Speech Impairment (adult)

Definition

Speech and language impairment may be any of several problems that make it difficult to communicate.

See also:

• Stuttering
• Expressive language disorder - developmental

Alternative names

Language impairment; Impairment of speech; Inability to speak; Aphasia; Dysarthria; Slurred speech; Dysphonia voice disorders

Causes

Some of these disorders develop gradually, but anyone can develop a speech and language impairment suddenly, usually in a trauma.

APHASIA

• Alzheimer's disease
• Brain tumor (more common in aphasia than dysarthria)
• Dementia
• Head trauma
• Stroke
• Transient ischemic attack (TIA)

DYSARTHRIA

• Alcohol intoxication
• Dementia
• Diseases that affect nerves and muscles (neuromuscular diseases), such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's 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's disease or Huntington's 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
• Stroke
• Transient ischemic attack (TIA)

VOICE DISTURBANCES

• Growths or nodules on the vocal cords
• People who use their voice heavily (teachers, coaches, vocal performers) are more likely to develop voice disorders

Considerations

Common speech and language disorders include:

APHASIA

Aphasia is loss of the ability to understand or express spoken or written language. It commonly occurs following strokes or traumatic brain injuries, or 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 is irreversible.

DYSARTHRIA

In 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 larynx and vocal cords, which make speech.

Dysarthria, which is a difficulty pronouncing words, is sometimes confused with aphasia, which is a difficulty producing language. They have different causes.

People with dysarthria may also have problems swallowing.

VOICE DISTURBANCES

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.

DYSPHONIA is another type of speech impairment. For information, see the article on spasmodic dysphonia.

Care

For dysarthria, speaking slowly and using hand gestures are recommended. 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.

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.

Recognition and treatment of 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.

Medical history questions documenting speech impairment may include the following:

• When did it develop?
• Did it develop suddenly?
• Is there a problem with clearly pronouncing words (dysarthria)?
• Is there a problem understanding speech?
• Is there a problem expressing thoughts through speech?
• Is there a problem understanding writing?
• Is there a problem expressing thoughts through writing?
• Has there been a head injury?
• Are there problems with dentures?
• What medications are used?
• Is there recent or former heavy alcohol use?
• What other symptoms are present?

The physical examination will include a detailed evaluation of brain function.

Diagnostic tests that may be performed include the following:

• Blood tests
• Cerebral angiography
• CT scan of the head
• EEG
• 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.

References

Swanberg MM, Nasreddine ZS, Mendez MF, Cummings JL. Speech and language. In: Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, PA: Saunders Elsevier; 2007:chap 6.

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Review Date: .4/23/2008

Reviewed By: Luc Jasmin, MD, PhD, Department of Neurology and Gene Therapeutics Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.4/23/2008