motor speech disorders
A 68-year-old man has slurred speech after a stroke. His speech sounds weak and imprecise, and his tongue movements are slow. He has difficulty coordinating his speech muscles.
What is the most likely motor speech disorder?
Dysarthria
A 9-year-old says, “I want the b-b-b-ball.” He frequently repeats the first sound of words and sometimes prolongs sounds. He becomes frustrated when he cannot get his words out.
Childhood-onset fluency disorder (stuttering)
A teacher has a rough, hoarse voice after speaking loudly throughout the school day. Their voice becomes worse by the end of the day.
Dysphonia, possibly associated with vocal overuse or vocal fold lesions
An older adult coughs repeatedly when drinking thin liquids. Their voice sounds wet after swallowing, raising concern that material may be entering the airway.
Oropharyngeal dysphagia with possible penetration or aspiration
A cough or wet voice raises concern but does not, by itself, confirm aspiration.
A 70-year-old has a stroke and struggles to find words. They may say “the thing you write with” instead of “pencil.” Their comprehension is relatively strong, but naming is difficult.
Anomia (word-finding impairment), possibly associated with aphasia
A 55-year-old woman has difficulty planning the movements needed for speech after a left-hemisphere stroke. She makes inconsistent sound errors, struggles to sequence sounds, and appears to search for the correct mouth position. Her muscle strength is relatively normal.
Acquired apraxia of speech (AOS)
A teenager speaks very quickly, leaves out syllables, blends words together, and has difficulty organizing a clear message. The teenager may not notice that others struggle to understand them.
Cluttering
A patient has a weak, breathy voice. During a laryngeal examination, one vocal fold is found to be immobile and does not close completely during phonation.
Unilateral vocal fold paralysis or paresis, depending on the degree of impairment
A patient with a history of stroke has food remaining in their cheek after meals. They have reduced tongue control and difficulty moving food around the mouth to form and transport a bolus.
Oral-phase dysphagia
A patient speaks in long, fluent sentences, but the words often do not make sense. They have difficulty understanding spoken language and may not recognize their communication errors.
Wernicke's aphasia
A patient with bilateral upper motor neuron damage speaks slowly and effortfully. Their voice sounds strained, and their speech movements are stiff and restricted.
Spastic dysarthria
A college student tries to say their name but gets stuck on the first sound. Their mouth appears tense, airflow is interrupted, and no sound comes out for several seconds.
Stuttering — specifically, a block
A singer has persistent hoarseness and vocal fatigue. Laryngeal examination reveals bilateral, symmetrical lesions on the vocal folds associated with repeated vocal trauma.
Vocal fold nodules
A patient reports that food feels stuck in the throat after swallowing. A swallowing evaluation identifies reduced pharyngeal clearance and residue after the swallow.
Pharyngeal-phase dysphagia
Following a left-hemisphere stroke, a patient speaks in short, effortful phrases, such as “want… water.” They have relatively strong comprehension but difficulty producing grammatical sentences.
Broca's aphasia
A patient with cerebellar damage speaks with irregular articulatory breakdowns, excess and equal stress, and an uneven rhythm. Speech may sound like the syllables are being separated unnaturally.
Ataxic dysarthria
A 63-year-old develops repetitions and blocks shortly after a stroke. The speech changes are new and occur alongside other neurological symptoms.
Possible neurogenic stuttering
A patient has a strained, effortful voice that sounds squeezed or tight. The voice may break during connected speech, and the laryngeal examination supports involuntary spasms of the laryngeal muscles.
Adductor spasmodic dysphonia (adductor laryngeal dystonia)
A patient with neurological disease has a delayed pharyngeal swallow response, reduced airway protection, and aspiration during swallowing on an instrumental examination.
Pharyngeal dysphagia with impaired airway protection
An 8-year-old has difficulty following multistep directions, learning new vocabulary, formulating complex sentences, and retelling stories in the correct order. Hearing has been evaluated, and the difficulties affect academic performance.
Developmental language disorder (DLD) or a language disorder affecting receptive and expressive language
The case supports a language concern, but a comprehensive assessment is needed before making a diagnosis.
A 72-year-old man with Parkinson's disease speaks in a soft voice with reduced pitch variation, imprecise consonants, and a rapid or accelerating speech rate.
Hypokinetic dysarthria
A child avoids saying their name in class, substitutes easier words, and shows tension and fear about speaking. Their disfluencies include sound repetitions and prolonged sounds.
Stuttering with secondary behaviors and avoidance
The avoidance and emotional reactions can accompany stuttering; they are not a separate fluency diagnosis by themselves.
A 40-year-old man continues to use an unusually high-pitched voice after puberty, despite no apparent structural explanation.
Puberphonia (mutational falsetto)
A patient reports that both solids and liquids feel stuck behind the breastbone. They also experience regurgitation, and a medical evaluation suggests impaired esophageal motility.
Esophageal dysphagia
This presentation warrants medical evaluation, often by gastroenterology. It is not necessarily an oropharyngeal swallowing disorder.
A patient speaks fluently and understands most spoken language but has marked difficulty repeating sentences and phrases. They make phonemic errors when trying to repeat what someone says.
Conduction aphasia