatism may have telegraphic speech, ie few words, without conjunctions or articles says "Water now!”

Prosody

• Prosody is the rhythm, stress, and intonation of speech. • Prosody reflect various features of the speaker: the

emotional state; whether it is a statement, a question, or a command; whether the speaker is being ironic or sarcastic;

• Person diagnosed with the disease can comprehend language and vocalize what he intends to say, but, he is not able to control the way in which the words come out of his mouth.

• Dysprosody is the rarest neurological speech disorder discovered,

Paraphasias

• Paraphasia can be further sub-divided into 3 categories:• In literal paraphasia, >1/2 of the spoken word is said correctly.

An example could be saying pun instead of spun. • Neologistic refers to a spoken word that is said <1/2 correct.

Occasionally the word is not said correctly at all, for example Balenti for Banana. This is common in the speech of patients with schizophrenia.

• The last is verbal paraphasia where another word is substituted for the target word. A common example is saying dog instead of cat.

Neologisms

• A Neologism is a newly coined word or phrase that may be in the process of entering common use, but has not yet been accepted into mainstream language.

2. Comprehension

• Ask the patient to point to fan,light,nose etc –single word comprehension normal

• Next give the patient multi-step command like ‘ touch your left elbow with your right index finger – to check the patients ability to comprehend sequences of words

• Then ask the patient Q’s which can be answered by yes or no like is this a hotel? Is it raining ? …

3. Repetition

• The only validated phrase to repeat is that in the MMSE “ no ifs ands or buts “

4. Naming and Word Finding

• Ask the patient to identify and the name the colours red, green, blue & yellow

• Check the ability to name the body parts like eyes,nose,teeth,eyelash…

• The ability to name objects in the room, like watch , door, skin, far…is also assessed

5. Reading

• First confirm if the patient is literate and if so check

• A. Reading- words

sentences

paragraph

• B. Comprehend what he is reading ( by assess by asking simple Q’s based on the material read )

6. Writing

• Letters and Numbers

• Short sentences

• Copying a sentence

Examination of Dysarthria

Bulbar palsy

• Pronunciaton of consonants is difficult.• Ask to repeat

p – lip seal

t - tip of tongue movement against the palate

k - movement of the bach of the tongue to close off the larynx

b – sound test for vocal cord function

Cerebellar dysarthria

• Speech is ‘scanning’ and robotic, with syllables pronounced individually and slowly

• Ask the patient to say “Eye-ay” repeatedly – abnormally slow in cerebellar disease

Pseudobulbar palsy

• Speech is stranged and spastic

• Tongue-twisters “British constitution is pronounced

as “Brizh conshishushon “

Dyshonia

• This is tested by repeating a large number of sounds such as the the months of the year

• A quiet voice result from poor ventilatory capacity…