material used for final exam preparation *at own risk

1. SPEECH ASSESSMENT (reference : Macleod clinical examination )
1. Introduce yourself
a. “hello Mr x, my name is Y, i am a final year medical student”
b. I would like to assess your speech for today
2. Gain consent
a. “Is that okay with you?”
3. “May i ask you a few questions?”
a. “What made you come here today?”
i. Listen to the patient's spontaneous speech, noting the volume, rhythm
and clarity (is there dysphonia or dysarthria?)
ii. Check fluency and appropriateness of the content (dysphasia)
b. “Could you repeat after me?”
i. Yellow lorry/lori langgar - To test lingual sounds (the tongue)
ii. Baby hippopotamus / mummy mama papa- to test labial sounds (the lips)
iii. Tongue twister - to test multiple processes
4. “Can you count until 30”
a. May reveal muscle fatigue
5. Can you cough
a. Requires coordinated adduction and abduction of vocal cords
6. Can you say “ahh”
a. Producing a note requires vocal cord tension
7. Could you name these 3 objects for me?
a. To test for nominal dysphasia
8. Stand behind patient and give instructions, “i'm going to give instructions, please wait
until i finish speaking before you carry it out”
a. Three stage command to test for receptive dysphasia (avoid visual clues by
giving instructions from behind)
i. Take a piece of paper, and fold the paper into half and place it to ground
9. “Could you repeat after me? Today is tuesday/apa khabar.”
a. Repetition of a simple sentence to test for conductive dysphasia
10. “Could you read the first sentence from this first page?”
a. Reading a passage from a newspaper to test for dyslexia
11. “Could you write a sentence?”
a. Examine the handwriting to look for dysgraphia
b. Dysgraphia and dyslexia can be caused by lesions in the parietal lobe
12. Thank the patient.

2. ADDITIONAL NOTES :-
Receptive dysphasia Expressive dysphasia Dysarthria Changed quality of
speech:-
Known as Wernicke's
dysphasia (pathology
in dominant temporal
lobe). Patient's
speech is fluent, but
does not make
sense. Neologisms
and paraphasias
(supplementation of
one word for another)
may be
used. Patient seems
unaware of mistakes
made. Reading,
writing, and
comprehension
impaired also
Known as Broca's
dysphasia (pathology
in dominant frontal
lobe).
Patient's speech is
non-fluent, and s/he
tries to word-find, but
often
mispronounces the
word, e.g.: 'spoot' for
'spoon'. s/he may be
able to
describe the word
rather than say it.
Reading and writing
are also
impaired
Poor articulation of
speech - does the
patient form and
pronounce
words abnormally?
This could be
suggestive of
neurological or
muscular problems
within the
oropharyngeal
muscles which aid in
formation of sounds
Low volume of
speech suggestive of
weak vocal muscles
or
poor respiratory
function
Harsh 'Donald Duck'
speech occurs with
increased tone
(spasticity) of the
oropharygeal
muscles, in
pseudobulbar palsy
(an upper motor
neuron lesion of the
bulbar nerves)
Nasal speech occurs
with decreased tone
of the oropharyngeal
muscles in bulbar
palsy (lower motor
neurone lesion of the
bulbar nerves) .
Dysphonia -
disturbance of the
sound of voice,
produced from the
vocal cords

3. Assessing for specific dysphasias:
Expressive
dysphasia
Receptive
dysphasia
Conduction
dysphasia
Nominal
dysphasia
Alexia
Patient's
understanding
can be in tact
but they cannot
string together
fluent
sentences
Patient's
understanding of
language is
impaired, and
they are unable
to
understand
tasks and to
self-moderate
their own use of
language (so
they
may use the
wrong words in
sentences).
However, their
speech is fluent
in
nature
Damage to the
arcuate
fasciculus
causes difficulty
in direct
repetition of
words or
phrases, as the
connection
between
Wernicke's and
Broca's areas is
lost
Patients have
difficulty naming
objects. This
may be a
component of
the
other forms of
dysphasia, or
may be an
isolated
A form of visual
receptive
dysphasia,
where written
language cannot
be
comprehended
This can be
tested by
engaging the
patient with
conversation
and assessing
the fluency of
their response
This can best be
tested by asking
the patient to
carry out a
simple 3 stage
task - e.g. "take
this paper with
your left hand,
fold it in half,
and put it on the
table next to
you"
Ask the patient
to repeat the
phrase: "no ifs,
ands, or buts"
Ask the patient
to name 2
objects - e.g.
pen and watch
Ask the patient
to read the
sentence "close
your eyes" and
follow the
command
If there is
conductive
dysphasia, the
patient will not
be able to
effectively
repeat the
phrase and will
need prompting
to complete the
sentence
If the patient is
unable to name
object, ask what
the object does
Isolated nominal
dysphasia could
indicate damage
in the temporal
lobe
Dr Santha : 21/4/21

4. Clinical features & aphasia and related conditions
comprehension repetition naming fluency
wernicke’s impaired impaired impaired preserved/increa
se
broca’s preserved
(except
grammar)
impaired impaired decrease
global impaired impaired impaired decrease
conductive preserved impaired impaired preserved
Speech
● Dysarthria-disturbed articulation
● Dysphonia- vocal cord, recurrent laryngeal nerve lesion
● Dysphasia - language area are loacted in dominant cerebral hemispheres
Bulbar palsy - involves lower motor neuron lesion
Pseudobulbar - involves upper motor neuron lesion