Speech impairment (adult)
Speech and language impairment may be any of several problems that make it difficult to communicate.
Language impairment; Impairment of speech; Inability to speak; Aphasia; Dysarthria; Slurred speech; Dysphonia voice disorders
Common speech and language disorders include:
Aphasia is loss of the ability to understand or express spoken or written language. It commonly occurs following strokes or traumatic brain injuries. It can also occur in people with brain tumors or degenerative diseases that affect the language areas of the brain. This term does not apply to children who have never developed communication skills. There are many different types of aphasia.
In some cases of aphasia, the problem eventually corrects itself, but in others the condition does not get better.
With dysarthria, the person has ongoing difficulty expressing certain sounds or words. They have poorly pronounced speech (such as slurring) and the rhythm or speed of speech is changed. Usually, a nerve or brain disorder has made it difficult to control the tongue, lips, larynx, or vocal cords, which make speech.
Dysarthria, which is difficulty pronouncing words, is sometimes confused with aphasia, which is difficulty producing language. They have different causes.
People with dysarthria may also have problems swallowing.
Anything that changes the shape of the vocal cords or the way they work will cause a voice disturbance. Lump-like growths such as nodules, polyps, cysts, papillomas, granulomas, and cancers can be to blame. These changes cause the voice to sound different from the way it normally sounds.
Some of these disorders develop gradually, but anyone can develop a speech and language impairment suddenly, usually in a trauma.
- Alzheimer disease
- Brain tumor (more common in aphasia than dysarthria)
- Head trauma
- Transient ischemic attack (TIA)
- Alcohol intoxication
- Diseases that affect nerves and muscles (neuromuscular diseases), such as amyotrophic lateral sclerosis (ALS or Lou Gehrig disease), cerebral palsy, myasthenia gravis, or multiple sclerosis (MS)
- Facial trauma
- Facial weakness, such as Bell's palsy or tongue weakness
- Head trauma
- Head and neck cancer surgery
- Nervous system (neurological) disorders that affect the brain, such as Parkinson disease or Huntington disease (more common in dysarthria than aphasia)
- Poorly fitting dentures
- Side effects of medications that act on the central nervous system, such as narcotics, phenytoin, or carbamazepine
- Transient ischemic attack (TIA)
- Growths or nodules on the vocal cords
- People who use their voice heavily (teachers, coaches, vocal performers) are more likely to develop voice disorders.
For dysarthria, speaking slowly and using hand gestures may help. Family and friends need to provide plenty of time for those with the disorder to express themselves.
Stop the use of medications that are causing the problem, if possible. Minimize the use of alcohol. Because patients with dysarthria may be able to express themselves with written words, typing on an electronic device or using pen and paper will help with communication.
For aphasia, family members may need to provide frequent orientation reminders, such as the day of the week. Disorientation and confusion often occur with aphasia. Often, people assume that patients with aphasia are incompetent. But patients and caregivers can sometimes learn nonverbal ways of communicating.
Recognizing and treating depression is also important for people with severe speech and language disorders.
It's important to maintain a relaxed, calm environment and keep external stimuli to a minimum.
- Speak in a normal tone of voice (this condition is not a hearing or emotional problem).
- Use simple phrases to avoid misunderstandings.
- Don't assume that the affected person understands.
- Provide communication aids, if possible, depending on the person and condition.
Frustration, profanity, and depression are typical responses in people with aphasia.
When to Contact a Medical Professional
Contact your health care provider if:
- Impairment or loss of communication comes on suddenly
- There is any unexplained impairment of speech or written language
What to Expect at Your Office Visit
Unless the problems have developed after an emergency event, the health care provider will take a medical history and perform a physical examination. The medical history may require the assistance of family or friends.
The provider will likely ask about the speech impairment. Questions may include when the problem developed, whether there was an injury, and what medicines the person takes.
Diagnostic tests that may be performed include the following:
- Blood tests
- Cerebral angiography
- CT scan of the head
- Electromyography (EMG)
- Lumbar puncture
- MR angiography
- MRI of the head
- Urine tests
- X-rays of the skull
The health care provider may refer you to a speech and language therapist or social worker.
Kirshner HS. Language and speech disorders. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chaps 12A and 12B.