Table of Contents IntroductionGeneral Dysarthria Dysphasia To complete exam Here’s some viva questions Introduction Wash hands Introduce self Ask Patient’s name, DOB and what they like to be called Explain examination and obtain consent General Listen to their speech, for example ask questions such as: What’s your name? How old are you? Describe how you got here today Describe the room Determine if the pathology is dysarthria or dysphasia, then proceed to the appropriate examination Dysarthria Dysphasia Difficulty with mechanics of speech: Bulbar palsy = flaccid Pseudobulbar palsy = spastic Cerebellar = slurred, staccato (broken up into syllables, i.e. jerky), scanning (variability in pitch/volume) Myasthenic = weak, quiet, fatigable Difficulty with processing of speech: Expressive (Broca’s) = patient knows what they want to say but cannot say it, resulting in non-fluent speech – they still understand speech and have awareness of their speech difficulty Receptive (Wernicke’s) = fluent, effortless speech that is disorganised and lacks meaning (talk Rubbish) + cannot understand language (written or spoken) – they lack awareness of their speech difficulty Dysarthria Repeat difficult phrases ‘Yellow lorry’ (tests tongue) ‘Baby hippopotamus’ (lips) ‘We see three grey geese’ (palate) Repeat sounds: ‘pa’ (facial and mouth), ‘ta’ (tongue), ‘ka’ (palate) Count to 30 (fatigability in myasthenia gravis) Test cranial nerves9, 10 and 12 Look in mouth and say ‘ahhh’ to observe palatal movement Look at uvula (deviates away from the side of lesion) Look at tongue (fasciculations = lower motor neuron, e.g. bulbar palsy) Assess cough and swallow Stick tongue out (deviates to side of lesion) Say you would also test gag reflex Dysphasia Commands (unable to follow =receptive) Single stage: ‘open your mouth’ Two stage: ‘with your right hand, touch your nose’ Three stage: ‘with your right hand, touch your nose then your ear’ Naming objects (difficulty saying name = expressive; incorrect names = receptive; difficulty naming objects when other aspects of speech are normal = ‘nominal dysphasia’) Example objects: watch, watch hands, pen, tie, belt Repetition (poor flow and articulation = expressive; lacking meaning = receptive) ‘No ifs ands or buts’ Read a sentence (poor flow and articulation = expressive; lacking meaning = receptive) Write a sentence (effortful with poor flow and mostly content words = expressive; effortless but lack of meaning = receptive) To complete exam Thank patient ‘To complete my examination, I would perform a full neurological examination.’ Summarise and suggest further investigations you would consider after a full history Here’s some viva questions Please describe the difference between Broca’s and Wernicke’s aphasia. Damage to which areas of the cerebral cortex cause each of these aphasias? Oops! This section is restricted to members. Which tests may be used to assess muscle fatiguability in patients with myasthenia gravis? Oops! This section is restricted to members. How would a patient present if they had complete damage to cranial nerve X (Vagus nerve)? Oops! This section is restricted to members. How would you differentiate between and bulbar and pseudobulbar palsy? Oops! This section is restricted to members.
