Speech disorder

Dysphasia / aphasia

Ø Impairment of the production and/or the comprehension of spoken or written words.

Ø Content of speech is abnormal. (language dysfunction)

Ø Assessment: mnemonic - CNS-RW

1. Comprehension

· 3 step instructions:

i. close your eyes/闭上您的眼睛(chinese simplified)/ अपनी आँखें बंद करो (Hindi)/ tutp mata (Malay)

ii. lift up your left hand /提起您的左手(chinese simplified)/ अपने बाएँ हाथ उठा (Hindi) / angkat tangan kiri (Malay)

iii. touch your left ear /接触您的左耳朵(chinese simplified)/ अपनी बाईं कान स्पर्श (Hindi)/ sentuh telinga kiri (Malay)

2. Naming objects

· Pen, key, book, card

3. Spontaneous speech

· Ask about his day, family, visitors, occupation

4. Repetition of sentence

· I want to go to the toilet /我想要去洗手间 (chinese simplified)/ मैं शौचालय जाना चाहती हूँ (Hindi)/saya nak pergi ke tandas (Malay)

5. Writing

· Write a given sentence e.g. regarding residence – I live in an apartment at Damansara Utama./ 我在公寓居住在damansara utama(chinese simplified)/ मैं एक अपार्टमेंट में damansara utama में रहते हैं (Hindi)/Saya tinggal di Damansara Utara dalam sebuah rumah bertingkat.(Malay)

· Write out a given instruction – “lift up your left hand” /提起您的左手(chinese simplified)/ अपने बाएँ हाथ उठा (Hindi) / angkat tangan kiri (Malay)

Ø Types of dysphasia :

Clinical features	Expressive (Broca’s) dysphasia	Receptive (Wernicke’s) dysphasia	Conductive dysphasia	Nominal dysphasia
Comprehension	Normal	Impaired	Normal	Normal
Naming objects	Impaired	Impaired	Impaired	Impaired
Speech	Telegraphic (staccato speech)	Paraphasia Neologism	Paraphasia Neologism	Lack nouns
Repetition	Impaired	Impaired	Impaired	Normal
Writing	Impaired	Impaired	Impaired	Pauses (lack nouns)
Spontaneous	Non-fluent (mute if severe)	Fluent	Fluent	Pauses
Site of lesion	Left inferior frontal gyrus	Left superior temporal gyrus	Left arcuate fasciculus	Left temporal lobe

Dysarthria

Ø Imperfection in articulation of speech.

Ø Content is normal.

Ø Subtypes:

o ”Hot potato” speech = Pseudobulbar dysarthria

o Nasal speech = Bulbar dysarthria

o Scanning / staccato speech(syllable by syllable) = Cerebellar dysarthria

o Monotonous, soft speech = Parkinsonian dysarthria

Dysphonia

Ø Impairment in production of voice (soft / hoarse voice)

Ø Content of speech is normal.

Ø E.g. vocal cord palsy