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Brain

Speech impairment (adult)

Definition

Speech impairment may be any of several speech problems, particularly the following:

• Aphasia is a problem with expressing or understanding written or spoken language.
• Dysarthria is difficult, poorly pronounced speech, such as slurring.

Dysarthria is sometimes confused with aphasia. It is important to distinguish between a difficulty in pronouncing words and a problem producing language. These problems have different causes.

Alternative Names

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

Considerations

DYSARTHRIA

Dysarthria is generally apparent in daily conversation. A person will have difficulty expressing certain sounds or words.

APHASIA

Aphasia is loss of communication skills that were previously learned. It commonly occurs following strokes, 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.

In some cases of aphasia, the problem eventually corrects itself, but in others the condition is irreversible.

Causes

DYSARTHRIA

• Alcohol intoxication
• Dementia
• Diseases that affect nerves and muscles (neuromuscular diseases), such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), myasthenia gravis, or multiple sclerosis (MS)
• Facial weakness, such as Bell's palsy or tongue weakness
• Head trauma
• 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)

APHASIA

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

Home Care

For dysarthria, speaking slowly and using hand gestures are recommended. Family and friends need to provide plenty of time for those afflicted 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.

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

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 recent 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 pathologist or social worker.

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.