Speech & Language Disorders

Speech and language disorders can occur following a brain injury (including strokes, concussions, TBI).  Expressive & receptive language difficulties may include aphasia, apraxia, and dysarthria.

Aphasia – Defined as a loss of language function due to an injury to the brain in the area associated with comprehension and production of language.  Most often, aphasia is the result of a stroke or cerebral vascular accident.  Although, other causes can include: accident, tumor, infection, or toxicity levels rising.  Presentation of symptoms can vary greatly depending on the site of the injury, severity of the injury, and characteristics of the person.   

Common characteristics that appear with aphasia include: 

  • Impaired auditory comprehension  

  • Impaired verbal expression 

  • Presence of paraphasias 

  • Perseveration 

  • Grammatical errors 

  • Non-fluent speech with impaired prosody (rate) 

  • Difficulty repeating words, phrases, sentences 

  • Problems with naming and word finding skills 

  • Difficulty with reading and writing abilities.  

Treatment for aphasia will vary greatly depending on symptoms.  Speech pathologists will assess the areas of language function and executive processing.  The patient will be asked to name specific environmental objects/items within the household along with the function of the items.  Yes/no simple and complex questions will be asked along with having the patient follow 1-2 step verbal commands.  The patient will be asked to repeat single words and phrases and then responses to logical questions.  Sequencing skills to be assessed along with number recognition.  Reading and writing skills to also be addressed as potentially another form of communication.  An individualized treatment plan will be created for each patient to improve their overall quality of life.   

Apraxia – A motor disorder resulting from neurological damage.  It is characterized by an inability to execute volitional, or purposeful, movements despite having normal muscle tone and strength.  It is understood best as “faulty programming” from the brain – the lips, tongue, jaw and facial musculature is capable of normal functioning yet has difficulty  completing the precise movements required for speech.   

Common characteristics that present with verbal apraxia include: 

  • The number of mis-articulations increases as the complexity of speech task increases. 

  • Consonant and vowel productions are affected; however, errors in consonant productions are more common.   

  • Sounds in the initial position are affected more than sounds in the medial or final positions. 

  • Sound substitutions, omissions, distortions, and additions are commonly observed.   

  • Struggling behaviors, such as groping, is observed in many patients. 

  • Severity varies from one to another; however, it is common to see apraxia of speech in combination of other communication disorders, such as dysarthria, delayed speech and language skills, aphasia and hearing loss.  

Treatment for verbal apraxia includes: 

Formalized assessment to assess cranial nerve function and how this affects oral motor function and phonological productions of speech. A speech pathologist will have the patient complete oral motor movements, such as sticking out his/her tongue, lick the lips, and clear their throat.  Then, single syllable to multi-syllabic words will be imitated and read aloud independently.  The assessment will progress towards longer length of utterances, such as paragraph level reading, turn taking conversation and picture discrimination to all the professional to assess consonant –vowel productions in a variety of situations.  An individualized treatment plan will be completed to assist with effective communication in a variety of settings to meet the patient’s overall goals.   

Dysarthria – Is a motor speech disorder that results from muscular impairment.  Weakness, slowness, or incoordination can affect all the basic processes of speech including: respiration, phonation, resonance, articulation, and prosody.  Articulation errors are the most common feature of dysarthria, followed by impairments of voice and fluency.  There are six types of dysarthria characterized by their causes and speech behaviors.   

Types of dysarthria, include:  

  • Flaccid – resulting in hypernasality, breathiness, monopitch, and nasal emission of sounds. 

  • Spastic – imprecise consonant productions, reduced stress in voicing, harsh voice quality, low pitch, and a slow rate 

  • Mixed (flaccid and spastic) – imprecise consonants, hypernasality, harsh voice, slow rate, monotone, excess and equal stress and prolonged intervals of speech. 

  • Ataxic – irregular articulatory breakdowns, loudness control problems, variable nasality

  • Hypokinetic – monopitch, monoloudness, inappropriate silences, short rushes of speech. 

Speech pathologists will assess the patient’s speech productions and create an individualized treatment program to address the patient’s deficits.  This will include a complete oral facial exam and speech same at structured levels and continuous speech.  After identifying the area of impairment, the therapist will create a treatment plan to address lingual and labial function for improved musculature control.  Repetition and rehearsal of sounds will improve carryover from imitation of speech productions to spontaneous productions.