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What is the difference between speech and language?

speech = how we say sounds and words

language = the words we use and how we use them


How can communication be improved wiht patients who have speech and language difficulties?

use simple language
one topic at a time
give more time
use gesture, drawing, writing
use adult language
write down key words
closed questions
don't pretend to understand


Define dysarthria

speech disorder caused by disturbance of muscular control.


Define dysphasia

impaired ability to understand or use the spoken word.

It is due to a lesion of the dominant hemisphere and may include impaired ability to read, write and use gestures.


Define receptive dysphasia

difficulty in comprehension,
language that is fluent with a normal rhythm and articulation but it is meaningless
they fail to comprehend what they are saying.


Define expressive dysphasia

difficulty in putting words together to make meaning

not fluent and have difficulty forming words and sentences.
There are grammatical errors and difficulty finding the right word.
In severe cases they do not speak spontaneously but they usually understand what is said to them.


What is meant by the term dominant hemisphere and what is its clinical significance

The speech area is in the left, dominant side of the brain in about 99% of right-handed people.

In left-handed people, the right hemisphere is the dominant side in only 30%.

As a general rule, a lesion of the left hemisphere will cause dysphasia


What deficits will a lesion in the non dominant hemisphere cause

neglect, visuo-spatial and cognitive problems.


define dyspraxia

partial loss of the ability to co-ordinate and perform skilled, purposeful movements and gestures with normal accuracy

can affect:
Gross and fine motor skills.
Motor planning and the organisation of movement
Speech and language
Ability to carry out activities of daily living.


At what age does idiopathic parkinson's disease most commonly start

between the ages of 55 and 65 years


What causes idiopathic PD

progressive neurodegenerative condition resulting from the death of dopaminergic neurones of the nigrostriatal pathyway.

This pathway goes from the pars compacta of the substantia nigra to the striatum. It acts to stimulate the cerebral cortex to initate movement and fine tune movement.

Therefore, when this pathway degenerates there are problems in initiating movement and fine tuning movement.


What are the key characteristics of PD



Describe the tremor in PD

Pill rolling – thumb over fingers
4-6 cycles/second
Worse at rest


Describe the rigidity of PD

increase in resistance to passive movement that can produce a characteristic flexed posture in many patients.



Describe the bradykinesia in PD

Slow to initiate movement
Slow, low amplitude repetitive actions eg. Blinking, micrographia, monotonous speech
- Decreased arm swing
- Festinance
- Freezing at obstacles and doors
Expressionless face


What is festinance

- Shuffling gait with flexed trunk


Give some other symptoms associated with PD

• Depression
• Dementia
• Poor decoding of emotional content of speech
• Poor executive functioning
• Visual hallucinations
• Reduced sense of smell
• Dribbling of saliva
• Frequency/urgency
• Constipation


Give the key characteristics of the gait in PD

• Reduced stride length - shuffling
• Hesitancy - difficulty starting and turning
• Lack of arm swing
• Unsteadiness – tendency to fall forwards or backwards
• Freezing at obstacles and doors


How many steps are there in the diagnostic criteria for PD



What is step 1 in diagnosis of PD

Bradykinesia (slowness of initiation of voluntary movement with progressive reduction in speed and amplitude or repetitive actions)

and at least one of the following:
• Muscular rigidity.
• 4- to 6-Hz resting tremor.
• Postural instability not caused by primary visual, vestibular, cerebellar or proprioceptive dysfunction.


What is step 2 in diagnosis of PD

exclusion criteria:

• History of repeated strokes with stepwise progression of Parkinsonian features.
• History of repeated head injury.
• History of definite encephalitis.
• Oculogyric crises. = dystonic reaction to certain drugs or medical conditions characterized by a prolonged involuntary upward deviation of the eyes
• Neuroleptic treatment at onset of symptoms.
• More than one affected relative.
• Sustained remission.
• Strictly unilateral features after three years.
• Supranuclear gaze palsy.
• Cerebellar signs.
• Early severe autonomic involvement.
• Early severe dementia with disturbances of memory, language and praxis.
• Babinski's sign.
• Presence of a cerebral tumour or communicating hydrocephalus on CT scan.
• Negative response to large doses of L-dopa (if malabsorption excluded).
• Exposure to MPTP.


What is step 3 of diagnosis of PD

supportive prospective criteria. need 3 or more for diagnosis of PD

• Unilateral onset.
• Rest tremor present.
• Progressive disorder.
• Persistent asymmetry affecting the side of onset most.
• Excellent response (70-100%) to L-dopa.
• Severe L-dopa-induced chorea.
• L-dopa response for five years or more.
• Clinical course of ten years or more.
• Hyposmia. = reduced ability to smell
• Visual hallucinations.


Give some differentials for PD

benign essential tremor
drugs or toxins
post encephalitis
huntingdon's disease
wilson's disease
corticobasal generation
mulit-onfarct dementia
lewy-body dementia
pick's disease
cerebellar tremor
psychogenic tremor
multiple system atripy
progressive supranuclear palsy


What is the difference between PD and benign essential tremor

in BET, tremor is worse on movement (eg, while trying to hold a cup of tea) and rare while at rest.


Which drugs or toxins can cause PD like symptoms

beta-adrenergic blockers,
Neuroleptics (eg, haloperidol, chlorpromazine)
anti-emetics (eg, prochlorperazine)


What is the difference between PD and Huntingdon's disease

present earlier with rigidity instead of chorea
Normally, there is family history


What is the difference between PD and Wilson's disease

in W - earlier onset with characteristic Kayser-Fleischer rings and hepatitis.


What is the difference between PD and corticobasal degeneration

manifest by obvious signs of cortical dysfunction - eg, apraxia, dementia and aphasia.


What is the difference between PD and multi-infarct dementia

characterised by:
cognitive impairment,
spasticity, and
extrapyramidal signs.


What is the difference between PD and Pick's disease

affects the frontal and/or temporal lobes.
Level of consciousness is not affected (unlike in Alzheimer's disease)
Parkinsonism is usually mild