Assessing Speech
April 1st, 2023
Overview
Listen to the patient speak on order to assess for a potential speech disorder. Listen to the rate of speech, volume, quantity, fluency and tonality.
Causes of Abnormal Speech
- Psychiatric disorder - mood disorder, anxiety, schizophrenia
- Confusion - delirium, dementia, intellectual disability
- Dysphasia / aphasia
- Dysarthria - stroke, brain injury, Parkinson's, MS
- Dysphonia - laryngitis, neuropathology, trauma, mass, atrophy, systemic disease
- Hearing impairment
- English as a non-native language
- Intoxication
Rate of Speech
The rate of speech refers to the speed at which the patient speaks.
Interpretation
- Slow speech (bradylalia)Depression, Parkinson's disease, cognitive impairment
- Normal speech rate
- Rapid speech (tachylalia) - fast speech but able to be redirectedNormal, mania, anxiety, stimulants
- Pressured speech - fast and without taking breaks, talking over other people and unable to be redirectedMania, anxiety
Volume of Speech
The loudness or softness of a person's speech can be indicative of emotional factors, cultural background, or hearing impairments.
Interpretation
- Loud (hyperphonia)Personality trait, hearing impairment, mania
- Normal speech volume
- Weak (hypophonia) - low or soft speechShyness, anxiety, depression, Parkinson's disease
Quantity of Speech
Speech quantity is the amount of speech produced by an individual, helping to identify patterns of over-talkativeness or paucity of speech.
Interpretation
- Excessive talking (logorrhoea) - speaking at length and apparently without endMania, ADHD, anxiety
- Talkative - actively takes part in conversation.Normal
- Poverty of speech - very little speech, even with persuasion.Shyness, depression, schizophrenia, cognitive impairment
Fluency
Fluency refers to the ease and flow of speech, exploring potential disruptions such as stuttering or hesitations, which could be related to anxiety, neurological disorders, or language impairments.
Examples of Dysfluency
- Stuttering - repetition, prolongation, or pauses in speechMay be developmental, neurogenic, or psychogenic
- Cluttering - rapid, disorganized speech with excessive word and phrase repetitionsOften related to language or learning disabilities
Causes of Impaired Speech Fluency
- Dysphasia / aphasia
- Dysarthria
- Confusion - delirium, dementia, intellectual disability
- Hearing impairment
- Foreign language
- Intoxication
Tonality
Tonality refers to the pitch, intonation, and expressiveness of an individual's speech.
Interpretation
- Expressive - varied pitch and intonationNormal tonality
- Monotone - the patient uses a single tone for vocal expression.Boredom, depression, schizophrenia, autism spectrum disorder
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