Speech disorders occur when an individual has difficulty communicating through speech. Patients may have difficulty pronouncing sounds, talking in a fluent rhythm, or have abnormalities in the pitch, quality, or volume of speech. Speech disorders may be serious, minor, temporary, or permanent.
Individuals are able to create vocal sounds when the vocal cords vibrate. The vocal cords are a pair of fibrous tissue that lie across the air column in the middle of the voice box (called the larynx).
There are many possible causes of speech disorders, including hearing loss, neurological disorders (such as Parkinson's disease), brain injuries, mental retardation, drug abuse, physical impairments (such as a cleft lip or palate), and overuse of the voice. However, in many cases, the exact cause of the speech disorder is unknown.
Usually, speech disorders can be improved with speech-language therapy. In some cases, surgery may be needed to correct a physical problem (such as a cleft palate) that is causing symptoms. Early diagnosis and treatment has been shown to increase an individual's long-term prognosis.
TYPES AND CAUSES
Aphasia: Aphasia is a communication disorder that occurs when the parts of the brain that are responsible for language are damaged. Patients with aphasia may be unable to communicate through verbal or written language, and/or they may be unable to understand spoken or written language.
One of the most common types of aphasia is called Broca's aphasia. This disorder occurs when the frontal lobe of the brain becomes damaged. As a result, patients with this disorder talk in short phrases, only using words that are necessary to convey a message. Small words, such as "this," "is," "am," and "the" are not used. For instance, patients may say things, such as "eat now" meaning, "I would like to eat now." These patients may be able to understand other people's language to some extent.
Another type of aphasia, called Wernicke's aphasia, occurs when the temporal lobe of the brain is damaged. Patients with this disorder often speak in long sentences that contain extra words, words that do not make sense, and/or made up words. These patients are often unable to understand other people's conversations.
Most cases of aphasia develop suddenly, usually as a result of a head injury or stroke. Sometimes the condition develops slowly, as in the case of a brain tumor. The severity of aphasia varies, depending on the amount of brain damage.
If only minor brain damage occurred to the language networks in the brain, the patient may be able to recover their language skills without treatment. However, most patients require speech-language therapy to regain some of their language skills. Few people are able to regain all of their language skills that were present before the brain injury occurred.
Articulation disorders: Articulation disorders occur when an individual has difficulties pronouncing certain consonants or vowels correctly (such as the letters "s" and "r"). As a result, certain words are mispronounced. Patients with these disorders will omit, replace, or distort the sounds of vowels or consonants that they have difficulty pronouncing. A common type of articulation disorder is a lisp.
In many cases, the cause for articulation disorders is unknown. However, most of the time articulation disorders are not a cause for concern. Articulation disorders are common in young children. However, most of these children are able to pronounce words correctly by the age of five. Patients with articulation disorders who are older than five years old should visit their doctors. Sometimes articulation disorders are caused by brain damage or brain disorders. They may also be caused by physical handicaps, such as a cleft palate, hearing loss, or cerebral palsy. In other cases, the condition may be caused by poor coordination of muscles in the mouth or dental problems.
Dysarthria: Dysarthria, often called slurred speech, is defined as slow, imprecise, and distorted speech that is the result of weakness, paralysis, spasticity, or the inability to control or coordinate the muscle used during speech.
Common causes of dysarthria include traumatic brain injuries, stroke, brain tumor, and degenerative brain disorders, such as Parkinson's disease or multiple sclerosis (MS). Excessive use of alcohol and certain medications, such as sedatives, may also cause dysarthria.
Dysfluency disorders: Dysfluency disorders, also called rhythm disorders, occur when an individual speaks in an uneven rhythm. Patients may repeat or add words or sounds when talking. They may also pause in the middle of phrases or frequently correct their pronunciation while talking. They may also say certain words longer than normal.
