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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