Speech and Swallow

Question 1

Define dysphasia ( aka aphasia).

Answer 1

Complete or partial loss of ability to understand, speak, read and write.
Commonly seen when there is damage to the left side of the brain.

Question 2

What is receptive dysphasia?

Answer 2

• Wernicke is like “what? I don’t understand”
• Lesions to the posterir portion of the superior temporal gyrus (Wernickes area)
  Fluent speech that is intelligible, but nonsensical
• This is receptive aphasia aka sensory aphasia
• ## It is where the temporal and parietal lobe meet (parietal lobe, has sensory aspect i.e. posterior to central sulcus)

Question 3

What is expressive dysphasia?

Answer 3

• Broca is broken as the words he says is broken.
• Cannot properly form words, but can understand the person that are talking to
• Broca’s area is in the frontal lobe because it is involves the motor aspect of speech (motor is anterior to the central sulcus in the frontal lobe)
• More insight into their deficit

Question 4

How does global dysphasia arise?

Answer 4

MCA infarct, then the whole hemisphere is affected and the person can get both receptive and expressive dysphasia.

Question 5

What is dysarthria?

Answer 5

Motor speech disorder resulting from disturbance in oral muscular control du to damage to CNS or PNS system. This is

Question 6

What is anarthria?

Answer 6

Total inability to articulate

Question 7

What is apraxia of speech?

Answer 7

• Inconsistent error patterns due to difficulties motor planning (i.e. speech muscles is fine and they know what they want to say, it is what happens in between two that is affected)

Question 8

How do we know it is a true apraxia?

Answer 8

Writing and reading functions should be intact if true apraxia of speech.

As opposed to an aphasia

Question 9

What is Dysphonia?

Answer 9

Voice quality can be hoarse or weak, but some kind of phonation still possible

Question 10

What is Aphnonia?

Answer 10

Phonation is not possible

Question 11

Causes of dysphonia and aphonia

Answer 11

Laryngeal cancer, myasthenia gravis, Hypo/hpyer thyroidism, sinusitis, lung cancer, Parkinson’s disease, vocal disorders (nodules and cysts), Stroke

Question 12

How do we assess speech?

Answer 12

1. Assess non speech activities with cranial nerve assessment (key nerves in articulation and voice) of CN V, VII, IX, X and XII
2. Speak with patient, and family members

Question 13

What is dysphagia?

Answer 13

Disorder or symptom that can be caused by structural, physiological and neurological impairments affecting the stages of swallowing

Question 14

What are the three phases of swallowing?

Answer 14

oral, pharyngeal and oesophageal

Question 15

Consequences of dysphagia

Answer 15

Aspiration pneumonia
Malnutrition
Dehydration
Increase hospital stay
Discharge to nursing care

Question 16

How do we assess dysphagia?

Answer 16

1. Cranial nerve assessment
2. Bedside swallow assessment: start with thin fluids, moving up to thicker substances. Note any coughing, spluttering
3. Videofluoroscopy if indicated, especially in patients with brainstem infarct where CN IX and X are affected and the sensorial pathways are affected. Patient is unable to cough, and aspiration occurs.

Question 17

Management of stroke patients

Answer 17

Always placed on nil by mouth

Then assessment by speech pathologist

Question 18

What is aspiration and what are the two types?

Answer 18

Defined as substance tracking below vocal folds (and into airways)
Normally, we cough when anything is aspirated up to the vocal cords.
- Overt aspiration if patient coughs.
- Silent aspiration if patient does not cough and the food tracks down to to airways. These are our most at risk patients (brainstem infarct).

Question 19

What is videofluoroscopy?

Answer 19

Radiological dye mixed in with fluid and food
Imaging detects the pathway of fluid and food
Begin with thin fluids, move to thicker substances
Watch for aspiration and reaction. If cough or no cough (silent aspiration)
Indicated when patient reports with difficulty swallowing, or high risk stroke patients`