Speech Disorders - Specialists and Information

Speech disorders include speech motor disorders as well as fluency disorders (stuttering and cluttering).

Speech motor disorders can be further subdivided into:

• Dysarthria
• Dyslalia
• Dysglossia

Depending on the type of neurological damage, the following forms of dysarthria can be described:

• Hypotonic and hypertonic dysarthria: These result from muscle tone that is too low or too high. In hypotonic dysarthria, individuals speak indistinctly and tire quickly when speaking. This leads to spastic speech that is indistinct and produced with a hoarse, strained voice.
• Hypokinetic dysarthria: Those affected speak indistinctly and monotonously. The facial muscles appear immobile, and the volume fluctuates significantly. In some cases, involuntary muscle movements or sounds occur (grimacing, clicking sounds).
• Ataxic dysarthria: Speech is characterized by highly fluctuating volume and pitch. Articulation is uncoordinated and changes frequently during speech.
• Mixed dysarthria: Exhibits characteristics of several forms of dysarthria.
• Anarthria: This is the most severe form, in which those affected are largely or completely unable to speak.

The causes are varied and include:

• Congenital malformations (cleft lip and palate)
• Damage to central or peripheral nerves
• Hearing loss
• Tooth loss
• Lack of sensory perception in the oral cavity
• Psychological factors

In cases of speech fluency disorders, there is no problem with articulation. Instead, those affected have difficulty speaking fluently. Speech fluency disorders are particularly disruptive for conversation partners.

Characteristic features include:

• Frequent pauses and repetitions
• Stuttering, cluttering (speaking too quickly)
• Logophobia (fear of speaking)
• Bradylalia (slowed speech with pauses and drawn-out syllables)
• Mutism (silence without an organic cause, psychologically induced).

Children with speech disorders have problems with speech motor skills @ YURII MASLAK /AdobeStock

In addition to congenital factors or injuries to the lips, tongue, etc., speech disorders are usually caused by neurological conditions:

1. Certain brain disorders of unknown cause
2. Aftereffects of trauma
3. Stroke
4. Inflammation of the brain or meninges (encephalitis, meningitis)
5. Brain tumor
6. Huntington’s disease
7. Parkinson's disease
8. Multiple sclerosis
9. Amyotrophic lateral sclerosis

1. To determine the cause of a speech disorder, the doctor first conducts a detailed medical history interview.
2. This is followed by a neurological examination.
3. If appropriate, supplementary neuropsychological tests are used: If organic brain damage is suspected, imaging techniques such as EEG (electroencephalography), CT (computed tomography), or MRI (magnetic resonance imaging) provide additional insights.
4. If inflammation of the brain or meninges is suspected, a cerebrospinal fluid (CSF) analysis may be performed. In this procedure, the doctor withdraws fluid from the spinal canal, which experts then examine in the laboratory.

Treatment depends on the type of condition, the extent of the damage, and the patient’s individual needs:

• If there is a specific cause, the doctor focuses on eliminating the cause and treating the underlying condition. Both medication and surgical procedures are used for this purpose.
• However, most patients benefit from speech-language therapy. Through this therapy, they learn to become aware of body tension, breathing, voice production, and articulation. Speech and voice exercises, as well as training of the laryngeal muscles, round out the therapeutic program.
• If psychological factors are the cause of speech disorders, these can be addressed through a combination of psychotherapy and speech therapy.

To improve their ability to communicate, those affected can make use of certain assistive devices. These include mechanical or electronic communication aids that enable correct pronunciation or improved intelligibility. Examples of such devices include soft palate prostheses, electronic amplifiers, or portable electronic typewriters.

The first point of contact for people with speech disorders is a neurologist.

The course and prognosis for individuals with speech disorders depend on several factors:

• Mild speech disorders that are treated early by doctors can often be completely resolved.
• In cases involving underlying medical conditions and nerve damage, the focus is on preserving the ability to communicate, if necessary with technical assistance.

A speech disorder is either a disorder of speech motor function or a disorder of speech fluency. Early diagnosis is helpful in finding an appropriate treatment. The appropriate specialists to consult are neurologists.