1. Common disorders of Speech & Language Source: Dr K.K.PERUMAL Former Prof Madya - AIMST

2. What is speech? Sounds form the basis of words used for communication. (no sound – no speech) Spoken sounds are created through the coordination of the breath, lips and tongue. Speech is defined as “Articulation and Phonation of language sounds”

3. What is speech? Some sounds develop earlier than others. For example, in English, Children pronounce ‘M, P, B, T & D’ first before they pronounce ‘S, Th & R’ correctly.

4. Speech versus Language Language differs from speech. It is a code in which we learn to communicate ideas and express our wants and needs. Reading, writing, speaking and gesturing are all forms of language.

5. What is language? It is complex system of communication with rules for proper usage (grammar) Using gestures (body-language), tone (para-language) and words (verbal language) and involves comprehension, formulation and transmission of ideas in verbal or written mode.

6. What causes Speech and Language Disorders? Speech and language disorders may occur for various reasons including hearing loss, intellectual disabilities, brain injury, autism, Down syndrome, or other genetic or medical conditions.

7. Speech and Language Disorders The disorders may exist from birth or result from an illness, accident or disease. Speech and language disorders may occur together or separately and may vary in severity.

8. Speech and Language disorders Sometimes,the speech and language disorder is the primary problem; Sometimes it is secondary to other conditions, such as autism or cerebral palsy.

9. What are Types of Speech Disorders? Speech disorders involve –Articulation (pronunciation of sounds), –Fluency (stuttering) and/ or –Voice (rough, hoarse, nasal quality).

10. Types of speech disorders For example,Children with articulation disorders may only to pronounce early developing sounds like p,b and m. They may mispronounce later developing sounds like r, s and l.

11. What are Types of Language Disorders ? Language disorders may involve speaking, listening, reading or writing.

12. Indicators of Speech & Language Disorders in infants and pre-school children –not crying to express different needs, –not responding to the human voice, or –not smiling or making pleasure sounds by 3 months of age –not babbling, or imitating simple sounds by 6 months. Not imitating gestures, imitating vocal quality of adult speech. Not speaking a first-word by 1 year. Absence of any words by 18 months. Absence of two-word phrases that have message by 2 years.

13. Indicators of Speech & Language Disorders in infants and pre-school children Not using three-four word sentences by 3 years. Echoing of speech after 3 years. Unclear speech after 4 years. Under developed play skills at any age. Word –finding problems. Need for frequent repetitions of directions.

14. What are the common disorders of speech 1. Aphasia including Dysphasia, Anomia, and Paraphasia. 2. Dysarthria. 3. Dysphonia. 4. Aphonia. 5. Stammering or stuttering.

15. continued 6. Bradilalia. 7. Echolalia. 8. Palilalia.

16. Aphasia Deficiency in any of the language function is called Aphasia, –acquired secondary to brain damage. Aphasia is –loss of language (or defective language) –from damage to the speech centres –within the dominant cerebral hemispheres

17. Aphasia & Dysphasia Aphasia – loss of speech function –Sensory aphasia – loss of comprehension answers “what is your name?” with nonsensical babble –Motor aphasia – loss of speech production –Global aphasia – loss of both comprehension & speech production Dysphasia indicates partial loss of speech (sensory or motor)

19. Anomia = nominal aphasia Anomia is the patient’s inability to speak out the correct word Also called “nominal aphasia” A patient with anomia may not be able to name common objects like a coin, a key- chain, a pencil or a comb –(this is how we test it in the clinic)

20. Paraphasia When patients are asked to name objects, –in anomia no word will be produced –in paraphasia, a wrong word or a nonsense-word is produced. eg, a coin, when shown, is named as ‘metal’ or ‘shiny’ but not as a coin.

