2. SPEECH & LANGUAGE
Speech:
Articulation & pronunciation
Physical ability to form words
Bulbar muscles
Language:
Process by which thoughts & ideas become spoken
Semantics
Syntax
DYSARTHRIA
DYSPHASIA
4. ASSESSMENT OF SPEECH & LANGUAGE
Simple conversation
Assess throughout history taking
3 main areas to assess
Quality: dysarthria, dysphonia
Content: expressive function – Broca’s area
Understanding: receptive function – Wernicke’s area
Baseline orientation
Time, place, person
5. WHAT IS DYSPHASIA?
Disorder of language
Comprehension
Expression
Causes
Acute
- CVD
- Head injury
Progressive
- Space-occupying lesion
- Degenerative
6. TYPES OF DYSPHASIA
Fluent (receptive) Non-fluent (expressive)
Wernicke’s Broca’s
Conduction Global
Trans-cortical sensory Trans-cortical motor
Nominal
7. HOW DO WE TEST FOR IT?
Fluency
- Familiar conversation
Comprehension
- Command (progressive difficulty)
Naming
- Name 3 common objects
Repetition
- ‘no ifs ands or buts’
Reading & writing
8. DYSPHONIA
Inability to produce sounds using the vocal
organs – harsh voice
Air expelled through glottis
Pressure drop across larynx
Vocal fold oscillation
Vocal fold paresis
Myasthenia gravis
Test:
“cough for me” – tests co-ordinated adduction and abduction
of vocal chords
“Say aaaahhhhh” – Requires vocal cord tension
9. DYSARTHRIA
Motor speech disorder
Dysfunction in the muscles needed to produce speech
Chest, neck, jaw, tongue, lips
CN V, VII, IX, X, XII
Parkinsonism, Huntington’s, stroke, traumatic brain
injury, ataxia
Abnormal rate and stress
Slurring of speech
‘m’ ‘p’ ‘t’
Speech:
Articulation: How speech sounds are made
Voice: The use of the vocal folds and breathing to produce sound (e.g., hoarseness, breathiness, projection)
Fluency and prosody: The rhythm, intonation, stress, and related attributes of speech
Language:
Semantics: selection of words to be spoken
Syntax: formation of appropriate words and phrases (social context/rules eg please could you open the window vs open the window now)
Primary auditory cortex:
Superior temporal gyrus of the temporal lobe, bilaterally
Receives input from the cochlear
Wernicke’s area:
Posterior section of the superior temporal gyrus of the temporal lobe (peripheral, secondary auditory cortex, ie within the cortex – diagram over simplified) Left lobe – dominant hemisphere in 99% of right handed people; only on right in 30% of left handed people. (Speech impairment following a stroke causing left sided weakness is rare)
Language comprehension
Language processing, whether written or spoken
Wenicke’s and Broca’s connected by the arcuate fasiculus
Broca’s area:
Left lobe only, inferior frontal gyrus
Speech production and articulation via activation of vocal apparatus in the motor cortex
Ability to articulate ideas, as well as use words accurately in spoken and written language
Not disorder of speech or thought
Aphasia – total loss of language (often used interchangeably with dysphasia)
Broadly – doesn’t fit neatly into boxes (clinically or anatomically)
Fluent (receptive)
words flow (with intonation) but not correct words
They are unaware
Anterior lesion?
Non-fluent (expressive) –
Good understanding (except global) but difficult to get words/sentences out Use correct words or work around
Little spontaneous speech
Posterior lesion
Fluent (receptive) – words flow but not correct words
Wernicke’s – poor comprehension, unable to repeat
TC sensory - poor comprehension, able to repeat
Conduction – good comprehension, repetition problem
Nominal – good comprehension, able to repeat, unable to name objects
non-fluent (expressive) – good understanding but unable to get words out (except global)
Broca’s – good comprehension, unable to repeat
TC motor - good comprehension, able to repeat
Global - poor comprehension and expression)
Wernicke’s (receptive) – supramaginal gyrus of parietal lobe and upper temporal lobe)
Broca’s (expressive) – inferior frontal gyrus
Global dysphasia – dominant hemisphere (Broca’s and Wernicke’s)
Conductive dysphasia – arcuate fasciculus
Mixed transcortical - ?
Motor transcortical – Broca’s area incomplete
Sensory transcortical – posterior parieto-occipital region
Nominal dysphasia – angular gyrus
Fluency/expression
Verbal output
How are you? How did you get here?
Tell me about your job/family etc.
Command (1-3 stage) -
Naming objects: watch, pen, paper etc. – not well localised
Repetition – impaired (perisylvian), echolalia (extrasylvian)
pair of vocal cords which move apart on breathing in (inspiration) and come closer together on breathing out (expiration). Vocal tone is produced by adjusting the frequency of vibrations
