Disorders Of Speech And Language

Introduction

Disturbed speech and language are important symptoms of neurological disease. The two are not synonymous. Language is a function of the dominant cerebral hemisphere and may be divided into (a) emotional — the instinctive expression of feelings representing the earliest forms of language acquired in infancy and (b) symbolic or propositional - conveying thoughts, opinions and concepts. This language is acquired over a 20-year period and is dependent upon culture, education and normal cerebral development.

An understanding of disorders of speech and language is essential, not just to the clinical diagnosis but also to improve communication between patient and doctor. All too often patients with language disorders are labelled 'confused' as a consequence of superficial evaluation. DYSARTHRIA

Dysarthria is a disturbance of articulation in which the content of speech - language - is unaffected.

Mechanism of articulation

Mechanism of articulation

Speech initiated

Descending corticobulbar pathway from left hemisphere to nuclei X and XII Connection through corpus callosum to motor cortex of right hemisphere (4) Descending corticobulbar pathway from right hemisphere to nuclei X and XII

Nuclei X and XII receive corticobulbar pathway from both ipsilateral and contralateral hemispheres (bilateral innervation). This 'safety factor' means that a lesion of one corticobulbar pathway does not produce symptoms.

Hypoglossal nucleus and nerve (XII) to tongue

7 St-^'" Nucleus ambiguus of mi va9us nerve (X)

supplying soft palate, pharynx and larynx

The extrapyramidal and cerebellar systems A - Corticobulbar pathway modulate articulatory muscle action

B - Cerebellum C - Extrapyramidal system

D - Nuclei of lower motor neurons of X, XII cranial nerves

Muscles of expression, innervated by the facial nerve, play an additional role in articulation and weakness also results in dysarthria.

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