Throughout the interview, note the characteristics of the patient's speech, including the following:
Quantity. Is the patient talkative or relatively silent? Are comments spontaneous or only responsive to direct questions?
Rate. Is speech fast or slow?
Loudness. Is speech loud or soft?
Articulation of Words. Are the words spoken clearly and distinctly? Is there a nasal quality to the speech?
Fluency. This involves the rate, flow, and melody of speech and the content and use of words. Be alert for abnormalities of spontaneous speech such as these:
Slow speech of depression; accelerated rapid, loud speech in mania
Dysarthria refers to defective articulation. Aphasia refers to a disorder of language. See Table 16-2, Disorders of Speech, p. 600.
■ Hesitancies and gaps in the flow and rhythm of words These abnormalities suggest apha sia. The patient may have so much
■ Disturbed inflections, such as a monotone difficulty in talking or in understand ing others that you may not be able
■ Circumlocutions, in which phrases or sentences are substituted for a word to obtain a history. Y°u may als° the person cannot think of, such as "what you write with" for "pen"
falsely suspect a psychotic disorder.
■ Paraphasias, in which words are malformed ("I write with a den"), wrong ("I write with a bar"), or invented ("I write with a dar").
If the patient's speech lacks meaning or fluency, proceed with further testing as outlined in the following table.
Testing for Aphasia
Ask the patient to follow a one-stage command, such as "Point to your nose." Try a two-stage command: "Point to your mouth, then your knee."
Ask the patient to repeat a phrase of one-syllable words (the most difficult repetition task): "No ifs, ands, or buts."
Ask the patient to name the parts of a watch.
Ask the patient to read a paragraph aloud.
These tests help you to decide what kind of aphasia the patient may have. Remember that deficiencies in vision, hearing, intelligence, and education may also affect performance. Two common kinds of aphasia—Wernicke's and Broca's—are compared in Table 16-2, Disorders of Speech, p. 600.
A person who can write a correct sentence does not have aphasia.
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