Speech

48 Speech



Instruction


Ask this patient some questions.



Salient features



Examination




• Proceed by asking the patient simple questions regarding personal details such as name, age, occupation, address and handedness (remember that over 90% of left-handed people have a dominant left hemisphere).


Test the following:



• Comprehension:


• Put your tongue out

• Shut your eyes

• Touch your nose

• Smile

• Two-step commands, such as touch your left ear with your right hand.

• Orientation:


• Time–date

• Place.

• Name familiar objects:


• Pen

• Coin

• Watch.

• Articulation, ask the patient to repeat the following:


• British constitution

• West Register Street

• Baby hippopotamus

• Biblical criticism

• Artillery.

• Abbreviated mental test:


• Address to recall: 42 West Street.

• Age

• Date of birth

• Time

• Year

• Recognition of two persons such as doctor and nurse

• Name of this place

• Name of the monarch or prime minister

• Year of World War I or World War II

• Count backwards from 20 to 1

• Serially subtract 7 from 200.

• Tell the examiner that you would like to check the ‘primitive’ reflexes:


• Snout reflex: brought about by tapping the upper lip slightly; there is puckering or protrusion of the lips with percussion and the muscles around the mouth and the base of the nose contract.

• Palmomental reflex: occurs when a disagreeable stimulus is drawn from the thenar eminence at the wrist to the base of the thumb (Arch Neurol 1988;45:425–7); there is ipsilateral contraction of the orbicularis oris and mentalis muscles, the corner of the mouth elevates slightly and the skin over the chin wrinkles.

• Sucking reflex: elicited by tapping or lightly touching the lips with a tongue blade or the examiner’s finger; sucking movements of the lips occur when they are stroked or touched.

Note: The above three reflexes are normal in infants, may be present in normal individuals and are said to be present in a larger number of patients with neurological disease. They are most often seen in those with diffuse cerebral conditions that affect the frontal lobes and pyramidal tracts. The occurrence of more than one reflex is more suggestive of disease than normality.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Speech

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