Speech impairment in adultsLanguage impairment; Impairment of speech; Inability to speak; Aphasia; Dysarthria; Slurred speech; Dysphonia voice disorders
Speech and language impairment may be any of several problems that make it difficult to communicate.
The following are common speech and language disorders.
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.
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 is a condition in which you have difficulty saying words because of problems with the muscles that help you talk.Read Article Now Book Mark Article
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 due to a stroke or trauma.
Dementia is a loss of brain function that occurs with certain diseases. Alzheimer disease (AD) is the most common form of dementia. It affects memo...Read Article Now Book Mark Article
- 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)
Amyotrophic lateral sclerosis
Amyotrophic lateral sclerosis, or ALS, is a disease of the nerve cells in the brain, brain stem and spinal cord that control voluntary muscle movemen...Read Article Now Book Mark Article
Multiple sclerosis (MS) is an autoimmune disease that affects the brain and spinal cord (central nervous system).Read Article Now Book Mark Article
- Facial trauma
- Facial weakness, such as Bell's palsy or tongue weakness
Bell palsy is a disorder of the nerve that controls movement of the muscles in the face. This nerve is called the facial or seventh cranial nerve. D...Read Article Now Book Mark Article
A head injury is any trauma to the scalp, skull, or brain. Head injury can be either closed or open (penetrating). A closed head injury means you rec...Read Article Now Book Mark Article
- 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)
Parkinson disease results from certain brain cells dying. These cells help control movement and coordination. The disease leads to shaking (tremors...Read Article Now Book Mark Article
Huntington disease (HD) is a genetic disorder in which nerve cells in certain parts of the brain waste away, or degenerate. The disease is passed do...Read Article Now Book Mark Article
- Poorly fitting dentures
- Side effects of medicines that act on the central nervous system, such as narcotics, phenytoin, or carbamazepine
A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack. " If blood flow is cut off for longer th...Read Article Now Book Mark Article
Transient ischemic attack (TIA)
Transient ischemic attack (TIA)
A transient ischemic attack (TIA) occurs when blood flow to a part of the brain stops for a brief time. A person will have stroke-like symptoms for ...Read Article Now Book Mark Article
- 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 the disorder to express themselves. Typing on an electronic device or using pen and paper can also help with communication.
Dysarthria is a condition that occurs when there are problems with the part of the brain, nerves, or muscles that help you talk. Most times, dysarth...Read Article Now Book Mark Article
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.
Nonverbal ways of communicating
Aphasia is loss of the ability to understand or express spoken or written language. It commonly occurs after strokes or traumatic brain injuries. I...Read Article Now Book Mark Article
It's important to maintain a relaxed, calm environment and keep external stimuli to a minimum.
A stimulus is anything that can trigger a physical or behavioral change. The plural of stimulus is stimuli. Stimuli can be external or internal. An ...Read Article Now Book Mark Article
- 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.
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for shor...Read Article Now Book Mark Article
When to Contact a Medical Professional
Contact the 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 provider will take a medical history and perform a physical exam. 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 to check blood flow in the brain
Cerebral angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the brain.Read Article Now Book Mark Article
CT or MRI scan of the head to check for problems such as tumor
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.Read Article Now Book Mark Article
A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...Read Article Now Book Mark Article
Electroencephalogram (EEG) to measure electrical activity of the brain
An electroencephalogram (EEG) is a test to measure the electrical activity of the brain.Read Article Now Book Mark Article
- Electromyography (EMG) to check the health of the muscles and the nerves that control the muscles
Electromyography (EMG) is a test that checks the health of the muscles and the nerves that control the muscles.Read Article Now Book Mark Article
Lumbar puncture to check the cerebrospinal fluid that surrounds the brain and spinal cord
Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...Read Article Now Book Mark Article
- Urine tests
- X-rays of the skull
If the tests find other medical problems, other specialist doctors 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.
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.
Review Date: 5/2/2022
Reviewed By: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. 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.