speech disorder
Introduction
Introduction to speech disorders Speech impairment refers to various anomalies in the application or understanding of spoken words, words or gestures. This article describes speech disorders caused by localized or peripheral neuropathy, including dysarthria and aphasia. Language (1anguage) is formed and developed by human beings in social labor and life. It refers to the ability to express one's thoughts or communicate with others through various ways or symbols (gestures, expressions, spoken language, words). It is a complex psychological activity that is acquired by human beings and unique to human beings. Speech impairment refers to various anomalies in the application or understanding of spoken words, words or gestures. This article describes speech disorders caused by localized or peripheral neuropathy, including dysarthria and aphasia. basic knowledge The proportion of illness: 0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: autism, autism, childhood, depression, consciousness disorder, intelligent disorder
Cause
Causes of speech disorders
Delay in development (15%)
The language barrier caused by delayed development is not caused by hearing impairment, organic damage of the central nervous system and severe mental retardation. It is called developmental aphasis. Shen Xiaoming is the editor of Clinical Pediatrics. According to reports, 7% to 10% of children have lower than normal standards in language development, and 3% to 6% of children have language perception or expression disorders, and affect future reading and writing.
Brain or peripheral neuropathy (40%)
The speech disorders discussed here mainly refer to speech disorders caused by localized or peripheral neuropathy including dysarthria and aphasia, brain diseases, especially speech disorders caused by cerebrovascular disease [consonant difficulties and/or aphasia). Symptoms, the incidence rate is quite high. According to the epidemiological survey of cerebrovascular disease in 6 cities in 1982, the annual incidence rate of cerebrovascular disease is 182/100,000, and the prevalence rate is 620/100,000. According to recent data, cerebrovascular disease has become the leading cause of death in adults. As well as various brain stems and post-brain brain neuropathy and certain myopathy, it can also cause difficulty in articulation.
Hemispheric hemorrhage (20%)
In the cerebral hemorrhage site statistics, hemispheric hemorrhage (internal and basal nucleus) involving the linguistic area accounted for 80%.
Arterial thrombosis (20%)
In the statistics of the location of ischemic cerebrovascular disease, middle cerebral artery thrombosis involving the language region also accounts for 60% to 80%. Common vertebral-basal artery thrombosis.
Prevention
Speech disorder prevention
Usually pay attention to living habits and prevent brain or peripheral neuropathy. Early detection, early diagnosis and early treatment are the key to the prevention and treatment of this disease.
Complication
Speech disorder complications Complications, autism, autism, depression, consciousness disorder, intelligent disorder
1 autism symptoms: autism.
2 symptoms of autism: social communication barriers, communication barriers, narrow interests, stereotypes of repeated behaviors.
3 Psychiatric symptoms: victim delusion, depression, disturbance of consciousness, mental retardation, personality change, hallucinations, behavior and emotional abnormalities.
4 can make the child's physical movement, feeling, intelligence, language, emotions, behaviors and other single or multiple defects, so that there are often learning and social difficulties.
Symptom
Symptoms of speech disorders Common symptoms
1. Difficulties in articulation : The impairment of speech structure caused by the damage of various organizational structures included in the stage of speech expression, or the disorder of physiological processes, is called difficulty in constructing sounds. If speech is completely impossible, it is called articulation.
This group of symptoms is characterized by the movement of the articulation movement (that is, the movement of speech in the brain into a sound, which constitutes the motor function of speech). Therefore, it does not include the correct understanding of the meaning or language and the obstacles to the use, but only the spoken language. The sound is difficult to form, and in severe cases, it is completely incapable of pronunciation.
(1) Difficulties in the construction of upper motor neuron damage: one side of the organ is controlled and dominated by bilateral upper motor neurons, including the central anterior cephalic region of the primary motor cortex and its pyramidal tract, so one side The upper motor neuron damage does not cause permanent dysarthria.
Dysplasia can occur when bilateral motor neuron damage, such as pseudobulbaric palsy, amyotrophic lateral sclerosis, and midbrain tumor or vascular disease invade the soles of both sides of the brain.
Symptoms of such difficulty in articulation are: vocal tendon, tongue is smaller and harder than normal, speech is ambiguous, especially lip sound and tooth sound are seriously involved, upper motor neuron dysarthria is often accompanied by swallowing Difficulties, drinking water, cough and affective disorder.
(2) Difficulties in the construction of lower motor neuron damage: the dysarthria caused by nuclear damage is often preceded by lingual paralysis, tongue movement is limited, the pronunciation is slow and ambiguous, followed by soft palsy and nasal sounds, when the throat When the muscle function is lost due to complete damage of the suspected nucleus, there is a complete tone.
