Difficulty speaking (dysarthria)

Symptoms of dysarthria

A person with dysarthria may have:

• slurred, nasal-sounding or breathy speech
• a strained and hoarse voice
• excessively loud or quiet speech
• problems speaking in a regular rhythm, with frequent hesitations
• "gurgly" or monotone speech
• difficulty with tongue and lip movements
• difficulty swallowing (dysphagia), which may lead to constant drooling
• only be able to produce short phrases, single words or no intelligible speech at all

Dysarthria doesn't directly relate to intelligence or understanding, but a person with the condition may also have problems in these areas. Speech problems can also affect:

• social interaction
• employment
• education

If you or your child has dysarthria, you may find it helpful to see a speech and language therapist (SLT). Ask your GP about your nearest speech and language therapy clinic.

Related conditions

There are a number of conditions which may be related to dysarthria, including:

• dysphagia – difficulty swallowing
• dysphasia or aphasia – language difficulties, which could be difficulty understanding language (receptive dysphasia) or expressing yourself (expressive dysphasia)
• dyspraxia and ataxia – problems with physical co-ordination, which can sometimes affect the movements needed for speech

Causes of dysarthria

The muscles used for speech are controlled by the brain and nervous system. Dysarthria can develop if either of these is damaged in some way.

Dysarthria can either be:

• developmental – when it occurs as a result of brain damage before or during birth, such as in cerebral palsy
• acquired – when it occurs as the result of brain changes later in life, such as damage caused by a stroke, head injury or brain tumour, or a progressive condition such as Parkinson's disease or motor neurone disease

Dysarthria in children is usually developmental, while dysarthria in adults is often acquired, although both types can affect people of any age.

Whether dysarthria will improve with speech and language therapy depends on the cause and the extent of the brain damage or dysfunction. Some causes stay stable, while others may worsen over time.

An SLT can carry out an assessment to work out the extent of the speech problem. They may ask you or your child to:

• make different sounds
• talk about a familiar topic
• count numbers or recite days of the week
• read a passage aloud

The therapist may also want to examine the movement of the muscles in the mouth and voice box (larynx), and may wish to make a recording.

Treating dysarthria

If someone you know develops dysarthria suddenly, you need to telephone 999 immediately.

It could be something very serious, such as a stroke.

An SLT can help to treat dysarthria. They will try to improve your, or your child's, ability to talk. They'll help you find different ways of communicating, and will assist you or your family in adapting to your particular situation.

They may recommend:

• strategies to improve speech, such as slowing speech down
• exercises to improve the volume or clarity of speech 
• assistive devices, such as a simple alphabet board, an amplifier, or a computerised voice output system

Some SLT’s may be able to carry out a specialist assessment of communication aids, including computerised voice output systems.

There's no guarantee that therapy can improve the speech of everyone with dysarthria.

Communication tips

The following advice may help you communicate more effectively if you've got dysarthria or if you're communicating with someone with the condition.

For people with dysarthria

If you have dysarthria, you may find it helpful to:

• take a breath before you start speaking
• put extra effort into stressing key words
• speak slowly, saying one word at a time if necessary
• leave a clear space between each word
• make sure you're in the same room as the person you're talking to and face them 
• attract the listener's attention before you begin talking
• keep sentences short and avoid long conversations if you feel tired
• reduce background noise – for example, switch off the TV or radio
• repeat yourself if needed

For family, friends and carers

If you're speaking to a person with dysarthria, you may find the following advice helpful:

• reduce distractions and background noise when you're having a conversation
• look at the person as they talk
• after speaking, allow them plenty of time to respond – if they feel rushed or pressured to speak, they may become anxious, which can affect their ability to communicate
• be careful about finishing their sentences or correcting any errors in their language as this may cause frustration
• if you don't understand what they're trying to communicate, don't pretend you understand as this can be patronising – it's always best to be honest
• if you need to clarify what they're saying  asking yes/no questions or try paraphrasing, for example, say: "Did you ask me if I'd done the shopping?"

More useful links

• How to use your health services