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Speech Exam

Aka: Speech Exam, Dysarthria, Dysphonia

I. See Also

  1. Aphasia
  2. Disorganized Speech
  3. Mental Status Exam
  4. Appearance, Behavior and Attitude Exam
  5. Attention and Concentration
  6. Higher Integrative Function (Executive Function, Intellectual Function)
  7. Thought Process ( Thought Content, Thought Form, Delusion, Obsession, Abstract Thought)
  8. Affect Examination
  9. Insight and Judgement
  10. Memory Evaluation
  11. Orientation Exam

II. Definition

  1. Dysphonia
    1. Disturbance of voice quality, pitch or intensity
  2. Dysarthria
    1. Muscle control disturbance results in speech disorder
    2. Muscle control areas potentially causing Dysarthria
      1. Respiration
      2. Articulation
      3. Phonation
      4. Resonance
      5. Prosody
  3. Alogia
    1. Poverty of speech

III. Pathophysiology

  1. Deficit requires bilateral neurologic lesion
  2. Multiple possible lesion sites
    1. Upper Motor Neuron Lesion (UMNL)
    2. Lower Motor Neuron Lesion (UMNL)
    3. Peripheral Nerve Lesion
    4. Cortical Lesion

IV. Exam: Characteristics

  1. Quality: Coherent or incoherent
  2. Quantity: Talkative, expansive, paucity of speech
  3. Rate: Fast, pressured, slow, normal
  4. Volume and Tone: Loud, soft, monotone, weak, strong, mumbled
  5. Fluency and rhythm: Slurred, hesitant, aphasic or clear

V. Interpretation

  1. Psychotic: Rambling, bizarre speech (distinguish from Aphasia)
  2. Manic: Loud and rapid speech
  3. Depressed: Slow and soft speech

VI. Exam: Innervation

  1. Cranial Nerve XII
    1. Say "la-la-la"
    2. Say "newly laid linoleum"
    3. Say "Lolita's lost her lettuce"
  2. Cranial Nerve VII
    1. Labial Dysarthria
    2. Say "paper bag"
    3. Say "PresbyEpiscopal"
  3. Bulbar Paralysis (nuclei) Lower Motor Neuron Lesion
    1. Atrophy and fasciculation of Tongue
    2. Decreased Gag Reflex
    3. Not labile
    4. No Babinski
  4. Pseudobulbar/Suprabulbar: (bilateral cortical)
    1. Babinski abnormal
    2. Hyperactive Gag Reflex
    3. Lability (emotional Incontinence)
    4. Irregular cadence
  5. Upper Motor Neuron Lesion (UMNL) - spastic Dysarthria
    1. Distinct explosive speech
    2. Hot potato voice
  6. Cerebellar
    1. Scanning speech with dysprosody
  7. Extrapyramidal
    1. Sloppy indistinct quiet slower speech
  8. Tongue (Upper or Lower Motor Neuron Lesion)
    1. Say "G, J, T, N, D"
  9. Lips (Upper or Lower Motor Neuron Lesion)
    1. Say "P, B, F"

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Ontology: Dysarthria (C0013362)

