types of dysarthria from cerebral palsy

Dysarthria: Dysarthria is a motor speech disorder characterized by difficulty forming and expressing words that is the result of injury to or pathology of the nervous system. See detailed information below for a list of 179 causes of Dysarthria, Symptom Checker, including diseases and drug side effect causes.

Dysarthria

"Dysarthria Intro Causes Treatment Symptom Checker Misdiagnosis Deaths Glossary Dysarthria: Dysarthria: Introduction Causes (179 conditions)Symptom Checker Misdiagnosis Deaths Treatments Definitions Choose Doctor Comorbid Symptoms Classifications Dysarthria: Introduction

» Review Causes of Dysarthria: Causes | Symptom Checker »Causes of Dysarthria: The following medical conditions are some of the possible causes of Dysarthria.

There are likely to be other possible causes, so ask your doctor about your symptoms. Cerebral stroke ( see Stroke symptoms )Painful oral ulcers Brainstem infarct ( see Stroke symptoms )Cerebellar infarct ( see Brain symptoms )Multiple sclerosis Poliomyelitis Guillian-Barr Syndrome Myasthenia gravis Botulism Parkinsonism Diptheria Macroglossia Maturational delay Hearing loss Neurologic disorders Psychologic disorders Speech disorders Articulation disorders Phonology disorders Fluency disorders Voice disorders Phonation disorders Resonance disorders Alcoholic cerebellar degeneration Amyotrophic lateral sclerosis Basilar artery insufficiency Olivopontocerebellar degeneration Stroke Parkinson's disease Manganese poisoningmore causes...»See full list of 179 causes of Dysarthria» Review Causes of Dysarthria: Causes | Symptom Checker »Causes of Types of Dysarthria: Review causes of types of Dysarthria in more specific categories: Dysarthria in childrenmore types...»See full list of 1 types for Dysarthria Dysarthria: Symptom Checker Listed below are some combinations of symptoms associated with Dysarthria, as listed in our database.

Visit the Symptom Checker , to add and remove symptoms and research your condition. Symptom Checker Dysarthria: Symptom Checker Symptom Checker Dysarthria and Nerve symptoms (145 causes)Dysarthria and Communication symptoms (138 causes)Dysarthria and Speech symptoms (138 causes)Dysarthria and Muscle symptoms (137 causes)Dysarthria and Movement symptoms (136 causes)Dysarthria and Mouth symptoms (132 causes)Dysarthria and Slurred speech (131 causes)Dysarthria and Musculoskeletal symptoms (125 causes)Dysarthria and Head symptoms (109 causes)Dysarthria and Face symptoms (99 causes)Dysarthria and Coordination problems (85 causes)Dysarthria and Eye symptoms (84 causes)Dysarthria and Behavioral symptoms (69 causes)Dysarthria and Spasms (69 causes)Dysarthria and Walking symptoms (68 causes)Dysarthria and Ataxia (67 causes)Dysarthria and Cognitive impairment (65 causes)Dysarthria and Personality symptoms (62 causes)more...»See full list of 501 Symptom Checkers for Dysarthria Dysarthria Treatments Review further information on Dysarthria Treatments .

Dysarthria: Comorbid Symptoms Some of the comorbid or associated medical symptoms for Dysarthria may include these symptoms: Nerve symptoms Communication symptoms Speech symptoms Muscle symptoms Movement symptoms Mouth symptoms Slurred speechmore associated symptoms...»See all associated comorbid symptoms for Dysarthria Causes of General Symptom Types Research the causes of these more general types of symptom: Slurred speech (250 causes)Speech symptoms (1393 causes)Communication symptoms (1386 causes)Neurological symptoms (9575 causes)Mouth symptoms (6864 causes)Throat symptoms (3410 causes)Brain symptoms (2787 causes)Respiratory symptoms (5166 causes)Nerve symptoms (9132 causes)Breathing symptoms (3381 causes)Breath symptoms (3023 causes)Head symptoms (10192 causes)Face symptoms (8109 causes)more symptoms...»Causes of Similar Symptoms to Dysarthria Research the causes of these symptoms that are similar to, or related to, the symptom Dysarthria: Joint pain (773 causes)Joint symptoms (1430 causes)Stiff joints (258 causes)Stroke (192 causes)Painful mouth ulcers Poliomyelitis (5 causes)Myasthenia gravis Enlarged tongue (29 causes)Friedreich's ataxia Spinocerebellar ataxias Wilson's disease (2 causes)Wolfram's disease Brainstem tumormore symptoms...»Dysarthria: Deaths Read more about causes and Dysarthria deaths .

Causes of Dysarthria listed in Disease Database: Other medical conditions listed in the Disease Database as possible causes of Dysarthria as a symptom include: Botulism Cardiofaciocutaneous syndrome Central pontine myelinosis Cerebellar syndrome Cerebrovascular accident Charlevoix-Saguenay spastic ataxia Friedreich's ataxia Multiple system atrophy syndromes Neuroferritinopathy Noonan's syndrome Paraneoplastic limbic encephalitismore causes...»See full list of 179 causes of Dysarthria- (Source - Diseases Database)Definitions of Dysarthria: Imperfect speech articulation due to disturbances of muscular control.

- (Source - Diseases Database)Imperfect speech articulation due to disturbances of muscular control.

- (Source - CRISP)Organs affected by Dysarthria: The list of organs typically affected by Dysarthria may include, but is not limited to: Brain Tongue Detailed list of causes of Dysarthria The list below shows some of the causes of Dysarthria mentioned in various sources: Aceruloplasminemia - dysarthria Acquired brain injury Alcoholic cerebellar degeneration Alopecia -- hypogonadism -- extrapyramidal disorder - dysarthria Amyloidosis, oculoleptomeningeal - dysarthria Amyotrophic lateral sclerosis Amyotrophic lateral sclerosis 3 - dysarthria Amyotrophic lateral sclerosis 6 - dysarthriamore causes...»See full list of 179 causes of Dysarthria How Common are these Causes of Dysarthria?

This information refers to the general prevalence and incidence of these diseases, not to how likely they are to be the actual cause of Dysarthria.

Of the 179 causes of Dysarthria that we have listed, we have the following prevalence/incidence information:0 causes are ""very common"" diseases3 causes are ""common"" diseases3 causes are ""uncommon"" diseases2 causes are ""rare"" diseases8 causes are ""very rare"" diseases167 causes have no prevalence information.

See the analysis of the prevalence of 179 causes of Dysarthria Conditions listing medical symptoms: Dysarthria: The following list of conditions have ' Dysarthria ' or similar listed as a symptom in our database. This computer-generated list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.

Select from the following alphabetical view of conditions which include a symptom of Dysarthria or choose View All.

View All A B C D E F G H I K L M N O P R S T V WAAceruloplasminemia ... dysarthria Alopecia -- hypogonadism -- extrapyramidal disorder ... dysarthria Amyloidosis, oculoleptomeningeal ... dysarthria Amyotrophic lateral sclerosis 3 ... dysarthria Amyotrophic lateral sclerosis 6 ... dysarthria Amyotrophic lateral sclerosis 7 ... dysarthria Amyotrophic lateral sclerosis 8 ... dysarthria Anton-Vogt syndrome ... dysarthria Ataxia spastic congenital miosis ... dysarthria Ataxia, Hereditary, Autosomal Dominant ... dysarthria Ataxia, spastic with congenital miosis ... dysarthria Ataxia, spastic, 3, autosomal recessive ... dysarthria Ataxia-oculomotor apraxia syndrome ... dysarthria Autosomal recessive spastic paraplegia, type 11 ... dysarthria BBabinski-Nageotte syndrome ... dysarthria Bahemuka Brown syndrome ... dysarthria Basal ganglia calcification, idiopathic 1 ... dysarthria Basal ganglia disease, biotin-responsive ... dysarthria Basilar artery migraine ... dysarthria Brain conditions ... Dysarthria CCANOMAD syndrome ... dysarthria Cerebellar ataxia type 1, autosomal recessive ... dysarthria Cerebellar ataxia, autosomal recessive ... dysarthria Cerebellar ataxia, X-linked ... dysarthria Cerebellar degeneration, subacute ... dysarthria Chemical poisoning -- Acrylamide ... dysarthria Chemical poisoning -- Aldicarb ... dysarthria Chemical poisoning -- Aluminum ... dysarthria Choreoathetosis-spasticity, episodic ... dysarthria Congenital Disorders of Glycosylation ... dysarthria DDemyelinating disorder ... Dysarthria Dialysis encephalopathy syndrome ... dysarthria Dykes-Markes-Harper syndrome ... dysarthria Dystonia 12 ... dysarthria Dystonia with cerebellar atrophy ... dysarthria EElephant's-ear poisoning ... dysarthria Epilepsy with myoclonic-astatic crisis ... dysarthria Epilepsy, progressive myoclonic 3 ... dysarthria Episodic ataxia, type 2 ... dysarthria Episodic ataxia, type 5 ... dysarthria Erythrokeratodermia with ataxia ... dysarthria FFACWA syndrome ... dysarthria Fitzsimmons-Guilbert syndrome ... dysarthria FOSMN syndrome ... dysarthria GGangliosidosis GM1 type 3 ... dysarthria Gluten ataxia ... dysarthria HHallervorden-Spatz disease ... dysarthria Hallervorden-Spatz Syndrome ... Dysarthria Heidenhain syndrome ... dysarthria HERNS syndrome ... dysarthria Hydroxyacyl-coa dehydrogenase, type 2, deficiency ... dysarthria Hypomagnesemia primary ... dysarthria Hypomyelination -- congenital cataract ... dysarthria Hypomyelination -- hypogonadotropic hypogonadism -- hypodontia ... dysarthria Hypomyelination and congenital cataract ... dysarthria KKing Cobra poisoning ... dysarthria LLhermitte-Cornil-Quesnel syndrome ... dysarthria Lhermitte-Mc Alpine syndrome ... dysarthria MMarinesco-Sjogren syndrome ... Dysarthria Mental retardation, X-linked -- acromegaly -- hyperactivity ... dysarthria Mental retardation, X-linked -- dystonia -- dysarthria ... dysarthria Muscular dystrophy, Duchenne and Becker type ... dysarthria Myasthenic syndrome, congenital, associated with acetylcholine receptor deficiency ... dysarthria Myopathy and diabetes mellitus ... dysarthria NNeurosyphilis ... dysarthria OOculodentoosseous dysplasia dominant ... dysarthria Optic atrophy 2 ... dysarthria Orofaciodigital syndrome type I ... Dysarthria Orofaciodigital syndrome type1 ... dysarthria PPallidopyramidal syndrome ... dysarthria Paraneoplastic cerebellar degeneration ... dysarthria Pellagra-like syndrome ... dysarthria Progressive supranuclear palsy, atypical ... dysarthria SSensory ataxic neuropathy, dysarthria, and ophthalmoparesis ... dysarthria Sialuria, Finnish type ... dysarthria Spastic ataxia, Charlevoix-Saguenay type ... dysarthria Spastic paraplegia 11, autosomal recessive ... dysarthria Spastic paraplegia 15, autosomal recessive ... dysarthria Spastic paraplegia 2, X-linked ... dysarthria Spastic paraplegia 20, autosomal recessive ... dysarthria Spastic paraplegia 7, autosomal recessive ... dysarthria Spastic paraplegia type 5A, recessive ... dysarthria Spastic paraplegia with precocious puberty ... dysarthria Spinocerebellar ataxia -- dysmorphism ... dysarthria Spinocerebellar ataxia 10 ... dysarthria Spinocerebellar ataxia 11 ... dysarthria Spinocerebellar ataxia 12 ... dysarthria Spinocerebellar ataxia 13 ... dysarthria Spinocerebellar ataxia 14 ... dysarthria Spinocerebellar ataxia 15 ... dysarthria Spinocerebellar ataxia 16 ... dysarthria Spinocerebellar ataxia 17 ... dysarthria Spinocerebellar ataxia 18 ... dysarthria Spinocerebellar ataxia 22 ... dysarthria Spinocerebellar ataxia 26 ... dysarthria Spinocerebellar ataxia 27 ... dysarthria Spinocerebellar ataxia 28 ... dysarthria Spinocerebellar ataxia 29 ... dysarthria Spinocerebellar ataxia 3 ... dysarthria Spinocerebellar ataxia 8 ... dysarthria Spinocerebellar ataxia with axonal neuropathy, type 2 ... dysarthria Spinocerebellar ataxia, autosomal recessive 1 ... dysarthria Spinocerebellar ataxia, autosomal recessive 2 ... dysarthria Spinocerebellar ataxia, autosomal recessive 4 ... dysarthria Spinocerebellar ataxia, autosomal recessive 7 ... dysarthria Spinocerebellar ataxia, autosomal recessive, with axonal neuropathy ... dysarthria Spinocerebellar ataxia, Machado-Joseph type I ... dysarthria Spinocerebellar ataxia, Machado-Joseph type II ... dysarthria Spinocerebellar ataxia, Machado-Joseph type III ... dysarthria Spinocerebellar ataxia, Machado-Joseph type IV ... dysarthria Spinocerebellar ataxia, Machado-Joseph type V ... dysarthria Spinocerebellar ataxia, X-linked, 5 ... dysarthria Spondyloepimetaphyseal dysplasia, X linked with mental deterioration ... dysarthria TTremor hereditary essential, 1 ... dysarthria Tremor hereditary essential, 2 ... dysarthria Trihydroxycholestanoylcoa oxidase isolated deficiency ... dysarthria WWilson's Disease ... Dysarthria Wolfram's disease ... Dysarthria Conditions listing medical complications: Dysarthria: The following list of medical conditions have Dysarthria or similar listed as a medical complication in our database.

The distinction between a symptom and complication is not always clear, and conditions mentioning this symptom as a complication may also be relevant. This computer-generated list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.

IInborn errors of thyroid hormone synthesis related to hypothyroidism ... dysarthria Join in at the forums Ask or answer a question about symptoms or diseases at one of our free interactive user forums. I cannot get a diagnosis. Please help. What is the best treatment for this? Medical story forums: If you have a medical story then we want to hear it.

Tell us your medical story. Share your misdiagnosis story. See a list of all the medical forums Causes of Dysarthria Based on Risk Factors This information shows analysis of the list of causes of Dysarthria based on whether certain risk factors apply to the patient: Travel - has the patient travelled recently?

Diabetes - history of diabetes or family history of diabetes? Doctors and specialists: Who should I consult about Dysarthria? Depending on the seriousness of the onset of Dysarthria, you may want to consult one of the following medical professionals.

Important: In extreme cases, always seek advice from emergency services : General practitioner Emergency physician Neurologistmore specialists...»What are the alternative names for Dysarthria: Anarthria- (Source - Diseases Database)Classifications of Dysarthria: Medical Conditions associated with Dysarthria: Slurred speech (250 causes), Speech symptoms (1393 causes), Communication symptoms (1386 causes), Neurological symptoms (9575 causes), Mouth symptoms (6864 causes), Throat symptoms (3410 causes), Brain symptoms (2787 causes), Respiratory symptoms (5166 causes), Nerve symptoms (9132 causes), Breathing symptoms (3381 causes), Breath symptoms (3023 causes), Head symptoms (10192 causes), Face symptoms (8109 causes)Symptoms related to Dysarthria: Joint pain (773 causes), Joint symptoms (1430 causes), Stiff joints (258 causes), Stroke (192 causes), Painful mouth ulcers, Poliomyelitis (5 causes), Myasthenia gravis, Enlarged tongue (29 causes), Friedreich's ataxia, Spinocerebellar ataxias, Wilson's disease (2 causes), Wolfram's disease, Brainstem tumor Medical articles on signs and symptoms: Doctor-patient articles related to symptoms and diagnosis: What to tell your doctor about your symptoms What questions will the doctor ask about your symptoms (and why)? What does your doctor do in a physical examination? What questions should you ask the doctor about a symptom or diagnosis? What questions to ask the doctor about the treatment Steps to take to get the most out of a doctor visit More articles on symptoms and diagnosis These general medical articles may be of interest: Medical Symptom Books Symptoms of the Silent Killer Diseases Online Diagnosis Self Diagnosis Pitfalls Pitfalls of Online Diagnosis See full list of premium articles on symptoms and diagnosis More Ways To Research Medical Signs and Symptoms: Symptom Center - over 12,000 symptoms listed Symptom List Symptom Descriptions All Symptoms Diseases Center - find symptom lists for over 20,000 diseases. Books on Medical Diagnosis» Next page: Causes of Dysarthria Medical Tools & Articles: Tools & Services: Bookmark this page Symptom Search Symptom Checker Medical Dictionary Medical Articles: Disease & Treatments Search Misdiagnosis Center Full list of interesting articles Forums & Message Boards Ask or answer a question at the Boards: I cannot get a diagnosis. Please help. Tell us your medical story. Share your misdiagnosis story. What is the best treatment for my condition? See all the Boards. "

Dysarthria Changes in muscle tone may accompany dysarthria. The movements of the soft palate, lips, tongue and jaw may be impaired not only during speech, but also in the context of vegetative functions. As such, changes may affect the oral and pharyngeal stages of the swallow, dysarthria and dysphagia often co-occur.

"Chapter 15. Dysarthria vs. Apraxia: A Comparison Etiology Dysarthria Dysarthric errors result from a disruption of muscular control due to lesions of either the central or peripheral nervous systems. In this way, the transmission of messages controlling the motor movements for speech is interrupted.

Because it involves problems with the transfer of information from the nervous system to the muscles, dysarthria is classified as a neuromotor disorder. Central Nervous System Lesions Damage to the pyramidal tract causes spastic dysarthria. Lesions of the substantia nigra cause hypokinetic dysarthria.

Disruption of feedback loops involving the cerebellum cause ataxic dysarthria. Peripheral Nervous System Lesions Finally, damage to any part of the peripheral nervous system serving the muscles of speech causes flaccid dysarthria. Apraxia Apraxia results from an impaired ability to generate the motor programs for speech movements rather than from the disordered transmission of controlling messages to the speech musculature.

Apraxia is a planning/programming problem, not a movement problem like dysarthria. Apraxia occurs following damage to Broca's Area, or Brodmann's area 44, which is located on the third gyrus of the left frontal lobe.

Thus, apraxia is always the result of a central nervous system lesion. It is a cortical problem, not a motor impulse transmission problem like dysarthria.

Type Of Errors Dysarthria In dysarthria, errors are consistent and predictable. There are no islands of clear speech; no matter what the speaking task or materials used, the patient will exhibit the same amount and types of errors. Errors are mainly distortions and omissions. Distortions are the most common type of error in dysarthria. Apraxia In apraxia, errors are inconsistent and unpredictable. Different error patterns occur in spontaneous speech versus repetition. Patients' spontaneous speech contains fewer errors than does his/her speech in repetition tasks. There are islands of clear speech; when producing over-learned material or material that has become automatic, the patient will speak clearly.

Substitutions are the most common type of error, with others normally being approximations of the targeted phoneme. Other types of errors found in apraxic speech, listed from most to least common, include: Repetitions Additions Transpositions Prolongations Omissions Distortions Errors are often perseveratory or anticipatory in nature. As in stuttering, the anticipation of errors causes dysfluent speech. The speech of apraxics is full of groping, trial and error types of articulatory movements.

This is probably related to the anticipation of errors. Speech Sounds Affected Dysarthria Consonants are consistently imprecise, with the production of final and initial consonants being equally impaired.

Vowels are not affected as much although, due to problems with tongue movement, they may sound too much alike. Apraxia For an apraxic, vowels are easier to produce than consonants. Single consonants are easier than blends.

As in stuttering, final consonants are easier than those in the initial position. This may occur because initial consonants are affected by anticipatory errors. Also, perhaps once an apraxic gets speech started with the production of a vowel, production continues in a more automatic fashion.

Fricative and affricates are the most difficult phonemes for apraxics to produce. (These sounds require very complex articulatory movements. )Aspects Of Speech Affected Dysarthria All aspects of speech, including articulation, phonation, resonance, prosody, rate and respiration, may be affected by dysarthria. Dysphagia frequently accompanies dysarthria. Apraxia Apraxia is mainly a disorder of articulation. Some prosodic problems may occur as a result of the hesitations caused by the apraxic speaker's anticipation of errors. However, problems with voice, resonance, etc., are not symptomatic of this disorder. Related Problems

Diadochokinesis will be slow. However, it will be normal within the limitations of the neuromuscular disorder; the patient may distort or omit phonemes but syllables will be produced in the correct order. Apraxia As lesions of Broca's area do not cause changes in muscle tone, apraxia may occur without such symptoms.

Therefore, apraxia of speech may occur without concomitant swallowing problems. The movement of the velum, lips, tongue and jaw will only be impaired during speech. Of course, a stroke may damage Broca's area and motor tracts or other areas involved in swallowing simultaneously.

In such a case, dysphagia and apraxia would be seen in the same patient. Diadochokinesis will be slow and abnormal; syllables may be produced out of order. Effects Of Utterance Complexity Dysarthria Utterance complexity does not directly affect the degree of imprecision present in a dysarthric patient's speech.

Such a patient will produce single syllable and multi-syllabic words with approximately the same amount of distortion. Apraxia Increases in utterance complexity cause increases in the complexity of apraxic symptoms. For example, it is much easier for a patient with apraxia to produce single syllable versus multisyllable words and sentences.

Effects Of Speech Rate Dysarthria As the rate of a dysarthric's speech increases, the intelligibility of that person's speech will decrease proportionally. In order to improve iltelligibility, the dysarthric must learn to slow rate by articulating complex words syllable by syllable.

Apraxia As the rate of an apraxic's speech increases, the intelligibility of that person's speech may actually increase probably to the same overlearned response as with automatic speech-days of the weeks etc.. Noting the effect of increased rate on speech intelligibility may be one way to help differentiate between dysarthria and apraxia.

Therapy Dysarthria For many clinicians therapy for dysarthria is strictly compensatory. If motor pathways are damaged, they cannot be repaired. The dysarthric patient must learn to use techniques that increase the intelligibility of his/her speech. Apraxia Although some recommend compensatory techniques most apraxics benefit more from therapy that focuses on retraining more than on compensation. Melodic Intonation Therapy (Sparks and Holland, 1976) is one technique that is frequently used with apraxic patients.

