Speech disorders

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.