Yingshan Shi, M.D.
(773) 702-6169 06/2003
Childhood Speech Disorders
Aphasia: Disturbance of fluency, understanding, word finding, and repetition.
Dysphonia: The volume is abnormal. A disturbance of voice production
Dysarthria: The words are not formed properly with difficulties at different levels - vocal cords, larynx, palate, tongue, and lips.
Aphasia
History: Family history, personal history, social history, right or left hand, language development
Simple question: name, address, job, and how old you are?
Test understanding:
Yes/no questions: "Is this a chair?"
Simple command: "open your mouth; touch your nose with your right hand"
Complicated commands "use your right hand to touch your nose and then touch your left ear"
Assess word finding
ability and naming
＾Name all the animals you can think of￣ - normal 18-22 in 1 minute
Give all the words beginning with a particular letter "f or s", normal −12 in 1 minute
Name familiar objects such as fork, spoon, shoes, etc.
Assess repetition: Repeat a simple phrase "The sky is blue.", then increasingly complicated phrases.
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Diseases |
Lesion Location |
Speaking Style |
Other |
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Aphasia |
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dominant hemisphere |
Use word correctly and fluently |
Understand |
Repetition |
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Global Aphasia |
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dominant hemisphere |
No |
No |
Yes |
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Transcortical Sensory Aphasia |
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posterior parieto-occipital region |
Yes |
No |
Yes |
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Wernicke's Aphasia |
Receptive, sensory aphasia |
Supramarginal gyrus of the parietal lobe and upper part of temporal lobe |
Yes |
No |
No |
May with field defect |
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Transcortical Motor Aphasia |
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Broca's area |
Not |
Yes |
Yes |
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Broca's Aphasia |
Expressive, motor aphasia |
inferior frontal gyrus |
Not |
Yes |
No |
May with a hemiplegia |
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Conductive Aphasia |
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arcuate fascilulus |
Yes |
Yes |
No |
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Nominal Aphasia |
Can not name objects |
angular gyrus |
Yes |
Yes |
Yes |
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Normal Speech |
Can name objects |
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Yes |
Yes |
Yes |
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Dysarthria
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Disorders |
Causes |
Symptoms & Signs, Dx |
Tx |
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Unfit dentures |
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Cerebellar |
Alcohol intoxication, multiple sclerosis, phenytoin toxicity, rarely: hereditary ataxias |
Rhythm abnormal, slurred speech as if drunk, sometimes with scanning speech (equal emphasis in each syllable). |
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Extrapyramidal
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Parkinsonism |
Rhythm abnormal, no slurred speech Monotonous, Sentences suddenly start and stop. |
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Spastic |
Bilateral upper motor neurone weakness Pseudobulbar palsy Motor neurone disease |
Rhythm abnormal, slurred speech, patient hardly opens mouth, try to speak from the back of mouth |
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Palatal Palsy |
Lower motor neurone Lesion of X |
Normal rhythm, nasal speech, as with a bad cold |
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Tongue Palsy |
Lower motor neurone Lesion of XII |
Normal rhythm Distorted speech, esp. letters T, S, D Can not see phases "yellow lorry" |
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Facial Palsy |
Lower motor neurone Lesion of |
Normal rhythm Difficulty with letters B, P, M, W "baby hippopotamus" |
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Myasthenia |
Muscle fatiguability |
Dysphonia Lower motor seurone pattern of dysathria |
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Dysphonia
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Disorders |
Causes |
Symptoms & Signs |
Dx |
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local laryngeal/ vocal cord disorder |
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， Speech pathology/ speech therapy evaluation ， Indirect laryngoscopy with mirror ， Flexible fiberoptic nasolaryngoscopy ， Stroboscopic videolaryngoscopy- check the vibration of the vocal cords ， pH probe ， Operative endoscopy ， Electromyography (EMG) |
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Vocal cord palsy |
Disturbance of nerve supply via the vagus |
Cough lacks explosive start- bovine cough |
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Myasthenia |
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Cannot sustained to say "eeeeee", and fatigues |
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Hysteria |
Psychological disturbance |
Normal cough |
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Childhood Hoarseness |
Medical Conditions Associated with
Dysphonia |
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，
Inflammatory/
Infectious (most common) Viral, bacterial, GER Allergic laryngitis Rheumatoid arthritis ，
Neoplastic/Anatomic Vocal cord nodules, polyp, cyst, granuloma Respiratory papillomatosis, laryngeal web ，
Neurologic Paresis/paralysis,
Neuromuscular disease, spasmodic dysphonia ，
Miscellaneous Vocal abuse Trauma- birth, blunt neck ，
Latrogenic Intubation Surgery
in airway, neck, |
， GER ， Asthma, cough ， Environmental allergies ， Cystic fibrosis, cough ， Sinusitis ， Adenoiditis ， Postnasal drip, throat clearing ， Hypothyrodism ， Juvenile rheumotoid arthritis |
Speech Delay
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Definition & Cause |
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Dyslexia |
From Greek words: dys- difficult; les- word Have difficulty in using words or language. Many dyslexics are right brain writing, are often very artistic and creative. Wernick's area-little brain activity Receptive- understanding the meanings of words, and string words together to form sentence. Broca's area: high
activity Expressive, speaking words Angular syrus: poor activity Turns the image of the word into sound |
， Difficulty connecting letters with sounds ， Difficulty dividing words into syllables ， Confusion or reversal of letter and numbers, such as "sing" and "sign"; "left" and "felt"; or "67" and "76" ， Confusion between letters that look similar, such as b and d; and p and q ， Difficulty remembering what has been read ， Difficulty spelling, hand writing ， Difficulty copying words or numbers from the chalkboard or a book ， Difficulty reading aloud ， Difficulty expressing thoughts and ideas verbally or in written form ， Confusion about directions relating to space or time, such as right and left, up and down, early and late, yesterday and tomorrow, months and days ， Difficulty following instructions, rhyming ， Poor self esteem, frustration, giving up |
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