Contents
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)
Causes
- 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 confusion – but 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
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 palsy – LMN
- Very nasal
- Might have nasal regurg in swallowing
- Likely to aspirate
Causes
- 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”
Dysphonia
A problem with speech volume, but normal articulation and normal language.
Often caused by Parkinsonism