Speech impairment in adults

The following are common speech and language disorders.

APHASIA

Aphasia is loss of the ability to understand or express spoken or written language. It commonly occurs after 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, it doesn't get better.

DYSARTHRIA

With dysarthria, the person has problems 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.

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.

Some of these disorders develop gradually, but anyone can develop a speech and language impairment suddenly, usually due to a stroke or trauma. In some cases, people may have both aphasia and dysarthria.

APHASIA

• Alzheimer 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 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 medicines 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.

For dysarthria, ways to help improve communication include speaking slowly and using hand gestures. Family and friends need to provide plenty of time for those with dysarthria to express themselves. Typing on an electronic device or using pen and paper can also help with communication. People with aphasia or dysarthria may benefit from speech therapy.

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. Using nonverbal ways of communicating may also help.

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 person understands.
• Provide communication aids, if possible, depending on the person and condition.

Mental health counseling may help with depression or frustration that many people with speech impairment have.

Contact your health care provider if:

• Impairment or loss of communication comes on suddenly
• There is any unexplained impairment of speech or written language

Unless the problems have developed after an emergency event, your provider will take a medical history and perform a physical exam. The medical history may require the assistance of family or friends.

Your 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 to check blood flow in the brain
• CT or MRI scan of the head to check for problems such as tumor or stroke
• Electroencephalogram (EEG) to measure electrical activity of the brain
• Electromyography (EMG) to check the health of the muscles and the nerves that control the muscles
• Lumbar puncture to check the cerebrospinal fluid that surrounds the brain and spinal cord
• Urine tests
• Swallowing study (X-rays while one swallows)
• X-rays of the skull

If the tests find other medical problems, other specialists will need to be consulted.

For help with the speech problem, a speech and language therapist or social worker will likely need to be consulted.

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

Kirshner HS. Dysarthria and apraxia of speech. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 14.

Kirshner HS, Wilson SM. Aphasia and aphasic syndromes. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 13.

Rossi RP, Kortte JH, Palmer JB. Speech and language disorders. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 155.

Updated by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.