21. Where is the Lesion*? Global aphasia. –Indicates lesion in dominant hemisphere affecting both Wernicke’s and Broca’s areas. Sensory Wernicke’s aphasia.. –Lesion in Wernicke’s area (supramarginal gyrus of the parietal lobe and upper part of temporal lobe) Motor or Broca’s aphasia.. –Lesion in Broca’s area (inferior frontal gyrus). Nominal aphasia.. –Lesion in Angular gyrus. * Lesion = the site/area of Pathology

22. Dysarthria Dysarthria means disordered articulation- –slurred speech with intact language It is due to a disturbance in peripheral motor functions of speech.

23. Dysarthria Voice production requires coordination of breathing,vocal cords, larynx, palate, tongue, and lips. Dysarthria can therefore reflect disorders at different components: some examples: –Labial dysarthria (lips – ‘P, B, M’) –Lingual,,(tongue – ‘L, R’) –Palatal,,(Soft palate – ‘K, Ng’)

24. Dysarthria continued Commonly occurs due to mechanical factors such as ill-fitting dentures. Difficulty with articulation due to incoordination or weakness of the musculature of speech. Clinical testing: –Ask the patient to repeat “British constitution” or “Baby Hippopotamus”

25. Dysarthria continued Lesions of - –upper motor neuron type, –the extra pyramidal system( such as Parkinson’s disease) and –Cerebellar lesions –disturb the integration of processes of speech production and tend to disturb the rhythm of speech.

26. Types of Dysarthria Spastic; slurred, patient hardly opens the mouth, as if trying to speak from the back of the mouth. Extra pyramidal; Monotonus, without rhythm, sentences suddenly start and stop. Cerebellar; slurred as if drunk, disjointed rhythm sometimes with scanning speech (equal emphasis on each syllables)

27. Dysarthria continued Lesions of some of the cranial nerves (CN 7, 9 &10) produce characteristic distortion of certain parts of speech but the rhythm is normal –Cranial nerve 7 the muscles of face. –Cranial nerves 9 &10 voice (Nasal tone) –Cranial nerve 10 produces hoarseness of voice. –Cranial nerve 12 involves Tongue.

28. Dysphonia (disorder of phonation) This is a disturbance of voice production –due to a vocal cord pathology such as Laryngitis (common) or cancer (rare) –an abnormality of the nerve supply (Vagus) or –occasionally a psychological disturbance.

29. Aphonia and Dysphonia Lesion in the 9 &10 cranial nerves, leads to palatal paralysis which results in nasal tone. Aphonia is due to bilateral vocal cord paralysis.

30. Vocal cord palsy Phonation Normal Phonation in Bilateral VC palsy During Normal breathing

31. Dysphonia (hoarse voice)

32. Stammering or Stuttering This comprises an abrupt halt to the flow of speech together with repetitive utterance of sounds or syllables or of the initial consonants of words. This disorder usually arises in childhood and is more common in Boys. It is not associated with organic neurological disease

33. Bradilalia (slow-speech) Undue slowness of speech occurs in some patients with –depression, –Parkinsonism or –Myxoedema (hypo-thyroidism)

34. Echolalia (Echoing speech) It is a term used to describe the automatic repetition by the patient of the examiner’s utterances. This imitative repetition is a normal stage of development of language in childhood. When it occurs in adult it is the manifestation of widespread cortical disease.

35. Palilalia Patient here repeat the final parts of their own utterances –either the last sentence, –the last phrase or –even the last word may be repeated often at an increasing rate –“My dad was illiterate but it has not affected me…., affected me.., affected me, affected me/affected-me” It occurs in Cerebrovascular disease and in some forms of Parkinsonism.

36. Treatment Many of these types of disorders can be treated by speech therapy, but others require medical attention by a Doctor in phoniatrics. (the study and treatment of speech defects). Patients will be treated in teams, depending on the type of disorder they have. A team can include specialists, family Doctors, teachers and parents/family members.

37. Thank You all for listening! Watch the movie “The King’s speech” To learn more about stuttering and its treatment