Speech

Definition
speech is a complex process used as means of Communication by which we express our thoughts. Types: It is either spoken or written its centers are in the categorial hemisphere ( dominant hemisphere) arranged along and near the sylvian fissure

Requirements of speech
Hearing
Understanding Thought and word finding Voice production Articulation

Aspects of speech
Sensory (receptive) and motor (expressive) aspects I. Sensory (receptive) aspect

Spoken speech

written speech

II. motor (expressive) aspect Spoken speech written speech

I. The sensory aspects

A.Spoken speech: 1.Primary auditory area ( area 41,42) in the temporal lobe in the supratemporal Hearing (detection of sound pitch intensity) spoken words are perceived. 2.Auditory association area in the supratemporal gyrus Assigning a meaning to sound

3.Wernicks area (left side)

in the posterior part of the superior temporal gyrus Function 1.comprehension of the thought behind words 2.Arranging words into coherent thought (thought formation 3.Finding the appropriate words 4.Involved in complex sensory experiences

B. Sensory aspect of written speech

1.Primary visual area 17 in the occipital lobe in both sides where read words are perceived 2.Visual association area (18,19) For understanding the meaning of the written words 3. The angular gyrus ( area 39): Located posterior to Wernicks area converts written words into forms that can be interpreted by Wernicks area 4. Wernick area

Speech has: Sensory and motor aspects I. Sensory (receptive) aspect Written speech Spoken speech Primary visual area Primary auditory area Visual association area Auditory association area Angular gyrus Wernicks area Wernicks area

II. Motor (expressive) aspect

Spoken speech

Written speech

Motor Aspect
A. spoken speech: Brocas area: In the inferior left frontal gyrus brodmann areas 44 and 45 Receives information from Wernicks area by the arcuate faciculus Transforms information reaching it to detailed coordinated pattern for vocalization Stores motor programs for speech and projects to the motor cortex

Written speech Exners area: Located in the frontal lobe adjacent to the arm motor area

projects to the arm motor area to the corticospinal tract and hand muscles
Transforms information reaching it into a coordinated pattern of movement which are stored to be projected to the motor cortex

Mechanism of speech

Wernicks Area
Area 22 Auditory association area

Brocas area

Area 4

Area 41,42 Primary auditory area Muscles of speech

Angular gyrus area 39

Wernicks Area

Exners area

Area 18,19 Visual association area Area 4

Area 17 Primary visual area Muscles of hand for writting

 Hearing X

Disturbances of speech
Deafness

Understanding X

Aphasia

Thought X word finding and

Voice production X Articulation Dysphonia Dysarthria

Aphasia
Aphasia means disturbance of speech due to lesions in the dominant hemisphere in absence of muscle paralysis or defects of vision or hearing

Types of aphasia
1.Sensory aphasia (receptive aphasia)
a. Auditory aphasia (word deafness) Lesion of auditory association area Patients can hear sounds , the discrimination between specific sounds which are closely spaced in time is lost unable to understand the meaning of spoken words

Types of aphasia
1.Sensory aphasia (receptive aphasia)
b. Visual aphasia (alexia) an acquired reading disability, where reading ability had previously been developed Cant understand the meaning of written words Lesion in areas of the occipital lobe

Types of aphasia
1.Sensory aphasia (receptive aphasia)
C. General sensory aphasia Damage to the Wernicks area Speech is effortless fluent produced at a normal rate, Difficulty in understanding speech. Frequent errors in the choice of words Impaired repetition of complex sentences No motor signs present

Wernicks Area
Area 22 Auditory association area

Brocas area

Area 4

Area 41,42 Primary auditory area Muscles of speech

Angular gyrus area 39

Wernicks Area

Exners area

Area 18,19 Visual association area Area 4

Area 17 Primary visual area Muscles of hand for writting

 Motor aphasia ( expressive aphasia)

1. Brocas aphasia May be damage to brocas area Speech is difficult and slow, articulation is impaired Defect to repeat complex sentences Patients seem to comprehend

Associated with right hemiparesis (arm>leg), Due to damage of Bocas area and underlying structures: white matter insula and basal ganglia

 Motor aphasia ( expressive aphasia)

2.Agraphia Due to damage of Exners area Understands both written and spoken speech letter formation becomes labored, incoordinated, and takes on a very sloppy appearance the wrong letters may be chosen, and the patient may seem to have "forgotten" how to form certain letters.

Legion of the angular gyrus area 39: There is no difficulty with speech or understanding of auditory information there is trouble understanding written words or pictures and naming errors because visual information is not processed and transmitted to Wernicks area

Dysarthria

Wernicks Area
Area 22 Auditory association area BG

Brocas area

Area 4

Area 41,42 Primary auditory area

Cerebellum Muscles of speech

Definitions
a group of speech disorders resulting from disturbances in muscular control over the speech mechanism due to damage of central or peripheral nervous system .

1.Impairment of the LMN of the cranial or spinal nerves. weakness and reduced muscle tone (Flaccid dysarthria )

2. damage to the UMN. weakness and spasticity (Spastic dysarthria)

3. Cerebellar disease: incoordination and reduced muscle tone resulting in slow and inaccurate force, range of motion, timing, ofspeech. (Ataxic Dysarthria) 4.basal ganglia disease. Hypokinetic dysarthria: rigidity and reduced force and range of movement. (parkinsonism)

 5. basal ganglia diseases characterized by involuntary movements e.g chorea

This involuntary movement interferes with speech. The normal speech is executed but interrupted by abnormal, unpredictable, involuntary movements that distort, slow, interrupt it. (Hyperkinetic dysarthria)

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