The dysarthria caused by subcutaneous palsy, often with soft sputum localized damage, difficulty in articulation, nasal sounds, such as recurrent laryngeal nerve numbness, vocal cord muscle paralysis, early glottic closure paralysis, bilateral vocal cords When paralyzed, the vocal cords are in a fixed position. At this time, there is suffocation due to difficulty in breathing (glotticus is closed), and when the glottic occlusion muscle is paralyzed, the glottis is enlarged. Although there is no difficulty in breathing, there is no pronunciation.
Infectious polyradiculitis (Gullain-Barre syndrome) can occur facial nerve palsy, medullary paralysis, often accompanied by soft palate and pharyngeal paralysis, vocal cord paralysis, tongue muscle paralysis is rare, so it is often expressed as weak, throat The sound barrier is significant.
(3) Difficulties in the basal nucleus damage of the brain: mainly due to extrapyramidal lesions leading to increased muscle tone of the organs, tremors and other factors, the symptoms are characterized by slow speech, slow rhythm when speaking, phonological disorder, syllable uneasiness, Much like muttering, and often have suffixes, more common in hepatolenticular degeneration, acromegaly, chorea, etc., Parkison syndrome is characterized by low speech, fast syllables and incoherence, monotonous speech and repeated speech .
(4) Difficulties in the structure of the cerebellar system: also known as ataxia-like dysarthria, mainly due to uncoordinated or forced movement of the muscles of the organs, mainly as follows:
1 Outbreak speech: Speech is prolonged and has uneven sound intensity, so it is often violent. The patient's voice intensity is extremely low, sometimes suddenly high, and a series of syllables or words are quickly issued.
2 poetry (or sub-section) speech: another feature of speech disorder in the cerebellar system damage, due to the abnormal configuration of the accent when speaking and is evenly divided into many incoherent speech stages, much like The tone of the old-fashioned poetry, the poetry-like speech is most common in the cerebellar palsy, cerebellar degenerative diseases, and 10% to 15% of patients with multiple sclerosis have such dysarthria.
The poetic language, intentional tremor and nystagmus together constitute the classic Charcot triad.
(5) Difficulties in articulation caused by muscle lesions:
1 myasthenia gravis: the lips, tongue, and soft palate muscles are the most powerless. This kind of powerlessness is better after rest. It is characterized by unclear speech after continuous speech, and then improved after rest. In addition, the extraocular muscles are especially lifted. It is weakly obvious and can be accompanied by chewing and difficulty in swallowing. The above symptoms are diagnosed after injection of imipenem (Tengxilong) or Xinsi's Ming.
2 progressive muscular dystrophy: facial scapular type may have atrophy of the orbicularis oculi muscle, the tongue muscle may have atrophy, so there is lip sound, tongue sound dysarthria.
3 atrophic myotonia: facial muscle and tongue muscle atrophy, soft palsy, orbicularis muscle atrophy, dysarthria, and sometimes tongue-sounding disorder may be one of the symptoms of increased muscle tone of the tongue.
2. Aphasia: The structural damage or dysfunction involved in the speech stage of the brain causes aphasia, which is independent of the hearing impairment (speech sense phase) and is not related to the speech muscle (speech expression stage) or other movement disorders. It is the difference between aphasia and dysarthria.
More than 95% of the left brain is the dominant hemisphere for speech and language expression, and the right brain of the right hand is extremely rare for the dominant hemisphere. Only in the literature, there are case reports, most of the left-handed human factors The left or right hemisphere lesions show some speech or language expression obstacles. This indicates that it is difficult to predict the dominance of the left-handed cerebral hemisphere based on the patient's individual condition, and the most predictive speech. Or the part of the language expression disorder is to control the hemisphere area or the lateral cerebral lobular margin area of the side that often likes to make skillful movements. The farther the lesion occurs, the smaller the possibility of causing speech or language expression disorder, due to Disorders of speech or language expression caused by lesions include a group of diseases, collectively referred to as aphasia.
(1) Speech center: The speech function is extremely complicated, and its position on the cerebral cortex cannot be narrowly positioned. It is quite difficult to determine the location of the lesion by the symptom of the speech disorder alone, but some areas on the cortex are quite The speech function and some aspects of it have the main meaning, and can still be divided into different speech centers.
There are four main speech centers, the speech sensation center is located in the posterior part of the iliac crest, the speech movement center is located in the posterior part of the inferior front, the reading center is located in the parietal horn, and the writing center is located in the posterior part of the frontal and middle, and between the speech centers. They are also related to each other.
(2) Clinical types of aphasia: There are different classifications of aphasia. At present, the Benson (1979) classification method is adopted. This method takes into account the clinical characteristics and lesion location, and has strong scientific and practicality.
1 The lateral aphasia syndrome: including motor aphasia, sensory aphasia and conductive aphasia, the common feature is the difficulty of oral retelling and the lesion site near the superior hemisphere lateral fissure.
