Speech

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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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:

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