Presenting problems

u Dysarthria problem with articulation, may or may not be due to

neurological disorder

Language and speech u Dysphasia problem with language processing, either in understanding or
expression

disorders

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Testing for dysarthria Causes of dysarthria

u Ask the patient to make sounds Cause Features

u M M M lips, CN VII
u La la la tongue, CN XII
u K K K oropharyngeal muscles, CN IX and X
u Ask patient to repeat phrases
u Baby hippopotamus labial sounds
u Red lorry yellow lorry lingual sounds
Bells palsy Weakness of facial muscles cannot articulate sounds requiring lip
usage
Bulbar palsy Lower motor neuron lesion of cranial nerves IX-XII
Dysarthria + dysphagia (swallowing difficulty)
Tongue is wasted, with fasciculations
Pseudobulbar palsy Upper motor neuron lesion of cranial nerves IX-XII damage to
frontal lobes results in changes in personality
Dysarthria + dysphagia (swallowing difficulty)
Jaw jerk is brisk

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Testing for dysphasia Types of dysphasia

u Ask name and DOB Type Site of damage Understanding Expression Repetition Other

u Give instructions e.g. shut your eyes, stick out your tongue
u Tests for receptive dysphasia Expressive Brocas area Retained Impaired Impaired non fluent
patient mutters
u Ask them to repeat no ifs ands or buts some sounds
u Testing for conduction dysphasia Receptive Wernickes area Impaired Retained Impaired fluent patient
u Ask patient to name objects e.g. a watch, a pen rambles non-
u Testing for nominal dysphasia sensically
Conduction Arcuate Retained Retained Impaired Rare
fasciculus
Nominal Temporal Retained Retained Retained Rare on its own

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Investigations

u Acute dysarthria and dysphasia are rarely isolated and associated with
other neurological symptoms
u In the acute setting a stroke must be considered