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

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

Dysarthria is occasionally confused with aphasia. It is important to distinguish between a difficulty in pronunciation of words, as opposed to a problem with the production of language, as these have different causes.

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

DYSARTHRIA

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 (nervous system) disorders affecting the cerebellum, basal ganglia, or brainstem (all are important parts of the brain) can also cause dysarthria. Stroke that affects the brainstem or cerebellar regions can also cause dysarthria. Any facial weakness, such as Bell's palsy or tongue weakness, can cause dysarthria.

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.

DYSARTHRIA

• Poorly fitting dentures
• Alcohol intoxication
• Side effects of medications that act on the central nervous system
• Degenerative neurological disorders, such as Parkinson disease or Huntington disease (more common in dysarthria than aphasia)
• Stroke
• Transient ischemic attack (TIA)
• Head trauma
• Other dementias

APHASIA

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

For dysarthria, speaking slowly is encouraged, and the use of hand gestures, when necessary, is recommended. Family and friends need to provide plenty of 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 misunderstandings, 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.

• 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.

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 also present?

The physical examination will include a detailed evaluation of brain function.

Diagnostic tests that may be performed include the following:

• CT scan of the head
• MRI of the head
• EEG
• X-rays of the skull
• Blood tests
• Urine tests
• Lumbar puncture
• MR angiography
• Cerebral angiography

The health care provider may provide a referral to a speech pathologist, and in some cases, to a social worker.