Speech and swallowing evaluation in the differential diagnosis of neurologic disease

Examination of the speech mechanism (the vocal tract) frequently provides information about certain neurologic lesions. The speech, swallowing and respiratory patterns of patients with cerebellar, upper motor neuron, lower motor neuron and extra-pyramidal lesions (parkinsonism) were studied, 10 of each category. The patient's lingual, labial and velar movement was examined cineradiographically during production of four short speech samples and the oral, through esophageal structures, during chewing and swallowing. Videotape, with simultaneous voice recording, and 16 mm. film were used. Oral, pharyngeal and esophageal transit times during swallowing were determined. These quantified tests reveal distinctive differences in vocal tract physiology between patient groups. The specific physiologic patterns characteristic of each neurological lesion were discussed and illustrated with films. Each patient group in this study exhibited a distinctive profile distinguishing it from every other. The results also indicate that if only a portion of these studies was completed, the disorder might be erroneously classified. The findings emphasize the need for complete and detailed physiologic studies of the speech and swallowing of patients with neurologic lesions, as an aid to accurate diagnosis.