It is believed that, through the use of melody and rhythm, this method stimulates the creation of more neuronal connections in the right hemisphere. This may allow the ""potential Broca's area"" located in the right hemisphere to begin generating motor programs that control speech production. Duffy (1995) describes the type of patient for whom MIT might help best. "

The key point is that dysarthria is a symptom, and diagnosis of the cause is essential. It may be due to a disorder of the brain (such as following a stroke) or nerve supply to the muscles of speech, which involve the face, the tongue, or the muscles of the throat. There are several types of dysarthria.

ASK THE DOCTOR: Should I worry about my sister's slurred speech?

ASK THE DOCTOR: Should I worry about my sister's slurred speech? By Martin Scurr for the Daily Mail Published: 19:43 EDT, 31 March 2014 | Updated: 19:43 EDT, 31 March 20144View comments For the past two years my 71-year-old sister has been slurring her speech. After some persuasion I finally managed to get her to go to her doctor who arranged an MRI scan, which he said was clear.

There are no other signs of a stroke. She hasn't asked for a second opinion or what could be causing the slurred speech and seems happy to let this be.

The only medication I know that she is on is for blood pressure and cholesterol. I would very much appreciate your comments.

Valerie Merino, Manchester.+4People with dysarthria usually slur their speech but they may also speak very slowly or sound hoarse, or nasal The symptoms you describe are characteristic of dysarthria, the loss of the ability to control the mouth and throat to articulate speech. Those affected have no problem understanding - their difficulty is solely in the clear formation of words. This is very different from aphasia and dysphasia, an impaired understanding or problems in expressing words, caused by a problem in the language centres of the brain.

People with dysarthria usually slur their speech and sound as though they are drunk, but they may also speak very slowly, or sound hoarse, or nasal. RELATED ARTICLESPrevious 1 2 Next The ballooning cost of weight-loss ops: One in five need... Fingers fractured by undoing bras.

Blood clots from making... Pelvic pain that can last years after childbirth: Pregnant... Share this article In some cases there may be problems in controlling saliva, or difficulty in chewing or swallowing.

With cerebellar dysarthria, the patient speaks deliberately and slowly, with normal flow being lost.+4Diagnosing dysarthria is the job for a neurologist In pseudobulbar dysarthria, individual syllables are slurred and consonants are imprecise; there may also be problems in swallowing, and it is therefore doubtful that your sister has this type. In bulbar dysarthria, the disorder results from some form of damage or disease involving the nerve supply to the muscles of speech, with slurring of words and sometimes nasal escape of fluids when swallowing.

Diagnosing dysarthria is the job for a neurologist: the MRI (magnetic resonance imaging) that was organised proved useful in that it excluded a stroke as the cause, and will almost certainly have excluded multiple sclerosis. Nor is your sister's current medication - the blood pressure pill and statin to reduce cholesterol - implicated.

What she needs is a detailed clinical examination looking at all aspects of the nervous system by a specialist in neurology and possibly further investigations. It is heartening that despite a two-year history, the problem does not seem to be getting worse, and that there aren't other symptoms.

Hopefully, you will be able to persuade your sister to press her GP practice to refer her for a further opinion - although if she is happy to let the problem be, then I do acknowledge that she should be allowed her autonomy.

Until I was 60, my pulse was 61 beats per minute; but since then it has dropped to 50, and 46 at its lowest - I am now 67. Three years ago, when it dropped to the low 50s, I saw my GP and was referred to a consultant whose advice was that I should go back if starting to feel faint and dizzy.

This seems sensible advice, but I can't get rid of the feeling of being a clockwork toy that is gradually running down. Do you have a key? Under these circumstances, is exercise inadvisable? I am otherwise fit. Ron Warrington, Bransgore, Hants.

Be reassured: you have been well advised so far. The reason I can be so confident about this is that you are symptom free.+4Most healthy people have a heart rate between 60 and 100 beats per minute Most healthy people have a heart rate between 60 and 100 beats per minute; when the rate is below 60, we refer to it as bradycardia.

This is not necessarily a sign of poor health, or heart disease - indeed it's normal in around 25 per cent of people under the age of 25 when at rest and in trained athletes (being super fit helps slow down the heart rate).

It can also occur in some older individuals such as yourself. Bradycardia, as your experience illustrates, doesn't usually cause symptoms. And if and when symptoms do occur, they may be minimal - perhaps nothing other than fatigue: there may also be sensations such as dizziness, faintness or lightheadedness.

If you do start feeling unable to exert yourself or exercise, or experience these other symptoms, you must be further investigated. This will involve a careful history supplemented by ambulant ECG (electrocardiography) monitoring, where you wear a device that records your heart's electrical activity for 24 hours, or longer, so the timing of symptoms can be compared with the recordings.

Should treatment be recommended, patients have a pacemaker implanted just below the collar bone. This is designed to monitor the heartbeat and if it detects a problem, it sends an electrical signal to the heart to stimulate it.

Powered by an internal battery that has a life of several years, the pacemaker is about the size of a 50p coin and weighs an ounce or two, with various types available.

It is connected to heart muscle by flexible wires. Once it's installed, the patient doesn't notice it and life goes on as normal - it is the most well-refined and effective technology. But in your current state, no treatment is needed. Exercise and enjoy life with confidence - you are in no danger.

By the way... Sore throat? You need a swab Doctors must take more care about prescribing antibiotics.

So says Professor Dame Sally Davies, chief medical officer for England, who has accused GPs of fuelling the spread of resistant bacteria by prescribing antibiotics unnecessarily. Antibiotic resistance means that these vital drugs are no longer effective against some infections. The problem is so dire that last year Dame Sally warned that, unless we take action, we will see a return to a time where infections kill us even after routine operations.

The nub of the issue is that antibiotics are being prescribed unnecessarily for everyday respiratory illnesses - colds, sore throats, coughs - when they are most often caused by viruses, which do not respond to antibiotics.+4What is needed to avoid a tragedy is for patients with throat infections to be given a throat swab Antibiotics only work for bacterial infections. The difficulty is: how do we distinguish between bacterial and viral conditions? Last week this issue was highlighted by Sara Lewis, an assistant coroner, who called for better guidelines in recognising bacterial throat infections following the death of Oliver Hiscutt, a two-year-old from Wilmslow, Cheshire.

The little boy had only been treated with paracetamol for his throat infection: a terrible bereavement for his parents who had contacted NHS Direct for advice, and then taken him to see his GP three days later.

The infection had caused tonsillitis which progressed to a quinsy (an abscess deep in the tonsils), which led to a fatal haemorrhage.

The assistant coroner called for mandatory paediatric training for GPs and made recommendations to the Department of Health. Surely, what is needed to avoid another such tragedy and to help ensure antibiotics are prescribed with accuracy, is for patients with throat infections to be given a throat swab.

This is mainstream technology. GPs carry out microbiology studies in the case of bladder and kidney infections so that the specific bacteria causing these can be identified and therefore the correct antibiotics chosen, so where is the problem? The difficulty, as I see it, in the case of respiratory illness is that patients must be seen, the result of the swab must be checked (it is returned in about 48 hours) and a responsible professional must contact the patient or parent and advise the necessary action.

None of that can be achieved by NHS Direct or its successor. It requires quick access to a GP or practice nurse and takes time, trouble, and the cost of a lab test.

Dr Maureen Baker, president of the Royal College of GPs, has advised that GP services are at breaking point, but what I am proposing is basic, routine care, nothing fancy. It needs no guidelines, no new recommendations, just diligence - and adherence to what we were all taught at medical school.

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Is everyone in Britain on drugs? Or what?36Click to rate Amy, aber, United Kingdom, 4 years agowouldn't get an appointment in the first place with my doctor.sore throat is 'not an emergency' and those manning the phones have the last say.

I now book to see the nurse who then get's me in to see doctor. shouldn't have to do it this way but it's better than possible outcome.216Click to rate Hec, BARNSLEY, United Kingdom, 4 years ago But maybe that SHOULD be the way forward with emergency surgeries being held by nurses (maybe 3 or 4) with a doctor on duty so that those who need referring can be.

I know nurses aren't doctors BUT if the nurses have to have x amount or experience post qualification in hospital nursing cover medical, surgical and children's ward I suspect that overall, though mistakes will still happen, there would be less mistakes than there are now.012Click to rateacechadwick, Liverpool, United Kingdom, 4 years ago This doctor is awesome.

That's all!06Click to rate The views expressed in the contents above are those of our users and do not necessarily reflect the views of Mail Online.

We are no longer accepting comments on this article. More top stories Site Web Advertisement Like Daily Mail+1Daily Mail Follow@Daily Mail Follow Daily Mail Follow@Mail Online Follow Daily Mail DON'T MISSPICTURED: Strip club worker who 'kissed and spent hotel weekend with Tristan Thompson days before Khloe Kardashian gives birth' as NEW video emerges S Club 7's Rachel Stevens stuns fans with her 'ageless' appearance as she documents her 40th birthday bash on Instagram Kourtney Kardashian looks incredible in tiny black string bikini as she joins sister stunning Kim on the beach in Turks And Caicos Geordie Shore's Marnie Simpson shows off her derriere in a multi-coloured playsuit in Ayia Napa... after admitting she was two-stone heavier Kate Hudson cradles her bump in first outing since pregnancy reveal as she flashes diamond on ring finger Announced pregnancy in last week Tristan Thompson 'cheats' on Khloe Kardashian: NBA star's ex Jordan Craig breaks her silence to plead for peace Shares a son with star Did Tristan Thompson cheat on Khloe Kardashian?

Fans go wild on Twitter with memes as video surfaces of NBA star 'kissing another woman'EXC: Where's Khloe?

Tristan Thompson caught on video locking lips with brunette at NY club just days before Khloe Kardashian is set to give birth Steven Gerrard and Jamie Carragher are slammed as their model daughters Lilly-Ella, 14, and Mia, 13, promote dieting in girls as young as eight Brooklyn Beckham fires back at Chloe Moretz in 'f*** you' socks after she hints at cheating ex following THAT kiss with Lexi Wood Bradley Walsh sends fans wild as he raps word perfect rendition of Drake's God's Plan... leading to calls for him to be 'KNIGHTED immediately'Advertisement Justin Bieber makes an awkward fashion faux pas as he steps out in socks and sliders for Adam Sandler's comedy show Fashion faux pas Amber Heard mocks dog smuggling scandal with ex Johnny Depp as she takes pooch to Syrian refugee camp She famously had to apologise Danielle Lloyd proudly displays her golden bikini body in coral two-piece on holiday in Puerto Banus Gave birth just seven months ago Busy Philipps flatters amazing figure in exquisite velvet suit as she enjoys lavish cocktail soirée American TV star was acting up Serena Williams shares stunning portrait with baby daughter Alexis Olympia as the child turns seven months old Brad Pitt is 'absolutely smitten by' MIT professor Neri Oxman as 'their chemistry is off the charts' First major relationship since Angelina split BBC drama Versailles 'is AXED as viewers switch off over constant sex scenes' Ratings fell drastically during the second season Eva Longoria 'breaks her waters' on Pauly D during funny pregnancy game on Ellen... and reveals she 'hasn't done anything' to prepare for her baby Elle Macpherson, 54, sends fans into a frenzy as she shares her secret breakfast recipe for 'magical' chocolate and avocado mousse Looks half her age James Stunt parades 'new blonde girlfriend' on night out at lavish dinner amid claims he has 'ended whirlwind engagement to Samantha Rowley'Advertisement Paul Bettany admits he proposed to Jennifer Connolly TWICE... and diary clashes made him miss out on The Crown On Lorraine with Elizabeth Olsen Lisa Hammond leaving East Enders after four years... with her final scenes as Donna Yates being aired this summer Leaving her long-term role Georgia Toffolo and George Lineker fuel romance rumours as they leave party together... after cosy pair are seen cuddling up inside bash Making a splash!

BBC presenter falls into the POOL during live interview - sending English Commonwealth Games swimmers into hysterics Vicky Pattison reveals why she's no longer friends with former Geordie Shore co-star Charlotte Crosby James Jordan fears he 'could be firing blanks' as he worries about trying for a baby later in life with wife Ola Former Strictly Come Dancing pro Robert De Niro cuts a relaxed figure with his unkempt beard as he takes a stroll around New York City The Oscar winner, 74, sported cosy knitwear Former East Enders star Charlie Brooks discusses her 'love' for ex Tony Truman... and reveals daughter Kiki, 13, is following in her acting footsteps'This is far more amazing than I would have dreamed': Ruby Rose expresses appreciation for her life in the wake of split from Jess Origliasso Amber Rose leaves little to the imagination as she grinds with shirtless hunks in raunchy new photo-shoot Raunchy campaign Advertisement Sofia Richie keeps casual in slouchy co-ord and shades as she heads for coffee with Scott Disick lookalike pal in LABrooklyn Beckham breaks his silence on Chloe Moretz split... after THAT kiss with Playboy model Lexi Wood Orlando Bloom exhibits his torso as he goes shirtless for Malibu beach day with beloved dog Mighty Orlando, 41, soaked up the sun on the beach'My heart is broken for you sis': Amber Rose reaches out to rival Khloe Kardashian via Instagram amidst Tristan cheating scandal Sienna Miller displays make-up free complexion as she steps out in casual outfit in NYC Worlds away from her red carpet glamour Kim Kardashian and sister Kourtney sport tiny bikinis in Turks and Caicos for National Sibling Day The sisters are currently on a beach getaway Olympic champion boxer Nicola Adams is left heartbroken after her female fiancée leaves her for a man Two-time Olympic gold medal winner Amy Schumer was persuaded to get married by Adele... but singer PULLED OUT of officiating her wedding to partner Chris Fischer at the last minute James Stunt shows off his billionaire status as he hands doorman a huge wad of cash at lavish dinner with female pal Paris Jackson cuddles late dad Michael in edited family snap... but fans slam Photoshop as 'creepy' Shared a fan edit of her late musician father Strictly Come Dancing: Former pro Gleb Savchenko says 'tired' show needs same-sex couples and SLAMS Brendan Cole axe Russian dancer Danniella Westbrook is ARRESTED over witness intimidation and malicious communications... amid claims she stole £10,000 from a former friend Radio 1's Nick Grimshaw and Greg James will keep their FULL salary in major shake-up... despite having their Friday shows axed Ellen Pompeo - the highest earning TV drama actress - reveals secret of $575,000 per episode of Grey's Anatomy pay and how YOU can get a pay rise Anna Faris says her son Jack is 'surrounded by love' after split with ex Chris Pratt on Ellen She called it quits with estranged husband Chris Pratt in August Advertisement Britain's Got Talent: Declan Donnelly will host the live shows ALONE as Ant Mc Partlin 'steps down from TV for now'Kylie Jenner flaunts her TINY waist after giving birth just two months ago Kylie seems to have already lost her pregnancy weight Kourtney Kardashian's beau Younes Bendjima spotted hugging Leo Di Caprio's girlfriend after night out After family holiday in Turks & Caicos Brad Pitt attends LA Dodgers game against Moneyball team Oakland Athletics after new romance reports He's 'absolutely smitten' with Neri Oxman'It's never nice seeing an ex move on': Charlotte Crosby explains why she broke down in tears when she saw ex Gaz Beadle's baby announcement Luann de Lesseps flaunts her fabulous figure in skimpy white bikini after shedding eight pounds Lost weight during her stint in rehab Heir we go!

Prince William punches the air as he cheers on Aston Villa and snaps a selfie with a player - leaving the heavily pregnant Duchess at home Olivia Culpo wows in skimpy lingerie and VERY racy black mesh dress for Italian fashion show in Verona She's been throwing herself into work PICTURE EXCLUSIVE: TOWIE 's Shelby Tribble flashes her cleavage in a hot pink crop top as she joins Chloe Lewis and pals for gruelling workout Blac Chyna follows Lani Blair on Instagram... the woman Tristan Thompson 'spent night with' She has a daughter with Khloe's brother Advertisement Blac Chyna designs dream home with sex room, money vault and helipad for Architectural Digest Selma Blair goes makeup free as she displays her slender pins in boho-inspired sundress in LA Anger Management star showcased off-duty style'I tried to tell myself he was on a business trip and he'd be back': UFC Champion Ronda Rousey, 31, opens up about her father's suicide when she was 8The ONLY arm candy to be seen with this season!

Beyoncé, Kylie Jenner and achingly cool bloggers go wild for 'ultra luxe' Dutch buggy brand Diver Tom Daley's movie director husband Dustin Black is wrongly accused of SHOPLIFTING and searched by security in Australia Laverne Cox, 45, FINALLY goes public with photo of hunky boyfriend after meeting on Tinder 9 months ago'It's respectful to do your research': Matty Samaei hits back at RHONY's Bethenny Frankel for not knowing who her Australian counterparts are Melanie Sykes, 47, flaunts her envy-inducing figure and washboard abs as she slips into skintight blue gym wear for sizzling snap Stacey Solomon posts make-up free selfie as she reveals she's come to terms with her adult acne Promoted body confidence in new post Blac Chyna's teen boyfriend YBN Almighty Jay proposes to her on Instagram YBN Almighty Jay established himself as an emerging talent Advertisement Emily Ratajkowski shows off hint of svelte torso in floral print crop top on Jimmy Fallon's show She is currently promoting her new film Lauren Goodger lashes out at 'negativity in the world' as she staunchly defends spending £100 on three days worth of food Heavily criticised Poppy Delevingne dazzles in ornate heart-print gown as she steps out at Genius: Picasso screening Dazzled as she stepped out Real Housewives Of Beverly Hills: Lisa Rinna and Erika Girardi wear lingerie and latex in Berlin Chose to wear lingerie and latex Bella Hadid flashes cleavage in sheer bandeau top paired with black suit at Dior event in Tokyo She's been busy making promotional appearances TOWIE's Yazmin Oukhellou steps out with a sombre Courtney Green... after THOSE explosive spats with beaus James Lock and Myles Barnett Cardi B talks pregnancy and meeting Beyonce and Jay-Z during TRL takeover in Times Square Cardi B hosted a special episode Snooki cuts effortlessly chic figure in flowing black jumpsuit as she grabs lunch with Deena Cortese Jersey Shore stars David Beckham has his hair washed by daughter Harper in sweet video as she also turns stylist to mum Victoria Russell Crowe gives a warning about hacking into his old Nokia as the radio show is forced to return the phone after finding it in the $34,000 car at his auction Advertisement SEBASTIAN SHAKESPEARE: The night Delia Smith left Her Majesty's chef with a LOT on his plate Blanca Blanco flaunts her toned booty in skimpy 'Mermaid' swimsuit for Malibu shoot Left little to the imagination Rita Ora puts on a VERY busty display in tight white sweater as she heads out in New York She's been putting on a fashion parade That's hair-raising!

Russell Crowe shares bizarre social media profile picture of his beard on Twitter following his 'Art Of Divorce' auction Eva Longoria dresses up baby bump in clingy grey dress ahead of appearance on Jimmy Kimmel Expected to welcome her first child in June Demi Lovato takes the plunge as the new face of CORE Hydration campaign Demi proved on point as she showcased her bountiful curves Kendall Jenner and Scott Disick go skydiving together outside Los Angeles The adventurous pair traveled to Perry to jump out of a plane Jennifer Lopez and Alex Rodriguez are simpatico in matching white athletic tops in Miami Toured a new gym facility Coco Austin rocks red and white outfit as she joins Ice-T and baby Chanel for Nordstrom NYC opening Coco, 39, chose a stylish ensemble Nicki Minaj flashes cleavage in jaw-dropping black leather ensemble at Los Angeles Lakers game Grammy-nominated beauty looked racy Advertisement SEBASTIAN SHAKESPEARE: So Paxo, did you pay £275 for that snip?

University Challenge host spotted leaving trendy hair salon Kourtney Kardashian flaunts her figure in crop top and track bottoms in LA after tropical holiday Cindy Crawford channels Grecian chic in flowing navy dress and sandals for Beverly Hills shoe event Joined by her celebrity friends Kendra Wilkinson enjoys glass of wine with other reality stars amid amicable split from Hank Baskett Was all smiles'He has a girlfriend': Real Housewives star Bethenny Frankel reveals Meghan Markle's ex-husband Trevor Engelson is in a new relationship Priyanka Chopra lost acting role due to her skin color as producers 'wanted someone who's not brown' 'It affected me,' the 35-year-old told In Style Commonwealth Games athletes boast on Tinder they 'can go all night' and are looking for 'wild troopers' to 'have some fun with' while competing Down Under From boxing to surfing and trail runs, how changing her attitude towards exercise has made Victoria's Secret model Bridget Malcolm fitter than ever Vicky Pattison cuts a stylish figure as she leaves KIIS FM's Sydney studios... as she reveals the REAL reason she no longer talks to Charlotte Crosby Caitlyn Jenner shows some leg in denim shorts while dining at Nobu with Sophia Hutchins Advertisement Paris Hilton rocks a cat hoodie as she takes her dog Diamond Baby to the salon in Beverly Hills She is, unequivocally and eternally, a dog person Hilary Duff enjoys a casual dinner date with boyfriend Matthew Koma in NYC Strolled arm-in-arm down the streets of NYC after dinner Katharine Mc Phee makes Broadway debut in Waitress and is all smiles at first night curtain call The pretty singer beamed with pride Heidi Klum, 44, stuns in skimpy bikini as she packs on the PDA with toyboy beau, 28, in Mexico They've been all over each other Sobbing mums, tearful teachers... are today's schools THAT tough?

