Speech disorders

1. Speech
Dr.RONAK PRAJAPATI
1st YEAR RESIDENT DOCTOR
DEPARTMENT OF PSYCHIATRY

2. Speech and language
• Speech is defined as the Process Of organizing thoughts,producing specific
sounds that convey meaning to the listener.
• Speech is just a sound & sound has to be Produced in a specific manner &
understanding of the sound that Somebody tells also Ambits of language.
• So assessment of Language has to be done with assessment of speech.
• Whole assessment of Mental status examination relays on speech.

4. • To understand the pathology in speech Disorder We first have to
understand the physiology of the speech.
• Mainly there are two brain area associated with speech:
• 1)Wernicke’s area:
• Area No.22
• At lateral aspect of temporal lobe, junction between temporal and parietal
lobe known as “angular gyrus”.
• Associated with comprehension of speech.
• Sends impulse to broca’s area

5. • 2) Broca’s area:
• Area no.44,44.
• Located at inferior frontol gyrus .
• Associated with speech production.
• Sends impulses to Larynx.
• Both Wernicke’s area and broca’s area are associated with each
others by Arcuate fasciculus.

6. SPEECH
|
Tympanic membrane
|
Wernicke’s area
(Comprehension)
|
Arcuate fasciculus
|
Broca’area
|
Speech production

7. DISORDERS OF SPEECH
• Organic Disorder: Functional disorders
|
- Stammering/stuttering
Further decided into two parts:
1)Central: - Mutism
• Brain damage due to stroke, Tumor,
Trauma, degenerative disorders like - Vorbeireden
Dementia, infections.
2)Peripheral: - Neologism
• Damage to vocal cords or any pathology
Around voice production area like Cancer, -Schizophazia
Infection or surgery.

8. CENTRAL ORGANIC SPEECH DISORDERS
• Includes Aphasias
• TYPES OF APHASIA:
• 1) RECEPTIVE APHASIA:
• 2) INTERMEDIATE APHASIA:
• 3) EXPRESSIVE APHASIA:

9. RECEPTIVE APHASIA
• 3 TYPES
• 1)pure word deafness
• 2) pure word blindness
• 3) Visual asymbolia

10. 1)Pure word deafness:
• Also known as “subcortical Auditory aphasia”.
• Lesion: DOMINANT TEMPORAL LOBE.
• Spontaneous speech present.
• Speak,read,write fluently And correctly with comprehension.
• Hearing is unimpaired,Hears words as sound but Can’t recognise meaning
even though he knows that they are words.
• Form of agnosia(lack of Recognition) For spoken words.

11. 2)Pure word blindness
• Also known as “agnosic Alexia without Dysgraphia”.
• Lesion: Left visual cortex and corpus callosum
• Speak normally, understand Spoken words & write spontaneously.
• Can’t read with understanding (ALEXIA).
• More difficulty in printed than hand written script.
• Patient also suffer from right homonemous hemianopia And inability to name colors
Even though they can be perceived.

12. 3)Visual Asymbolia
• Also known as “CORTICAL VISUAL APHASIA”.
• Disorganization of visual words schemas, so words can note
recognized and motor word can note activated
• Lesion : ANGULAR AND SUPRAMARGINAL GYRI
• Able to understand words Or sentence But difficult in read & write.
• Often associated with acalculia ,spatial disorientation,visual
agnosia,Nominal aphasia and right homonemous hemianopia.

13. INTERMEDIATE APHASIA
• 1)Nominal aphasia:
• Unable to produce name and sound at will.
• Lesion: Diffuse brain damage or damage to dominant temporoparietal
region.
• Patient describe the object and & its function recognise name when
presented.
• E.g. – patient describe watch as a clock vessel.
• Speech is flat,structure of sentence is correct & understanding
unimpaired.

14. • 2)central or Conduction aphasia:
• Lesion: Arcuate Fibre
• Loss of connection between Wernicke’s and broca’s area.
• Patient cannot repeate the message although he can speak or write.
• If he is questioned about message he is able to give ‘yes’ or
‘no’answers correctly.

15. EXPRESSIVE APHASIA
• 1)cortical motor area
• Also known as Broca’s aphasia/verbal aphasia.
• Lesion- broca’s area in 3rd Frontal gyrus.
• Disturbance to the process of selecting words,constucting sentences &
expressing them.
• Patient understand what is said to them And knows what they want to say
But cannot find the right words.
• Words are mispronounced ,telegram style speech.

