Exam

Speech Exam

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Speech Exam, Dysarthria, Dysphonia

  • See Also
  1. Aphasia
  2. Disorganized Speech
  3. Mental Status Exam
  4. Appearance, Behavior and Attitude Exam
  5. Attention and Concentration
  6. Higher Integrative Function (Executive Function, Intellectual Function)
  7. Thought Process ( Thought Content, Thought Form, Delusion, Obsession, Abstract Thought)
  8. Affect Examination
  9. Insight and Judgement
  10. Memory Evaluation
  11. Orientation Exam
  • Definition
  1. Dysphonia
    1. Disturbance of voice quality, pitch or intensity
  2. Dysarthria
    1. Muscle control disturbance results in speech disorder
    2. Muscle control areas potentially causing Dysarthria
      1. Respiration
      2. Articulation
      3. Phonation
      4. Resonance
      5. Prosody
  3. Alogia
    1. Poverty of speech
  • Pathophysiology
  1. Deficit requires bilateral neurologic lesion
  2. Multiple possible lesion sites
    1. Upper Motor Neuron Lesion (UMNL)
    2. Lower Motor Neuron Lesion (UMNL)
    3. Peripheral Nerve Lesion
    4. Cortical Lesion
  • Exam
  • Characteristics
  1. Quality: Coherent or incoherent
  2. Quantity: Talkative, expansive, paucity of speech
  3. Rate: Fast, pressured, slow, normal
  4. Volume and Tone: Loud, soft, monotone, weak, strong, mumbled
  5. Fluency and rhythm: Slurred, hesitant, aphasic or clear
  • Interpretation
  1. Psychotic: Rambling, bizarre speech (distinguish from Aphasia)
  2. Manic: Loud and rapid speech
  3. Depressed: Slow and soft speech
  • Exam
  • Innervation
  1. Cranial Nerve XII
    1. Say "la-la-la"
    2. Say "newly laid linoleum"
    3. Say "Lolita's lost her lettuce"
  2. Cranial Nerve VII
    1. Labial Dysarthria
    2. Say "paper bag"
    3. Say "PresbyEpiscopal"
  3. Bulbar Paralysis (nuclei) Lower Motor Neuron Lesion
    1. Atrophy and Fasciculation of Tongue
    2. Decreased Gag Reflex
    3. Not labile
    4. No Babinski
  4. Pseudobulbar/Suprabulbar: (bilateral cortical)
    1. Babinski abnormal
    2. Hyperactive Gag Reflex
    3. Lability (emotional Incontinence)
    4. Irregular cadence
  5. Upper Motor Neuron Lesion (UMNL) - spastic Dysarthria
    1. Distinct explosive speech
    2. Hot potato voice
  6. Cerebellar
    1. Scanning speech with dysprosody
  7. Extrapyramidal
    1. Sloppy indistinct quiet slower speech
  8. Tongue (Upper or Lower Motor Neuron Lesion)
    1. Say "G, J, T, N, D"
  9. Lips (Upper or Lower Motor Neuron Lesion)
    1. Say "P, B, F"