CHRISTOPHER STEVENS reviews last night's TVGentlemen, start your engines! Bachelor In Paradise reject Florence Alexandra, 28, rides a scooter in Bali wearing a racy Victoria's Secret swimsuit =Abby Lee Miller 'sent to emergency room after leaving her halfway house in ambulance'Jaime King returns for first time to site of Beverly Hills attack and hugs restaurant worker who helped She was closely flanked by her bodyguard Lottie Moss cuts a chic figure in a white bandeau and black blazer as she joins Georgia Toffolo and Tallia Storm at Bluebird launch party Tallia Storm turns heads in flared denim skirt and navy slogan t-shirt at glitzy Bluebird launch party The reality star continued to work her magic Advertisement Olivia Attwood PICTURE EXCLUSIVE: Star unveils '23' tattoo tribute to footballer ex Bradley Dack's shirt number... after split from Chris Hughes Danielle Lloyd PICTURE EXCLUSIVE: Star parades her incredible post-baby figure in a skimpy white bikini as she soaks up the sun in Marbella Kirsten Dunst covers baby bump in chic black maternity dress as she steps out for lunch date Sheree Whitfield 'FIRED from Real Housewives of Atlanta'... a decade after first appearing on series Yolanda Hadid legally changes her name a year after finalizing divorce from David Foster She was formerly Yolanda Hadid Foster Amy Childs is pregnant: Ex TOWIE star reveals blossoming baby bump in glam Instagram snap She surprised her fans on Sunday Yvonne Staples of the Staple Singers dies at age 80 in Chicago The Chicago funeral home says she passed away Tuesday.

Amal Clooney on romancing George and raising twins: Lawyer reveals actor wooed her with emails in the voice of his dog when she'd given up on love at 35Roseanne is called a 'selfish old woman' amid clash with daughter Becky over surrogacy arrangement Tyra Banks reveals she almost didn't become a Victoria's Secret Angel after brand sent her home from her first day Advertisement Justin Bieber is unmissable in all red outfit as he runs errands in Los Angeles He's making regular appearances out in LAPrince of Wilts!

Charles, 69, suffers in the scorching 89F Australian heat as beads of sweat trickle down his face Janelle Monáe dances around in VAGINA pants and shows off fake pubic hair in provocative new music video that 'celebrates self love and sexuality'Real Housewives Of Cheshire EXCLUSIVE: Interior designer Dawn Ward opens doors to her lavish home after transforming bleak call centre into manor Taylor Swift fan ARRESTED for trying to scale wall at her Beverly Hills mansion On Sunday transient Justin Christoph Lilly was arrested Kendall Jenner models braids and razor-thin sunglasses for Ferrari joyride in LA Chose a casual and sporty look for sunny day out The Handmaid's Tale star Samira Wiley reveals season 2 will be 'even more bleak' than the first Arrow star Katie Cassidy turned down the chance to date Prince Harry because she didn't want to be known as his 'girl'Roseanne cast then and now: see how the stars have changed since their school days Classic shots of the ensemble have been unearthed Russell Crowe looks a little downcast as he drinks coffee and smokes a cigarette in Sydney the day after his divorce from Danielle Spencer was finalised Advertisement Christina El Moussa looks fabulous in skinny jeans and gray tee filming Flip Or Flop with ex Tarek The TV personality, 34, has stayed friends Ali Fedotowsky dresses her growing baby bump in springtime florals at Hallmark's Home & Family Hailey Baldwin says Kylie Jenner's daughter Stormi 'is one of the most beautiful babies I've ever seen'Courteney Cox leaves LA venue hand-in-hand with unidentified man who is not Johnny Mc Daid Went out with best pal Jennifer Aniston Kylie Minogue dazzles in a floor-length pink and gold gown as she promotes new album Golden in Germany Demi Rose looks on the verge of a wardrobe malfunction as she models plunging dress on 'date' Used to date Kylie Jenner's rapper ex Tyga Nicole 'Snooki' Polizzi reveals Jersey Shore cast only earned $200 a week for first season In 2009, the 'gorillas and guidettes' got paid through sales positions Jeffrey Dean Morgan sports massive beard: is it a Walking Dead Season Nine spoiler?

Actor is currently promoting his new movie, Rampage Twerking, touch-ups and teeny bikinis! Ashley Graham puts her curves on show in candid behind-the-scenes look at her Sports Illustrated Swimsuit shoot Irish couple on Don't Tell The Bride reveal double heartache of losing two babies shortly after birth - but viewers are left baffled as the groom plans their wedding in IKEAAdvertisement Patsy Palmer admits she home schools children Fenton, 17, and Emilia, 16, and doesn't care if they go to college Raising aspiring models Pregnant Zara Tindall cuts a sombre figure as she joins her mother Princess Anne for the funeral of equestrian sport commentator Mike Tucker Break out the fat-suit: Ripped Damian Lewis will play obese, crack-smoking former Toronto Mayor Rob Ford in new movie Britain's Got Talent: Fans are puzzled by Alesha Dixon's missing heels in glam promo photos for new series Hollyoaks SPOILER: Ste KISSES ex lover Harry after confronting Ryan over Amy's death Katie Holmes seems to be following in ex Tom Cruise's footsteps as she takes on action role Dad's night off!

Prince William is spotted at Aston Villa v Cardiff City match in Birmingham - leaving a heavily pregnant Duchess of Cambridge at home Jenna Dewan leans on her family for support and 'seems relieved' after splitting with Channing Tatum Ant Mc Partlin's estranged wife Lisa Armstrong 'likes' cryptic post about a reunion after marriage split Cryptic message about a romantic reunion TOWIE's Amber Turner hints Dan Edgar has 'broken her' in cryptic post... as Clelia Theodorou slams her for 'bedding star while they were an item'Advertisement Cardi B is 'prepared' for motherhood... but admits she only 'kinda, sorta' considered abortion Chris Pine and Annabelle Wallis pictured together for the first time at swanky dinner in Malibu amid romance rumours Chris Martin's ex Mollie King and Maya Jama score new shows on BBC Radio 1 with major presenter shake-up amid gender gap scandal Love Island's Kady Mc Dermott flaunts her peachy posterior in thong bikini as she soaks up the sun in Thailand Candice Swanepoel puts naked baby bump on display as she announces she's six months along Model looked healthy and fit in the image Cindy Crawford and mini-me daughter Kaia Gerber coordinate in b&w outfits in Beverly Hills Marie Osmond, 58, proves Hollywood friendships DO last as she poses with pal Priscilla Presley, 72Kim Kardashian shows off her curves in microscopic hot pink bikini during Turks and Caicos vacation Keeping Up With The Kardashian star Anna Faris calls decision to get breast augmentation 'f***ing awesome' as she talks Chris Pratt 'I wanted to fill out a bikini,' she says Adriana Lima leaves the gym with sweat-drenched hair as she flaunts her flat abs in sexy sports bra Dorit Kemsley, 41, of RHOBH looks absolutely unrecognizable in 1994 high school yearbook photo EXCLUSIVE: Is Oscar winner Leonardo Di Caprio's Scottish stepdad the coolest and most connected man in Hollywood?

High-flying'If they hear you, they hunt you!' Movie fans vent frustration with Emily Blunt's movie A Quiet Place, revealing that the totally silent film makes it impossible for them to eat popcorn in peace Jennifer Garner pays tribute to her sisters on National Siblings Day Katharine Mc Phee looks flawless as she arrives makeup-free for Broadway debut in Waitress Amy Schumer shares stunning flashback photo from 2010... after revealing she loves carbs Paddy Mc Guinness splurges on £160,000 Ferrari California as he cruises through streets of Manchester'I'm an emotional wreck!' Twitter users are left 'heartbroken' over Netflix movie Irreplaceable You, labeling it 'the saddest film EVER made' - so can YOU watch it without weeping?

Nicki Minaj's seductive pose for new song Chun Li resembles Lil' Kim's Hard Core image Claudia Schiffer, 47, looks chic in leopard print scarf and skinny jeans as she steps out with her daughters in NYCTaylor Swift fan robs bank and throws cash onto her Rhode Island home in hopes of impressing star Carrie Underwood says her face 'is healing really nicely' after getting 50 stitches She got 40 to 50 stitches on her face after suffering from a 'hard fall'Wendy Williams says Marlon Wayans was just 'stating the obvious' about Kim Zolciak's 'fillers'Geordie Shore's Marnie Simpson goes braless in Ayia Napa with boyfriend Casey Johnson... after revealing her two stone weight gain Tracy Morgan sports dapper grey suit as he accepts Hollywood Walk of Fame star with his family Rio Ferdinand shares cheeky snap as he and 'little beauty' girlfriend Kate Wright are buried in the sand by his 'little rat' children in Dubai Hilarious holiday photo Katie Price 'to run London Marathon dressed as a giant LUNG to support her mother Amy's terminal illness' She loves dressing up Gretchen Rossi stuns in gold bandage dress as she joins Real Housewives stars in West Hollywood Ne Ne Leakes steps out in Gucci T-shirt as pal EJ Johnson looks chic in crop top and mini skirt Paulina Porizkova shares adorable picture of herself as a little girl to mark her 53rd birthday - after posting a SIZZLING snap of herself in a tiny pink bikini Ricky Martin regrets not coming out in 'horrible' US TV interview with Barbara Walters from 2000 'Diane Kruger is comfortably chic in fuzzy teddy bear coat and personalized Christian Dior handbag Jennifer Lopez's trainer Tracy Anderson, 43, reveals fit abs as she says singer 'never hates on herself'Emily Blunt nearly missed the chance to work with husband in his horror film A Quiet Place Emily Ratajkowski lets her chest do the talking as she leaves talk show in NYC Showing her style sense Chloe Ferry spent £50,000 on plastic surgery as she looks worlds away from Geordie Shore debut Confessed she loves injections and fillers Brad Pitt and MIT genius Neri Oxman pose together in previously-unseen snap as SIX MONTH relationship is revealed Has he moved on?

Chloe Moretz and Brooklyn Beckham split: Actress emerges for the first time since THAT kiss... and her friendship ring is OFF After THAT kiss Celebrating his inner child!

Lego artist transforms You Tuber Jake Paul's sprawling mansion by installing thousands of the toy bricks INSIDE the walls The Grand Tour: Jeremy Clarkson films exciting scenes for season three of Amazon show in the Scottish Highlands Casey Batchelor shows her baby bump in a bikini as she lauds her pregnancy 'cellulite and big bum' She's due to give birth in less than two months Jessica Simpson lifts the lid on her sex life with Eric Johnson as she jokes they 'always practice' making babies Made a joke about their sex life Princess Diana's bridesmaid India Hicks reveals she's STILL got her flower crown from the wedding day in 1981 - and says it 'brings back memories'Dancing With The Stars professionals Emma Slater and Sasha Farber enjoy their honeymoon in Mexico Showing off their stunning bodies Emily Van Camp displays her endless legs in elegant shift as she promotes new show The Resident in London The 31-year-old actress looked stunning Advertisement Today's headlines Most Read Cancer victim, 22, DIES months after having an abortion to boost her chances of survival Noel Gallagher’s daughter Anaïs reveals her battle with psoriasis as she shares a VERY candid gym selfie... People who have suffered just one mild concussion are more at risk of dementia, new research suggests Ever wondered why you had that meal?

New study reveals why we eat certain foods throughout the day Chronic ovarian cysts increase a woman's risk of mental health issues - and of having children with ADHD and... Why you REALLY shouldn't sweat the small stuff: People who fret over minor things for more than a day have a...'Treatments make us happy': Surgeon SLAMS writer for telling women to stop 'sewing their a** to their face'... Could these headphones clean your ears better than a Q-tip?

Start-up unveils wearable device that washes out... Storage tank company says human error caused fertility tank failure - NOT their equipment Eye-bleeding outbreak rages on in Illinois: A third man dead and 37 more hospitalized with horrific side...

The divided states of America: Major health study warns US is at breaking point as the wealthy coasts thrive... Cereal brands are launching MORE sugary breakfasts to fight drop in sales despite health fads hijacking... Parents who exercise may boost the intelligence of future generations, study finds Could astronauts conceive in space?

Nasa sends human SPERM to the ISS for the first time to find out if sex... Cheese, pizza and lasagne protect MEN from brittle bones as they age - but not women MORE HEADLINESMORE DON'T MISSTOWIE's Chloe Sims flaunts her INCREDIBLY pert derriere in skintight leggings following Brazilian bum lift surgery Ribbed khaki leggings Amy Schumer admits she eats carbs 'almost every single night' after romantic honeymoon to Milan Emmy Rossum shows off her tanned legs in a darling white shirtdress on shopping trip with husband Popped in and out of boutique shops Human Ken Doll introduces Jessica Alves: 'Gender fluid' Rodrigo dons skimpy red lingerie and a black wig as he dresses up as a woman Gwen Stefani announces Las Vegas residency and thinks about marrying Blake Shelton 'all the time' Kicks off June 27 at Planet Hollywood Stanley Johnson hilariously reveals he thought presenters Ant and Dec were ONE PERSON called 'Anton Dec' Tickled viewers The Apprentice's Jessica Cunningham shows off her baby bump as the pregnant star poses in a monochrome bikini Pregnancy physique'Real Housewives of New Jersey' star says she and her autistic son were kicked out of a public library because he was 'tapping DVDs and making noise'Mel B signs deal to pen 'explosive and moving' tell-all-book about her marriage to ex-husband Stephen Belafonte following divorce Barack Obama WON'T be going to Prince Harry and Meghan Markle's wedding next month nor will Donald Trump or Theresa May as none of them are invited British singer forced to have her cervix REMOVED after cancer diagnosis says she's 'so angry' she let embarrassment stop her from having a smear British label Ralph & Russo that was behind Meghan Markle's stunning engagement gown unveils its FIRST ready-to-wear collection (but prices start at £995)Tamara Beckwith, 47, shows off age-defying figure in VERY small bikini as she sizzles on Miami Beach The English socialite, 47, looked red hot Hollyoaks SPOILER: Sienna confronts her stalker, Ryan is out of prison and Peri is homeless in new spring trailer Explosive new trailer Paul Hollywood's 22-year-old girlfriend: Eamonn Holmes, 58, admits his daughter would 'disown him' if he started dating a much younger woman The proof Meghan visits a psychic like Diana did?

Make-up artist publicly thanks royal bride-to-be for recommending a 'truly gifted intuitive'Emily Ratajkowski poses TOPLESS in her latest provocative selfie after stepping out in NYC The model was up to her old tricks Lauren Goodger admits she'll 'always care' for ex Joey Morrison and reveals she wants 'to get pregnant this year' Would like to find love Olivia Buckland slammed for homophobic slur: Love Island star criticised for 'ignorant and upsetting' comment on Alex Bowen's shirtless snap Novak Djokovic shares a kiss with wife Jelena as Serbian tennis ace takes a break from training in Marbella The Serbian tennis player, 30, was smitten Brooklyn Beckham's new girlfriend Lexi Wood compares herself to sex toys in raunchy unearthed interview Woman who has won Brooklyn's heart Sofia Vergara's ex-fiance Nick Loeb compares his embryo battle with the star to slavery Locked in a bitter lawsuit with his ex since 2015Brandi Glanville runs into former RHOBH co-stars Lisa Rinna and Erika Jayne at Craig's They've always been on friendly terms during the show Kimberley Walsh's lookalike sister Amy discusses harrowing Emmerdale plot... but fans are fuming with British Soap Award snub Noel Gallagher's daughter Anaïs reveals her battle with psoriasis as she shares a VERY candid gym selfie showing the marks on her skin Mummy Diaries EXCLUSIVE: Nelly dozes off during Maldives dinner... after throwing HUGE tantrum and expertly taking snaps of mum Billie Peter Andre's wife Emily Mac Donagh blocks his LA dream: Singer 'wants to pursue more acting in the US... but she doesn't want to up sticks with the kids'TOWIE's Gemma Collins and James 'Arg' Argent seen together for the first time after rekindling romance following explosive bust-up Camila Cabello rocks black lace costume to kick off first solo tour Never Be The Same in Vancouver Songstress rocked a unique lace costume Britain's Got Talent's Stephen Mulhern tells Ant and Dec to 'LUMP IT', climbs into bed with Amanda and Alesha and snubs boss Simon Cowell in new trailer Simon Cowell gushes over son Eric as David Walliams SLAMS star for losing touch with 'reality' How his life has positively changed Gigi Hadid hides her figure wearing sweatshirt and jeans as she heads to a photo shoot in New York The 22-year-old stunner sported a heavy sweater Bisexual TV presenter Anna Richardson reveals men are EASIER to date because they're 'simple' - and admits she's 'locked horns' with girlfriend Sue Eagle-eyed royal fans spot a hilarious £25 commemorative plate that features a picture of ED SHEERAN instead of Prince Harry (but seller insists it's a joke)Seth Meyers reveals wife Alexi Ashe gave birth to second son in their lobby Comedian revealed at the start of his talk show on Monday Caroline Flack and Andrew Brady back together: Couple step out holding hands in London following shock split Reunited very soon Lorraine Kelly sells her sprawling seven bedroom Dundee mansion for £845k... four months after putting the home on market for £20k less Brad Pitt takes up woodwork to heal broken heart: Actor has immersed himself in furniture design following split from Angelina Jolie Who is Neri Oxman?

The MIT professor that stole Brad Pitt's heart after Angelina Jolie split Who is the woman who finally helped Brad Pitt get over his ex Angelina Victoria's Secret model Barbara Palvin 'constantly at war with her body trying to adhere to fashion industry's criteria' Body insecurities Emily Ratajkowski says she is glad 'all sizes' are now accepted... even though she's only 119lbs 'Beauty as defined by the fashion industry'Rachel Mc Adams, 39, 'gives birth to a baby boy' with boyfriend after keeping pregnancy private Rachel has given birth to her first child Letizia looks elegant as she and King Felipe perform their first engagement as a couple following the Queen's 'tense' exchange with her mother-in-law Spain's King Juan Carlos is all smiles as he leaves hospital following a knee op - after the royal family's awkward encounter was caught on camera Harry and Meghan's engagement photographer reveals the couple were 'so deliciously in love' - and insists no effort was needed to capture it Eva Longoria looks ready to pop on TV's Ellen but still has weeks to go before birth of first child Dressed in a figure-hugging red dress Game Of Thrones star Sophie Turner's SECRET Instagram account revealed... which has already racked up 22,000 followers Paloma Faith shimmers in sequinned dress as she enjoys time out in Sydney during Australia tour Impossible to miss in Sydney Heidi Pratt cradles her baby son Gunner as she enjoys a hike in Santa Monica... after revealing she's got her pre-baby body back Cooing over her son Royal bride practice!

Meghan takes the lead at cutting the cake on her primary school graduation day aged just 11 Harry's bride to be Bad Girls Club reality TV star Nicky Vargas is arrested while topless for giving oral sex to her boyfriend in the parking lot of a Florida apartment complex TOWIE newbie Clelia Theodorou slams Amber Turner for 'bedding Dan Edgar while they were an item' 22nd series is dominated by their love triangle Eamonn Holmes forced to WALK OFF Good Morning Britain set after huge coughing fit on air... before Ruth Langsford does the same on This Morning Mark Wright exhibits his chiselled abs as he wipes away sweat during football match in Los Angeles Making the most of the California sunshine EXCLUSIVE: Obama aide reveals how the groupie president fawned over celebs and was steamed when a high school coach called his wife 'fat-butt'Jess Impiazzi parades her cleavage and envy-inducing abs in a skimpy floral bikini in Marbella Seen taking a well-deserved break from TVScott Disick, 34, takes girlfriend Sofia Richie, 19, for a romantic meal... as bikini-clad ex Kourtney Kardashian sizzles on holiday Enjoying a late date British Soap Awards 2018 longlist announced: TV stars battle it out as nominees revealed A whole host of stars across are nominated'He makes my heart happy!'

Dog with two legs leaves This Morning viewers smitten as it whizzes around the in studio on WHEELSKeira won't be happy!

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With dysarthria, the person has ongoing difficulty expressing certain sounds or words. They have poorly pronounced speech (such as slurring) and the rhythm or speed of speech is changed. Usually, a nerve or brain disorder has made it difficult to control the tongue, lips, larynx, or vocal cords, which make speech. Dysarthria, which is difficulty pronouncing words, is sometimes confused with aphasia, which is difficulty producing language. They have different causes.

Speech Impairment (Adult)

Search Health 3,000+ Topics Send Feedback Health > Times Health Guide > s > Speech Impairment (Adult)Speech Impairment (Adult)Overview Alternative Names Considerations Causes Home Care References Illustrations Brain Speech and language impairment may be any of several problems that make it difficult to communicate.

Reference from A. D. A. M. Back to Top Alternative Names Language impairment; Impairment of speech; Inability to speak; Aphasia; Dysarthria; Slurred speech; Dysphonia voice disorders Back to Top Considerations Common speech and language disorders include: APHASIAAphasia is loss of the ability to understand or express spoken or written language.

It commonly occurs following strokes or traumatic brain injuries. It can also occur 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. There are many different types of aphasia. In some cases of aphasia, the problem eventually corrects itself, but in others the condition does not get better. DYSARTHRIA

People with dysarthria may also have problems swallowing. VOICE DISTURBANCESAnything that changes the shape of the vocal cords or the way they work will cause a voice disturbance. Lump-like growths such as nodules, polyps, cysts, papillomas, granulomas, and cancers can be to blame.

These changes cause the voice to sound different from the way it normally sounds. Back to Top Causes Some of these disorders develop gradually, but anyone can develop a speech and language impairment suddenly, usually in a trauma.

APHASIAAlzheimer disease Brain tumor (more common in aphasia than dysarthria)Dementia Head trauma Stroke Transient ischemic attack (TIA)DYSARTHRIAAlcohol intoxication Dementia Diseases that affect nerves and muscles (neuromuscular diseases), such as amyotrophic lateral sclerosis (ALS or Lou Gehrig disease), cerebral palsy, myasthenia gravis, or multiple sclerosis (MS)Facial trauma Facial weakness, such as Bell's palsy or tongue weakness Head trauma Head and neck cancer surgery Nervous system (neurological) disorders that affect the brain, such as Parkinson disease or Huntington disease (more common in dysarthria than aphasia)Poorly fitting dentures Side effects of medications that act on the central nervous system, such as narcotics, phenytoin, or carbamazepine Stroke Transient ischemic attack (TIA)VOICE DISTURBANCESGrowths or nodules on the vocal cords People who use their voice heavily (teachers, coaches, vocal performers) are more likely to develop voice disorders.

Back to Top Home Care For dysarthria, speaking slowly and using hand gestures may help. Family and friends need to provide plenty of time for those with the disorder to express themselves. Stop the use of medications that are causing the problem, if possible. Minimize the use of alcohol.

