1. Dr Mohamad Shehadeh Agha MD MRCP (UK)
Speech Disorders
Dr Mohamad Shehadeh Agha
MD MRCP (UK)

2. Process of speech Hearing deafness Understanding aphasia
Thought and word finding
Voice production dysphonia
Articulation dysarthria

3. Aphasia The lesion here is in the dominant hemisphere
The dominant hemisphere is on the left in right
handed subjects and half the left handed subjects
85% of people are right handed and 15% are left handed

4. Mechanism Concept area Wernicke’s area Broca;s area
Hearing Voice production
&articulation

5. Mechanism Concept area Wernicke’s area Broca;s area
Hearing Voice production
&articulation

6. Wernicke’s aphasia Poor comprehension Fluent but meaningless speech
No repetition
May be associated with field defect
Wernike’s area is the supramarginal gyrus of the parietal lobe and upper part of the temporal lobe

7. Mechanism Concept area Wernicke’s area Broca;s area
Hearing Voice production
&articulation

8. Transcortical sensory aphasia
Poor comprehension
Fluent but meaningless speech
Preserved repetition
The lesion is in the posterior parieto-occipital region

9. Mechanism Concept area Wernicke’s area Broca;s area
Hearing Voice production
&articulation

10. Broca’s aphasia Preserved comprehension Non-fluent speech
No repetition
May be associated with a hemiplegia
Broca’s area is in the inferior frontal gyrus

11. Mechanism Concept area Wernicke’s area Broca;s area
Hearing Voice production
&articulation

12. Transcortical motor aphasia
Preserved comprehension
Non-fluent speech
Preserved repetition
Incomplete lesion in the Broca’s area

13. Mechanism Concept area Wernicke’s area Broca;s area
Hearing Voice production
&articulation

14. Conductive aphasia Loss of repetition Preserved comprehension
Preserved output
The lesion is in the arcuate fasciculus

15. Global aphasia The lesion is in the dominant hemisphere
Affects both Wernicke’s and Broca’s areas

16. Nominal aphasia Inability to words finding and naming
The lesion is the angular gyrus

17. Dysarthria
Voice production requires coordination of breathing, vocal cords, larynx, palate, tongue and lips

18. Spastic dysarthria Slurred Patient hardly opens his mouth
As if he is trying to speak from the back of his mouth
Bilateral upper motor neuron weakness

19. Extrapyramidal dysarthria
Monotonous
No rhythm
Sentences suddenly start and stop
Common causes parkinsonism

20. Cerebellar dysarthria
Slurred as if drunk
Disjointed rhythm
Scanning speech ( with equal emphasis on each syllable)

21. Lower motor neurone dysarthria
Palatal: nasal speech, as with a bad cold
CN X
Tongue: distorted speech, especially letters
t, s, d
CN XII
Facial: difficulty with b, p, m, w
CN VII

22. Myasthenic speech Muscle fatigability
During speech dysphonia and dysarthria