1.

Stuttering

Stuttering refers to a speech disorder that interrupts the flow of speech.

People who stutter can experience the following types of disruption:

Repetitions occur when people involuntarily repeat sounds, vowels, or words.

Blocks happen when people know what they want to say but have difficulty
making the necessary speech sounds. Blocks may cause someone to feel as
though their words are stuck.

Prolongations refer to the stretching or drawing out of particular sounds or

words.

The symptoms of stuttering can vary depending on the situation. Stress,

excitement, or frustration can cause stuttering to become more severe.
Some people may also find that certain words or sounds can make a stutter
more pronounced.

Stuttering can cause both behavioral and physical symptoms that occur at
the same time. These can include:

tension in the face and shoulders

rapid blinking

lip tremors

clenched fists

sudden head movements

2. Apraxia

The brain controls every single action that people make, including speaking.
Most of the brain’s involvement in speech is unconscious and automatic.
When someone decides to speak, the brain sends signals to the different
structures of the body that work together to produce speech. The brain
instructs these structures how and when to move to form the appropriate
sounds.

For example, these speech signals open or close the vocal cords, move the
tongue and shape the lips, and control the movement of air through the
throat and mouth.

Apraxia is a general term referring to brain damage that impairs a person’s

motor skills, and it can affect any part of the body. Apraxia of speech, or
verbal apraxia, refers specifically to the impairment of motor skills that affect
an individual’s ability to form the sounds of speech correctly, even when they
know which words they want to say.

3. Dysarthria

Dysarthria occurs when damage to the brain causes muscle weakness in a

person’s face, lips, tongue, throat, or chest. Muscle weakness in these parts
of the body can make speaking very difficult.

People who have dysarthria may experience the following symptoms:

slurred speech

mumbling

speaking too slowly or too quickly

soft or quiet speech

difficulty moving the mouth or tongue

Symptoms

Symptoms of a speech disorder can include repeating or prolonging sounds,

rearranging syllables, and speaking very softly.
The symptoms of speech disorders vary widely depending on the cause and
severity of the disorder. People can develop multiple speech disorders with
different symptoms.

People with one or more speech disorders may experience the following
symptoms:

repeating or prolonging sounds

distorting sounds

adding sounds or syllables to words

rearranging syllables

having difficulty pronouncing words correctly

struggling to say the correct word or sound

speaking with a hoarse or raspy voice

speaking very softly

Causes

Causes of speech disorders can include:

brain damage due to a stroke or head injury

muscle weakness

damaged vocal cords

a degenerative disease, such as Huntington’s disease, Parkinson’s disease,

or amyotrophic lateral sclerosis

dementia

cancer that affects the mouth or throat

autism

Down syndrome
hearing loss

Risk factors that can increase the likelihood of a person developing a speech
disorder include:

being male

being born prematurely

having a low weight at birth

having a family history of speech disorders

experiencing problems that affect the ears, nose, or throat

Treatment

A person may receive speech therapy to treat a speech disorder.

The type of treatment will typically depend on the severity of the speech
disorder and its underlying cause.

Treatment options can include:

speech therapy exercises that focus on building familiarity with certain words
or sounds

physical exercises that focus on strengthening the muscles that produce

speech sounds

We discuss some of the treatment options for speech disorders below:

Target selection

Target selection involves a person practicing specific sounds or words to

familiarize themselves with particular speech patterns. Examples of therapy
targets may include difficult words or sounds that trigger speech disruptions.
Contextual utilization

For this approach, SLPs teach people to recognize speech sounds in different
syllable-based contexts.

Contrast therapy

Contrast therapy involves saying word pairs that contain one or more
different speech sounds. An example word pair might be “beat” and “feet” or
“dough” and “show.”

Oral-motor therapy

The oral-motor therapy approach focuses on improving muscle strength,

motor control, and breath control. These exercises can help people develop
fluency, which produces smoother speech that sounds more natural.

Ear device

Ear devices are small electronic aids that fit inside the ear canal. These
devices can help improve fluency in people who have a stutter.

Some ear devices replay altered versions of the wearer’s voice to make it
seem as though someone else is speaking with them. Other ear devices
produce a noise that helps control stuttering.

Medication

Some speech disorders can cause people to develop anxiety disorders.

Stressful situations can trigger anxiety, resulting in more pronounced speech
disorder symptoms. Anxiety medications may help reduce symptoms of
speech disorders in some people.

4. *Vocal cord paralysis*

normally only affects one of the vocal cords.

The condition is caused by damage to nerves going to the vocal cord – the
nerve impulses in the larynx (voice box) are interrupted, resulting in
paralysis of the vocal cord muscles. It can also be caused by brain damage.

Patients with vocal paralysis typically experience hoarseness, vocal fatigue,

mild to severe reduction in speech volume, a pain in the throat when
speaking, and swallowing things down the wrong way and choking.

The vocal cords, as well as allowing us to produce utterances (speak, etc.)

also protect the airway, preventing food, drink, and saliva from entering the
trachea (windpipe). In extreme cases, the resultant choking can lead to
death.

