Speech disorder

Introduction Speech is an advanced function unique to the human brain. Speech disorders limited to the brain and peripheral nerves can be divided into aphasia and dysarthria. Aphasia is caused by the impairment of the speech function area of the cerebral cortex, which makes the patient's speech, obedient, reading and writing insufficiency or loss, rather than due to mental factors, sensory disturbances or muscle weakness, the patient can hear speech sounds and see text symbols, but Can not understand the meaning it represents, patients can chew, swallow, hands can move, but can not read words, write, etc., common aphasias have motor errors, sensory errors, nominal aphasia, loss of writing, loss of reading, misuse And loss of recognition, etc. The dysarthria is caused by the dysphonic muscles and tendons caused by the damage of the neuromuscular system, the ataxia, and the abnormal muscle tone. The clinical pronunciation is not accurate, the vocabulary is unclear, the tone, the speed, Abnormal rhythms, sounds, etc., excessive nasal sounds, etc., when severe, do not distinguish between sounds, words are not a sentence, making people difficult to understand, even more serious patients can not pronounce, these patients have normal understanding and expression.

Cause

Cause of speech disorder

1, aphasia: Common in cerebrovascular disease, brain tumors and brain metastases, brain trauma, local inflammation, etc., motor neuron disease, multiple sclerosis, cerebral palsy.

2, dysarthria: common in muscle diseases such as muscular dystrophy, facial scapular type, polymyositis, myasthenia gravis, cranial neuropathy such as facial nerve palsy, IX and X cranial nerve palsy, medullary cavity, Guillain-Barré syndrome cranial nerve type, posterior fossa lesions, motor neuron lesions, pseudobulbar paralysis, extrapyramidal diseases such as Parkinson's syndrome, rheumatic chorea, Wilson's disease, hereditary dance Disease and other cerebellar lesions.

an examination

Related inspection

Brain ultrasound examination brain evoked potential brain CT examination amniotic fluid alpha fetoprotein determination (AFP) blood oxygen saturation

Speech disorder check

First, medical history

It is difficult to collect the medical history of patients with speech disorders, and it is generally based on the family's representative. Should pay attention to the time of the patient's illness, the urgency of the disease, whether there is a similar episode in the past, and how effective the treatment is. Speech disorders with more acute onset are more common in cerebrovascular diseases, especially cerebrovascular diseases in dominant hemispheres. The acute onset of speech is a verbal language, and those with ataxia are more common with cerebellar vascular disease. Recurrent speech disorders eventually lead to dysarthria, and those with dysphagia and dysphagia are more common with multiple cerebrovascular disease or multiple sclerosis. The pronunciation disorder is light in the morning, heavy in the afternoon, or at the beginning of normal, after a short period of speech, the words appear to be low in speech or unclear in articulation are mostly myasthenia gravis. Genetically related dance movements with speech disorders are more common with hereditary chorea.

Second, physical examination

Pay attention to the mental state of the patient. Valuable results can only be obtained if the mind, orientation or judgment is unobstructed. The examination of aphasia begins when the patient describes the medical history. Have words that are not fluent in language, inappropriate in words, and incomprehensible. The following situations suggest speech dysfunction: the omission of words in speech, the loss of grammatical structure in severe cases, also known as telegraph speech; the misuse or substitution of words, the use of synonyms or other inappropriate words instead of words that cannot be conceived, There are a large number of typo typos; slow speech, stereotypes or inappropriate interruptions. Observe whether the patient can correctly understand and answer the questions raised by the examiner. The questions can be from simple to complex, and the instructions are delicious, so that the patient can follow the implementation and observe its implementation. For the naming check, the examiner takes out some commonly used items, asks the patient to name it, and explains its purpose. The disuse check can observe whether the patient's spontaneous movement has an error, and whether the correct action can be performed, such as closing the eyes, extending the left hand, lighting the cigarette, and the like. The examination of the misidentification can ask whether the patient can correctly identify and use daily necessities, whether he still knows an acquaintance, whether he is familiar with the sounds and music of daily life, and the tactile misidentification can be checked with some common items, so that he can close his eyes and touch it with one hand.

Third, auxiliary inspection

Patients with language disorders should be based on different types of language disorders. Generally speaking, acute aphasia is more common in central nervous system diseases. Brain CT or MRI should be selected. For dysarthria, different examinations should be performed according to the specific conditions, such as: neostigmine test, chest X-ray examination, electromyography examination, lumbar puncture examination, etc.

Differential diagnosis

Speech disorder confusing symptoms

1. Increased speech: Patients with mania, bipolar disorder, and thinking disorder will have increased speech.

2. Speech disorder: more common in schizophrenia, mental activities such as thinking, emotion and will behavior of schizophrenia patients are inconsistent, and their psychotic symptoms are not generated on the background of low or high emotions. Thinking is not coherent and so on.

3. Speech interruption: The flow of speech is interrupted before a thought or a concept ends. More common in stuttering, speech interruption, repetition, and fluency are common language barriers in childhood. About half of the stuttering children develop symptoms before the age of five.

First, medical history

It is difficult to collect the medical history of patients with speech disorders, and it is generally based on the family's representative. Should pay attention to the time of the patient's illness, the urgency of the disease, whether there is a similar episode in the past, and how effective the treatment is. Speech disorders with more acute onset are more common in cerebrovascular diseases, especially cerebrovascular diseases in dominant hemispheres. The acute onset of speech is a verbal language, and those with ataxia are more common with cerebellar vascular disease. Recurrent speech disorders eventually lead to dysarthria, and those with dysphagia and dysphagia are more common with multiple cerebrovascular disease or multiple sclerosis. The pronunciation disorder is light in the morning, heavy in the afternoon, or at the beginning of normal, after a short period of speech, the words appear to be low in speech or unclear in articulation are mostly myasthenia gravis. Genetically related dance movements with speech disorders are more common with hereditary chorea.

Second, physical examination

Pay attention to the mental state of the patient. Valuable results can only be obtained if the mind, orientation or judgment is unobstructed. The examination of aphasia begins when the patient describes the medical history. Have words that are not fluent in language, inappropriate in words, and incomprehensible. The following situations suggest speech dysfunction: the omission of words in speech, the loss of grammatical structure in severe cases, also known as telegraph speech; the misuse or substitution of words, the use of synonyms or other inappropriate words instead of words that cannot be conceived, There are a large number of typo typos; slow speech, stereotypes or inappropriate interruptions. Observe whether the patient can correctly understand and answer the questions raised by the examiner. The questions can be from simple to complex, and the instructions are delicious, so that the patient can follow the implementation and observe its implementation. For the naming check, the examiner takes out some commonly used items, asks the patient to name it, and explains its purpose. The disuse check can observe whether the patient's spontaneous movement has an error, and whether the correct action can be performed, such as closing the eyes, extending the left hand, lighting the cigarette, and the like. The examination of the misidentification can ask whether the patient can correctly identify and use daily necessities, whether he still knows an acquaintance, whether he is familiar with the sounds and music of daily life, and the tactile misidentification can be checked with some common items, so that he can close his eyes and touch it with one hand.

Third, auxiliary inspection

Patients with language disorders should be based on different types of language disorders. Generally speaking, acute aphasia is more common in central nervous system diseases. Brain CT or MRI should be selected. For dysarthria, different examinations should be performed according to the specific conditions, such as: neostigmine test, chest X-ray examination, electromyography examination, lumbar puncture examination, etc.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.