A. Anonymia: Also known as Broca aphasia or non-fluent aphasia, the patient can't speak, but has no influence on the speech of others and the comprehension of reading the newspaper. He knows what he wants to say, but he can't do this. Speaking, repeating words, often telling the wrong, but after the mistake, the patient immediately noticed, so he was troubled by his own troubles. Therefore, this patient is often silent, and sometimes the patient can sing and sing smoothly, although he cant make a discussion. Calculations, curses, lesions concentrated in the posterior cortex or subcortical below the superior lateral forehead.
B. Sensory aphasia: also known as Wernicke aphasia or fluent aphasia, characterized by fluent discourse and comprehension disorders (must rehearsing disorders, common naming difficulties), lesions located on the left dome or dome In the occipital region, since the function of listening to speech occurs earlier than other speech functions, the sensory speech center is the main speech center, and the symptoms caused by the damage are the most serious, and the dysfunction of other speech centers associated with the central nervous system can occur at the same time. Although the sports speech center is still preserved, the correctness of speech has been destroyed, and it is inevitable to incorporate sports aphasia. The patient can not only understand the content of other people's speeches, but also can't find out the mistakes of his own speech. Therefore, he often feels annoyed that others cannot understand. In his words, patients also like to speak, but they are not accurate, use wrong words, or even create new words, so-called fluent idioms. Such aphasias generally have a poor prognosis.
C. Conductive aphasia: characterized by fluent and self-speech, understanding the near-normal and repetitive difficulty, and the limitation of conduction-type aphasia, which is the smallest lesion in all types of aphasia, and the lesion may be in the dominant hemisphere arched bundle (Connected to the language sense center and the language movement center), the conventional neurological examination has no change, most patients have naming difficulties, the reading examination has serious discourse, the prognosis is generally good, and can be restored to only the naming disorder.
2 watershed (marginal zone) aphasia syndrome: the characteristics of such aphasia are: aphasia without repetitive disorder or retelling is relatively good, the lesion is in the watershed area, including transcortical motor aphasia, transcortical sensory aphasia and transcortical mixed aphasia 3 types.
A. Transcortical motor aphasia: except for repetitive barriers, its characteristics are similar to those of sports aphasia. Spoken language is better, but patients often have serious misuse. Therefore, judgments need to be careful, naming is difficult, writing is also flawed, large Most patients have hemiplegia on the right side, and the lesions are mostly in the front or upper part of the dominant area Broca. The most characteristic is the lower part of the frontal or middle part.
B. Transcortical sensory aphasia: In addition to retelling well, other similar to sensory aphasia, naming, reading and writing often have obstacles, the lesion is in the left dome of the watershed.
C. Transcortical mixed aphasia: coexistence of transcortical motor aphasia and transcortical sensory aphasia. It is characterized by the fact that all language functions are abnormal except for oral retelling, and the lesion is in the dominant hemisphere watershed large lesions.
3 subcortical aphasia syndrome: It is traditionally considered that typical aphasia syndrome generally only suggests pure cortical lesions, or both cortical and subcortical involvement, while the thalamus and basal ganglia do not play a role in aphasia. In recent years, through these The role of structure in language and in-depth study of surviving cases, pointed out that simple subcortical lesions can also cause aphasia syndrome. Many data indicate that the aphasia syndrome caused by subcortical lesions does not match the so-called typical aphasia. :
A. Thalamic aphasia: This type of aphasia is characterized by less speech, difficulty finding words, naming obstacles, low-pitched tone, less autonomous speech, no understanding of complex commands, reading and writing obstacles, retelling, mostly memory impairment, thalamic aphasia The prognosis is generally good, and can be recovered within a few weeks, leaving a naming disorder.
B. bottom node aphasia: the lesion is limited to the shell nucleus, caudate nucleus, globus globule area, often including the inner capsule, which is characterized by dysarthria, low-pitched tone, can have idioms, and the oral comprehension is relatively good. There are obstacles in naming, reading and writing. Some of the basic aphasias are similar to transcortical motor aphasia. Some are similar to transcortical sensory aphasia. These aphasias often have hemiplegia symptoms and have a good prognosis.
4 anomic aphasia: refers to aphasia with naming disorder as the only or main symptom, characterized by fluent oral English, neurological examination generally no positive signs, but also mild hemiplegia, lesions in the left iliac crest Binding area.
5 Complete aphasia: All language functions are severely impaired, oral expression is obviously limited, but true silence is also rare, usually pronounced, monosyllabic, serious understanding of spoken language, can not be repeated, naming, reading, writing obstacles, there are Severe signs of the nervous system, lesions in the left middle cerebral artery distribution area, poor prognosis.
6 alexia (alexia): refers to the loss of understanding of the written language, can be complete, or partial, often accompanied by atypical aphasia, mainly due to the dominance of the hemisphere.
