Speech Disorders


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Speech Disorders

 

Definition

According to the American Speech-Language-Hearing Association (ASHA), a language disorder is an impairment in comprehension use of the spoken, written, or other symbol system.

Description

Speech disorders affect the language and mechanics, the content of speech, or the function of language in communication. Because speech disorders affect a person's ability to communicate effectively, every aspect of the person's life can be affected, for example, the person's ability to make friends, and to communicate at school or at work.

Amyotrophic lateral sclerosis (als)

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, is a neurological disease that attacks the nerve cells in the brain that control voluntary muscles. ALS causes motor neurons to die so that the brain and spinal cord are unable to send messages to the muscles telling them to move. Because the muscles are not functioning, they begin to atrophy. Muscles in the face and jaw can be affected, and thereby affecting a person's speech.

Aphasia

Aphasia results from damage to the language centers of the brain, which affects a person's ability to communicate through speaking, listening, and writing.
Persons with aphasia have trouble with expressive language, what is said, or receptive language, what is understood. Not only are speech and understanding speech affected, but also reading and writing is affected. The severity of aphasia varies from person to person, but in the most severe cases, a person may not be able to understand speech at all. Persons with mild aphasia may only become confused when speech becomes lengthy and complicated.

Developmental apraxia of speech

Developmental apraxia is a disorder that affects the nervous system and affects a person's ability to sequence and say sounds, syllables, and words. The brain does not send the correct messages to the mouth and jaw so that the person can say what he or she wants to say.
Children who are suffering from this disorder don't babble as an infant and first words are delayed. Older children may have more difficulty with longer phrases, and may appear to be searching for words to express a thought. Listeners will likely have a difficult time understanding the child.

Laryngeal cancer

Laryngeal cancer is characterized by a malignant growth in the larynx, or the voice box, which sometimes requires removal of the larynx or part of it.
Cancer anywhere in the throat affects speech, swallowing, and chewing. Depending on the size of the growth, a person may have trouble moving the mouth and lips. Therefore, speech sounds and eating will be affected and a person will have trouble communicating.

Orofacial myofunctional disorders

Orofacial myofunctional disorder (OMD) causes the tongue to move forward in an exaggerated manner while a person is speaking or swallowing. The tongue also may protrude when resting in the mouth.
Because heredity contributes to the size and shape of a person's mouth, there may be genetic reasons for the disorder. Allergies also affect the mouth and face muscles, which make it difficult to breathe because of nasal congestion. Because a person may sleep with the tongue protruding, lip muscles weaken. Enlarged tonsils also can block airways, creating the same breathing problems. Additionally, thumb-sucking, nail-biting, and teeth-clenching and grinding also can contribute to the disorder.

Stuttering

Stuttering is a disorder of speech fluency that frequently interrupts the flow of speech.
Because children typically stumble and confuse their words as speech develops, stuttering is not immediately evident. It is usually when children become older and continue to stumble that stuttering becomes evident.

Causes and symptoms

Amyotrophic lateral sclerosis (als)

Initial symptoms include weakness in any part of the body, and appendages begin to tire easily. Occasionally the disease affects only one appendage rather than both at the same time. Persons with ALS may have trouble maintaining balance and may stumble or have difficulty with tasks that require manual dexterity, such as buttoning a shirt or tying a shoe.
Eventually, the diaphragm and chest wall become so weak that a person cannot breathe on his or her own and needs the help of a ventilator. Because of the lack of muscle strength, a person with ALS will experience difficulty speaking loudly and clearly until the person is unable to speak at all using the vocal cords. The person will have difficulty pronouncing words and have difficulty completing lengthy sentences.
Along with the difficulty in speaking also comes difficulty in chewing and swallowing. Food can be broken down and pureed to make it easier to chew and swallow. However, a person eventually will have difficulty chewing and swallowing foods that are broken down or pureed. When ability to eat is affected, proper nutrition and body weight also are affected, and medical professionals may decide that it is best to put in a feeding tube.

Aphasia

Stroke is the most common cause of aphasia, although other injuries, such as a brain tumor or gunshot wound, also can cause aphasia.

Developmental apraxia of speech

Developmental apraxia is a disorder that affects the nervous system and affects a person's ability to sequence and say sounds, syllables, and words. The brain does not send the correct messages to the mouth and jaw so that the person can say what he or she wants to say.
Children who are suffering from this disorder don't babble as an infant and first words are delayed. Older children may have more difficulty with longer phrases, and may appear to be searching for words to express a thought. Listeners will likely have a difficult time understanding the child.
There is no known cause for developmental apraxia of speech. Symptoms include weakness of the jaw, tongue, and lips, and delayed speech development. Persons with the disorder also may have trouble identifying an object in the mouth using the sense of touch, which is known as oral-sensory perception.

