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Language disorders (diagnosis and treatment of language and speech disorders in adults)

Summary/Definition

Language disorders in adults include aphasia, bulbar and spastic dysarthria, and speech apraxia. 

Aphasia is a disorder that occurs when the speech centers are affected as a result of a stroke or a traffic accident. The most common cause is stroke. Symptoms of aphasia caused by stroke occur relatively quickly and vary depending on the localization. In the case of other causes, such as brain tumors or infections, the symptoms of aphasia manifest relatively slowly compared to stroke. 

Articulation disorder is a condition in which there is a violation of the sound of speech and which is caused by unclear or not pure pronunciation, functional disorders and structural anomalies, for example, cleft palate and shortened frenulum. Patients with mental retardation, hearing impairment, cleft palate, cerebral palsy may also have unclear pronunciation, accompanied by a violation of articulation. 

Dysarthria is a condition in which the formation of speech is disrupted due to damage to the central nervous system, peripheral nervous system or vocal muscles, or diseases of the corresponding areas.  It can occur along with aphasia after a traumatic brain injury or due to a violation of articulation.  

Speech apraxia is a condition in which acquired brain damage causes difficulties in controlling the position of articulatory organs or performing a series of continuous articulatory movements. This may be caused by damage to the supplementary motor area (SMA) of the brain or damage to the insula of the brain. 

Symptoms 

Symptoms of aphasia vary depending on the affected area. It can be divided into Brock’s aphasia, Wernicke’s aphasia and conductor aphasia, and with each there are problems in the field of speech formation, speech comprehension and speech repetition.  

Symptoms of articulation disorder include inaccuracy or difficulty understanding speech. Depending on the type of consonant or vowel sound, the clarity or accuracy of speech decreases, and symptoms such as omission, replacement and distortion of sounds appear. 

Symptoms of dysarthria include: 

Types and causes Symptoms 
Sluggish type: decreased motor function, myasthenia gravis Harsh sounds, double sounds, hypernasal speech 
Spastic type: bilateral upper motor neurone disease Monotonous volume, pitch, compressed sound 
Ataxic type: cerebellar lesion Disturbances in the tempo, range and intensity of speech 
Hypokinetic type: Parkinson’s disease Quiet voice, silence, trembling in the voice 
Hyperkinetic type: athetoid cerebral palsy. Sudden change in pitch or intensity of speech 

The National Portal of Medical Information of the Korean Agency for Disease Control and Prevention, “Language disorders (diagnosis and treatment of language and speech disorders in adults)” 

The symptoms of speech apraxia include intermittent speech errors, difficulty in answering sudden questions, constant lip movements to determine the correct place of articulation. 

Diagnostics 

Diagnostics includes speech assessment and brain imaging techniques. Speech evaluation involves evaluating vowel lengthening, measuring the speed of alternate and sequential pronunciation, evaluating propositional utterances, and reading paragraphs. Typical speech assessments include the Western Classification Aphasia Test (WAB), the Boston Diagnostic Examination for Aphasia (BDAD), and the Minnesota Differential Diagnosis of Aphasia (MMDDA). Brain imaging techniques include ET, single-photon emission computed tomography (SPECT), cerebrovascular computed tomography (CT), and magnetic resonance imaging of the brain (MRI). With the help of these tests, it is possible to determine whether the blood flow or the function of the speech center is reduced. 

The National portal of Medical information of the Korean Agency for Disease Control and Prevention, “Language disorders (diagnosis and treatment of language and speech disorders in adults)”

Treatment and course of the disease  

The main goal of the treatment of language disorders in adults is to restore natural and effective communication skills. The initial treatment involves slow and clear pronunciation of sounds, changing the tempo and using auxiliary instruments. In most cases of aphasia, the cause is a stroke or a brain tumor, so first of all it is necessary to eliminate the cause. In case of articulation disorders, it is possible to combine speech therapy with the elimination of violations of organic processes. The priority goals in identifying articulation disorders are pronunciation, age, existing problems with the clarity of voice and speech, which are corrected with the help of treatment. Relief of dysarthria symptoms can be achieved by treatment based on the process of speech utterance, for example, breathing and vocalization, taking into account the type of dysarthria (sluggish or rigid). Since apraxia of speech is a violation of articulation and prosody, it is necessary to determine the nature of articulation errors and identify errors during the patient’s speech. 

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