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
Slow speechPsychomotor retardation
Normal speech rate
Rapid speech - fast speech but able to be redirectedNormal, psychomotor agitation
Pressured speech - fast and without taking breaks, talking over other people and unable to be redirectedMania, anxiety
Volume of Speech
Loud - may be associated with psychomotor agitation
Normal speech volume
Weak - may represent shyness (normal), low self-esteem (depression), dysarthria
Quantity of Speech
Expansive - speaking at length and apparently without endMania, anxiety
Talkative - actively takes part in conversation.Normal
Poverty of speech - very little speech, even with persuasion.Shyness or psychomotor depression
Fluency
Listen For
- Speed, intonation, phrasing and expression of speech.
Significance
- Normal people comfortably speak at a rate of 100 words per minute - less than 50 per minute is indicative of dysfluency.
Causes of Impaired Speech Fluency
- Dysphasia / aphasia
- Dysarthria
- Confusion - delirium, dementia, intellectual disability
- Hearing impairment
- Foreign language
- Intoxication
Tonality
Resonant - rich, deep tone.
Monotone - the patient uses a single tone for vocal expression.Boredom, psychomotor retardation
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