Because patients with dysarthria may be able to express themselves with written words, typing on an electronic device or using pen and paper will help with communication. For aphasia, family members may need to provide frequent orientation reminders, such as the day of the week. Disorientation and confusion often occur with aphasia. Often, people assume that patients with aphasia are incompetent.

But patients and caregivers can sometimes learn nonverbal ways of communicating. Recognizing and treating depression is also important for people with severe speech and language disorders.

It's important to maintain a relaxed, calm environment and keep external stimuli to a minimum. Speak in a normal tone of voice (this condition is not a hearing or emotional problem). Use simple phrases to avoid misunderstandings. Don't assume that the affected person understands. Provide communication aids, if possible, depending on the person and condition. Frustration, profanity, and depression are typical responses in people with aphasia.

Back to Top References Kirshner HS. Language and speech disorders. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chaps 12A and 12B. More Information on This Topic Review Date: 5/28/2014 Reviewed By: Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by Veri Med Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, Ph D, and the A. D. A. M. Editorial team.

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ms. Slurred Speech What is slurred speech? Slurred speech, aka dysarthria, is a speech impediment characterized by mumbling, poor pronunciation and lack of control in speed and/or rhythm when a person talks. Slurring speech can hinder your children from communicating properly, as it makes it difficult for them to be understood. If your child shows signs of drooling along with slurring speech, he or she could be suffering from a serious illness or medical condition. Early diagnosis is key to finding the root of this problem and determining treatment. About Dysarthria

How to Help Your Child Overcome Slurred Speech Problems

In Parenting, Parents How to Help Your Child Overcome Slurred Speech Problems Modified : March 19,2017Verbal speech is one of the most important means of communication for your children as it enables them to express their thoughts and feelings on any given subject.

As your children grow, they will become more adept in communicating their needs. By the time your child is 4 years old, he or she should be speaking clearly enough to be understood. But what if you child starts with Slurred Speech? If your child is having difficulties speaking by the age of 4, he or she may be suffering from a speech impediment.

Having your child tested by a language specialist makes it easier to identify the problem. The sooner a speech and/or hearing difficulty is diagnosed, the sooner your child can start treatment to improve his or her communications skills. Early treatment can often help correct or improve many speech proble

Children who have dysarthria do not have full control over the facial muscles used to produce proper speech.

Poor muscle control causes difficulty in pronouncing words, forming sentences, regulating the speed and rhythm of your speech as well as controlling your volume.

In some cases, children have a hard time speaking above a whisper. What causes slurred speech? Children can develop this condition as a result of: Childhood stroke Brain injury Medical conditions or birth defects that produce muscle disorders Problems with mouth, jaw or tongue Anxiety In order to develop proper speech, a child’s brain, mouth, larynx and tongue need to function normally. Any damage in these areas will have an adverse effect on a child’s ability to speak.

Brain injuries, strokes, injury to mouth, jaw or tongue and muscular disorders are common causes of slurred speech as they impede proper speech development. Medical conditions such as muscular dystrophy, cerebral palsy and myasthenia gravis which weaken muscle control are also possible slurred speech causes.

Certain voice disorders may also be considered speech disorders. One of the most commonly experienced speech disorders is stuttering. Other speech disorders include apraxia and dysarthria. Apraxia is a motor speech disorder caused by damage to the parts of the brain related to speaking. Dysarthria is a motor speech disorder in which the muscles of the mouth, face, or respiratory system may become weak or have difficulty moving.

Speech Disorders

Speech Disorders Causes Symptoms Diagnosis Treatment Complications Outlook What are speech disorders? Speech disorders can affect the way a person creates sounds to form words.

Some people with speech disorders are aware of what they would like to say but unable to articulate their thoughts. This may lead to self-esteem issues and the development of depression. Speech disorders can affect adults and children. Early treatment can correct these conditions. Causes What causes speech disorders? Speech disorders affect the vocal cords, muscles, nerves, and other structures within the throat.

Causes may include:vocal cord damagebrain damagemuscle weaknessrespiratory weaknessstrokespolyps or nodules on the vocal cordsvocal cord paralysis People who have certain medical or developmental conditions may also have speech disorders. Common conditions that can lead to speech disorders are:autismattention deficit hyperactivity disorder (ADHD)strokesoral cancerlaryngeal cancer Huntington’s diseasedementiaamyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease Speech disorders may be hereditary, and they can develop over time.

Symptoms What are the symptoms of a speech disorder? Depending on the cause of the speech disorder, several symptoms may be present.

Common symptoms experienced by people with speech disorders are:repeating sounds, which is most often seen in people who stutteradding extra sounds and wordselongating wordsmaking jerky movements while talking, usually involving the headblinking several times while talkingvisible frustration when trying to communicatetaking frequent pauses when talkingdistorting sounds when talkinghoarseness, or speaking with a raspy or gravelly sounding voice Diagnosis How are speech disorders diagnosed?

Many tests are available to diagnose speech disorders. Denver articulation screening exam The Denver articulation screening examination (DASE) is a commonly used testing system to diagnose articulation disorders.

This test evaluates the clarity in pronunciation in children between the ages of 2 and 7. This five-minute test uses various exercises to assess the child’s speech. Early language milestones scale 2This test, created by neurodevelopmental pediatrician James Coplan, determines a child’s language development.

This test can quickly identify delayed speech or language disorders. Peabody picture vocabulary test, revised This test measures a person’s vocabulary and ability to speak. The person will listen to various words and choose pictures that describe the words. People who have severe intellectual disabilities and those who are blind won’t able to take this assessment.

The Peabody picture vocabulary test has been revised many times since its first version was administered in 1959. Treatment How are speech disorders treated? Mild speech disorders may not require any treatment. Some speech disorders may simply go away. Others can improve with speech therapy. Treatment varies and depends on the type of disorder. In speech therapy, a professional therapist will guide you through exercises that work to strengthen the muscles in your face and throat.

You’ll learn to control your breathing while speaking. Muscle-strengthening exercises and controlled breathing help improve the way your words sound.

You’ll also learn ways to practice smoother, more fluent speech. Some people with speech disorders experience nervousness, embarrassment, or depression. Talk therapy may be helpful in these situations. A therapist will discuss ways to cope with the condition and ways to improve the outlook of your condition.

If your depression is severe, antidepressant medications can help. Complications What are the potential complications of speech disorders? Untreated speech disorders may cause a person to experience a great deal of anxiety. Over time, this anxiety can trigger anxiety disorders or a phobia of speaking in public. Early treatment for anxiety can help prevent the development of anxiety disorders or phobias. Treatment options include talk therapy and antianxiety medications. Outlook What is the long-term outlook? The outlook improves for people who seek early treatment. Early treatment helps prevent a speech disorder from worsening. The outlook for those with permanent disabilities depends upon the severity of the disability.

ia definition: speech disorder due to the dysfunctional motor execution resulting in incoordinated,weak, and slow articulatory movements. -impaired movement of the muscles used for speech production -lips, tongue, vocal folds, and/or diaphragm -type and severity of dysarthria depends on which area of the nervous system is affected

Motor speech disorders (Apraxia, Dysarthria, AAC)

"51 terms Yvette1991Motor speech disorders (Apraxia, Dysarthria, AAC)Learn Flashcards Write Spell Test Match Gravity Advertisement Upgrade to remove ads Like this study set? Create a free account to save it. Create a free account Maybe later Sort Motor speech disorders -what they are?

Difficulty with properly planning and/or executing motor movements for speech Motor planning: processes that define and sequence articulatory goals -prior to initiation of movement Motor programming: processes that establish and prepare the flow of motor info across muscle, as well as control timing and force of movement -prior to initiation of movement Motor execution processes that activate relevant muscles -during and after initiation of movement Motor planning/programming disorder inability to group and sequence the relevant muscle with respect to each other -apraxia of speech (AOS)-acquired and developmental Motor execution disorders deficits in physiology and movement abilities of muscles -dysarthria= acquired and developmental Apraxia of speech definition: speech disorder due to dysfunctional motor planning and programming.

- the messages from the brain to the mouth are disrupted (e.g. the person cannot move his or her lips or tongue to the right place to say sounds correctly, even though the muscles are not weak.)

-severity of apraxia depends on the nature of the brain damage -apraxia can occur in conjunction with dysarthria or aphasia -children can also have apraxia Signs of apraxia of speech -difficulty coordinating the muscle movements necessary to say all the sounds in the words -often say something completely different or make up words (""bipem"" or chicken for ""kitchen"") -quite frustrating for the person Signs of apraxia of speech -individuals with apraxia may demonstrate: -difficulty imitating and producing speech sounds marked by speech errors such as sound distortions, substitutions and or omissions.

-inconsistent speech errors -groping of the tongue and lips to make specific sounds and words -slow speech rate -impaired rhythm and prosody (intonation of speech) -better automatic speech (greetings) than purposeful speech -inability to produce any sound at all in severe cases Causes of apraxia in adults, damage is often to the left frontal cortex surrounding Broca's area -in children, no known specific cause theories suggest disruption of messages from brain to muscles to produce speech Childhood apraxia of speech -developmental - salient charactristics of this disorder is the same as acquired (AOS) -considerable delay in speech production, limited sound inventory, unintelligibility, and progress slowly in speech therapy.

Childhood apraxia of speech (CAS) • Children who exhibit severe articulatory output problems due to difficulty formulating and executing motor plans for speech • Characteristics - Multiple speech sound errors -Difficulty with sound sequencing -Context changes articulatory proficiency Receptive language > expressive language Apraxia treatment focus on intervention is on improving the planning, sequencing, and coordination of muscle movements for speech production -retraining with repetition repetition,and repetition • Sounds and sequences - CV, CVCV, complexity increases • Motor memory -Other strategies •slow speech •AACApraxia Treatment -speech therapy -awareness of articulators -exercises -sound selection -syllable contrasting Dysarthria speech disorders due to damage to the central or peripheral nervous system pathways (neuromuscular dysfunction) -as a group, they involve all major sub components of speech production: respiration, phonation, resonance, and articulation Dysarthr

signs of dysarthria ""slurred"", ""Choppy"", or ""mumbled"" speech that may be difficult to understand -slow rate of speech -rapid rate of speech with a ""mumbling"" quality -limited tongue, lip, and jaw movement -abnormal pitch and rhythm when speaking -changes in voice quality such as hoarse or breathy voice or speech that sounds ""nasal or ""stuffy ""Dysarthria: causes damage to the nervous system pathways results in in inability to send proper message form brain to the muscles involved in speech.

-stroke -brain injury -parkinson's disease -Lou Gehrig's disease -Huntington's disease -multiple sclerosis Dysarthria: causes -cerebral palsy -stroke -progressive neurological disease -cerebral palsy= damage to motor control centers of the developing brain during pregnancy, birth, or shortly after -due to anoxia, trauma, or infection -usually affects multiple sites in motor pathwaysstroke disturbance in blood supply t the brain -due to blockage (ischemia) or leakage (hemorrhage)progressive neurological disease gradual deterioration in brain areas/ systems Upper motor neurons (UMN) -originate in motor cortex -cell bodies and axons totally contained within central nervous system (CNS) -axons synapse on cell bodies of lower motor neurons in brainstem and spiral cord Lower Motor Neurons (LMN) -originate brainstem and spinal cord -receive information from upper motor neurons -axons synapse on muscle fibers -cell bodies contained CNS; axons leaves CNS -form a final common pathway for information descending from cerebrum to periphery Spastic Dysarthria -bilateral damage to the pyramid and EP tracts -hypertonicity -muscles fight against stretching -articulatiory imprecision -slow rate -short phrases -harsh voice quality -pitch variation Lower motor neuron lesion Flaccid Dysarthria caused by damage to the lower motor neurons -muscle weakness and atrophy -slow speech rate -rapid fatigue with prolonged use -hypernasal, nasal emission, breathiness -better after rest -increased difficulty over time Other lesions (extrapyramidal) -Hypokinetic parkinson's reduced movement lesion in substantia nigra of basal ganglia Hypokinetic dysarthria -parkinson's disease damage to the dopamine cells of the basal ganglia -hypotoned and rigid muscles -resting tremors that disappears with voluntary movements -accelerated movements and short rushes of speech -monopitch and loudness Other lesions (extrapyramidal) Hyperkinetic -Huntington's -too much (involuntary) movement -lesion in striatum Hyperkinetic Dysarthria -Damage to the basal ganglia of the EP -involuntary movements that may be fast or slow -may occur in one limb or the whole body -speech characterized by impaired: prosody, articulatory imprecision, rate of speech production Other lesions (extrapyramidal ) -Ataxic -incoordinated movement -like intoxicated speech -lesion in cerebellum Ataxic Dysarthria -damage to the cerebellum *cerebellum responsible for coordinating the direction, extent, and timing of movements -inaccurate and dysrhythmic movements -speech is monotonous -reflexes are normal -minimal weakness -speech intelligibility mildly affected Mixed dysarthria -affects more than 1 part of the motor system -multiple sclerosis - amyotrophic lateral sclerosis ( Lou Gehrig's disease) -progressive diseases -characteristics of speech production depends on which systems are damaged/ to what extent Acquired dysarthria classification look at slide 12 for chart Dysarthria Assessemt and Treatment ... Assessment -SLP's goal: assess all 4 subsystems of speech -oral motor examination (look for direction in strength, speed, ROM, and coordination ) -Standardized protocols *Frenchay Dysarthria Assessment * assessment of the Intelligibility of Dysarthric speech -speech and non-speech sounds -postural supports Treatment -speech therapy *Compensatory strategies -reduce speech rate, increase loudness, exaggerate articulation *exercises (restorative) -respiration -muscle coordination/strength - Surgery - Medications -AACCerebral Palsy A syndrome of deficits from injury to the nervous system at or shortly after birth -the child's muscles are weak, paralyzed, and/or uncoordinated What causes cerebral palsy ?

-prenatal *anoxia (lack of 02) disease, metabolic problems -perinatal *brain trauma *premature separation of the placenta *anoxia from umbilical cord problems (strangulation) -postnatal *brain trauma Spastic CP -Damage to pyramidal/extra pyramidal tracts -Spasticity *abnormal resistance to muscle lengthening -Muscles resist movement -Hypertonicity *arms bent upward *legs positioned like scissors -Muscle atrophy Athetoid CP -primary damage in basal ganglia (EP tract) -involuntary writhing and twisting movements -child appears to be in almost constant motion Ataxic CP -caused by damage to the cerebellum -disturbances in motor coordination *errors in the speed, direction, and accuracy of movement -difficulty in motor tasks involving a target -difficulty in motor tasks involving precision and rhythm ex.

playing a drum Levels of severity -MILD -good self-help skills, ambulates, good speech -Moderate -needs help to develop self-help skills, special equipment needed for ambulation, speech impairments -Severe -poor prognosis for developing self-help, ambulation, or speech even with assistance Speech and Language Development with CP -Respiration -Phonation -Resoanance -Articualtion -Prosody Speech and Language development with CP -RESPIRATION reduced vital capacity inefficient valving at the glottis/velopharynx and oral cavity cannot generate/maintain subglottal pressure well -PHONATION Intermittent breathiness/strangled harshness of voice -Resonance Hypernasality and nasal emission Premature opening of velopharynx Speech and Language Development with CP -Articualtion Mandible may be hyperextended Difficulties rounding or protruding mouth Abnormal tongue position All prevent precise shaping vocal tract and lead to articulation problems -Prososdy Poor respiration control --> one or two utterances per breath Poor laryngeal tension control --> hard to manipulate changes in pitch Augmentative and alternative communication (AAC) Communication devices can help people communicate who have trouble using their voice to do so Augmentative and alternative communication (AAC) -SLP's goal: maximum efficiency of communication (first, oral speech; then augmenting or substituting speech with AAC only when necessary) -AAC is individualized Communication needs Cognitive ability Physical capabilities (sensory, motor) Literacy Long-term prognosis -training (patients, family members, etc.

)Augmentative Communication -Systems for speech -Can take various forms: Gestures Communication boards Electronic devices -Issues Motor control Cognitive and intellectual impairments Is slower than oral speech AAC -Unaided: Gestures, manual sign, facial expressions -Aided: Something in addition to your body to communicate, communication devices with voice output -Augmentative communication is slow; environments may not support it's use AAC Low and High tech Low Tech ex. picture board High tech ex. computerized communication device "

Refers to a group of speech disorders resulting from weakness, slowness, or incoordination of the speech mechanism due to damage to any of a variety of points in the nervous system. Dysarthria may involve disorders to some or all of the basic speech processes: respiration phonation, resonance, articulation, and prosody. Dysarthria is a disorder of speech production not language (e.g., use of vocabulary and/or grammar).

Related Disorders

Related Disorders The following related disorders may cause or accompany aphasia. Additionally, aphasia is sometimes confused with other disorders. There are many causes for aphasia including stroke, brain trauma, brain tumours, and progressive neurological disease.

Moreover, there are a variety of disorders of communication that may be due to paralysis, weakness, or incoordination of the speech musculature or to cognitive impairment.

Such impairment may accompany aphasia or occur independently and be confused with aphasia. It is important to distinguish these related disorders from aphasia because the treatment (s) and prognosis of each disorder are different.

Apraxia A collective term used to describe impairment in carrying out purposeful movements. People with severe aphasia are usually extremely limited in explaining themselves by pantomime or gesture, except for expressions of emotion. Commonly they will show you something in their wallet, or lead you to show you something, but this is the extent of their non-verbal communication.

Specific examination usually shows that they are unable to perform common expressive gestures on request, such as waving good-bye, beckoning, or saluting, or to pantomime drinking, brushing teeth, etc. (limb apraxia). Apraxia may also primarily affect oral, non-speech movements, like pretending to cough or blow out a candle (facial apraxia).

This disorder may even extend to the inability to manipulate real objects. More often, however, apraxia is not very apparent unless one asks the patient to perform or imitate a pretended action.

For this reason it is almost never presented as a complaint by the patient or the family. Nevertheless it may underlie the very limited ability of people with aphasia to compensate for the speech impairment by using informative gestures.read more Apraxia of Speech Frequently used by speech pathologists to designate an impairment in the voluntary production of articulation and prosody (the rhythm and timing) of speech.

Highly inconsistent errors characterizes apraxia.read more Brain Trauma Aphasia can be the result of a brain injury and may accompany damage after head trauma. This common complication may present differently for each individual. People with aphasia after a head injury often see improvement as the brain heals, and speech-language therapy treats lingering aphasia.read more Dysarthria

Unlike apraxia of speech, the speech errors that occur in dysarthria are highly consistent.read more Dysphagia Refers to those who have difficulty swallowing and may experience pain while swallowing. Some people may be completely unable to swallow or may have trouble swallowing liquids, foods, or saliva.

Eating then becomes a challenge. Often, dysphagia makes it difficult to take in enough calories and fluids to nourish the body. (Definition from National Institute of Deafness & Other Communication Disorders – www.nidcd.nih.gov)read more Dementia A condition of impairment of memory, intellect, personality, and insight resulting from brain injury or disease. Some forms of dementia are progressive, such as Alzheimer’s disease, Picks disease, or some forms of Parkinson’s disease. Language impairments are more or less prominent in different forms of dementia, but these are usually overshadowed by more widespread intellectual loss.

Since dementia is so often a progressive disorder, the prognosis is quite different from aphasia.read more Stroke Stroke is the number one cause for aphasia, and 25% – 40% of stroke survivors develop aphasia. Just as hearts can experience a “heart attack,” brains can experience a “brain attack” when problems with blood flow to a section of the brain occurs. Bleeding in the left side of the brain can cause aphasia as the blood affects language centers in the brain.

Luckily, the brain can sometimes form new channels of communication after sustaining damage in a section, and speech-language therapy can help patients regain communication skills.read more Image: Blue Coat Photos via Flickr via Creative Commons license

s)Dysarthria is a term used for a group of speech disorders caused by weakness, paralysis, rigidity, spasticity, sensory loss, or incoordination of muscle groups responsible for speech. Dysarthrias are neurogenic speech disorders that can affect any of the following subsystems necessary to produce speech & language Respiration Phonation

Classifications of the Dysarthrias  (Motor Speech Disorders)

Classifications of the Dysarthrias (Motor Speech Disorder

Resonance Articulation Prosody All of the following Speech Disorders are caused by a pathology affecting the nervous system. Most neurogenic speech disorders fit into one of the dysarthria types. Meaning that if this speech disorder is diagnosed, the brain is somehow involved, and it's most likely that we, an SLP, can easily figure out where the SOL (Site of Lesion) is occurring based on the symptoms. Site of Lesion can mean a few different things, so don't rush to judgement and automatically think cancer.

It just means, refer to the neurologist first if they have not already been and you are suspecting dysarthria. There are seven (7) main types of Dysarthrias. Flaccid Dysarthria The patient shows weakness and is usually marked by a droop towards one side of the face (mouth open, drooling, etc).

All of the speech CN's are involved Flaccid Dysarthria. (CN V)Trigeminal, (CN VII)Facial Nerve, (CN IX)Glossopharyngeal , (CN X)Vagus Nerve and all three of it's branches; In the vagus nerve we worry about VF peresis or paralysis, and respiratory.

-Pharyngeal Branch -Superior Laryngeal Nerve Branch -Reccurrent Laryngeal Nerve (RLN)CN XIIC3 C4 & C5 of the Cranial Nerves Neuropathology location: LMN Speech characteristics: depends upon what CN, SN, muscles are involved (motor, sensory) Hyperkinetic Dysarthria HYPER kinetic Dysarthria is marked by involuntary movements Orofacial stable at rest and involuntary movements, involuntary jerk single or repetitive movements, jerky movements of the velum, tics, chorea, slower movements and slower involuntary movements as well as Spasmodic Dysphonia.

Neuropathology location: extrapyramidal system Speech characteristics: dependent upon site of dyskinesias In terms of voice disorder, we worry about dyskinesias at the level of the vocal folds Spasmodic dysphonia Dyskinesias affect the nerves innervating laryngeal muscles causing forceful,inappropriate contractions of muscle groups - Adductor type -Most severe form of vocal hyperfunction -VFs are adducted involuntarily at intervals, resulting in hyperadduction (ventricular folds and a-e folds also approximated) -Results in a harsh voice quality periodically - Abductor type -VFs are abducted involuntarily at intervals -Results in a normal voice with periods of aphonia - Much rarer -Mixed -Some abductor and adductor spasms -With or without tremor Essential tremor - Often confused with Spasmodic Dysphonia, but it is very different.