7Agraphia: Almost all aphasia patients have different degrees of loss of writing, so it can be used as a screening test for aphasia. Writing is the most difficult language function, and there is still no satisfactory classification.
Examine
Verbal disorder check
Necessary selective examination: Choose according to the possible cause.
1. Blood routine, blood biochemistry, electrolytes: pay attention to the specific changes in the diagnostic value of the primary disease.
2. Blood sugar, immune items, cerebrospinal fluid examination: If abnormal, there is a differential diagnosis.
If the following items are abnormal, there is a differential diagnosis.
1. CT, MRI examination.
2. EEG, fundus examination.
3. Skull base film.
4. Otolaryngology examination.
The advent and application of CT has greatly improved people's understanding of aphasia positioning.
Kertesz et al found that patients with conductive aphasia had anterior-posterior-related lesions; patients with no-named aphasia had more parietal lesions; and in most cases with complete aphasia, there was more than one cerebral lobe injury. After studying the relationship between aphasia and CT lesions, it was found that the cortical areas associated with aphasia were Broca, Wernicke, marginal and gyrus, located in Brodman 44, 22, 40 and 39, respectively; Broca cortex was located on the left. Before the lateral fissure, the anterior horn of the lateral ventricle; the Wernicke representative area is located after the left lateral fissure, to the lateral side of the left ventricle; the superior margin and the anterior gyrus are located in the posterior part of the left ventricle of the parietal lobe.
It is generally believed that small injuries can cause mild aphasia. The location of lesions seen on CT in all types of aphasia is relatively consistent and reliable. The type of aphasia may indicate the location of the injury, but conversely, it is difficult to locate from the lesion. Determining the type of aphasia, the problem that this clinical manifestation is inconsistent with CT findings, is currently considered to be related to the CT at different time of the lesion, or may have different cerebral collateral circulation supply to the patient and cause different degrees of generation. Repayment related.
Diagnosis
Speech impairment diagnosis
diagnosis
Diagnosis can be made based on medical history, clinical manifestations, and examination.
Differential diagnosis
It is mainly based on the definition of articulation difficulties and aphasia and their respective characteristics. The diagnosis of primary brain disease or peripheral neuropathy has clinical significance for the identification of dysarthria and aphasia.
In addition, care must be taken to identify speech dysfunction caused by hearing or mental illness.
1. For the diagnosis of developmental language disorders in children, refer to the following criteria.
(1) Language development retardation is the most important symptom.
(2) Hearing is normal, and hearing loss can be reduced, but the volatility is large, which is not commensurate with the severity of language development retardation. Children may not respond to language, but may have other responses to other sounds.
(3) The inner language function is normal, such as playing games with rag dolls.
(4) Interpersonal communication is normal. If you can stare at people with your eyes, express your emotions and needs with your expressions or actions, you can express your attachment to your mother and play with other children.
(5) Visual and visual-spatial perception is normal, and the ability to understand and imitate music is normal.
(6) When the intelligence test is performed, the operation points are often within the normal range.
(7) Brain organic diseases and facial diseases should be excluded.
2. The examination of aphasia is mainly based on the neurological specialist examination. Before the aphasia examination, the examiner must first understand the mental state of the patient, and must obtain reliable results in the normal situation of attention, orientation and judgment. Secondly, it is necessary to clarify whether the patient's vision and hearing are normal. When performing the exercise system examination, pay special attention to whether there is partiality or use of symptoms, the environment should be quiet, and the time should be sufficient. The most brief examination is as follows.
(1) Check the patient's speech comprehension ability: You can use the spoken language to make the patient do some actions, first use simple sentences, such as raising the right hand, closing the eyes, etc. (speech sensory analyzer), and then using complex sentences.
(2) Check the patient's speech: record the patient's automatic speech as completely as possible, pay attention to whether the speech is free, correct, whether there is a rich vocabulary, whether there is any falsification, etc., and let the patient repeat the examiner's speech while paying attention to the patient's speech. Facial expressions and other postures.
(3) Check the ability to understand the written text: use the written order to make certain actions, take something, etc., and be careful not to let the patient read the command sentences.
(4) Check the writing ability: let the patient write automatically, pay attention to whether it is neat or difficult to write, whether the sentence is correct, whether there is a wrong writing, etc. If the patient has hemiplegia (usually on the right side), he can be encouraged to write with the healthy side. Don't let the patient write his own name and address.
(5) Let the patient say the name of the object: by this, except for the nominal aphasia, if the patient cannot say the correct name of the object, he must pay attention to whether he can use the posture or the definition to describe the object he is familiar with, when the patient touches the object. Whether he restored the impression of losing the name of the object. When the patient cannot name the object, it depends on whether he can find the correct name of the object in a series of words, or whether the patient is referred to when the examiner mentions the name of an object. Can correctly point out this object.
(6) dictation, transcription, drawing, calculation.
