Physical examination maneuver

Physical Exam

Speech Assessment

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How to Perform

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

How to Interpret

Showing 6 of 14 findings

Aspiration

Dysphonia in a patient with acute stroke
Rule in
Somewhat helpfulWide CI
Rule out
Somewhat helpfulWide CI
Evidence:Moderate
Dysarthria in a patient with acute stroke
Rule in
Minimally helpfulDerived CI
Rule out
InconclusiveWide CI
Evidence:Moderate

Hypovolemia

Speech not clear or expressive
Rule in
InconclusiveWide CI
Rule out
Somewhat helpfulWide CI
Evidence:Moderate

Multiple System Atrophy

Speech and/or bulbar signs
Rule in
Somewhat helpfulDerived CI
Rule out
HelpfulDerived CI
Evidence:Moderate

Parkinson Disease

Progressively softer voice (hypophonia)
Rule in
Somewhat helpful
Rule out
Somewhat helpful
Evidence:Moderate

Stroke

Dysarthria in a patient with acute dizziness
Rule in
Somewhat helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:ModerateResearch in progress

Related Bedside Tests

🎬Video coming soon
Babinski Reflex
aka Plantar reflex
Rule in:VHUpper Motor Neuron Lesion, VHVascular Parkinsonism, HMultiple System Atrophy +4 more
Rule out:SHUpper Motor Neuron Lesion, MHMultiple System Atrophy, NHVascular Parkinsonism +4 more
🎬Video coming soon
Gait Assessment
Rule in:VHStroke, HFalls, HVascular Parkinsonism +24 more
Rule out:SHDementia, SHVascular Parkinsonism, MHFalls +24 more
Head and Face InspectionMembers
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Head and Face Inspection
Rule in:HAcromegaly, HStroke, SHCushing Syndrome +5 more
Rule out:SHAcromegaly, SHCushing Syndrome, SHStroke +5 more
Extraocular MovementsMembers
Sign in
Extraocular Movements
Rule in:VHStroke, SHHyperthyroidism, SHMyasthenia Gravis +9 more
Rule out:HMyasthenia Gravis, SHHyperthyroidism, NHOrbital Fracture +9 more
Pupillary Light ReactionMembers
Sign in
Pupillary Light Reaction
Rule in:VHSerious Eye Disease, HPoor Neurologic Outcome, HStructural Brain Lesion +11 more
Rule out:SHPoor Neurologic Outcome, SHSerious Eye Disease, SHStructural Brain Lesion +11 more
Alternate Cover TestMembers
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Alternate Cover Test
aka Cross-cover test, Test of skew
Rule in:VHSkew Deviation, VHVestibular Dysfunction, HStroke +1 more
Rule out:VHStroke, VHVestibular Dysfunction, HSkew Deviation +1 more

Related Systems / Regions

Neurological

Related Diagnoses

AphasiaAspirationDominant Angular Gyrus LesionHypothyroidismHypovolemiaMultiple System AtrophyParkinson DiseaseStroke

Related Chief Complaints

Balance ProblemsChoking When EatingConfusionDifficulty SpeakingDifficulty SwallowingDifficulty Understanding SpeechDifficulty WalkingDizzinessDouble VisionFacial DroopHeadacheHoarsenessLanguage DifficultyNumbness on One SideRight-sided WeaknessSlurred SpeechSudden Vision LossTremorVision ChangesVoice ChangeWeakness on One Side

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.
  • Zhu Z, Li Q, Wang L, Xiao C, Wang H, Xu Y. Risk Factors and Risk Model Construction of Stroke in Patients with Vertigo in Emergency Department. Comput Math Methods Med. 2022;2022:2968044. doi:10.1155/2022/2968044. PMID: 35633924. PMCID: PMC9142295.
  • 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.