-May or may not be associated with tremors elsewhere in the body (head, hand, lip, tongue, jaw, soft palate) -Idiopathic, but aggravated by stress and reduced by alcohol - Only produced during volitional movement -Mid-late ages -Steady fluctuation in pitch and loudness; voice sounds quavery -More frequent cycle than SD; NOT present at rest -May accompany SD or in isolation Spastic Dysarthria Spasticity causing harsh & strained voice.

Marked by slow speech as well. Hypernasal Ataxic Dysarthria This is the drunk sounding dysarthria (slur)Incoordination Hypokinetic Dysarthria HYPO kinetic Dysarthria is most associated with Parkinsons' Disease characterized by Rigidity, Masked Face, flat, diminished, monotone speech. Speech mirrors movements. Slow shuffled gait. SOL is in the Basal Ganglia. Apraxia of Speech Automatic speech is fine, prompted speech is difficult - Demonstrates inconsistency Marked by groping and increasing errors with complex language Articulation & Prosody may be different. AOS is often associated with Broca's Aphasia due to it's location in the brain. There is evidence of AOS also diagnosed in a lot of children.

Children with Cerebral Palsy may have only minor difficulty with fine motor skills, such as grasping and manipulating items with their hands. Severe Cerebral Palsy could involve significant muscle problems in all four limbs, mental retardation, seizures, and difficulties with vision, speech, and hearing.

Cerebral Palsy

Cerebral Palsy Cerebral palsy is a chronic disability of the central nervous system characterized by abnormal control of movement and posture. The symptoms of Cerebral Palsy and their severity are variable.

What are some of the symptoms of cerebral palsy? Although the defect in brain function that causes Cerbral Palsy is not progressive, the symptoms often change over time. Most of the symptoms relate in some way to the abnormal control of muscles. Cerebral Palsy is categorized by the type of movement disturbance present. Spastic diplegia, for example, refers to tight muscles that have no voluntary control in both legs, while athetoid quadraparesis describes uncontrolled writhing movements and weakness in all four limbs.

Cerebral Palsy can also be categorized as mild, moderate, or severe. Spastic, muscles can cause serious orthopedic problems, including curvature of the spine ( scoliosis ), hip dislocation, or contractures.

A contracture is shortening of a muscle. Contractures may become permanent without some sort of intervention which can cause postural abnormalities in the affected limbs. Clenched fists and contracted feet are common in people with CP. Spasticity in the thighs causes them to turn in and cross at the knees, resulting in an unusual method of walking known as scissors gait.

Any of the joints in the limbs may be stiff due to spasticity of the muscles. Athetosis (writhing, involuntary movements of the hands) and dyskinesia (inability to make voluntary movements) often occur with spasticity but do not often occur alone.

Other symptoms of CP may include: mental retardation/learning disabilities behavioral disorders seizure disorders visual impairment hearing loss speech impairment abnormal sensation and perception What causes cerebral palsy? The cause of most cases of Cerebral Palsy remains unknown, but it has become clear that birth difficulties are not to blame in most cases.

Rather, developmental problems before birth, usually unknown and generally undiagnosable, are largely responsible. Cerebral Palsy may be caused by fetal stroke in the uterus before labor, fetal infection before birth, malformation of the brain originating at conception, genetic diseases, complications of prematurity or unknown causes. Sometimes, CP is caused by brain damage from lack of oxygen due to an event during labor or delivery.

When this happens in full term babies, the newborn will have evidence of severe p H abnormality in the cord blood and neurologic abnormalities soon after birth. Frequently there will be signs of sudden oxygen deprivation seen on the fetal monitor, very low Apgar scores at birth, and involvement of other organs such as the kidneys within a few days. If you have reason to believe that a medical error in your care during pregnancy or birth may have caused your child’s CP, it is important that you discuss this with a qualified attorney promptly.

What can I do if I think my child might have cerebral palsy? Cerebral palsy cannot be cured, but many of the disabilities it causes can be managed through planning and timely care.

Treatment for a child with Cerebral Palsy depends on the severity, nature, and location of the primary muscular symptoms, as well as any associated problems that might be present. Optimal care of a child with mild Cerebral Palsy may involve regular interaction with only a physical therapist and occupational therapist, whereas care for a more severely affected child may include visits to multiple medical specialists throughout life.

With proper treatment and an effective plan, most people with Cerebral Palsy can lead productive, happy lives. To find out who to speak to in your area, you can contact the National Dissemination Center for Children with Disabilities by logging on to www.nichcy.org/states.htm.

In addition, the Centers for Disease Control and Prevention (CDC) has links to information for families (www.cdc.gov/ncbddd). What will my child need? About half of the people who have cerebral palsy will need to use braces, walkers, wheelchairs, and other assistive devices to help them get around.

People with severe cerebral palsy might need special medical care, educational, social services, and other help throughout their lives from both their families and their communities.

The average lifetime cost associated with cerebral palsy is about $921,000 per person. Anyone who has been the victim of a birth trauma that has resulted in a cerebral palsy diagnosis, as the result of medical negligence, is eligible to recover medical, hospital, and other expenses to cover the care of the child. After you seek medical care, the next step is to have your case evaluated by an experienced law firm to begin filing a case to cover your child’s lifetime cost. The following sections explain: Traumatic Brain Injury Homepage Birth Trauma Brain Injury from Birth Cerebral Palsy Erb’s Palsy and Brachial Plexus Palsy Perinatal Asphyxia Meconium Aspiration Syndrome Medical Negligence

In addition to its widely recognized effects on gait, posture, balance, and upper limb coordination, Parkinson's disease (PD) can have a profound effect on speech and voice, within a cluster of speech characteristics termed hypokinetic dysarthria.

Nonpharmacological Management of Hypokinetic Dysarthria in ParkinsonÃââs Disease

Abstract and Introduction

Although dopaminergic therapy produces significant benefits in the early stages of PD, speech symptoms may show selective resistance to pharmaceutical therapy in patients with a disease history of more than 10 years. This article discusses the pathophysiology of PD as it relates to speech disorders and considers nonpharmaceutical therapeutic options for hypokinetic dysarthria.

Parkinson's disease (PD) is a degenerative illness whose cardinal symptoms include rigidity, tremor, and slowness of movement. [ 1] In addition to its widely recognized effects on gait, posture, balance, and upper limb coordination, PD can have a profound effect on speech and voice.

Although symptoms vary widely from patient to patient, the speech symptoms most commonly demonstrated by patients with PD are reduced vocal loudness, monopitch, disruptions of voice quality, and abnormally fast rate of speech. This cluster of speech symptoms is often termed hypokinetic dysarthria. [ 2] While dopaminergic medications are typically effective in treating the voice or speech symptoms that present in the early stages of the disease, [ 3] some research has suggested that these symptoms may become selectively resistant to pharmaceutical treatment in the latter stages (10+ years) of the disease.

[ 4] Despite the fact that some 60-80% of patients with PD may be expected to develop some voice or speech symptoms, [ 5, 6] it has been estimated that only four percent of these patients receive speech therapy.

[ 7] In this article, we will review the putative pathophysiology of PD as it relates to voice and speech disorders and discuss current trends in the nonpharmaceutical treatment of these symptoms. The most common symptom of hypokinetic dysarthria is hypophonia, or reduced vocal loudness. Patients demonstrating this symptom may be unaware of the volume at which they are speaking and may require frequent requests to speak louder.

Hypokinetic dysarthria also manifests as a lack of variability in pitch or loudness, wherein a patient may demonstrate monopitch, monoloudness, or reduced use of conversational inflection.

Similarly, patients with PD often have disruptions of voice quality, in which their voice takes on an abnormal breathiness or hoarseness. Finally, hypokinetic dysarthria can, paradoxically, result in an abnormally fast rate of speech—not unlike the festination of gait that is often a symptom of PD.

While it is difficult to attribute these symptoms to specific biological determinants, the pathophysiology of PD is specifically related to speech function in a number of key areas, most notably respiratory or aerodynamic function, laryngeal abnormalities, and motor control.

[ 3]PD seems to produce a consistent impairment of respiratory function. This impairment takes the form of an overall reduction in function [ 8] and an increased variability in air flow. [ 9] Although early research suggested that these abnormalities were caused by reduced movement of glottic and supraglottic structures, [ 9] more recent research has suggested that they may be more related to irregularities in muscle activation patterns within the chest wall [ 10] or reduced expansion of the rib cage.

[ 11] Impairment of respiratory function has been implicated strongly in hypophonia and is targeted accordingly by many speech therapy paradigms. While there are few data on the laryngeal abnormalities of patients with PD, the classic pathophysiology of hypokinetic dysarthria includes dysfunction of vocal fold kinematics [ 12] (i.e., slow opening and inadequate closing of the vocal folds), vocal fold asymmetry and bowing, [ 13] and vocal fold paresis.

[ 14] These physiological changes may be responsible for much of the vocal hoarseness and hypophonia seen in hypokinetic dysarthria. It has also been suggested that, in some patients with PD, vocal hoarseness may result from dyskinesia within the laryngeal system. [ 15]Given the primarily motoric sequelae of PD, it is not surprising that motor control has been implicated in speech dysfunction. As aforementioned, motor control deficits are related to speech breathing in PD. [ 10, 11] Impaired motor control has also been shown to reduce the speed and amplitude of both jaw movements [ 16] and lip movements. [ 17] While it has been hypothesized that reduced amplitude of oral movements is the primary cause of reduced speech intelligibility in PD, the studies required to clearly establish this causal link are still lacking. [ 3, 18]Next Section Geriatrics and Aging. 2006;9 (1):40-43. © 2006 1453987 Ontario, Ltd.

The term dysarthria encompasses a group of motor speech disorders caused by a disturbance in the neuromuscular control of speech. [ 3] These disorders result from central or peripheral nervous system damage and are manifested as weakness, slowness, or incoordination of speech.

Communication Disorders

"Drugs & Diseases > Physical Medicine and Rehabilitation Communication Disorders Updated: Sep 17, 2015Author: Renee S Melfi, MD; Chief Editor: Stephen Kishner, MD, MHA more... Share Email Feedback Sections Overview The Normal Communication Process Voice Disorders (Dysphonia)Motor Speech Disorders Language Disorders (Aphasia)Selected Cognitive-Communicative Disorders Hearing Impairment Show All Tables References Overview Disorders impairing a patient’s communication abilities may involve voice, speech, language, hearing, and/or cognition.

[ 1, 2] Recognizing and addressing communication disorders is important; failure to do so may result in isolation, depression, and loss of independence. [ 3, 4]A voice disorder exists when the voice’s quality, pitch, or volume differs from that of other persons of similar age, culture, and geographic location.

Dysphonia is classified as either an organic or a functional disorder of the larynx. [ 5, 6]Another type of communication problem, dysarthria, encompasses a group of motor speech disorders caused by a disturbance in the neuromuscular control of speech.

[ 3] A second form of motor speech disorder, apraxia, occurs in the presence of significant weakness or incoordination of the muscles of speech production.

Aphasia is a language disorder that results from damage to the areas of the brain responsible for language comprehension and expression, [ 7] while a cognitive-communicative disorder affects the ability to communicate by impairing the pragmatics, or social rules, of language. The Normal Communication Process Communication is a multidimensional dynamic process that allows human beings to interact with their environment. Through communication, people are able to express thoughts, needs, and emotions. Communication is an intricate process that involves cerebration, cognition, hearing, speech production, and motor coordination. Evaluation of a communication disorder includes consideration of all aspects of the normal communication process.

Language is the transformation of thoughts into meaningful symbols communicated by speech, writing, or gestures. Thoughts are organized by the brain, specifically the left hemisphere, and encoded into a sequence according to learned grammatic and linguistic rules.

These rules govern the way sounds are organized (phonology), the meaning of words (semantics), how words are formed (morphology), how words are combined into phrases (syntax), and the use of language in context (pragmatics).

Speech production Speech involves the coordinated motor activity of muscles involved in respiration, phonation, resonance, and articulation. The entire system is modulated by central and peripheral innervation, including with cranial nerves V, X, XI, and XII, as well as with the phrenic and intercostal nerves. Respiratory muscles, specifically the muscles associated with expiration, must generate enough air pressure to provide adequate breath support to make speech audible.

The diaphragm is the main muscle of expiration; however, the abdominal and intercostal muscles help to control the force and length of exhalation for speech. Phonatory muscles of the larynx generate vibratory energy during vocal cord approximation to produce sound. [ 8] Vocal pitch and intensity are modified by subglottic air pressure, tension of the vocal cords, and position of the larynx.

Articulatory muscles within the pharynx, mouth, and nose form the tone of the sound. The coordinated action of these muscles produces speech. By altering the shape of the vocal tract, we are capable of producing a tremendous range of sounds. Sound waves are transformed by the auditory system into neural input for the speaker and the listener. The outer ear detects sound-pressure waves in the air and converts them into mechanical vibrations in the middle and inner ear.

The cochlea then transforms these mechanical vibrations into vibrations in fluid, which act on the nerve endings of the eighth cranial nerve. Thus, the process of communication begins and ends in the brain. Voice Disorders (Dysphonia)Voice is the audible sound produced by passage of air through the larynx. Voice typically is defined by the elements of pitch (frequency), loudness (intensity), and quality (complexity). By varying the pitch, loudness, rate, and rhythm of voice (prosody), the speaker can convey additional meaning and emotion to words.

A voice disorder exists when the quality, pitch, or volume differs from that of other persons of similar age, culture, and geographic location.

Dysphonia is classified as either an organic or a functional disorder of the larynx. [ 5, 6, 9]Organic dysphonia Organic disorders cause an interruption in the smooth approximation of the vocal folds.

[ 8] Such disorders include the following: Vocal nodules - Callus formation on the vocal fold Laryngitis - Inflammation Vocal polyps - Fluid-filled sacs on the vocal fold Laryngeal and esophageal tumors Contact ulcers Vocal cord paralysis - Secondary to trauma or to severing of the recurrent laryngeal nerve [ 10, 11]Chronic obstructive pulmonary disease Surgery - Eg, laryngectomy or tracheostomy Functional dysphonia Functional disorders affect the quality and volume of the voice.

They include the following: Vocal abuse/misuse - Including screaming, excessive throat clearing, and substance abuse (eg, smoking, alcohol)Normal aging [ 12]Psychosocial disorders Hysterical conditions Conversion voice impairment A study of 162 teachers with behavioral dysphonia suggested that a 6-week course of vocal function exercises can prevent one out of three cases of dysphonia aggravation, as compared with prevention of one out of five cases using a voice amplifier. [ 13]Diagnosis and referral Rule out a treatable medical condition in all patients with voice disorders.

For example, a voice disorder may be one of the first symptoms of laryngeal cancer. Patients should be referred to an otolaryngologist (ear, nose, and throat [ENT] specialist) for specialized examinations, which may include peripheral oral/nasal examination, voice analysis, and indirect or fiberoptic laryngoscopy. Once an organic disorder has been either treated or excluded, the patient may be referred to a speech-language pathologist (SLP).

The SLP helps the patient to produce the most functional voice possible. [ 14, 15]In a retrospective study of more than 60,000 patients over age 65 years with a laryngeal/voice disorder, Roy et al found that age, gender, comorbidities, geographic location, and physician type (primary care physician [PCP] or otolaryngologist) were associated with the specific disorder diagnosed.

For example, PCPs arrived at a diagnosis of acute laryngitis more often than otolaryngologists did, while otolaryngologists more often diagnosed patients as having nonspecific dysphonia and laryngeal changes/lesions. [ 16]Laryngectomy rehabilitation Laryngectomy remains a common procedure for the treatment of laryngeal cancer.

Total laryngectomy results in the complete loss of voice (aphonia). Options for the restoration of speech following laryngectomy patient are detailed below.

External prosthetic devices for speech restoration include the following: Electrolarynx - This device may be placed either into the oral cavity or through the neck tissue to introduce a vibratory tone into the mouth and pharynx; the muscles of articulation then produce words from this tone Pneumatic reed - This device is placed over a tracheostoma; air passes across the reed, producing a tone that is carried into the mouth.

Tracheo-esophageal shunt - This 1-way–valve voice prosthesis shunts air from the lungs into the esophagus; the air is vibrated in the pharyngo-esophageal segment to produce an esophageal voice. Esophageal speech is accomplished by training the patient to suck air into the esophagus, hold the air, and then release it in a controlled manner through the oral cavity. Motor Speech Disorders The production of speech depends on motor coordination of the structures of the respiratory system, larynx, pharynx, and oral cavity. Disorders of motor speech are classified into dysarthrias and apraxias. [ 17, 18, 19]Dysarthria

The term dysarthria encompasses a group of motor speech disorders caused by a disturbance in the neuromuscular control of speech. [ 3] These disorders result from central or peripheral nervous system damage and are manifested as weakness, slowness, or incoordination of speech.

Any or all of the normal motor structures may be involved. Unless a concomitant language disorder exists, a person with dysarthria has intact comprehension and is able to understand written, spoken, and read language.

The most typical dysarthrias are summarized in Table 1, below. Table 1. Summary of Dysarthrias (Open Table in a new window)Type Characteristics Neurologic Location Neuromuscular Deficit Examples Flaccid Hypernasal, breathy voice quality; imprecise articulation Lower motor neuron Weakness, hypotonia, fasciculations Bulbar palsy, poliomyelitis, myasthenia gravis Spastic Strained/harsh voice quality, hypernasal, slow rate, monopitch Upper motor neuron Hypertonia, weakness, reduced range and speed of movement Pseudobulbar palsy, stroke, encephalitis, spastic cerebral palsy Ataxic Excess and equal stress, slow rate Cerebellum Hypotonia, slow and inaccurate movement Stroke, tumor, alcohol abuse, infection Hypokinetic Monopitch, reduced loudness, inappropriate silences Extrapyramidal Rigidity, reduced range and speed of movement Parkinson disease, drug induced Hyperkinetic Quick Sudden variations in loudness, harsh quality, hypernasal Extrapyramidal Quick, involuntary, random movements Chorea, myoclonus, Tourette syndrome Slow Unsteady rate and loudness Extrapyramidal Sustained, distorted, slow movements Athetosis, dyskinesia Tremors Rhythmic alterations in pitch and loudness Extrapyramidal Involuntary, purposeless movements Organic voice tremor Mixed Hypernasality, harsh voice quality, monopitch, reduced stress, slow rate, variable quality Variable, upper and lower motor neurons, cerebellar, extrapyramidal Variable weakness, slow movement, limited range of motion, intention tremor, rigidity, spasticity Amyotrophic lateral sclerosis, Wilson disease, multiple sclerosis The diagnosis of dysarthria is made clinically by assessing the pitch, nasality, articulation, rate, and intelligibility of the patient's speech.

Additionally, each of the subsystems of speech (respiratory, laryngeal, pharyngeal, and oral structures) must be assessed. Bedside evaluation of dysarthria includes the following exercises: Alternating motion rates (rapid repetition of ""puh, tuh, kuh"")Sequential motor rates (rapid repetition of ""puh, puh, puh"")Prolongation of ""aah""SLPs can administer formal speech intelligibility tests, such as the Tikofsky word list or the Assessment of the Intelligibility of Dysarthric Speech. The overall goal in the treatment of dysarthria is functional communication in which a patient can reliably communicate his or her basic needs of daily living.

A generalized hierarchy of treatment moves through the following 3 stages, based on the severity of speech impairment: Severely involved speakers - Establish a functional means of communication using communication boards or computer-based speech systems Moderately involved speakers - Maximize speech intelligibility with palatal lift or by teaching speakers to control and emphasize words Mildly involved speakers - Increase the naturalness of speech by using a pacing board to control rate or by teaching intonation and appropriate phrasing.

Apraxia The second category of motor speech disorders, apraxia, involves the capacity to program the positioning of the speech musculature and sequence the movements necessary for speech. [ 3] Apraxia occurs in the presence of significant weakness or incoordination of the muscles of speech production. The 2 recognized types of apraxia related to speech disorders are oral apraxia and apraxia of speech (AOS).

Oral apraxia is an apraxia of nonverbal oral movements. Patients have difficulty performing movements such as sticking out their tongue, licking their lips, and protruding their lips. Lesions of the premotor cortex are a frequent finding in patients with this disorder. AOS is a disorder of articulation that encompasses the intonation, rhythm, and stress of speech (prosody).

Patients with AOS find it difficult to accurately plan, initiate, and sequence speech movements. Typically, AOS occurs with left frontal lesions adjacent to the Broca area. The following characteristics usually are present: Effortful, groping articulatory movements with attempts at self-correction [ 20]Dysprosody that is unrelieved by extended periods of normal intonation, rhythm, and stress Articulatory inconsistency or repeated production of the same utterance Difficulty initiating an utterance Diagnosis is made clinically, based on the above characteristics. Additionally, AOS may be differentiated from dysarthria and aphasia because in AOS, automatic speech, motor control, and other language modalities (ie, listening, reading, writing) are spared.

A number of extensive, objective tests exist and may be administered by the SLP to provide additional qualitative and quantitative information. Treatment of apraxia is designed to teach effective communication strategies and improve volitional control of the oral musculature.

Exercises are used to teach sound sequencing, program sound patterns, and improve rhythm in speech. Language Disorders (Aphasia)Aphasia is a language disorder that results from damage to the areas of the brain responsible for language comprehension and expression. [ 7] These injuries usually occur in the dominant side of the brain, which, for most people, is the left hemisphere.

Depending on the site of the lesion, aphasia may involve spoken and written language expression, auditory comprehension, and reading and writing abilities. [ 3]Aphasia may be described by a variety of abnormalities in speech production. Table 2, below, summarizes the terminology used to describe expressive disorders of aphasia.

