Expansion
Language, articulation and voice are separate problems
Expansion
- Dysphasia is a disorder of language, so of the dominant hemisphere
- Dysarthria is a disorder of articulation, so of the muscles or their control
- Dysphonia is a disorder of voice production, so of the larynx or vagus
Types of dysphasia
| Type | Fluency | Comprehension | Repetition | Site |
|---|---|---|---|---|
| Broca (expressive) | Non-fluent | Intact | Impaired | Inferior frontal |
| Wernicke (receptive) | Fluent but meaningless | Impaired | Impaired | Superior temporal |
| Conduction | Fluent | Intact | Impaired | Arcuate fasciculus |
| Global | Non-fluent | Impaired | Impaired | Large MCA territory |
| Nominal | Fluent | Intact | Intact | Angular gyrus |
Broca’s patients are typically aware and frustrated; Wernicke’s are typically unaware, and may be mistaken for confused or psychotic.
Assessment: listen to spontaneous speech for fluency, then test comprehension (one, two and three step commands), repetition (“no ifs, ands or buts”), naming (watch, strap, buckle, moving from common to rare) plus reading and writing.
Dysarthria patterns
- Cerebellar: slurred, scanning, staccato
- Pseudobulbar: spastic, strained, “hot potato” speech, with a brisk jaw jerk
- Bulbar: nasal, flaccid, with a wasted fasciculating tongue
- Extrapyramidal: quiet, monotonous, hypophonic
Test with “British constitution”, “baby hippopotamus” and “West Register Street”.