Laryngeal cancer

Any kind of smoking of cigarettes, cigars, or tobacco and alcohol abuse contribute to oral cancer, including smokeless tobacco. Persons with laryngeal cancer or another type of oral cancer may have a red or white patch or lump in the mouth. Symptoms also include difficulty chewing, swallowing, or chewing.

Stuttering

There is no known cause for stuttering, although poor muscle coordination and the rate of language development are believed to contribute to it.
Stuttering is characterized by repetition of sounds, syllables, portions of a word, words, and complete phrases; stretching the sounds and syllables; hesitation between words; words spoken in spurts; tense muscles in the jaw and mouth; and a feeling of loss of control.

Diagnosis

Amyotrophic lateral sclerosis (als)

About 20,000 people in the United States have ALS at any given time with 5,000 new cases diagnosed every year. ALS is in the same family of disorders as multiple sclerosis, Parkinson's disease, and muscular dystrophy. Persons of all races and ethic groups are afflicted by the disease, although men are more likely to have it than women.

Aphasia

About 700,000 persons in the United States have strokes every year, and one million are estimated to have aphasia.

Developmental apraxia of speech

A child suspected to have apraxia should first have his or her hearing tested to determine if the child has any deafness. Muscle development in the face and jaw should be evaluated and speech exercises tested. Articulation of words should be tested as well as the person's expressive and receptive language skills.

Laryngeal cancer

It is likely that a dentist or physician will first detect signs of possible cancer. Oral cancer makes up about 2-5% of all cancers, and about 30,000 cases are diagnosed each year. Twice as many men than women are diagnosed with cancer typically between the ages of 50 and 70.

Orofacial myofunctional disorders

The diagnosis of orofacial myofunctional disorder affects speech sounds because of weak tongue tip muscles, although a person's speech may not be affected at all.

Stuttering

Stuttering is a problem that most likely will manifest itself during childhood rather than adulthood.

Treatment

Amyotrophic lateral sclerosis (als)

In addition to treatments such as a feeding tube, a person with ALS would likely enlist the help of a speech therapist to help him or her determine ways in which he or she can maintain vocal control. A person also may enlist the help of an occupational therapist, a medical professional trained to help persons who have trouble with activities of daily living such as dressing, bathing, and eating.

Aphasia

A speech-language pathologist can perform drills and exercises with a person that include practice in naming objects and following directions to try to improve skills. The person learns the best way to express himself of herself. Group therapy also is an option, which focuses on structured discussions.

Developmental apraxia of speech

Treatment should focus on the coordination of motor movements necessary during speech production, which includes controlling breathing. A speech-language pathologist teaches exercises to a person with apraxia that will strengthen the jaws, lips, and tongue to improve coordination during speech. The therapist uses tactile, auditory, and visual feedback to direct the brain to move the muscles used during speech.

Laryngeal cancer

Depending on when the cancer is first detected, and depending on the size of the cancer, the entire larynx may not need to be removed. Radiation, chemotherapy, or partial removal can be done in lieu of complete removal. In these cases, the voice may be preserved although the quality likely will be affected.

Orofacial myofunctional disorders

In cases where speech is affected, a speech pathologist should be consulted to help control breathing problems and work on speech articulation. The lip, palate, tongue, and facial muscles should be evaluated so that errors in speech can be detected. Therapy includes increasing awareness of the mouth and facial muscles, as well as the posture of the mouth and tongue. Muscle exercise can be done to increase strength and control.

Stuttering

A treatment plan by a speech therapist includes improving fluency and ease with which a person speaks. Strategies include reducing the rate of speech and using slower speech movements; articulating lightly; and starting air flow for speech before any other muscle movement.

Alternative treatment

Developmental apraxia of speech

Some persons with apraxia may decide to use alternative communication systems, such as a computer that transcribes and "speaks" what a person is directing it to say. These augmentative systems should only be used when a person is so severely impaired that effective speech or communication isn't possible.