Table 2. Terminology Describing Expressive Disorders of Aphasia (Open Table in a new window)Term Definition Adynamia Difficulty initiating speech Agrammatism Absence of grammatical elements (verbs, articles, pronouns, prepositions)Anomia Difficulty producing nouns Circumlocution Utterance of associated words related to the word that cannot be retrieved Echolalia Repetition of an utterance that does not require repetition Jargon Well-articulated, but mostly incomprehensible, language Logorrhea Excessively lengthy, often incomprehensible, but well-articulated language Neologism Substitution of contrived or invented words, well articulated Paragrammatism Misuse of grammatical elements Phonemic paraphasia Substitution of one sound for another (for example, ""fable"" for ""table"")Semantic paraphasia Word substitution belonging to the same semantic class (such as ""table"" for ""chair"")Stereotypes Repetition of nonsensical syllables for all communicative attempts (""dee, dee, dee"")Telegraphic speech Utterance of mostly nouns and verbs Aphasias are classified in several ways.

Traditionally, aphasia syndromes were classified as expressive or receptive. Individuals with expressive, or motor, aphasia have difficulty producing words and are believed to have a lesion in the Broca area in the dominant frontal lobe. Patients with receptive, or sensory, aphasia have difficulty comprehending language and are thought to have a lesion in the Wernicke area of the dominant temporal lobe.

In the 1960s, a popular modification of the classification system was proposed based on the fluency, or rate of speech. Fluent speech is produced at normal to rapid rates and is effortless and well articulated. Nonfluent speech is slow, labored, and poorly articulated. As a rule, lesions anterior to the fissure of Rolando produce nonfluent aphasias; lesions posterior to this fissure produce fluent aphasias.

Newer brain imaging techniques, however, have shown that subcortical and right hemispheric structures also contribute to language functions. The traditional classification systems are limited in that they classify the types of disorders according to the site of the lesion only in the dominant cortical hemisphere.

The currently accepted classification system evaluates fluency, comprehension, and repetition; it also divides the aphasias into cortical and subcortical forms. Classification of the cortical aphasias is summarized in Table 3 and the diagram below it. Table 3.

Summary of Cortical Aphasias (Open Table in a new window)Aphasia Type Fluency Comprehension Repetition Characteristics Lesion Site Broca (Motor, expressive) Nonfluent Good Poor Effortful, telegraphic, often associated with apraxia, agrammatic Left middle cerebral artery (MCA), frontal Wernicke (Sensory, receptive) Fluent Poor Poor Neologisms, paraphasias, well articulated, paragrammatism Left MCA, temporal Conduction Fluent Good Poor Paraphasias, normal rate Arcuate fasciculus, left MCAAnomia Fluent Good Good Circumlocutions, word-finding difficulty Angular gyrus, left MCATranscortical Motor Nonfluent Good Good Greater ease of articulation, intact naming, adynamia Adjacent to Broca area, left anterior cerebral artery Transcortical Sensory Fluent Poor Good Neologism, well articulated Adjacent to Wernicke area, left posterior cerebral artery Mixed Transcortical Nonfluent Poor Good Echolalia Border zone of frontal, temporal, parietal areas Global Nonfluent Poor Poor Often associated with apraxia, rare vocalization Multiple lobes, left MCAClassification of the aphasias.

Subcortical aphasia The advent of computed tomography (CT) scanning and magnetic resonance imaging (MRI) has enhanced our ability to identify small subcortical lesions as causes of aphasia.

[ 21, 22] The following 2 major forms of subcortical aphasias are recognized: (1) thalamic and (2) those due to lesions in the caudate, putamen, and/or internal capsule. Thalamic aphasia generally consists of fluent speech, mild impairment in comprehension, and intact repetition.

Paraphasias, neologism, perseveration, and fluctuating attention are also common in thalamic aphasia. Lesions involving the putamen and caudate with extension into the internal capsule may cause several aphasic syndromes.

The core syndrome is one of relative intact fluency, comprehension, and repetition. Depending on the extent and location of the lesion, the syndrome may include better or worse articulation and comprehension, apraxia, and paraphasias. Testing Evaluation of aphasia should be performed by the SLP using a formal, standardized assessment of the components of language.

Tests are designed to evaluate the patient's receptive and expressive language capacities by sampling components such as conversational speech, comprehension, repetition, naming, reading, and writing. Several of the most commonly used aphasia batteries are summarized below, in Table 4. [ 21, 22]Table 4.

Comprehensive Tests for Aphasia (Open Table in a new window)Test Characteristics Minnesota Test for Differential Diagnosis of Aphasia (MTDDA) Most comprehensive; can identify aphasia type; contains subtests in each major area of language; takes several hours to administer Boston Diagnostic Aphasia Examination (BDAE) Commonly used; can identify aphasia type; quantitates strengths and weaknesses in various areas of language; takes several hours to administer Western Aphasia Battery (WAB) Commonly used; based on BDAE but can be completed in 1 hour; classifies aphasia syndromes; assigns a severity of impairment Porch Index of Communicative Ability (PICA) Measures overall communication ability; takes 1½ hours to complete; uses 10 common objects (eg, pen, comb) to elicit patient responses; may be used to predict and follow recovery Communication Effectiveness Index (CETI) Assesses communication for basic needs, life skills, and health threats; based on observation by patient's significant other in those skill areas Treatment Successful treatment of aphasia is based on the detailed knowledge of a patient's cognitive and linguistic strengths and weaknesses obtained from the formal testing batteries. Traditional treatment strategies focused on syndrome-specific approaches, in which treatment was based on the diagnosed aphasia syndrome.

More current strategies promote getting a message across by any means, that is, through language, gestures, drawing, or any other expressive method. Whatever strategy is employed, patients and families must be taught to maximize the individual's communicative strengths.

Some treatment strategies are summarized below, in Table 5. Table 5. Methods of Treating Aphasia (Open Table in a new window)Method Characteristics Ideal For Melodic Intonation Therapy (MIT) Undamaged right hemisphere is recruited for language recovery by using melody-based therapy Nonfluent aphasia Amer-Ind Code Use of gestures that are associated with verbal labels Nonfluent aphasia Visual Communication Therapy Use of symbols to express needs and respond to questions Global aphasia Visual Action Therapy Use of pictures, drawings, and gestures to indicate objects Global aphasia Promoting Aphasics Communication Effectiveness (PACE) Encourages patients to convey information through any available modality (eg, speech, gestures, drawings, expressions, mime) Any Selected Cognitive-Communicative Disorders Cognitive-communicative disorders affect the ability to communicate by impairing the pragmatics, or social rules, of language.

[ 23] Cognitive processes involved include the following: Orientation Attention Perception Memory Organization Impulsivity Reasoning Recall Planning and sequencing Social behavior Cognitive-communicative impairments occur primarily with the following 3 conditions: Right hemispheric dysfunction Traumatic brain injury (TBI)Dementia Right hemispheric dysfunction Patients with right hemispheric lesions have relatively intact language but demonstrate impaired overall communication abilities.

Common deficits seen in right hemispheric lesions are as follows: Visuospatial processing Insensitivity to context (missing subtleties)Impulsivity Difficulty with expression and reception of emotions Lack of affective aspects (vocal inflection, facial expressions)Impaired conversational rules (turn taking)Left-sided neglect Poor topic maintenance (tangential)Unawareness of deficits Failure to recognize humor These impairments often cause patients to be considered difficult to get along with, rude, indifferent, or depressed.

Formal testing batteries for evaluating right hemispheric deficits can be administered by the SLP, including the RIC Evaluation of Communication Problems in Right Hemisphere Dysfunction (RICE) and the Mini Inventory of Right Brain Injury (MIRBI). Such batteries include analysis of the above deficits and assist the practitioner in deciding what treatment approaches to use. Treatment of right hemispheric dysfunction tends to focus on behavior modification. The goal of treatment is to improve a patient's understanding of the context and pragmatics of communication.

Importantly, family training to allow adjustments to and understanding of the patient's new personality is paramount to rehabilitation success. Traumatic brain injury Patients with TBI may experience a variety of communication disorders, including aphasia, dysarthria, apraxia, and stuttering. Most typical are disturbances of perception, behavior, information retrieval, memory, and executive functioning. Social difficulties are common due to impairment in social perceptiveness, self-regulation, emotional lability, and perseveration. Expressive language deficits often include confabulation, circumlocution, and verbosity. Because patients with TBI often show deficits in perception, language, and memory, all of these modalities should be evaluated.

As patients recover, they generally demonstrate progressive improvement in cognitive functioning. Because recovery is a dynamic process, patients with TBI should be tracked serially by a neuropsychologist to help guide the treatment plan.

Treatment of the cognitive-communicative deficits in patients with TBI requires special considerations. Most patients with TBI are aged younger than 30 years and have the potential to return to the workforce. Although initially the patient benefits from traditional rehabilitative techniques, he or she will require additional focus on areas of orientation, memory, attention, and self-regulation.

Additionally, the patient's environment should be structured so that predictability reinforces memory. Lastly, generalization to real world settings is necessary during therapy if reentry into the community is to be successful. Dementia Dementia results in generalized intellectual impairment that compromises communication ability.

A result of diffuse, bilateral damage, dementia may be cortical and/or subcortical. The severity of language impairment is associated with impairment in other mental functions. Patients with dementia often are classified into the following stages: Early stage - The person is least affected; some difficulties with pragmatics, orientation, and word finding occur Middle stage - Further deterioration from the above description is noted; additionally, disruption of grammar is present Late stage - A progression to global impairment occurs, with all components of language affected; speech becomes mainly neologistic and echolalic and eventually disappears, with the patient becoming mute Assessment of the demented patient should include a full history and physical examination, as well as formal testing.

The Mini Mental Status examination can be administered quickly and easily. The SLP can administer the Arizona Battery for Communication Disorders of Dementia to assess communicative deficits.

Assessment should be performed at regular intervals to follow the patient's progression. Dementia is progressive and diffuse; therefore, treatment is supportive. Treatment goals should include environmental controls, capitalization on any preserved memory, and family training.

Hearing Impairment As mentioned earlier, the ability to hear is an integral part of the normal communication process. An impaired ability to relate to sounds can result in social isolation, depression, avoidance, and diminished quality of life. Frequencies used in the measurement of clinical hearing range from 250-8000Hz. The most critical part of this spectrum is the range of frequencies used for the reception and understanding of speech, 400-4000Hz. Conductive hearing loss Conductive hearing loss results from dysfunction of the outer and/or middle ear.

Patients with conductive hearing loss usually can understand (discriminate) speech correctly but require louder volumes of speech. Possible causes of conductive hearing impairment include cerumen impaction, presence of a foreign body, tympanic membrane perforation, otitis media, and otosclerosis. Sensorineural hearing loss Sensorineural hearing loss results from dysfunction of the inner ear (cochlea) or of neural fibers of the eighth cranial nerve.

Patients with sensorineural hearing loss usually have decreased speech discrimination. Conditions causing sensorineural impairment include excess noise, advanced age (presbycusis), ototoxic drugs, viral or bacterial illness, tumors, and cortical lesions. Mixed and central hearing loss A mixed hearing disorder involves components of conductive and sensorineural hearing loss. Central hearing impairment results from dysfunction of the central auditory pathways (eg, tumors, demyelinating disease, vascular damage).

Evaluation of hearing loss In general, conductive hearing is assessed by measuring sensitivity to sound waves vibrating through the air and moving from the external auditory canal and middle ear. Bone conduction is assessed by placing a vibrating tuning fork over the mastoid process. This maneuver bypasses the outer and middle ear and conducts sound vibrations directly to the cochlea.

Therefore, it reflects the sensitivity of the sensorineural system. The type and extent of hearing loss should be quantified further by audiometric screening by an otolaryngologist. Assessment includes measurements of air and bone conduction, as well as tests of speech discrimination.

Treatment and rehabilitation In many cases of conductive or mixed hearing loss, the disease process can be reversed through proper treatment (eg, cerumen removal, tympanoplasty, myringotomy). The most common rehabilitative therapy for hearing impairment is the hearing aid. Any person with hearing difficulties that limit daily activities should be considered a prospective candidate for a hearing aid.

A hearing aid evaluation should be performed by a certified clinical audiologist. The use of a hearing aid does not cure the impairment, but it does improve the ability to communicate effectively.

Successful hearing aid use is dependent on the patient's self-perceived impairment, acceptance of the device, and desire to use hearing amplification. Cochlear implants are auditory prostheses that provide hearing for the profoundly deaf. The implant converts sound into electrical signals that are delivered directly to any viable eighth-nerve neurons in the cochlea.

Sounds perceived with a cochlear implant are entirely different from the amplified sound heard with a hearing aid. Assistive listening devices are used in selected listening environments. They employ a microphone placed close to the specific sound source, that transmits to the hearing-impaired listener. Assistive listening devices are effective in that they enhance the desired sound and diminish background noise.

Other devices, such as closed-captioned television decoders, flashing alarms, telephone equipment, and tactile/vibration devices, are available. Auditory training teaches the patient to be an assertive listener. Patients are instructed to inform others as to their most effective means of communication. The hearing-impaired person also is trained to use speech reading (recognizing facial expressions, gestures) to improve understanding of speech. Sections Communication Disorders Overview The Normal Communication Process Voice Disorders (Dysphonia)Motor Speech Disorders Language Disorders (Aphasia)Selected Cognitive-Communicative Disorders Hearing Impairment Show All Tables References "

. While the other students are reading in small groups, she works with Pearl one on one, using the same storybook. Pearl has a speech disorder, too, but hers is called dysarthria. It causes Pearl’s speech to be slurred, very soft, breathy, and slow. Here, the cause is weak muscles of the tongue, lips, palate, and jaw.

Speech and Language Impairments

Speech and Language Impairments Jun 16, 2010A legacy disability fact sheet from NICHCY January 2011 | Resources updated, July 2015En español | In Spanish See fact sheets on other disabilities Table of Contents Day in the life of an SLPDefinition of SL impairments Development of SL skills Characteristics of SL impairments Causes Incidence Finding help Educational considerations Tips for teachers Tips for parents Resources of more info A Day in the Life of an SLPChristina is a speech-language pathologist.

She works with children and adults who have impairments in their speech, voice, or language skills.

These impairments can take many forms, as her schedule today shows. First comes Robbie. He’s a cutie pie in the first grade and has recently been diagnosed with childhood apraxia of speech—or CAS. CAS is a speech disorder marked by choppy speech. Robbie also talks in a monotone, making odd pauses as he tries to form words.

Sometimes she can see him struggle. It’s not that the muscles of his tongue, lips, and jaw are weak. The difficulty lies in the brain and how it communicates to the muscles involved in producing speech.

The muscles need to move in precise ways for speech to be intelligible. And that’s what she and Robbie are working on. Next, Christina goes down the hall and meets with Pearl in her third grade classroom

So that’s what Christina and Pearl work on—strengthening the muscles used to form sounds, words, and sentences, and improving Pearl’s articulation. One more student to see—4th grader Mario, who has a stutter. She’s helping Mario learn to slow down his speech and control his breathing as he talks. Christina already sees improvement in his fluency. Tomorrow she’ll go to a different school, and meet with different students.

But for today, her day is…Robbie, Pearl, and Mario. Back to top Definition There are many kinds of speech and language disorders that can affect children. In this fact sheet, we’ll talk about four major areas in which these impairments occur. These are the areas of: Articulation | speech impairments where the child produces sounds incorrectly (e.g., lisp, difficulty articulating certain sounds, such as “l” or “r”);Fluency | speech impairments where a child’s flow of speech is disrupted by sounds, syllables, and words that are repeated, prolonged, or avoided and where there may be silent blocks or inappropriate inhalation, exhalation, or phonation patterns;Voice | speech impairments where the child’s voice has an abnormal quality to its pitch, resonance, or loudness; and Language | language impairments where the child has problems expressing needs, ideas, or information, and/or in understanding what others say.

( 1)These areas are reflected in how “speech or language impairment” is defined by the nation’s special education law, the Individuals with Disabilities Education Act, given below.

IDEA is the law that makes early intervention services available to infants and toddlers with disabilities, and special education available to school-aged children with disabilities. Definition of “Speech or Language Impairment” under IDEAThe Individuals with Disabilities Education Act, or IDEA, defines the term “speech or language impairment” as follows:“ (11) Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.” [34 CFR §300.8 (c) (11]Back to top Development of Speech and Language Skills in Childhood Speech and language skills develop in childhood according to fairly well-defined milestones (see below).

Parents and other caregivers may become concerned if a child’s language seems noticeably behind (or different from) the language of same-aged peers. This may motivate parents to investigate further and, eventually, to have the child evaluated by a professional.______________________More on the Milestones of Language Development What are the milestones of typical speech-language development?

What level of communication skill does a typical 8-month-old baby have, or a 18-month-old, or a child who’s just celebrated his or her fourth birthday?

You’ll find these expertly described in How Does Your Child Hear and Talk?, a series of resource pages available online at the American Speech-Language-Hearing Association (ASHA): http://www.asha.org/public/speech/development/chart.htm______________________Having the child’s hearing checked is a critical first step.

The child may not have a speech or language impairment at all but, rather, a hearing impairment that is interfering with his or her development of language. It’s important to realize that a language delay isn’t the same thing as a speech or language impairment. Language delay is a very common developmental problem—in fact, the most common, affecting 5-10% of children in preschool.

( 2) With language delay, children’s language is developing in the expected sequence, only at a slower rate.

In contrast, speech and language disorder refers to abnormal language development. ( 3) Distinguishing between the two is most reliably done by a certified speech-language pathologist such as Christina, the SLP in our opening story. Back to top Characteristics of Speech or Language Impairments The characteristics of speech or language impairments will vary depending upon the type of impairment involved.

There may also be a combination of several problems. When a child has an articulation disorder, he or she has difficulty making certain sounds. These sounds may be left off, added, changed, or distorted, which makes it hard for people to understand the child.

Leaving out or changing certain sounds is common when young children are learning to talk, of course.

A good example of this is saying “wabbit” for “rabbit.” The incorrect articulation isn’t necessarily a cause for concern unless it continues past the age where children are expected to produce such sounds correctly. ( 4) ( ASHA’s milestone resource pages, mentioned above, are useful here. )Fluency refers to the flow of speech. A fluency disorder means that something is disrupting the rhythmic and forward flow of speech—usually, a stutter.

As a result, the child’s speech contains an “abnormal number of repetitions, hesitations, prolongations, or disturbances. Tension may also be seen in the face, neck, shoulders, or fists.” ( 5)Voice is the sound that’s produced when air from the lungs pushes through the voice box in the throat (also called the larnyx), making the vocal folds within vibrate.

From there, the sound generated travels up through the spaces of the throat, nose, and mouth, and emerges as our “voice.”A voice disorder involves problems with the pitch, loudness, resonance, or quality of the voice.

( 6) The voice may be hoarse, raspy, or harsh. For some, it may sound quite nasal; others might seem as if they are “stuffed up.” People with voice problems often notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use. ( 7)Language has to do with meanings, rather than sounds. ( 8) A language disorder refers to an impaired ability to understand and/or use words in context. ( 9) A child may have an expressive language disorder (difficulty in expressing ideas or needs), a receptive language disorder (difficulty in understanding what others are saying), or a mixed language disorder (which involves both).

Some characteristics of language disorders include:improper use of words and their meanings,inability to express ideas,inappropriate grammatical patterns,reduced vocabulary, andinability to follow directions. ( 10)Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate.

These symptoms can easily be mistaken for other disabilities such as autism or learning disabilities, so it’s very important to ensure that the child receives a thorough evaluation by a certified speech-language pathologist.

Back to top What Causes Speech and Language Disorders? Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, intellectual disabilities, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown. Back to top Incidence Of the 6.1 million children with disabilities who received special education under IDEA in public schools in the 2005-2006 school year, more than 1.1 million were served under the category of speech or language impairment.

( 11) This estimate does not include children who have speech/language problems secondary to other conditions such as deafness, intellectual disability, autism, or cerebral palsy. Because many disabilities do impact the individual’s ability to communicate, the actual incidence of children with speech-language impairment is undoubtedly much higher.

Back to top Finding Help Because all communication disorders carry the potential to isolate individuals from their social and educational surroundings, it is essential to provide help and support as soon as a problem is identified.

While many speech and language patterns can be called “baby talk” and are part of children’s normal development, they can become problems if they are not outgrown as expected. Therefore, it’s important to take action if you suspect that your child has a speech or language impairment (or other disability or delay).

The next two sections in this fact sheet will tell you how to find this help. Help for Babies and Toddlers Since we begin learning communication skills in infancy, it’s not surprising that parents are often the first to notice—and worry about—problems or delays in their child’s ability to communicate or understand.

Parents should know that there is a lot of help available to address concerns that their young child may be delayed or impaired in developing communication skills. Of particular note is the the early intervention system that’s available in every state. Early intervention is a system of services designed to help infants and toddlers with disabilities (until their 3rd birthday) and their families.

It’s mandated by the IDEA. Through early intervention, parents can have their young one evaluated free of charge, to identify developmental delays or disabilities, including speech and language impairments. If a child is found to have a delay or disability, staff work with the child’s family to develop what is known as an Individualized Family Services Plan, or IFSP.

The IFSP will describe the child’s unique needs as well as the services he or she will receive to address those needs. The IFSP will also emphasize the unique needs of the family, so that parents and other family members will know how to support their young child’s needs.

Early intervention services may be provided on a sliding-fee basis, meaning that the costs to the family will depend upon their income. To identify the EI program in your neighborhood | Ask your child’s pediatrician for a referral to early intervention or the Child Find in the state.

You can also call the local hospital’s maternity ward or pediatric ward, and ask for the contact information of the local early intervention program. Back to top Help for School-Aged Children, including Preschoolers Just as IDEA requires that early intervention be made available to babies and toddlers with disabilities, it requires that special education and related services be made available free of charge to every eligible child with a disability, including preschoolers (ages 3-21).

These services are specially designed to address the child’s individual needs associated with the disability—in this case, a speech or language impairment.

Many children are identified as having a speech or language impairment after they enter the public school system. A teacher may notice difficulties in a child’s speech or communication skills and refer the child for evaluation.

