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  1. Home
  2. Examination
  3. Speech Exam

The Speech Exam

 
 
 
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The three major types of disordered speach are dysarthria, dysphonia and dysphasia. By performing a detailed examination it is possible to distinguish between these speech disorders and attempt to identify the underlying pathology causing them.
***
  • Types of dysarthria

  • Flaccid Dysarthria

    Lower motor neuron weakness

    Hypernasal speech with impaired articulation

  • Spastic Dysarthria

    Upper motor neuron weakness

    Strained-strangled speech

  • Ataxic Dysarthria

    Cerebellar lesion

    Slurred or ‘scanning’ speech

  • Hypokinetic Dysarthria

    Parkinsonism

    Hypophonia and monotony

  • Hyperkinetic Dysarthria

    Basal ganglia lesion

    Involuntary movements

  • Types of dysphasia

  • Receptive Dysphasia

    Wernicke’s

    Poor comprehension with paraphasias

  • Expressive Dysphasia

    Broca’s

    Non-fluency with telegraphic speech

  • Conductive Dysphasia

    Inability to repeat phrases

  • Anomic Dysphasia

    Inability to name objects, with circumlocution

The Patient

  • Ask about glasses and dominant hand

  • Facial Inspection

    Asymmetry, spasm, scars

  • Orientation

    Time, place, person

Spontaneous Speech

  • Ask the patient to describe an image, e.g. the Boston cookie theft image

  • Voice Quality

    Dysphonia, hypophonia, hypernasal / harsh speech

  • Fluency of Speech

    Rate, continuity, effort, repetition

  • Grammar

    Agrammatism, telegraphic speech

Repetition

  • Repetition of Simple Sounds

    Papapa, tatata, kakaka, bababa, aye-eye

  • Phrase Repetitition

    Emerald, perimeter, British constitution

  • Bulbar Fatiguability

    Ask patient to count to 20 / read a paragraph; listen for development of hypernasal speech

Naming

  • Object Naming

    Point to objects or pictures and ask for names

Comprehension

  • Verbal Comprehension

    Ask patient to point to objects, multi-step commands

  • Written Comprehension

    “Close your eyes”

On this page: The PatientSpontaneous SpeechRepetitionNamingComprehension
 
   

 

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Ely EW, Truman B, Shintani A, Thomason JWW, Wheeler AP, Gordon S, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003 Jun. 11;289(22):2983-2991. 
 http://www.rch.org.au/clinicalguide/guideline_index/Mental_State_Examination/
Kipps CM, Hodges JR. Cognitive assessment for clinicians.
 Nasreddine Z, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montral Cognitive Assessment, MoCA: A Brief Screening Tool for Mild Cognitive Impairment. Journal of the American Geriatrics Society. 2005 Apr; 53(4): 695-699. Rubin DC, Hoyle RH, Leary MR. Differential Predictability of Four Dimensions of Affect Intensity. Cogn Emot. 2012; 26(1): 25-41. Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale: Validity and Reliability in Adult Intensive Care Unit Patients. American Journal of Respiratory and Critical Care Medicine. 2002;166:1338-1344. Silverberg NB, Ryan LM, Carillo MC, Sperling R, Peterson RC et al. Assessment of Cognition in Early Dementia. The Journal of the Alzheimer's Association. 2001 May; 7(3): e60-e76. Zun L, Howes DS. The Mental Status Examination: Applications in the Emergency Department. American Journal of Emergency Medicine. 1988 Mar; 6(2): 165-172.
 
 
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