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Expressive dysphasia

  • People understand commands, but are unable to find the words to respond appropriately.
  • To test for this, ask them to do basic motor tasks (e.g. close eyes), put hands on head. Then ask them what their name is – they might look to their name badge, or try to write it down.
  • 90% of people who are right handed have their language centre in the left side of the brain. So, look for peripheral signs: E.g. right spastic arm (stroke)


  • Stroke
  • Other brain lesions:
    • Trauma
    • Mass lesion

Receptive disorder

Bright, alert patient, who is not delirious or hallucinating. Not struggling to speak. Speaks fluently, but gives totally irrelevant answers. E.g.
  • What’s your name – ‘I’m looking forward to lunch’
  • What are you having for lunch – ‘Liverpool aren’t playing very well at the moment’
Often mistaken for confusionbut unlike confusion, there is not impaired consciousness/drowsiness.
They cannot obey motor commands.
They sometimes respond to written commands – but they can’t understand the spoken command about the written words!
Expressive disorders are more common than receptive disorders
Causes – Often similar to expressive speech disorder

Translocation disorders

Damage at the midpoint between Brocke’s and Wernick’es area.

Ataxic speech disorders – Cerebellar

  • Sound like they are drunk
  • But there is also another type of disorder associated with the cerebellum
  • Scanning speech (aka staccato speech)
  • Ask them to say “British constitution” and “west register street”. These are phrases that require a lot of co-ordination, and the patient may not be able to do it.
Emotionally labile / emotional incontinence
Emotion is not appropriate to behaviours. E.g might cry / laugh at inappropriate times. Suggest damage to frontal lobes, or damage to connections between frontal lobe and language centre. Often related to Pseudobulbar palsy.
  • Pseudobulbar palsy is a name for characteristic symptoms, and is NOT a diagnosis.
  • Hot potato /Donald duck speech
  • Very rigid, erect and stiff posture
  • Often looking a bit menacing – they don’t blink very often.

Bulbar palsyLMN

  • Very nasal
  • Might have nasal regurg in swallowing
  • Likely to aspirate


  • Gullian-Barre syndrome
  • MND
  • Can affect UMN and LMN – and to make the diagnosis you must have both. If the tongue is fasciculated and wasted and they have bulbar type speech symptoms – it is probably MND!
  • Myasthenia – fatigable
  • Myotonic dystrophy
Dystonia of the vocal chords
The intonation of his voice sounds like the Children’s TV program “The Clangers”
A problem with speech volume, but normal articulation and normal language.
Often caused by Parkinsonism


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