It is considered normal for young children to speak dysfluently from time to time. However, if symptoms worsen over time, or the individual avoids saying particular words, or makes odd facial or body movements (such as twitching of the eyes or nose) during dysfluent speech, a healthcare provider should be consulted. These may be signs that brain damage or a brain disorder may be causing symptoms.
Mutism: Mutism describes the inability or unwillingness to speak.
Selective mutism is a psychiatric disorder that occurs most often in children. It is typically caused by emotional distress, anxiety, or social phobia. Although patients are able to speak normally and understand spoken language, they do not speak in certain settings.
Deaf-mutism occurs when individuals cannot speak because they are unable to hear speech.
In some cases, frontal lobe damage to the brain may prevent individuals from being able to speak.
Vocal disorders: Vocal disorders occur when there are abnormalities in the quality, pitch, and/or volume of speech.
The seriousness of vocal disorders varies depending on the cause. There are many possible causes of vocal disorders, including infection or irritation of the voice box (a condition called laryngitis), colds, upper respiratory infections, overuse or strain of the voice, aging, smoking, paralysis of the vocal cords, vocal cords that are too far apart from one another, abnormal growths on the vocal cords, loosening of the vocal folds, allergies, cancer of the throat, thyroid disorders, and brain injuries. If a brain injury or disorder is causing a vocal disorder, the condition is called a neurologic voice disorder or spasmodic voice disorder.
SIGNS AND SYMPTOMS
Aphasia: In general, patients with aphasia have difficulty understanding and/or expressing verbal and written language. The severity and specific type of symptoms vary depending on the extent of brain damage, as well as the part of the brain that is affected. Patients with aphasia may speak in short, abbreviated sentences, speak in long sentences that do not make sense, make up words, not understand other people's conversation, have difficulty finding the right words, not understand written words, write sentences that do not make sense, and make significant spelling mistakes.
Articulation disorders: Patients with articulation disorders have difficulty pronouncing certain vowels or consonants. Patients may leave out certain sounds in words. For instance, they may say "at" instead of "hat." Patients may replace sounds that are difficult to pronounce with others. For instance, the letter "r" is often replaced with the letter "w." These patients may say "wunning" instead of "running." Finally, some patients may make distorted sounds when they try to pronounce certain words. A distorted sound may be a whistle, the air may come out the sides of the mouth causing a "slushy" sound or lateral lisp, or the tongue may thrust between the teeth causing a frontal lisp. Most children with articulation disorders are able to overcome this disorder without treatment by the age of five.
Dysarthria: Symptoms of dysarthria may include slurred or jerky speech that is difficult to understand, difficulty controlling pitch and loudness when speaking, slow or rapid speech, mumbled speech, difficulty chewing or swallowing food, drooling, and limited ability to move the lips, tongue, and jaw.
Dysfluency disorders: Most dysfluency disorders are characterized by a repetition of a word, sound, or phrase. An example of this type of disorder is stuttering. Patients may also add extra syllables or words that add no meaning to the message. They may pause longer than two seconds in the middle of a phrase. They may make frequent corrections in pronunciation during speech. Patients may also say certain sounds or syllables longer than normal.
Mutism: Individuals with selective mutism are unable to talk in specific settings, usually social or interactive environments. Most patients are able to communicate through other ways, such as body movements. Patients are often able to speak to people whom they feel comfortable around, such as family members and friends.
Patients who experience deaf-mutism are unable to speak at all.
Patients who are mute as a result of frontal lobe brain damage are also unable to speak at all.
Vocal disorders: Patients with vocal disorders have abnormalities in the quality, pitch, and volume of the voice. If the quality of the voice is affected, the patient's voice may sound hoarse or scratchy. The voice may become high- or low-pitched. Patients may also be unable to control how loud or quietly they talk.
Interpersonal problems: Speech disorders may affect an individual's ability to communicate with others. This problem is generally most severe for patients with aphasia. Friends and family members of the patient may have difficulty understanding the patient and vice versa. Therefore, it is recommended that patients receive speech therapy as soon as they are diagnosed. Therapy has been shown to improve the long-term prognosis of patients.