16. • 2)pure word dumbness
• Unable to speak spontaneously, to repeat words and to Read a loud.
• Can write spontaneously and copy.
Lesion: Beneath lesion of Insula

17. FUNCTION DISORDERS OF SPEECH
• 1) stammering/stuttering:
• Normal flow of the speech is interrupted by Pauses or by repetition
of Fragments of words.
• Begins at the age of 4 and more common in boys than girls
• Improves with time and only become noticeable When person is
anxious.
• Grimacing and tick like movement of body are associated with
stammer.
• Occasionally stammering occurs during severe adolescent crisis or at
onset of Acute schizophrenia.

18. 2)Mutism: complete loss of speech
-Elective Mutism:
• Patient decide not to speak to certain person.
• E.g. Child not speak in school but Speak well with parents.
-Hysterical Mutism(Dissociative disorder):
• Loss of speech because of Extreme conflict in mind.

19. -Depressive Mutism:
• In severe depression patient’s thought process Completely
stops/retarded – not able to produce sound.
-Catatonic Mutism:
• Mutism is always almost present In catatonic stupor But it may also
occur in Non-stuporous Catatonic individual as a mannerism.

20. 3) Vorbeireden
• Talking past the point or Approximate answers.
• Content of the patients replies to questions show that they
understand what has been asked But have responded by talking
About and associated topic.
• E.g. If asked “what is the color of grass? "the patient may reply
“white” and then if the asked “ what is the color of snow?” the
patient may reply “Green”.

21. • Occurs in hysterical psedodementia When psychiatric symptoms are
‘unconsciously’ being presented for Some advantage.
• Approximate answer may be a features of Ganser syndrome.
• Also found in acute schizophrenia mostly with hebephrenic subtype.

22. 4)NEOLOGISM
• New words that are constructed by patient or ordinary words that are
used in a new way.
• Seen in schizophrenia.
• Some patients with the motor aphasia use the wrong word,Invent
new words or distort phonetic structure of words that usually known
as Paraphasia.
• Neologism in patients with catatonia Known as mannerism or
stereotypies.

23. • Neologism may be the obvious result of derailment,for example a
patient used the word 'Relativity’ instead of word 'relationship’.
• Hallucinatory voices seems to play a great Part in formation of
Neologism.
• Voices may use in neologism or these may lead patient to use them as
well.

24. 5)schizophasia
• Also known as speech confusion or word salad or formal thought
disorder.
• Disorganised speech seen in “schizophrenia”

25. SPEECH DISTURBANCES
• 1)Aphonia & Dysphonia :
• Aphonia: Loss of ability to vocalize,patient talks in whisper.
• Dysphonia: impairment with hoarsness but without complete loss of
function.
• Occurs with paralysis of 9th cranial nerve or with disease of vocal cord.

26. 2)Dysarthria
• Disorder of articulation by lesion of brainstem Such as bulbar and
pseudobulbar palsy
• Also occurred with Structure or muscular disorder of
mouth,pharynx,larynx and thorax.
• Idiosyncratic disorder of articulation are Sometimes seen in
schizophrenia and also with personality disorders consciously
Produced.

27. 3)Logoclonia
• Spastic repetition of Syllables occurs with parkinsonism.
• Patient may stuck using particular words.
4)Echolalia
• Patient repeat words or sentences that are spoken to him or in
his presence.
• No understanding of meaning of words.
• Demonstrated in excited schizophrenia states, with mental
retardation and with organic states like dementia.

28. Assessment of speech
• Should be done in mother Tongue.
• By history and collecting information.
• By observation,By interviewing,By cognitive test.

29. For speech sample
• We have to ask open ended questions.
• Like.1-Asking about patients
friends/festivals/Place/city/work/school/collage.
• 2-Asking about climate change/politics/media/education system.
• If patient fails to answer this We can ask: How do u prepare tea?

30. Speech in MSE
• Speech has to be elicited by following headings:
• Coherence: By seeing that speech is logical,Consistent and understandable.
• Relevant : By seeing the answer of the questions we ask.
• Spontaneity :By seeing how spontaneous is the speech is.
• Amount of speech: By seeing volume of speech.

31. • Tone : By seeing loudness of patients voice.
• Tempo : By seeing Flow of speech.
• Reaction time : By seeing time to take response of questions.
• Prosody : By seeing emotional intonations of speech.
• If all components normal C/R/T/T/RT/V is normal.