Definition (NCI) Slow and slurred speech resulting from inability to coordinate the muscles that are used in speech. Causes include brain damage, Parkinson disease, and developmental causes.
Definition (NCI_CTCAE) A disorder characterized by slow and slurred speech resulting from an inability to coordinate the muscles used in speech.
Definition (CSP) imperfect speech articulation due to disturbances of muscular control.
Definition (MSH) Disorders of speech articulation caused by imperfect coordination of pharynx, larynx, tongue, or face muscles. This may result from CRANIAL NERVE DISEASES; NEUROMUSCULAR DISEASES; CEREBELLAR DISEASES; BASAL GANGLIA DISEASES; BRAIN STEM diseases; or diseases of the corticobulbar tracts (see PYRAMIDAL TRACTS). The cortical language centers are intact in this condition. (From Adams et al., Principles of Neurology, 6th ed, p489)
Definition (PSY) Articulation disorder resulting from central nervous system disease, especially brain damage.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D004401
ICD9 784.51, 438.13
SnomedCT 206979005, 8011004
LNC LP145911-6, MTHU043324
English Dysarthrias, DYSARTHRIA, DYSARTHROSIS, [D]Dysarthria, [D]Dysarthria (context-dependent category), Dysarthria, speech articulation dysarthria, speech articulation dysarthria (physical finding), Dysarthrosis, Dysarthoses, Dysarthosis, Late eff CV-dysarthria, Dysarthria [Disease/Finding], Late effects of cerebrovascular disease, dysarthria, dysarthria, dysarthrias, [D]Dysarthria (situation), Dysarthria (finding)
French DYSARTHRIE, DYSARTHROSE, Dysarthrie, Dysarthrose
Portuguese DISARTRIA, Disartrose, DISARTROSE, Disartria
Spanish DISARTRIA, Disartrosis, [D]disartria (categoría dependiente del contexto), DISARTROSIS, [D]disartria (situación), [D]disartria, disartria (hallazgo), disartria, Disartria
German DYSARTHRIE, Dysarthrose, DYSARTHROSIS, Dysarthrie
Dutch dysartrose, dysartrie, Dysarthria, Dysartrie
Italian Disartrosi, Disartria
Japanese 関節異常, ｺｳｺﾞｼｮｳｶﾞｲ, ｶ�ｾﾂｲｼﾞｮｳ, 構語障害, 延髄言語, ディザルトリア, 末梢性構音障害, 構話�全, 構語障害症, 構語障�, �言語
Swedish Bristfälligt uttal
Czech dysartrie, Dysartróza, Dysartrie, anartrie
Finnish Dysartria
Russian DIZARTRIIA, ДИЗ�РТРИЯ
Polish Dyzartria
Hungarian Dysarthrosis, Dysarthria
Norwegian Dysartri
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Dysphonia (C1527344)

Definition (MSH) Difficulty and/or pain in PHONATION or speaking.
Definition (NCI_NCI-GLOSS) Trouble with the voice when trying to talk, including hoarseness and change in pitch or quality or voice.
Definition (NCI) A speech disorder resulting in impaired utterance of sounds by the vocal folds.
Definition (PSY) Any speech disorder involving problems of voice quality, pitch, or intensity.
Concepts Finding (T033)
MSH D055154 , D014832
ICD9 784.42
ICD10 R49.0
SnomedCT 206973006, 16617009, 158310005, 229634004, 47004009
French DYSPHONIE, Dysphonie, Troubles de la phonation
English DYSPHONIA, [D]Dysphonia, [D]Dysphonia (context-dependent category), speech phonation dysphonia (physical finding), speech phonation dysphonia, Phonation Disorder, PHONATION DIS, Phonation Disorders, Dysphonia [Disease/Finding], Dysphonia (disorder), [D]Dysphonia (situation), Dysphonia (finding), dysphonia, Phonation disorder, Dysphonia, NOS, Dysphonia -RETIRED-, Dysphonia
Portuguese DISFONIA, Transtornos da Fonação, Disfonia, Distúrbios da Fonação
Spanish DISFONIA, [D]disfonía (categoría dependiente del contexto), Trastornos de la Fonación, Disfonía, disfonía - RETIRADO - (concepto no activo), [D]disfonía (situación), [D]disfonía, disfonía - RETIRADO -, disfonía (trastorno), disfonía
Japanese 発声障害, ﾊｯｾｲｼｮｳｶﾞｲ, 痙性発声障害, 発声困難, 攣縮性発声障害, 発声障害-攣縮性
German DYSPHONIE, Dysphonie, Phonationsstörungen
Czech Dysfonie, dysfonie
Italian Disfonia, Disturbo della fonazione
Korean 발성장애
Russian DISFONIIA, GOLOSOOBRAZOVANIIA NARUSHENIIA, ГОЛОСООБР�ЗОВ��ИЯ ��РУШЕ�ИЯ, ДИСФО�ИЯ СП�СТИЧЕСК�Я, ДИСФО�ИЯ, DISFONIIA SPASTICHESKAIA
Swedish Dysfoni
Polish Dysfonia spastyczna, Zaburzenia fonacji, Dysfonia, Dysfonia hiperkinetyczna
Hungarian Dysphonia
Norwegian Dysfoni
Dutch dysfonie, Dysfonie, Fonatiestoornis
Derived from the NIH UMLS (Unified Medical Language System)

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