Aphasia: A speech pathologist will evaluate the patient's ability to understand and express verbal and written language. The speech pathologist will assess the patient's ability to participate in conversations, comprehend words, use words correctly, respond to questions about things the patient read and heard, tell a story, explain a figurative phrase, or write down sentences.
Articulation disorders: Articulation disorders are common among young children. However, patients who are older than five years of age and have symptoms of the condition should visit their doctors. A speech pathologist will evaluate the patient for characteristic symptoms of articulation disorders.
Dysarthria: Dysarthria can be diagnosed by a physician or a speech-language pathologist based on an evaluation of the patient's symptoms. A speech-language pathologist may ask the patient to perform tasks, such as blowing out a candle or sticking out the tongue, to determine the strength, motion, and accuracy of the muscles involved in speech. The speech-language pathologist may also ask the patient to sing or repeat words or sentences in order to detect lost vowel sounds and slurred or slowed speech.
Dysfluency disorders: It is considered normal for young children to speak dysfluently from time to time. However, if symptoms worsen over time, or the individual avoids saying particular words, or makes odd facial or body movements (such as twitching of the eyes or nose) during dysfluent speech, a healthcare provider should be consulted. If a dysfluent disorder is suspected, a speech-language pathologist will make a diagnosis based on an evaluation of the patient's symptoms.
Mutism: Mutism can be diagnosed after a detailed medical history and physical examination. The healthcare provider will observe the patient's symptoms. If the patient is able to understand language, but does not talk in particular settings, selective mutism is diagnosed.
Vocal disorders: Patients should visit their healthcare providers if they experience vocal change or hoarseness for more than two weeks. There are many tests available to diagnose vocal disorders because there are many potential causes. A doctor may place a small mirror in the back of the patient's throat to look for abnormalities in the vocal folds. A flexible laryngoscopy may also be performed. During this test, a thin, flexible tube with a tiny light and camera is inserted into the patient's nose. This allows doctors to look for abnormalities in the vocal folds. An acoustic analysis may also be performed. This test measures irregularities in the voice cause by vocal fold movements. Doctors may also use a direct laryngoscope, a rigid viewing scope, to look at the patient's vocal folds.
General: In some cases, speech disorders require no treatment. This is often true in disorders that are known to affect young children (such as dysfluency). In general, most speech disorders improve with speech-language therapy. Sometimes surgical procedures are necessary to correct physical problems (such as a cleft palate) that may be causing symptoms.
Speech-language therapy: Speech-language therapy is considered the primary treatment for most speech disorders. Speech-language pathologists, also called speech therapists or speech-language professionals (SLPs), evaluate, diagnose, treat, and help to prevent speech, language, communication, swallowing, and other related disorders. These professionals have been educated in the study of human communication. SLPs have earned Master's degrees and state certification/licensure in the field. They are also certified in clinical competency from the American Speech-Hearing Association.
Speech-language therapy is most effective when it is started shortly after diagnosis. If the patient is a child, parental involvement is necessary for the best possible progress and prognosis.
During speech-language therapy, a qualified SLP works with the patient on a one-to-one basis, in a small group, or directly in a classroom, to overcome speech disorders. Programs are tailored to the patient's individual needs. On average, patients receive five or more hours of therapy per week for three months to several years.
Speech pathologists use a variety of exercises to improve the patient's communications skills. Exercises typically start off simple and become more complex as therapy continues. For instance, the therapist may ask the patient to name objects, tell stories, or explain the purpose of an object.
The therapist may also help patients learn how to cope with some of their symptoms. For instance, the therapist may teach the patient to over-articulate words that are hard to pronounce or to pause before saying big words.
Speech pathologists help patients improve their stronger communication skills in order to enhance those that are weaker. For instance, the therapist may teach the patient how to improve their skills with gestures or body language.
