- 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)
- Other brain lesions:
- Mass lesion
- 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’
Causes – Often similar to expressive speech disorder
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.
- 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 palsy – LMN
- Very nasal
- Might have nasal regurg in swallowing
- Likely to aspirate
- Gullian-Barre syndrome
- 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