Parents may ask to have their child evaluated. This evaluation is provided free by the public school system. If the child is found to have a disability under IDEA—such as a speech-language impairment—school staff will work with his or her parents to develop an Individualized Education Program, or IEP. The IEP is similar to an IFSP. It describes the child’s unique needs and the services that have been designed to meet those needs.

Special education and related services are provided at no cost to parents. There is a lot to know about the special education process, much of which you can learn at the Center for Parent Information and Resources (CPIR).

We offer a wide range of publications and resource pages on the topic. Enter our special education information at: http://www.parentcenterhub.org/repository/schoolage/Back to top Educational Considerations Communication skills are at the heart of the education experience. Eligible students with speech or language impairments will want to take advantage of special education and related services that are available in public schools.

The types of supports and services provided can vary a great deal from student to student, just as speech-language impairments do. Special education and related services are planned and delivered based on each student’s individualized educational and developmental needs. Most, if not all, students with a speech or language impairment will need speech-language pathology services.

This related service is defined by IDEA as follows: (15) Speech-language pathology services includes— (i) Identification of children with speech or language impairments; (ii) Diagnosis and appraisal of specific speech or language impairments; (iii) Referral for medical or other professional attention necessary for the habilitation of speech or language impairments; (iv) Provision of speech and language services for the habilitation or prevention of communicative impairments; and (v) Counseling and guidance of parents, children, and teachers regarding speech and language impairments.

[34 CFR §300.34 (c) (15)]Thus, in addition to diagnosing the nature of a child’s speech-language difficulties, speech-language pathologists also provide:individual therapy for the child;consult with the child’s teacher about the most effective ways to facilitate the child’s communication in the class setting; andwork closely with the family to develop goals and techniques for effective therapy in class and at home.

Speech and/or language therapy may continue throughout a student’s school years either in the form of direct therapy or on a consultant basis. Assistive technology (AT) can also be very helpful to students, especially those whose physical conditions make communication difficult. Each student’s IEP team will need to consider if the student would benefit from AT such as an electronic communication system or other device.

AT is often the key that helps students engage in the give and take of shared thought, complete school work, and demonstrate their learning.

Back to top Tips for Teachers— Learn as much as you can about the student’s specific disability. Speech-language impairments differ considerably from one another, so it’s important to know the specific impairment and how it affects the student’s communication abilities.— Recognize that you can make an enormous difference in this student’s life! Find out what the student’s strengths and interests are, and emphasize them. Create opportunities for success.—If you are not part of the student’s IEP team, a sk for a copy of his or her IEP.

The student’s educational goals will be listed there, as well as the services and classroom accommodations he or she is to receive.— Make sure that needed accommodations are provided for classwork, homework, and testing.

These will help the student learn successfully.— Consult with others (e.g., special educators, the SLP) who can help you identify strategies for teaching and supporting this student, ways to adapt the curriculum, and how to address the student’s IEP goals in your classroom.— Find out if your state or school district has materials or resources available to help educators address the learning needs of children with speech or language impairments.

It’s amazing how many do!— Communicate with the student’s parents. Regularly share information about how the student is doing at school and at home. Back to top Tips for Parents— Learn the specifics of your child’s speech or language impairment. The more you know, the more you can help yourself and your child.— Be patient.

Your child, like every child, has a whole lifetime to learn and grow.— Meet with the school and develop an IEP to address your child’s needs. Be your child’s advocate. You know your son or daughter best, share what you know.— Be well informed about the speech-language therapy your son or daughter is receiving. Talk with the SLP, find out how to augment and enrich the therapy at home and in other environments.

Also find out what not to do!— Give your child chores. Chores build confidence and ability. Keep your child’s age, attention span, and abilities in mind. Break down jobs into smaller steps. Explain what to do, step by step, until the job is done. Demonstrate. Provide help when it’s needed. Praise a job (or part of a job) well done.— Listen to your child. Don’t rush to fill gaps or make corrections.

Conversely, don’t force your child to speak. Be aware of the other ways in which communication takes place between people.— Talk to other parents whose children have a similar speech or language impairment. Parents can share practical advice and emotional support. See if there’s a parent nearby by visiting the Parent to Parent USA program and using the interactive map.— Keep in touch with your child’s teachers. Offer support. Demonstrate any assistive technology your child uses and provide any information teachers will need.

Find out how you can augment your child’s school learning at home. Back to top Readings and Articles We urge you to read the articles identified in the References section.

Each provides detailed and expert information on speech or language impairments. You may also be interested in: Speech-Language Impairment: How to Identify the Most Common and Least Diagnosed Disability of Childhood http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2491683/Organizations to Consult ASHA | American Speech-Language-Hearing Association Information in Spanish | Información en español.

1.800.638.8255 | actioncenter@asha.org | www.asha.org NIDCD | National Institute on Deafness and Other Communication Disorders 1.800.241.1044 (Voice) | 1.800.241.1055 (TTY) nidcdinfo@nidcd.nih.gov | http://www.nidcd.nih.gov/Cleft Palate Foundation 1.800.242.5338 | http://www.cleftline.org Childhood Apraxia of Speech Association of North America | CASANA http://www.apraxia-kids.org National Stuttering Foundation 1.800.937.8888 | info@We Stutter.org | http://www.nsastutter.org/Stuttering Foundation 1.800.992.9392 | info@stutteringhelp.org | http://www.stuttersfa.org/Back to top References1 | Minnesota Department of Education. (2010). Speech or language impairments. Online at: http://education.state.mn.us/MDE/Ed Exc/Spec Ed Class/Disab Categ/Speech Lang Impair/index.html2 | Boyse, K. (2008). Speech and language delay and disorder. Retrieved from the University of Michigan Health System website: http://www.med.umich.edu/yourchild/topics/speech.htm3 | Ibid.4 | American Speech-Language-Hearing Association. (n.d.). Speech sound disorders: Articulation and phonological processes. Online at: http://www.asha.org/public/speech/disorders/speechsounddisorders.htm5 | Cincinnati Children’s Hospital. (n.d.). Speech disorders. Online at: http://www.cincinnatichildrens.org/health/s/speech-disorder/6 | National Institute on Deafness and Other Communication Disorders.

(2002). What is voice? What is speech? What is language? Online at: http://www.nidcd.nih.gov/health/voice/pages/whatis_vsl.aspx7 | American Academy of Otolaryngology — Head and Neck Surgery. (n.d.). About your voice. Online at: http://www.entnet.org/content/about-your-voice8 | Boyse, K. (2008). Speech and language delay and disorder. Retrieved from the University of Michigan Health System website: http://www.med.umich.edu/yourchild/topics/speech.htm9 | Encyclopedia of Nursing & Allied Health. (n.d.). Language disorders. Online at: http://www.enotes.com/nursing-encyclopedia/language-disorders10 | Ibid.11 | U. S. Department of Education. (2010, December). Twenty-ninth annual report to Congress on the Implementation of the Individuals with Disabilities Education Act: 2007. Online at: http://www2.ed.gov/about/reports/annual/osep/2007/parts-b-c/index.html Back to top Share:

Muscles in the tongue, palate and lips may be affected to result in slowed, distorted or slurred speech, according to the American Heart Association. The condition that affects the tongue and other muscles is called dysarthria. Recovering stroke victims may need the help of a speech therapist to regain their speech.

Signs of a Stroke in the Tongue

Signs of a Stroke in the Tongueby JERRY SHAW Aug. 14, 2017Several symptoms may occur for people having a stroke. Symptoms that affect the tongue may provide a quick answer when determining whether someone may be having a life-threatening stroke.

Although finding signs in the tongue provides important clues, other signs of a stroke include sudden weakness or numbness in the face or limbs, severe headaches, feelings of confusion, visual problems, dizziness or loss of balance and temporary loss of speech or inability to speak clearly. Video of the Day Error setting up player: Invalid license key Speech Stroke victims often have difficulty understanding words and coming out with the right words they are thinking.

A condition called aphasia may affect the ability to talk and occurs with a stroke on the left side of the brain, which controls speech and language. Weakness on the side of the body and in muscles also causes speech problems in stroke victims.

Slanting Tongue People suspected of having a stroke can be asked to stick their tongue out, advises Disabled World. A tongue that doesn't appear straight, droops or slants to one side instead of coming straight out of the mouth indicates a stroke.

Other methods to determine the necessity of immediate medical help for a stroke victim is asking the person to smile or speak a simple sentence.

Difficulties with those activities or with raising the arms above the head indicate a stroke. Swallowing Difficulty Stroke victims who have difficulty swallowing may suffer from dysphagia, a condition that impairs the swallowing reflex by disrupting the muscular coordination of the tongue or throat muscles, Healthtree.com explains.

Many strokes result in this condition. Difficulty swallowing can lead to other dangerous situations, such as choking or having food particles caught in the lungs, causing aspiration pneumonia. A stroke victim may also complain about difficulty eating or not being able to eat at all. Victims may also have difficulty chewing food because the muscles on one side of the mouth are very weak.

A lack of feeling on one or both sides of the mouth increases the risk of choking. Lose Weight. Feel Great!Change your life with My Plate by LIVE STRONG .

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How to Regain Speech After a Stroke Early Signs of Tongue Cancer What Are the Causes of Spontaneous Paralysis of Part of the Body?

What Is a Hypoglycemic Stroke? Exercises for Stroke Paralysis on One Side Danger Signs of Hypertension Can High Cholesterol Cause Headaches and Dizziness? Tongue Symptoms of Vitamin Deficiencies Consequences of an Occipital Stroke What Are the After Effects of a TIA Stroke? My Tongue Is Still Coated on Day Nine of a Master Cleanse

There are three major types of dysarthria in cerebral palsy: spastic, dyskinetic (athetosis) and ataxic. Speech impairments in spastic dysarthria involves four major abnormalities of voluntary movement: spasticity, weakness, limited range of motion and slowness of movement.

Signs and Symptoms of Cerebral Palsy Cerebral Palsy: Diagnosis & Treatment : About Cerebral Palsy Warning Signs Your browser does not currently recognize any of the video formats available.

Click here to visit our frequently asked questions about HTML5 video.0:00 / 2:00All types of cerebral palsy are characterized by abnormal muscle tone (i.e. slouching over while sitting), reflexes, or motor development and coordination. There can be joint and bone deformities and contractures (permanently fixed, tight muscles and joints).

The classical symptoms are spasticities, spasms, other involuntary movements (e.g. facial gestures), unsteady gait, problems with balance, and/or soft tissue findings consisting largely of decreased muscle mass. Scissor walking (where the knees come in and cross) and toe walking (which can contribute to a gait reminiscent of a marionette) are common among people with CP who are able to walk, but taken on the whole, CP symptomatology is very diverse.

The effects of cerebral palsy fall on a continuum of motor dysfunction which may range from slight clumsiness at the mild end of the spectrum to impairments so severe that they render coordinated movement virtually impossible at the other end the spectrum. Babies born with severe CP often have an irregular posture; their bodies may be either very floppy or very stiff.

Birth defects, such as spinal curvature, a small jawbone, or a small head sometimes occur along with CP. Symptoms may appear or change as a child gets older. Some babies born with CP do not show obvious signs right away. Classically, CP becomes evident when the baby reaches the developmental stage at six and a half to 9 months and is starting to mobilise, where preferential use of limbs, asymmetry or gross motor developmental delay is seen.

Secondary conditions can include seizures, epilepsy, apraxia, dysarthria or other communication disorders, eating problems, sensory impairments, mental retardation, learning disabilities, and/or behavioral disorders. Speech and language disorders are common in people with Cerebral Palsy.

The incidence of dysarthria is estimated to range from 31% to 88%. Speech problems are associated with poor respiratory control, laryngeal and velopharyngeal dysfunction as well as oral articulation disorders that are due to restricted movement in the oral-facial muscles.

al. Speech Difficulties Dysarthria is the most common speech disorder experienced by people with ALS and by people with MS. They may speak slowly, softly, in strange rhythms, or slur their words. Although this can make it difficult to understand their speech, the meaning of what they are saying is normal. In people with ALS, the dysarthria tends to get progressively worse.

Is it MS or ALS? The Differences Between the Symptoms

"Brain & Nervous System Multiple Sclerosis Symptoms Is it MS or ALS? The Differences Between the Symptoms Similarities and Differences Between Multiple Sclerosis and Lou Gehrig's Disease By Julie Stachowiak, Ph D | Reviewed by Claudia Chaves, MDUpdated February 15, 2018Share Pin Email Print Getty Images/Jose Luis Pelaez Inc Because the list of possible symptoms is so long and varied, it is inevitable that there will be some overlap between some multiple sclerosis symptoms and many other diseases and disorders, especially neurological ones. Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, is no exception. However, distinct differences in the symptoms of MS and ALS become evident to health care professionals fairly quickly.

The Primary Difference Between MS and ALSOne significant difference in the presentation of these two neurological diseases is that the symptoms of ALS all involve nerves that control voluntary muscle movement, whereas the nerves affected in MS affect both voluntary and involuntary muscle movement. That said, there is more to the story. Initial Symptoms of ALS and MSMuscle weakness on one side of their body is the first symptom for 80 percent of people with ALS.

This is usually in the hands (such as trouble writing or picking up tiny objects), shoulder (such as difficulty lifting arms above the head to do tasks like combing their hair or reaching for an object), or feet/legs (usually seen as ""foot drop"" or difficulty climbing stairs). The other initial ALS symptoms usually involve trouble speaking (dysarthria) or swallowing (dysphagia).

In contrast, the first symptoms usually experienced by people with multiple sclerosis are often paresthesias (numbness or tingling in extremities) or optic neuritis.

Of course, any of the symptoms of MS can show up first; these two are just the most common. Similarities in Symptoms of ALS and MSWhile the initial presentations of these diseases are different, they share symptoms that are similar, but also subtly different, which include: Muscle Weakness in Arms and Legs People with ALS will experience a decline in the strength and ability to use the muscles in their arms and legs. The muscles actually atrophy, making it difficult to walk. Eventually, an assistive device (walker, wheelchair or scooter) will be needed by everyone with ALS. While many people with MS experience problems walking, this is not univers

In MS, it is usually intermittent. In addition, it is usually more severe in people with ALS. People with MS often have additional symptoms that interfere with communication, such as dysphasia, which are problems understanding or communicating spoken or written words. These are one type of MS-related cognitive dysfunction. People with ALS typically do not experience these types of symptoms.

Although some people with ALS do experience some cognitive dysfunction, these symptoms are usually more subtle. Swallowing Problems People with ALS also commonly experience dysphagia, which means they have difficulty swallowing.

This will often progress to the point that a feeding tube or other means of feeding will need to be introduced. While people with MS may also have this symptom, it is usually much less severe and people may not be aware of it.

They may have occasional MS-related swallowing problems that feel like gagging or coughing when eating. Breathing Problems When the muscles controlling respiration begin to atrophy, the person with ALS begins to experience problems breathing, as they simply cannot take enough air into their lungs.

At some point, many people with ALS will use a device to help them breathe, often starting with noninvasive ventilation —wearing a mask that delivers oxygen. Breathing problems also occur in people with MS, but usually not to the same extent. It is extremely rare for MS-related respiratory problems to require breathing assistance. It has been shown that lung function is lower than normal in most people with MS, but most people do not notice it or are only bothered by shortness of breath upon exertion, like when climbing stairs or moving quickly.

Differences in Symptoms Vision In ALS, people lose control of voluntary muscle movement, but usually retain the ability to see. In MS, vision can be affected by optic neuritis or nystagmus. Sensory Symptoms Some people with ALS report tingling, also known as paresthesia; however, this is not a common symptom and it usually goes away.

Sensory symptoms are much, much more common in people with MS, as people with MS often experience a range of unpleasant sensory symptoms, such as numbness and tingling and pain.

Bladder and Bowel Symptoms It is estimated that over 90 percent of people with MS experience bladder dysfunction, including incontinence, at some point. People with ALS usually do not experience urinary incontinence; however, it is fairly common. Both people with MS and ALS experience constipation, but people with MS are more likely to experience bowel incontinence (diarrhea) than people with ALS.

Bottom Line Because nerves controlling many bodily functions (voluntary and involuntary) are affected in MS, some symptoms of MS and ALS are similar—often rare symptoms of MS are common symptoms of ALS.

If you have a strange symptom that has you worried or impacts your life in a negative way, talk to your neurologist. He or she will probably reassure you that it is just another unpredictable, funky ""MS thing"" or tell you that there is no connection, but it is nothing to worry about.

However, if you are really concerned, your doctor can evaluate you to rule out other diseases. Sources: Amyotrophic Lateral Sclerosis (ALS) Fact Sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Amyotrophic-Lateral-Sclerosis-ALS-Fact-Sheet. Multiple Sclerosis. American Academy of Family Physicians. https://familydoctor.org/condition/multiple-sclerosis/?adfree=true. "

Dysarthria is a motor speech disorder that is due to a paralysis, weakness, altered muscle tone or incoordination of the speech muscles. Speech is slow, weak, efforful, imprecise or uncoordinated. Voice and breathing for speech may also be affected.

"1. Advocate One that pleads in another's behalf; an intercessor: one that defends or maintains a cause or proposal2. American Speech and Hearing Association The American Speech-Language-Hearing Association (ASHA) is the professional, scientific, and credentialing association for audiologists, speech-language pathologists, and speech, language, and hearing scientists. Their mission is to ensure that all people with speech, language, and hearing disorders have access to quality services to help them communicate more effectively.3.

Aphasia Partial or total loss of the ability to articulate ideas or comprehend spoken or written language, resulting from damage to the brain caused by injury or disease.4. Aphonia Loss of the voice resulting from disease, injury to the vocal cords, or various psychological causes.5.

Applied Behavioral Analysis ABA is a method to change behavior. It consists of delivery of systematic directions that elicit responses from the student which are consistently reinforced.

The theory is that reinforced behavior will reoccur. ABA is a discipline that requires consistency, behavior prompting and rewards for correct behavior or approximations of correctness.6. Articulation Disorder Characterized by the inability to produce individual speech sounds clearly and difficulty combining sounds correctly for words.7.

Asperger Syndrome Asperger Syndrome, also known as Asperger's Disorder or Autistic Psychopathy, is a Pervasive Developmental Disorder (PDD) characterized by severe and sustained impairment in social interaction, development of restricted and repetitive patterns of behavior, interests, and activities. These characteristics result in clinically significant impairment in social, occupational, or other important areas of functioning. In contrast to Autistic disorder (Autism), there are no clinically significant delays in language or cognition, self help skills or in adaptive behavior, other than social interaction.8.

Assessment Formal (e.g., standardized tests) and informal procedures used to identify a person's unique needs, strengths, weaknesses, learning style, and nature and extent of intervention services needed.

Assessment may be interchangeable with ""Evaluation,"" and it is at this clinic.9. Associative Play When children play with each other, sharing the same materials and activities in an unorganized way. At this level the children may be involved in play related to the same theme (e.g., playing blocks, playing ""police/firefighter"") but not have organized scenarios with a common goal in their play.

Each child purses his/her own unique ideas. Predominateds between 30-36 months.10. Attention Deficit Disorder ADD/ADHD in the DSM (Diagnostic Statistical Manuel) IV refers to 1) Attention Deficit/Hyperactivity Disorder Combined Type, 2) Attention Deficit/Hyperactivity Disorder/Predominately Inattentive Type, or 3) Attention Deficit/Hyperactivity Disorder/Predominately Hyperactive-Impulsive Type.

Overall, behaviors include hyperactivity, impulsivity, and inattention, depending on the diagnosis. These behaviors must occur to a degree, which is maladaptive and inconsistent with developmental level, and occur in at least two settings over a period of at least 6 months.

These behaviors may interfere with speech/language learning, academic performance and social activities (e.g., making friends, sustaining friendships. The disorder is diagnosed before the age of 7, or symptoms were present before this age. There must also be the presence of related impairment in social, academic, or occupational functioning.

For examples of related behaviors and symptoms of ADD/ADHD, please click on ""Understanding"" and then ""Other Impairments and Disorders"" at the top of this screen.

Scroll down to ADD/ADHD.11. Audiologist A professional who specializes in the identification, testing, habilitation and rehabilitation of hearing loss and hearing related disorders (e.g., central auditory processing disorder). A person who is also extensively trained in the anatomy and physiology of the audtiory mechanism, counseling for hearing disorders, and diagnostic testing/fitting of hearing aids as well as assistive listening devices.12.

Auditory Perceptual Processing Disorder or Central Auditory Also referred to as an auditory percetpual problem, central auditory dysfunction or central auditory processing disorder (CAPD). It can be defined as difficulty in listening to or comprehending auditory information, especially under less optimal listening conditions (e.g., background noise).

It is a condition wherein a person does not process speech/language correctly. They may have difficulties knowing where sound has occurred and indentifying the source of the sound or in distinguishing one sound from another.

Children and adults with CAPD are diverse and have difficulty using auditory information to communicate and learn. For more information, please click on ""Understanding"" and then ""Auditory Perceptual Processing Disorder"" at the top of the screen.13. Auditory Processing The auditory system, mechanism, and processes responsible for the following: sound localization and lateralization, auditory discrimination, auditory pattern recognition, temporal aspects of audition, and auditory performance with competing acoustic signals.14. Autism Autism is a complex developmental disability that appears during the first three years of life.

The result of a neurological disorder that affects the functioning of the brain, autism and its associated behaviors have been estimated to occur in as many as 1 in 500 individuals (Centers for Disease Control and Prevention 1997).

Autism is four times more prevalent in boys than girls and knows no racial, ethnic, or social boundaries. Family income, lifestyle, and educational levels do not affect the chance of autism's occurrence. Per the DSM IV, autism includes delays and/or abnormal functioning (with onset prior to age 3) in at least one of the following areas: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder. Futher, for a diagnosis, a total of six or more items from A, B and C (below), and at least two from A and one each from B and C must be present.

See ""Autism--Diagnositc Criteria"" A, B and C below.15. Autism--Diagnostic Criteria ""A"" A. Qualitative impairments in reciprocal social interaction: Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction.

Failure to develop peer relatiohships appropriate to developmental level. Lack of spontaneous seeking to share enjoyment, interest, or achievements with others. Lack of social or emotional reciprocity.16. Autism--Diagnostic Criteria ""B"" B. Qualitative impairments in communication: A delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime).