Oftentimes, family members participate in therapy, serving as communication partners. This allows patients to practice their communication skills in a comfortable and supportive environment. This type of group therapy may include role playing, which allows patients to practice their language in social situations.
Sometimes a speech pathologist takes the patient on field trips, such as the mall or a restaurant, to help patients practice their communication skills.
For patients with dysarthria, speech therapists may recommend specific exercises to strengthen the muscles in the mouth and face. Strengthening these muscles may help improve slow or slurred speech.
Voice therapy: Patients who frequently overuse or strain their vocal cords may benefit from voice therapy. This type of therapy involves teaching the patient good vocal technique to reduce the amount of pressure put on the vocal cords. As a result, this helps reduce symptoms of vocal disorders from occurring in the future.
Unclear or conflicting scientific evidence:
Alexander technique: The Alexander technique is an educational program that teaches movement patterns and postures, with an aim to improve coordination and balance, reduce tension, relieve pain, alleviate fatigue, improve various medical conditions, and promote well-being. There is currently insufficient scientific evidence available to determine if the Alexander technique is an effective treatment for stuttering. More study is needed in this area.
Serious side effects have not been reported in the available literature. It has been suggested that the technique may be less effective with learning disabilities or mental illnesses. The Alexander technique has been used safely in pregnant women.
Traditional or theoretical uses lacking sufficient evidence:
Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called "chi," circulates. These pathways contain specific points that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi. Traditionally, acupuncture has been used to treat stuttering. However, scientific studies are lacking in this area. Further research is needed before acupuncture can be recommended as a possible treatment for this condition.
Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, neurological disorders or if taking anticoagulants. Avoid on areas that have received radiation therapy and during pregnancy. Avoid electroacupuncture with irregular heartbeat or in patients with pacemakers. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with a history of seizures.
Aromatherapy: Aromatherapy refers to many different therapies that use essential oils. The oils are sprayed in the air, inhaled, or applied to the skin. Essential oils are usually mixed with a carrier oil (usually a vegetable oil) or alcohol. Aromatherapy has been used to treat laryngitis, a condition that causes the voice to be hoarse. Clinical research is needed to determine if this is a safe and effective therapy for this indication.
Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if driving/operating heavy machinery. Use cautiously if pregnant.
Ginseng: Traditionally, ginseng has been used to improve symptoms of a hoarse voice. However, research is lacking in this area.
Avoid ginseng with known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
Hypnotherapy, hypnosis: Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Hypnotherapy has traditionally been used to treat speech disorders, such as stuttering. However, research in this area is lacking. In order to reach a firm conclusion on the safety and efficacy of this therapy, well-designed studies are needed.
Use cautiously with mental illnesses, such as psychosis/schizophrenia, manic depression, multiple personality disorder, or dissociative disorders. Use cautiously with seizure disorders.
Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Although yoga has been suggested as a possible treatment for speech disorders caused by vocal cord dysfunction, scientific evidence of safety and efficacy is lacking. Research is warranted in this area.
Yoga is generally considered safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine or fragile or atherosclerotic neck arteries. Avoid if at risk for blood clots or with high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung diseases. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction. However, poses that put pressure on the uterus, such as abdominal twists, should be avoided during pregnancy.
Hearing loss increases an individual's risk of developing speech disorders. Therefore, infants who are at risk for hearing loss should have their hearing tested.
Parents should not place excessive attention on speech dysfluency in their young children. It is normal for young children to speak dysfluently from time to time. Drawing extra attention to dysfluent speech increases the chances that a pattern may develop.
Because overusing or straining the voice may lead to vocal disorder, patients should rest their voice if it starts to feel hoarse or scratchy. Individuals who rely on their voice on a regular basis, such as singers or teachers, may benefit from voice therapy. This type of therapy teaches the patient good vocal technique to reduce the pressure put on the vocal cords.
It is important that patients with speech disorders receive immediate treatment. Early diagnosis and treatment has been shown to increase an individual's long-term prognosis.
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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