Individuals with vocal cord paralysis may find the effectiveness of coughing,
swallowing or sneezing in removing laryngeal area waste is undermined
reduced vocal cord mobility. This may result in accumulations in the area,
allowing for bacterial and viral colonization

causes of vocal cord :

Injury to the chest or neck: a trauma may damage the nerves that serve the
vocal cords or the larynx

Stroke: the part of the brain that sends messages to the larynx (voice box)
may be damaged by a stroke

Tumors: these may develop around or in the cartilages, nerves or muscles of

the voice box. The tumors may be benign or malignant (cancerous)

Inflammation or scarring of the vocal cord joints: as well as the space

between the two vocal cord cartilages may prevent the larynx from working
properly. Although the cord nerves are usually working correctly, the
inflammation can give vocal cord paralysis-like signs and symptoms. Some
infections may also cause inflammation.

Vocal cord paralysis may also be idiopathic, which means there is no

identifiable cause.

Symptoms of vocal cord paralysis

The vocal cords consist of two bands of muscle, located at the trachea
(entrance to the windpipe).

When we make an utterance (produce sound from the mouth) the two bands
of muscle tissue touch each other and vibrate.

When we are not uttering sounds, the vocal cords are in an open, relaxed
position, allowing air to flow freely into our windpipe – allowing us to breathe.

Most cases of vocal cord paralysis involve just one cord being paralyzed.
However, sometimes both are affected, and the patient is likely to
experience swallowing as well as breathing difficulties.

Potential signs and symptoms of vocal cord paralysis include:

Changes to the voice – it may become more “breathy,” like a loud whisper

Hoarseness, huskiness

Noisy breathing

Changes to vocal pitch

Coughs that do not clear the throat properly

When swallowing solids or liquids, the patient might choke (including saliva
sometimes)
While speaking, the sufferer may have to catch their breath more often than
usual

Voice volume may be affected – the patient may not be able to raise their
voice

Pharyngeal reflex (gag reflex) may be lost – the pharyngeal reflex is a reflex
contraction of the back of the throat, evoked by touching the soft palate. It
prevents something from entering the throat except as part of normal

Treatment for vocal cord paralysis

Vocal cord paralysis treatment depends on several factors, including what

caused it, how severe symptoms are, and how long they have been present.
The patient may be advised to have voice therapy, surgery, or both.

Voice therapy

Voice therapy is the equivalent of physical therapy for large muscle paralysis.
The therapist asks the patient to do special exercise and some other
activities to strengthen their vocal cords, improve their breath and control
while speaking, prevent unusual tensions in other muscles near the affected
vocal cord(s), and protect the airway from liquids and solids.

Surgery

If the patient does not recover completely with voice therapy, the doctor
may recommend surgical intervention. There are a number of surgical
options:

Bulk injection

– the vocal cord muscle will most likely be weak due to paralysis of the
nerve. The otolaryngologist (ear, nose, and throat specialist doctor) may
inject fat, collagen or some filler into the vocal cord.

The extra bulk brings the vocal cord nearer to the middle of the larynx (voice
box), making it easier for the opposite cord muscle to move effectively when
the patient coughs, swallows or speaks.
Phonosurgery

(vocal cord repositioning) – this operation repositions and/or reshapes the

vocal fold (cord) to improve voice functions.

Tracheotomy – if both vocal folds (cords) are affected and very close to
each other, breathing will be more difficult because of decreased air flow.

The doctor makes an incision (cut) in front of the neck, and an opening is
created into the trachea (windpipe). A breathing tube is inserted so that the
patient can breathe with air bypassing the paralyzed vocal cords.

Put simply, the patient breathes through a hole

5. Orofacial Myofunctional Disorders

Orofacial myofunctional disorders (OMDs) are atypical movement patterns of

the face and mouth. Speech-language pathologists can help with eating and
speech problems that happen from those atypical movement patterns. Visit
ProFind to locate a professional in your area.

People who have an OMD might have problems with breathing through their
nose, producing some speech sounds correctly, and eating. One type of
common OMD in children is called tongue thrusting or fronting. Tongue
thrusting is when the child pushes their tongue forward when they talk,
drink, or eat.

Signs and Symptoms of Orofacial Myofunctional Disorders

Just because a person has some or all of these symptoms does not mean
that they have an OMD. Always see a professional for more information. To
find an SLP, use ASHA’s ProFind.
Some signs of an OMD may include the following:

Always breathing through their mouth or having trouble breathing through

their nose.

Difficulty moving their tongue

Problems with chewing or keeping food in their mouth more than usual. You
might notice that babies, toddlers, and young children will be a little messy
while eating. This is normal, and children are expected to do this less as they
get older.

An overbite, underbite, and/or other dental problems.

The tongue pushing past the teeth, even when a person is not talking or
using the tongue.

Difficulty saying some sounds, like “s” in “sun,” “sh” in “ship,” or “j” in
“jump.”

Excessive drooling that soaks through clothes several times a day or

continues beyond age 4 years.

Difficulty closing the lips to swallow.

Causes of Orofacial Myofunctional Disorders

OMDs may be caused by several factors:

Blocked nasal passages because of tonsil size or allergies. When the

nasal passages are blocked, people may need to breathe through their
mouth instead.

Anything that (a) causes the tongue to be misplaced when at rest or (b)
makes it difficult to keep the lips together when at rest.

Thumb sucking or use of a pacifier past the age of 3 years.

Speech-Language Pathology Treatment for Orofacial Myofunctional

Disorders

After breathing problems are medically evaluated and treated, SLPs can help
your child do the following:
Pay closer attention to their mouth and facial movements.

Know where their tongue and mouth muscles are when they speak, drink,
and eat.

Say sounds more clearly.

Change how they chew and swallow.

Practice different breathing patterns