Language impairment; Speech impairment (adult); Inability to speak; Aphasia; Dysarthria; Slurred speech; Dysphasia
Speech impairment may be any of several speech problems, particularly the following:
- Dysarthria is difficult, poorly articulated speech, such as slurring.
- Aphasia is impaired expression or comprehension of written or spoken language.
Dysarthria is occasionally confused with aphasia. It is important to distinguish between a difficulty in articulation of words versus a problem with the production of language, as these have different causes.
Dysarthria is generally apparent in daily conversation where there is difficulty expressing certain sounds or words. This condition may be caused by taking excess medications such as narcotics, phenytoin, or carbamazepine. Alcohol intoxication causes dysarthria.
Degenerative neurological disorders affecting the cerebellum or brainstem can also cause dysarthria. Stroke that affects brainstem or cerebellar regions can also cause dysarthria. Any facial weakness, such as Bell’s palsy or tongue weakness, can cause dysarthria.
Aphasia is loss of communication skills previously learned and 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 resolves itself, but in others the condition is irreversible.
- Poorly fitting dentures
- Alcohol intoxication
- Any degenerative neurological disorder
- Head trauma
- Alzheimer’s disease
- Transient ischemic attack (TIA)
- Brain tumor
For dysarthria, speaking slowly is encouraged, and the use of hand gestures, when necessary, is recommended. Family and friends need to provide ample time for those afflicted with the disorder to express themselves. Medications that are causing the problem should be stopped, if possible. Use of alcohol should be minimized.
For aphasia, family members may need to provide frequent orientation reminders, such as what day it is, because disorientation and confusion often follow the onset of aphasia.
A relaxed, calm environment where external stimuli are kept to a minimum is important.
Speak in a normal tone of voice (this condition is not a hearing or emotional problem), use simple phrases to avoid misunderstanding, and don’t assume that the affected person understands. Frustration, profanity, and depression are typical responses in people suffering from aphasia.
Provide communication aids, if possible, depending on the particular person and condition.
Call your health care provider if
- If impairment or loss of communication comes on suddenly, call your health care provider immediately.
- If there is any unexplained impairment of speech or written language, call your provider.
What to expect at your health care provider’s office
The health care provider will obtain a medical history and will 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 also present?
The physical examination will include a detailed evaluation of brain function.
Diagnostic tests that may be performed include the following:
- Cerebral angiography
- CT scan of the head
- MRI of the head
- MR angiography
- X-rays of the skull
- Blood tests
- Urine tests
- Lumbar puncture
The health care provider may provide a referral to a speech pathologist, and in some cases, to a social worker.
by Janet G. Derge, M.D.