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Monday, January 25, 2010

Speech Disturbances

A. Disturbances in the Speech Area of the Brain. Various parts of the brain are involved in the use of  language, the sensory areas of hearing and vision, the area in which memories are recorded, the area in which imagination and creative thinking occur, and the areas in which the muscle actions are coordinated and initiated. These areas, interconnected by many nerve fibers, function smoothly in enabling a person to speak. For the most part these several areas are located in the dominant hemisphere of the cerebrum, midway between the back of the head and the forehead. Collectively they are called the "speech area." By "dominant hemisphere" we mean the left side of the brain in a right-handed person or the right side in a left-handed person. In every person, one side of the brain is "boss," and this side controls the complex functions of speech.
Any condition which handicaps the normal functioning of the speech area or, especially, any destruction of a part of the brain included in the speech area or any interruption of the nerve fibers that connect the parts of this area, will curtail the ability to speak in proportion to the damage done. Such speech handicap is called aphasia. Aphasia is usually caused by the rupture of an artery of the brain, by the development of a clot in such an artery, or by the lodgment of a fragment of blood clot so as to deprive a portion of the brain of its blood supply. The manifestations of aphasia vary all the way from mild limitation in the patient's vocabulary to total inability to express ideas. In mild cases it is the less familiar words or the proper names that are lost from the vocabulary. In more severe cases only simple words used almost automatically are retained. In such cases, even the simple words are not always used appropriately. For example, the patient may say Yes when he means No. The patient often appears humiliated and thwarted by his inability. It is not that his organs of speech are paralyzed, for the words he does use are enunciated normally. It is that his capacity for translating thoughts to words is now limited.

B. Faulty Control of the Organs of Speech.
Damage to any of the nerves that carry impulses from the brain to the organs of speech will, of course, interfere with the function of speech. If the facial nerve which controls the muscles of the cheeks and lips is damaged, the sounds of "b" and "p" are difficult to execute. The hypoglossal nerve controls the tongue; its malfunction makes the sounds of "1" and "t" difficult. The vagus nerve controls the soft palate, the pharynx, and the muscles within the larynx. When the branches to the soft palate are damaged, speech has a nasal sound. When the branch to one side of the larynx is interrupted, speech is weak and unnatural.
In Parkinson's disease or multiple sclerosis, the rhythm of speech is altered because of the interference with normal muscle stability, muscle tone, and muscle coordination. In certain functional disorders the organs of speech and their nervous control remain normal but the production of words is abnormal. Examples are stuttering and hysterical mutism, which appear to be the result of unsolved psychological problems.
C. Diseases of the Larynx. Acute laryngitis, such as sometimes occurs in connection with a sore throat or with the common cold, causes the voice to be hoarse. Chronic laryngitis, as in smokers or in those with respiratory disease producing purulent secretions that pass through the larynx, also causes hoarseness. Benign tumors (as polyps or papillomas) sometimes develop within the larynx and interfere with normal production of sound. Probably the most serious disease affecting the larynx is laryngeal cancer. The first symptom of this condition is usually a persisting hoarseness. This should be interpreted as a danger signal to act at once, for success in treating cancer of the larynx depends on early treatment.
D. Defects in the Auxiliary Organs of Speech. Defects of the lip, palate, and other auxiliary organs of speech may be congenital, or they may have resulted from mutilating accident or disease. In the congenital group we think of hare-lip and cleft palate. These, when taken early in a child's life, can be treated quite satisfactorily by surgery. In tissue losses due to accident or disease, the speech can often be much improved by the wearing of a prosthetic device.
E. Stuttering and Stammering. For practical purposes, these are synonymous. In this condition the flow of speech is interrupted by pauses and by repetition of sounds or syllables. Facial grimaces often accompany the effort to enunciate the desired word.
The problem of stuttering typically appears between ages two and ten. It affects about I percent of school-age children, being six times more common in boys than in girls. In the usual case, the fault is not with the organs of speech. It occurs as a symptom of some emotional disturbance such as when a child feels that his security is threatened. A child's stuttering may be aggravated by starting to school too soon, being pushed to carry schoolwork beyond his present stage of development, feeling insecure in personal relations at home, or being resentful of an older brother's or sister's domination. The child who stutters should ideally be placed under the professional care of a speech therapist. Parents may do a great deal to help the child by spending more time in congenial companionship.
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