Laryngeal cancer

In cases of a full laryngectomy, a hole is made in the neck and, rather than using the mouth and nose to talk and breath, the person must use the hole.
Once the larynx is removed, the person needs to develop a new speech system without a voice. A speech pathologist should follow one of three plans: esophageal speech, artificial larynx, or tracheoesophageal puncture (TEP).
  • Esophageal speech. Without a larynx, a person is no longer able to exhale air from the lungs through the mouth to speak. Using esophageal speech, the person inhales and traps the air in the throat, causing the esophagus to vibrate and create sound.
  • Artificial larynx. A mechanical instrument can be used that produces sound for some speech. These devices can be held against the neck or used by inserting a tube in the mouth.
  • Tracheoesophageal puncture. This is a popular method in restoring speech production. During surgery, a hole is made between the trachea and esophagus and a valve is inserted into the hole. The person breathes air into the lungs and then covers the hole in the throat. During exhalation, the esophagus vibrates and creates speech.

Stuttering

A person suffering from stuttering may employ distraction strategies to help him or her stop stuttering. Typically, a person stuttering becomes frustrated and embarrassed; subsequently, encouraging the person to think of something or do something else may break the stuttering cycle.

Prognosis

Amyotrophic lateral sclerosis (als)

ALS patients often die of respiratory failure within three to five years of being diagnosed, although some persons have been known to survive as many as 10 years or longer.

Aphasia

Persons with aphasia can improve and eventually function in more typical public settings, and possibly return to school or work.

Developmental apraxia of speech

With proper treatment, apraxia can be brought under control and the person will be able to function normally as an adult.

Laryngeal cancer

Full removal of the larynx removes the risk of a cancer relapse, although other parts of the throat and mouth can be affected.

Orofacial myofunctional disorders

A person can learn to control this disorder with proper treatment and maintain normal speech and breathing patterns.

Stuttering

With proper speech therapy, stuttering can be controlled or eliminated.

Prevention

Laryngeal cancer

Persons should not engage in smoking or drug abuse to decrease the risk of oral cancer.

Orofacial myofunctional disorders

In cases where the cause is evident, such as allergies or enlarged tonsils, a person should first remedy that problem; perhaps have the tonsils removed and treat allergies with medication.

Resources

Books

Paul, Rhea. Language Disorders from Infancy through Adolescence. 2nd ed. St. Louis: Mosby, Inc., 2001.

Organizations

American Speech-Language-Hearing Association. 1801 Rockville Pike, Rockville, MD 20852. (800) 638-8255. http://www.asha.org.

Key terms

Neurons — Nerve cells in the brain, brain stem, and spinal cord that connect the nervous system and the muscles.

Patient discussion about Speech Disorders

Q. I HAVE HAD TROUBLE WIT MY SPEECH, SINCE A KID, AND CANT FIND A JOB TROUBLE WITH MY SPEECH

A. How old are you now?
What are your interests?
Are you sure the problem getting a job is your speech and not the way to dress or present yourself?
What other jobs have you held in the past and what happened to them?
I can think of a few places I have run into people with speech problems, such as the cable man or a waitress at a local restaurant. Consider asking a speech therapist what kinds of jobs other people with your particular problem hold.

More discussions about Speech Disorders
References in periodicals archive ?
The relationship of bottle feeding and other sucking behaviors with speech disorder in Patagonian preschoolers.
For the objective measurement of the intelligibility of children with speech disorders, an automatic speech recognition system was applied, a word recognition system developed at the Chair for Pattern Recognition (Lehrstuhl fur Mustererkennung) of the University of Erlangen.
Until recently, the literature has focused on dysarthria, a speech disorder that affects about half of individuals with MS (Yorkston, Beukelman, Strand, & Bell, 1999).
Now Joe Pulizzi and Pam Kozelka are taking that passion for helping those with autism and speech disorders to a new level by founding The Orange Effect Foundation.
Dysfluencies; on speech disorders in modern literature.
After searching all available facilities, I was finally able to enrol him at the Abu Dhabi Centre for Language and Speech Disorders in October 2011," Rajalah, 37, a planning engineer from India, told Gulf News.
With further study, the neural pathway in primates from the brain to facial mechanics could help illuminate the neurological basis of speech disorders in humans, he said.
Speech-language pathologists and researchers from North America, Australia, South Africa, and the UK focus on children with functional or motor-based speech disorders from early childhood through early elementary school, describing 23 phonological and articulatory interventions, their efficacy, and how to select them, including direct speech production interventions, interventions in broader contexts, and those for achieving speech movements.
Preventing speech disorders following adenoidectomy by preoperative examination.
Acoustic measures of prelinguistic phrases should now be tested in other infants likely to develop speech disorders, such as those with autism, he adds.
Eighty-three percent (N = 10) of patients with speech disorders and 69% (N = 11) of those with facial disfigurement had impaired psychosocial status.
Deprived of this chemical, Parkinson's patients experience tremors, rigidity, uncontrolled muscle movement, speech disorders and a variety of other debilitating symptoms.