Physical Exam

Speech Assessment

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Video coming September 2026

How to Perform

Assess speech and language by listening to spontaneous speech for fluency, articulation, rate, volume, and prosody.

How to Interpret

Aspiration

Dysphonia in a patient with acute stroke

Rule in

Somewhat helpfulDerived CI

Rule out

Somewhat helpfulDerived CI

Evidence:Limited

Dysarthria in a patient with acute stroke

Rule in

Minimally helpfulDerived CI

Rule out

InconclusiveWide CI

Evidence:Limited

Hypovolemia

Speech not clear or expressive

Rule in

InconclusiveWide CI

Rule out

Somewhat helpful

Evidence:Limited

Parkinson Disease

Progressively softer voice (hypophonia)

Rule in

Somewhat helpful

Rule out

Somewhat helpful

Evidence:Limited

Stroke

Dysarthria in a patient with acute dizziness

Rule in

Very helpfulDerived CI

Rule out

Not helpfulDerived CI

Evidence:Limited

References

Research in progress on one or more findings above; ratings may change.

Flamand-Roze C, Falissard B, Roze E, Maintigneux L, Beziz J, Chacon A, Join-Lambert C, Adams D, Denier C. Validation of a new language screening tool for patients with acute stroke: the Language Screening Test (LAST). Stroke. 2011;42(5):1224-1229. PMID: 21487118. doi:10.1161/STROKEAHA.110.609503. El Hachioui H, Visch-Brink EG, de Lau LML, van de Sandt-Koenderman MWME, Nouwens F, Koudstaal PJ, Dippel DWJ. Screening tests for aphasia in patients with stroke: a systematic review. J Neurol. 2017;264(2):211-220. PMID: 27260296. doi:10.1007/s00415-016-8170-8.
Indra R, Patil SS, Joshi R, Pai M, Kalantri SP. Accuracy of physical examination in the diagnosis of hypothyroidism: a cross-sectional, double-blind study. J Postgrad Med. 2004;50(1):7-11. PMID: 15047991. Barker DJ, Bishop JM. Computer-based screening system for patients at risk of hypothyroidism. Lancet. 1969;2(7625):835-838. PMID: 4186294.
McGee S, Abernethy WB 3rd, Simel DL. The rational clinical examination. Is this patient hypovolemic? JAMA. 1999;281(11):1022-1029. PMID: 10086438.
Rao G, Fisch L, Srinivasan S, D'Amico F, Okada T, Eaton C, Robbins C. Does this patient have Parkinson disease? JAMA. 2003;289(3):347-353. doi:10.1001/jama.289.3.347. PMID 12525236.
Daniels SK, Brailey K, Priestly DH, Herrington LR, Weisberg LA, Foundas AL. Aspiration in patients with acute stroke. Arch Phys Med Rehabil. 1998;79(1):14-19. PMID: 9440410.
Wenning GK, Ben-Shlomo Y, Hughes A, Daniel SE, Lees A, Quinn NP. What clinical features are most useful to distinguish definite multiple system atrophy from Parkinson's disease? J Neurol Neurosurg Psychiatry. 2000;68(4):434-440. doi:10.1136/jnnp.68.4.434. PMID: 10727478; PMCID: PMC1736862.
Navi BB, Kamel H, Shah MP, et al. Rate and predictors of serious neurologic causes of dizziness in the emergency department. Mayo Clin Proc. 2012;87(11):1080-1088. PMID: 23063099.
Fridriksson J, Kjartansson O, Morgan PS, Hjaltason H, Magnusdottir S, Bonilha L, Rorden C. Impaired speech repetition and left parietal lobe damage. J Neurosci. 2010;30(33):11057-11061. doi:10.1523/JNEUROSCI.1120-10.2010. PMID: 20720112.
El Hachioui H, Visch-Brink EG, de Lau LML, van de Sandt-Koenderman MWME, Nouwens F, Koudstaal PJ, Dippel DWJ. Screening tests for aphasia in patients with stroke: a systematic review. J Neurol. 2017;264(2):211-220. PMID: 27260296.
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 10, 2026.