This document summarizes the examination of speech and dysarthria. It discusses evaluating various aspects of speech like fluency, comprehension, repetition, naming, reading and writing. It also examines specific speech issues like circumlocution, agrammatism, prosody, paraphasias and neologisms. Tests are outlined to check single word and multi-step comprehension, repetition, naming body parts and objects, reading words, sentences and paragraphs as well as writing letters, numbers and sentences. The examination also evaluates different types of dysarthria like bulbar palsy, cerebellar dysarthria and pseudobulbar palsy by having patients repeat sounds and perform tongue twisters.

1. Examination of
Speech

2. Speech
• Fluency
• Comprehension
• Repetition
• Naming and Word Finding
• Reading
• Writing

3. 1. Fluency
• Word Output (nl 50-150)
• Word finding difficulty
• Initiation difficulty
• Circumlocution
• Grammar
• Prosody
• Paraphasias
• Neologisms

4. Circumlocution
• Circumlocution is using many words to describe
something simple
• Eg: "a tool used for cutting things such as paper and
hair - scissors"

5. Agrammatism
• Agrammatism is a form of expressive aphasia that
refers to the inability to speak in a grammatically
correct fashion.
• People with agrammatism may have telegraphic
speech, ie few words, without conjunctions or
articles says "Water now!”

6. Prosody
• Prosody is the rhythm, stress, and intonation of speech.
• Prosody reflect various features of the speaker: the
emotional state; whether it is a statement, a question, or a
command; whether the speaker is being ironic or sarcastic;
• Person diagnosed with the disease can comprehend
language and vocalize what he intends to say, but, he is
not able to control the way in which the words come out of
his mouth.
• Dysprosody is the rarest neurological speech disorder
discovered,

7. Paraphasias
• Paraphasia can be further sub-divided into 3 categories:
• In literal paraphasia, >1/2 of the spoken word is said correctly.
An example could be saying pun instead of spun.
• Neologistic refers to a spoken word that is said <1/2 correct.
Occasionally the word is not said correctly at all, for example
Balenti for Banana. This is common in the speech of patients with
schizophrenia.
• The last is verbal paraphasia where another word is substituted
for the target word. A common example is saying dog instead of
cat.

8. Neologisms
• A Neologism is a newly coined word or phrase that may be in the
process of entering common use, but has not yet been accepted
into mainstream language.

9. 2. Comprehension
• Ask the patient to point to fan,light,nose etc –single word
comprehension normal
• Next give the patient multi-step command like ‘ touch your left
elbow with your right index finger – to check the patients ability to
comprehend sequences of words
• Then ask the patient Q’s which can be answered by yes or no like
is this a hotel? Is it raining ? …

10. 3. Repetition
• The only validated phrase to repeat is that in the MMSE “ no ifs
ands or buts “

11. 4. Naming and Word Finding
• Ask the patient to identify and the name the colours red, green,
blue & yellow
• Check the ability to name the body parts like
eyes,nose,teeth,eyelash…
• The ability to name objects in the room, like watch , door, skin,
far…is also assessed

12. 5. Reading
• First confirm if the patient is literate and if so check
• A. Reading- words
sentences
paragraph
• B. Comprehend what he is reading ( by assess by asking simple
Q’s based on the material read )

13. 6. Writing
• Letters and Numbers
• Short sentences
• Copying a sentence

14. Examination of
Dysarthria

15. Bulbar palsy
• Pronunciaton of consonants is difficult.
• Ask to repeat
p – lip seal
t - tip of tongue movement against the palate
k - movement of the bach of the tongue to close off the larynx
b – sound test for vocal cord function

16. Cerebellar dysarthria
• Speech is ‘scanning’ and robotic, with syllables pronounced
individually and slowly
• Ask the patient to say “Eye-ay” repeatedly – abnormally
slow in cerebellar disease

17. Pseudobulbar palsy
• Speech is stranged and spastic
• Tongue-twisters “British
constitution is pronounced
as “Brizh conshishushon “

18. Dyshonia
• This is tested by repeating a large number of sounds such as the
the months of the year
• A quiet voice result from poor ventilatory capacity…