If the patient is awake and alert, you have already observed his or her speech. The patient should now be asked to recite short phrases such as ''no ifs, ands, or buts.'' Is dysarthria, dysphonia, dysphasia, or aphasia present? Dysarthria is difficulty in articulation. In general, lesions of the tongue and palate are responsible for dysarthria. Dysphonia is difficulty in phonation. The result is an alteration in the volume and tone of the voice. Lesions of the palate and vocal cords are often responsible. Dysphasia is difficulty comprehending or speaking as a result of cerebral dysfunction. Patients with a total loss of speech have aphasia. Different areas of the brain are responsible for the different types of aphasia. A motor, expressive, nonfluent aphasia is present when patients know what they want to say but have motor impairment and cannot articulate properly. They understand written and verbal commands but cannot repeat them. A frontal lobe lesion is often the cause. A sensory, receptive, fluent aphasia is present when the patient articulates spontaneously but uses words inappropriately. The patient has difficulty understanding written and verbal commands and cannot repeat them. A temporoparietal lesion is frequently the cause.
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