Marked impairment in the ability to initiate or sustain a conversation with others despite adequate speech. Sterotyped and repetitive use of language or idiosyncratic language. Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental level.17. Autism--Diagnostic Criteria ""C"" Restricted, repetitive, and sterotyped patterns of behavior, interest, or activity, emcompassing preoccupation with one or more sterotyped and restricted patterns of interest, abnormal either in intensity or focus.

An apparently compulsive adherence to specific nonfunctional routines or rituals. Sterotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, complex whole body movements). Persistent preoccupation with parts of objects.18. Autistic Spectrum Disorders May also be referred to as pervasive developmental disorders. Autistic spectrum disorders include Asperger syndrome, autism, and pervasive developmental disorders--not otherwise specified.

They are neurological in origin and symptoms appear in the first few years of life. The disorders share a set of behavioral characteristics, but each child/adult shows symptoms and characteristics very differently.

Autism is referred to as a spectrum disorder to signify these differences among those sharing a common diagnosis.19. Behavior Management Plan A behavioral management plan tries to prevent maladaptive behaviors, teaches socially acceptable behaviors to take the place of unpleasant behaviors, and creates a crisis intervention plan.20.

Behavioral Therapist The Behavioral Therapist seeks to effect positive and lasting change by working with the client to modify their maladaptive thoughts and/or behaviors.21. California Speech and Hearing Association The State of California's professional, scientific, and credentialing association for audiologists, speech-language pathologists, and speech, language, and hearing scientists.22. Clinical Fellowship Year (CFY) An important transitional phase between supervised graduate-level practicum and the independent delivery of services.

It is designed to foster the continued growth and integration of the knowledge, skills, and tasks of clinical practice in speech-language pathology consistent with ASHA's current scope of practice. The CFY lasts a continuous 9 months while maintaining full-time employment (30+ hours a week).23. Communication a. The exchange of thoughts, messages, or information, as by speech, signals, writing, or behavior. b. Interpersonal rapport.

c. communications (used with a sing. or pl. verb). The art and technique of using words effectively and with grace in imparting one's ideas.24. Congenital a. Existing at or before birth. b. Acquired at birth or during uterine. Developmental, as a result of either hereditary or environmental influences.25.

Constructive Play ""Manipulation of objects for the purpose of constructing or creating something (Rubin, 1984). Children use materials to achieve a specific goal in mind that requires transformation of objects into a new configuration.

Usually emerges around two years of age and predominates from age three on.26. Cooperative Play When children plan, assign roles and play together it is referred to as cooperative play. Cooperative play is goal-oriented and children play in an organized manner toward a common end. Emerges around 36 to 48 months of age and continues through the school years.27.

Deficit A deficiency or impairment in mental or physical functioning.28. Delay To perform below expected norms according to chronological age or grade level.29. Developmental Disability Developmental Disabilities in infants and toddlers are displayed as significant differences between expected level of development for age and current level of functioning.

Children with developmental disabilities are those who have a delay in one or more of the following areas: cognitive development; physical and motor development, including vision and hearing; communication development; social or emotional development; or adaptive development.30.

Developmental Language Disorder Children who do not develop language skills appropriately or according to language norms are language delayed or disordered.31. Developmental Speech Disorder Children who do not develop speech production skills appropriately or according to normative data are speech delayed or disordered.32.

Diagnosis a. The act or process of identifying or determining the nature and cause of a disease or injury through evaluation of patient history, examination, and review of other significant data. b. The opinion derived from such an evaluation.33. Disability The functional consequence of impairment34.

Discrete Trial Training Discrete trial training (DTT) is a method of behavioral intervention. DTT programs generally involve several hours of direct one-on-one instruction per day over many months or years and teach specific skills in an intensive manner.

The discrete trial method has four distinct parts (according to Anderson et al, 1996): (1) the trainer's presentation, (2) the child's response, (3) the consequence, (4) a short pause between the consequence and the next instruction (between interval trials).

In general, DTT programs target skills that are broken down into finite, discrete tasks. The behavioral therapist typically uses repetition, feedback, and positive reinforcers to help the child master small tasks. Once mastered, basic skills are used as building blocks to develop more complex abilities. Behavioral excesses such as tantrumming, aggression, and repetitive behaviors, may also be addressed.

Not all programs using DTT follow the same program sequences or curriculum.35. Disorder An ailment or condition that affects the function of mind or body:36. DOB Date of Birth37. Down Syndrome A congenital disorder, caused by the presence of an extra crititical portion of the 21st chromosome in all, or some, of one's cells. This additional genetic material changes the developmental course, causing the charateristics associated with the syndrome. Those affected usually have mild to moderate mental retardation38. Dysarthria

Dysarthria is a motor speech disorder that is due to a paralysis, weakness, altered muscle tone or incoordination of the speech muscles. Speech is slow, weak, efforful, imprecise or uncoordinated. Voice and breathing for speech may also be affected.

39. Dysphagia A disorder/condition that affects an individual's ability to swallow.40. Dysphasia Impairment of speech and verbal comprehension; term often used when associated with stroke or brain injury.41. Early Intervention Early intervention applies to children prior to school age who are discovered to have or be at risk of developing a handicapping condition or other special need that may affect their development. Early intervention consists of the provision of services for such children and their families for the purpose of lessening the effects of the condition.

Early intervention can be remedial or preventive in nature--remediating existing developmental problems or preventing their occurrence.42. Educational Model Therapy focuses on intervention to improve the child's ability to learn and function in the school environment.43. Educational Therapist A professional who uses educational and therapeutic approaches in working with clients of all ages with learning problems and learning disabilities. Educational Therapists perform professional work which requires applying the concepts, principles, and practices of education and rehabilitation therapy.44.

Emotionally Disturbed A disturbance which can be characterized by: an inability to build or maintain satisfactory interpersonal relationships; inappropriate types of behavior or feelings under normal circumstances; general pervasive mood of unhappiness or depression; or a tendency to develop physical symptoms or fears associated with personal or school problems.

If frequently affects the ability to learn.45. Evaluation An assessment of an individual's abilities (i.e., speech and language, motoric, cognitive, etc.)

in order to determine their strengths and weaknesses, and to see whether or not deficits are significant for intervention. It is usually the first thing that takes place to get a child qualified for service. The purpose is most often eligibility for a service (s).46. Floor Play Therapy where skills such as speech, language and play are developed through floor-based play involving toys, games, activities, etc.47.

Fragile X Syndrome A genetic condition caused by a spontaneous partial break in the long arm of the X chromosome. Measurement of testes in males and a chromosome analysis helps confirm the diagnosis. There are often very few outward signs of Fragile X syndrome. The spectrum of the syndrome ranges from normal development to developmental delay, learning disabilities, mild-severe intellectural disability, autistic-like behavior and attentional problems.

The majority of children are mildy to moderately affected.48. Functional Play May also be a term used for ""relational play"" (seen between 9-24 months) denoting use of objects in play for the purposes for which they were intended, e.g., using simple objects correctly, combining related objects (man in car), and making objects do what they are made to do.49.

Habilitation The process (therapy) to make suitable for specific use50. Handicap The loss or limitation of opportunities to take part in the life of the community on an equal level with others.51. Hard of Hearing Broad term covering individuals with hearing loss ranging from mild to profound (deaf).52. Health Management Organization A corporation financed by insurance premiums whose members, physicians and professional staff provide curative and preventive medicine within certain financial, geographic, and professional limits to enrolled volunteer members and their families.53.

Hearing Impaired Broad term covering individuals with hearing loss ranging from mild to profound (deaf).54.

High Functioning Autism Characteristics that are typically seen in individuals with ""high functional autism"" may include some of the following: average or above average IQ, superior vocabulary skills, higher rate of unusual obsessions, motor deficits (clumsiness), less impaired on ""theory of mind"" tests, and speech is less commonly delayed.55.

Hyperlexia A syndrome observed in children who have the following characteristics: an ability to read words, far above what would be expected at their chronological age, frequently an intense and early fascination with letters or numbers, significant difficulty in understanding/processing verbal language, abnormal social skills, and deficits in social/pragmatic communication abilities.

Precocious reading abilities are developed spontaneously before the age of five; they are not taught.56. ICD Code A universal billing system that utilizes a numeric format (codes) that differ as related to specific diagnosis. ICD stands for International Classification of Diseases.57. Impairment An abnormality of structure or function58.

Individual Education Plan (IEP) A written plan for every student receiving special education services within the public school system. The plan contains information such as the student's special learning needs and the specific special education services required by the student.59. Infantile Autism A spectrum of neuropsychiatric disorders characterized by deficits in social interaction and communication, and unusual and repetitive behavior.

Typically occurs within the first three years of life. Some, but not all people with autism, are non-verbal.

Please see Autism in this glossary for more information.60. Insurance Coverage a. Coverage by a contract binding a party to indemnify another against specified loss/conditions in return for premiums paid. b. The sum or rate for which such a contract insures something. c. The periodic premium paid for this coverage.61. Intelligence Quotient The ratio of tested mental age to chronological age, usually expressed as a quotient multiplied by 100.62. Landau-Kleffner syndrome (LKS) A disorder with seizures starting in childhood in which the patient loses skills, such as speech, and develops behavior characteristic of autism.63.

Language The use by human beings of voice sounds, and often written symbols representing these sounds, in organized combinations and patterns in order to express and communicate thoughts and feelings.

Language also includes other forms of communication as well, e.g., use of symbols, gesture, and sign.64. Language Based Learning Disability Disabilities which interfere with age-appropriate reading, spelling, and/or writing. Please see ""Learning Disabilities"" for a broader definition of learning disabiity. A language based learning disability is specific to language processing and use.65. Language Comprehension Also called Receptive Language. A person's ability to understand and process language at the sound, word, phrase, sentence, multi-sentence and conversational levels.

Involves understanding of vocabulary, concepts, grammar (morphology and syntax), and higher level language associated with processing more abstract language (e.g., inferences, idioms, verbal problem solving and abstract reasoning).

Also involves the ability to retain linguistic information for the purpose of understanding and interpretation. Difficulties with receptive language can interfere with academic or occupational achievement or with social communication66. Learning Disabilities Disabilities affecting the manner one takes in information, retains it, and expresses the knowledge and understanding they have. Learning disabilities is a general term for a heterogeneous group of disorders manifested by significant difficulties in acquistion and use of listening, speaking, reading, writing, reasoning, or mathematical abilities.

They are intrinsic to the individual, presumed to be due to central nervous system dysfunction, and may occur across the life span. Problems in self-regulatory behaviors, social perception, and social interaction may exist with learning disabilities but do not by themselves constitute a learning disability.

Though learning disabilities may occur concomitantly with other handicapping conditions or with extrinsic influences, they are not the result of those conditions or influences (National Joint Committee on Learning Disabilities, 1981, revised 1988). See ""Learning Disabilities--Continued"" for other frequent characteristics.67. Learning Disabilities--Continued Frequent characteristics of learning disabilities include, but are not limited to, a marked discrepancy between achievement and potential with uneven abilities within an individual, average to above average intellectual functioning, processing deficits (e.g., auditory and/or visual perceptual problems), and long/short term auditory and/or visual memory deficits.68.

Medical Model Therapy focuses on treatment to cure or alleviate specific underlying medical conditions.69.

Mental retardation Impaired intellectual ability that is equivalent to or less than an IQ of approximately 70 with onset before age 18, and presenting with concurrent impairments in adaptive functioning. The condidtion is manifested typically by abnormal development, learning difficulties, and problems in social adjustment70.

Multidisciplinary Team A group or team of disciplines that work, assess, report results, and/or deliver treatment to clients.71. Non-Public School Agency (NPA) An approved, but unrelated, agency that provides a service to meet the needs/demands of a public school system.72. Nonverbal Learning Disability A specific pattern of neuropsychological assets and deficits that eventuates in the following: a specific pattern of relative assets and deficits in academic (well-developed single-word reading and spelling relative to mechanical arithmetic) and social (e.g., more efficient use of verbal than nonverbal information in social situations) learning; specific, developmentally dependent patterns of psychosocial functioning.73.

Noonan's Syndrome ""A grouping of specific abnormalities affecting both males and females, both sporadic in appearance but also reflecting a hereditary component (thought to be autosomal dominant). Symptoms may include webbed neck, sternum abnormalities (pectus excavatum, occasionally pectus carinatum), sagging eyelids (ptosis), wide-set eyes (hypertelorism), low-set ears abnormally shaped ears, undescended testicles, delayed puberty, mental retardation, short stature, and small penis.""74. Occupational Therapist Provides evaluation and treatment of daily living skills for individuals with disabilities.

Therapy emphasizes remediation of or compensation for perceptual, sensory, visual-motor, fine-motor, and self-care deficits.75. Oral Motor Referring to the oral motor structures for speech, e.g., lips, tongue, teeth, palate, larynx, and so forth.76. Otitis Media Inflammation of the middle ear, occurring commonly in children as a result of infection and often causing pain and temporary hearing loss.77.

Parallel Play The child plays near or beside another child using some or all of the same/similar materials as the other child without trying to modify or influence the other child and being mainly concerned with toy materials, not with relating to the other child. Predominates between 24-30 months.78. Pathologist One who engages in the scientific study of the nature of disease and its causes, processes, development, and consequences.79.

PDD/NOS When children display similar behaviors to but do not meet the criteria for autistic disorder, they may receive a diagnosis of Pervasive Developmental Disorder-Not Otherwise Specified (PDD/NOS). It is a neurological disorder that affects such areas as a child's ability to communicate, understand language, play, and relate to others.80.

Phonological Awareness / Processing Phonological awareness is a person's explicit knowledge of the sound segments (phonemes) which comprise words. Phonological processing skills include the ability to recognize and produce rhyming words or patterns of alliteration, segmenting or breaking apart words into syllables/sounds, identify where a specific sound occurs in a word, and blend sounds into words. Problems in these areas indicate a weakness in phonological processing/awareness. Other symptoms seen with a phonological processing deficit are difficulty with rapid-naming tasks and incorrect repetition of multisyllabic words.81.

Phonological Disorder A disorder characterized by failure to use speech sounds that are appropriate for the individual's age and dialect. Symptoms typically include but are not limited to failure in sound production and use, substitutions of one sound for another, and omissions of sounds. The pattern of errors may indicate use of inappropriate phonological processes/rules for the child's age, e.g., final consonant deletion, or omission of final consonants in words when speaking.82.

Physical Therapist Provides assessment and treatment for disorders related to physical and musculoskeletal injuries. Therapy emphasizes remediation of or compensation for mobility, gait, muscle strength, and postural deficits.83. Post-Lingual After the development of speech.84. Pre-Lingual Before the development of speech.85. Psychiatrist A physician who specializes in psychiatry. (MD)86. Psychiatry The branch of medicine that deals with the diagnosis, treatment, and prevention of mental and emotional disorders.87.

Psychologist A person trained and educated to perform psychological research, testing, and therapy. Holds a Master's degree or ph. D in the field of psychology. Since not an MD, they may not prescribe medications.88.

Regional Centers The Centers shall function as a leader and advocate in promoting the continuing entitlement of citizens with developmental disabilities to all services that enable full community inclusion. The Association shall also participate in the development of public legislative policy and serve as a focal point for communication, education, training and prevention services.89.

Rehabilitation To restore to good health or useful life, as through therapy and education.90. Remediation The act or process of correcting a fault or deficiency91. Representational Play Pretend play which emerges when a child begins to use familiar objects in appropriate ways to represent their world (i.e.

pushing a toy lawn mower over the grass). Begins to occur between 12- to 21-months of age.92. Resource Specialist Typically, a Resource Specialist provides support, pertinent information, consultant services, and direct intervention to individuals, their family, and staff members regarding educational/learning needs and issues.

Frequently found within the public school setting.93. Sensory Integration The process of the brain organizing and interpreting sensory information.94. Sensory Integration Dysfunction Sensory integration dysfunction is the inability to process certain information received through the senses.95. Social Impairment Verbal and/or nonverbal difficulties in socializing and relating with peers.96. Sociodramatic Play Play involving acting out scripts, scenes, etc. (i.e., from a favorite cartoon or book or from daily life). Children take/assume roles using themselves and/or characters (dolls, figures) as they interact together on common themes.

A faciliator may assist ideas for characters, settings or props and use the children's ideas for a story.

Typically occurs between 3 - 4 years of age. As a child matures, themes, sequences, plans, problem solving, characters and so forth become more rich and they begin to organize other children for role play with independence (around 5 years of age).97.

Solitary Play The child plays alone with toys that are different from those used by the children within speaking distance and makes no effort to interact with other children. The child plays alone without concern for the activties of those around him/her. Seen by 15-18 mos up through 2 yrs.98.

Special Education Resources, services, classes, etc. for students with special educational needs. The public school system is involved with the identification of students with special needs, ages three on up. They provide assessment and, if appropriate, intervention services for those who qualify. Specific procedures are involved in assessment and intervention.

If identified with special needs, an Individualized Educational Plan (IEP) is written for the child to address learning needs.99. Speech a. The faculty or act of speaking. b. The faculty or act of expressing or describing thoughts, feelings, or perceptions by the articulation of words.100.

Speech Pathology The study of speech and language defects and disorders101. Speech-Language Pathologist A professionals who is educated to assess speech and language development, treat language and speech disorders, and help people with swallowing disorders. Requires at least a Master's Degree, state, and national credentials.102. Stroke A group of brain disorders involving loss of brain functions that occur when the blood supply to any part of the brain is interrupted.103.

Stuttering Excessive repetition of parts of words, involutary prolongation of sounds in words, and/or struggle to ""get words out.""

A certain amount of dysfluent speech may be normal as a child learns to talk, and determination of stuttering is based on such information as the type, amount, and severity of the dysfluencies, the amount of struggle and tension during speech, and the length of time a child has been dysfluent.

Stuttering tends to run in families. It is seen more in males than females. There is evidence that stuttering may be associated with some neurological deficits. There can also be a strong psychological component. Stuttering may persist into adulthood. Early intervention is important.104. Symbolic Play Symbolic, or dramatic, play is when children begin to substitute one object for another.

For example, using a hairbrush to represent a microphone. The child may pretend to do something (with or without the object present or with an object representing another object) or be someone. They may also pretend through other inanimate objects (e.g., has a doll pretend to feed another doll).

Dramatic play with sequence of pretend acts predominates after 2 years of age.105. Table Top Play Organized play that occurs at a table or related location.

For example a board game, cards, etc.106. Theory of Mind A ""Theory of Mind"" (often abbreviated as TOM) is a specific cognitive ability to understand others as intentional agents, that is, to interpret their minds in terms of theoretical concepts of intentional states such as beliefs and desires. It has been commonplace in philosophy (see Davidson 1984; Dennett 1987) to see this ability as intrinsically dependent upon our linguistic abilities.

After all, language provides us a representational medium for meaning and intentionality : thanks to language we are able to describe other people’s and our own actions in an intentional way as in : ""Ralph believes that Mary intends him to persuade George that p"".

According to this view, the intentionality of natural language, that is, its suitability for expressing meanings and thoughts, is the key for understanding the intentionality of our theory of mind.107. Therapist One who specializes in the provision of a particular therapy.108. Therapy Treatment of illness, disability, or delay.109. Tourette's Syndrome A severe neurological disorder characterized by multiple facial and other body tics, usually beginning in childhood or adolescence and often accompanied by grunts and compulsive utterances, for example, interjections and obscenities.

Also called Gilles de la Tourette syndrome.110. Tramatic Brain Injury An acute assault/injury on the brain that can range from mild to severe.111. Treatment Plan An organized course of action, involving goals/objectives and methods for treatment of a patient.112.

Tutor A person charged with the instruction and guidance of another. Used to describe one who assists another with homework and teaches academic subjects to pupils who require individual instruction. They do not test, remediate or deal with the social-emotional problems typically associated with learning disability.

They may not have specialized training in the field of learning disabilities.113. Velopharyngeal Dysfunction Velopharyngeal insufficiency (VPI) is also known as velopharyngeal dysfunction (VPD) or even velopharyngeal incompetence (VPI). The most common cause of velopharyngeal insufficiency is a history of cleft palate or submucous cleft.

However, other causes include a short velum, poor pharyngeal wall movement, cranial base anomalies, a history of adenoidectomy, surgery for midface advancement, enlarged tonsils, and irregular adenoids. Neuromotor disorders can cause poor velopharyngeal movement, resulting in velopharyngeal dysfunction.

Frequently, hypernasality is perceived.114. Verbal Dyspraxia Motor speech disorder where the speaker shows reduced efficiency in accomplishing the oral postures necessary for phoneme production and the sequences of those postures for production of syllables, words, sentences, and/or conversation. The speaker may show groping behaviors and struggle to initiate, organize and carrythrough speech movement.

It is a motor planning problem for speech. Generally, unlike dysarthria, there is nothing wrong with the speech muscles themselves.115. Verbal Expression Also called Expressive Language. Refers to a person's ability to express themselves at the word, phrase, sentence, multi-sentence and conversational levels.

Includes ability to use age appropriate vocabulary, concepts and grammar to communicate needs, wants, desires, thoughts, and ideas. Verbal expression refers to the use of oral language for communication. However, expressive language includes the use of alternative or augmentative communication to include gestures, sign language, and simple to complex augmentative devices (for example, picture boards, alphabet boards, computerized systems with or without voice). Difficulties with expressive language can interfere with academic or occupational achievement or with social communication116.

Voice Disturbance In general, there are five categories that characterize the underlying causes of the majority of voice disorders; in decreasing order of frequency, these are: 1. Infectious and inflammatory conditions 2. Vocal misuse and abuse syndromes 3. Benign and malignant growths 4. Neuromuscular diseases 5. Psychogenic conditions. It is common for multiple factors to be involved in the development of a voice disorder.

An example is a patient with Reinke's edema, a term used to describe very swollen vocal cords. These patients almost always are heavy, long-term smokers, most of whom have gastroesophageal reflux as well. Another example of a voice issue is a patient with vocal nodules. This condition is always associated with signs of increased laryngeal muscle tension. Since voice disorders are often multifactorial, appropriate diagnosis and treatment in each case depends upon identification and correction of all of the underlying factors. "