LOSS, neurologic conditions that affect control of
the muscles of the face and throat, and brain
injury are additional factors that influence the
ability to speak, particularly in adults. STROKEis a
leading cause of speech disability in adults.
Symptoms of speech disorders range from the
obvious to the subtle and may include
- omitted sounds, in which certain consistent
sounds do not appear in speech, for example,
leaving the starting or ending consonants off
words - substituted sounds, in which one sound substi-
tutes for another, such as wfor r(wabbit) - distorted sounds, in which extra noises such as
whistling or whooshing accompany certain
words or letters - slurred, slow sounds, called dysarthria, which
represent an inability to coordinate the neuro-
logic and muscular functions necessary for
speech
Speech disorders may indicate disorders of
brain function; a comprehensive NEUROLOGIC EXAM-
INATIONhelps make this determination. Speech dif-
ficulties that suddenly arise suggest a physical
basis, such as injury to the brain (stroke) or dam-
age to the NERVEpathways between the brain and
the face. Speech disorders may also appear as a
component of learning disabilities and other
developmental factors. In children, the reasons for
speech disorders sometimes remain unclear,
though speech therapy often can eliminate the
symptoms.
The first goal of treatment is to remedy any
apparent physical causes such as cleft palate or
misaligned teeth. Other treatment targets
strengthening the muscles of the tongue and face
in conjunction with learning proper placement of
the tongue and lips during speech. This is the
venue of speech therapy, which provides instruc-
tion to help with forming the mouth positions and
movements necessary for articulation. The speech
therapist, also called speech-language pathologist,
may use video and audio recordings in combina-
tion with physical findings to assess the extent and
possible causes of speech disorders and to develop
methods to overcome the difficulties. With appro-
priate treatment, most people experience
improvement, and many people experience com-
plete restoration, of speech. Children may need
ongoing speech therapy as their facial features
continue to grow and change.
See also APHASIA; VOICE THERAPY.swallowing disorders Conditions that impair the
functions of the muscles and nerves of the THROAT,
interfering with the ability to swallow. The clinical
term for this impairment is dysphagia. Swallowing
disorders often exist with neuromuscular disorders
such as AMYOTROPHIC LATERAL SCLEROSIS (ALS) and
MUSCULAR DYSTROPHY, and as a consequence of
damage to portions of the BRAINresulting from
STROKEor TRAUMATIC BRAIN INJURY(TBI). Dysphagia
can affect any aspect of the swallowing process,
from chewing to entry of the swallowed material
into the STOMACH. Swallowing problems in young
infants may indicate structural anomalies. Swal-
lowing disorders are common among the elderly
and in people of any age who have significant
physical debility.
The symptoms of swallowing disorders may vary
in severity and sometimes with circumstances. For
example, dysphagia may manifest when the person
is very tired or eats certain foods though not be
apparent at other times. Symptoms may include- SIALORRHEA(drooling)
- extended chewing because the food will not
move to the back of the throat for swallowing - difficulty initiating swallowing
- inability to swallow certain kinds of substances
such as liquids - frequent choking
- weight loss (secondary to inability to consume
adequate calories)
- extended chewing because the food will not
The diagnostic path includes a careful health
history and complete physical examination. Swal-
lowing studies evaluate the coordination and con-
trol of muscles involved in moving food from the
MOUTHto the stomach. A BARIUM SWALLOWX-ray, in
which the person swallows a solution containing
barium that coats the ESOPHAGUS, or videofluo-
roscopy can show irregularities in the passageway
to the stomach. COMPUTED TOMOGRAPHY(CT) SCANorswallowing disorders 55