What is Slurred Speech & How is it Treated?

Proper speech requires coordination between the brain, tongue, mouth and vocal cord. Any lack of coordination between these organs or any damage that may alter the normal functioning of these organs can lead to slurred speech or abnormal speech. Slurred speech can occur suddenly or may worsen gradually over a period of time. Slurring of speech if left untreated can lead to lack of confidence while socializing with other people and can even lead to emotional disturbances.

Slurred speech is also known as dysarthria in the medical world. It is characterized by abnormal speech with poor pronunciation of words, with change in rhythm and speed of the speech. The person affected by slurred speech generally mumbles and is unable to talk clearly. There is weakness and loss of control over the muscles used for speech. Slurred speech may be associated with other underlying disorders, based on which it may be permanent or temporary. Slurred speech is most commonly caused by neurological disorders such as brain damage, tumors, stroke and other conditions that may cause facial paralysis and weakness in tongue and throat muscles.

The symptoms of Slurred speech generally depend on the causative agent and extent of damage. The most commonly encountered signs and symptoms of Slurred speech are as follows:

• Poor speech that is difficult to comprehend
• Slow speech or rapid speech
• Difficulty is speaking loudly
• Whispering while talking
• Abnormal rhythm while speaking
• Nasal twang in speech
• Raspy strained speech
• Uneven volume in speech
• Monotone voice while talking
• Limited movement of tongue and facial muscles.

The prognosis of slurred speech depends on the severity and extent of the causative agent. Temporary slurring corrects by itself as the causative conditions improves. In other cases, slurring can be corrected with the help of a speech therapist. In advanced stages, it can lead to permanent damage and can lead to social isolation and depression.

Slurred speech can be caused by multiple reasons. In most of the cases, slurring of the speech is caused due to the presence of certain underlying conditions. The most common causes of slurred speech are listed below:

• Amyotrophic lateral sclerosis/LouGehrig’s disease
• Injury to brain
• Cerebral palsy
• Brain tumor
• Trauma or injury to head
• Lyme disease
• Alcohol consumption
• Multiple sclerosis
• Stroke
• Wilson’s disease
• Guillain-Barre syndrome
• Huntington’s disease
• Myasthenia gravis
• Muscular dystrophy
• Parkinson’s disease
• Side effects of certain medications such as narcotics and sedatives
• Tongue abnormalities.

Slurring of speech, if not corrected, can lead to psychological and emotional disturbances which may include:

• Social Difficulty: Slurred speech over a period of time can bring about a gap in relationships in view of improper communication. Slurring of speech can affect communication with close contacts, family and friends and can make social situations challenging.
• Emotional Issues: Slurred speech can lead to emotional disturbances, social isolation and depression.

It is advised to visit a physician as soon as the symptoms of Slurred speech develop so that it can be corrected at an early stage to avoid complications. A detailed case history is obtained followed by a clinical examination. Intervention by a neurologist, ENT specialist and speech therapist is often required for evaluation and management. A speech language pathologist helps is determining the type of speech difficulty, which in turn helps the neurologist to determine the causative underlying condition causing Slurred speech.

There are a number of specialised tests that help in diagnosis of slurred speech. These include:

• Imaging Studies: These include CT scan and MRI of the brain, head and neck region. OPG or x-ray of the jaw may be done to rule out if Slurred speech issue is due to oral and maxillofacial disorders.
• Brain and Nerve Studies: Specific studies such as electroencephalogram, electromyogram and nerve conduction studies help in pin pointing the cause of slurred speech.
• Blood Work and Urinalysis: This is done to rule out infectious and inflammatory conditions.
• Lumbar Puncture or Spinal Tap: Here a needle is used to withdraw cerebrospinal fluid from the lower back for laboratory testing for detecting neurological disorders at central nervous system, and malignancies of the brain of the spinal cord.
• Brain Biopsy: Most commonly done in cases of brain tumor.
• Cognitive Assessment: These studies are done to determine the thinking skills, understanding skills, reading skills, writing skills and other skills of cognition. Speech abnormalities are not directly related to these issues; however, cognitive assessments help in determining presence of other condition which causes slurred speech.

Treatment modality for slurred speech involves detection of the causative issues and treatment of the same. If slurred speech is caused due to side effects of a medication, it is advised to discontinue the medicine or opt for an alternate medication after consulting a physician. Other treatment involves visit to speech and language therapist. They help in normalising the speech and improve communication. Speech therapist help in adjusting the speed of speaking, muscle strengthening, improve breathing, improve articulation etc. Specific exercises may be suggested to improve the strength and tone of the muscles.

One can also consider a visit to a speech language pathologist for learning augmentative and alternative communication systems. These may include gestures, alphabet boards, visual cues, computer aided support etc. when the speech is severely impaired.

In some cases, surgical intervention may be suggested to correct the condition of Slurred speech. In cases of slurred speech caused by enlarged tongue or growth in the oral cavity or brain tumor, surgical repair is considered.

The following pointers are suggested to cope up with speech issues in day to day life:

• Speak Slowly: These give the listener ample amount of time to comprehend and understand better.
• Keep it Short: It is advised to start with smaller topics and smaller sentences so the listener can understand the discussion.
• Gauge Understanding: One can always confirm with the listener if he or she is able to follow his speech.
• Having a Back-up: In difficult situation, writing the message on paper pads, or typing the message on a cell phone can be helpful.
• Using Sign Language and Gestures: These can help in communicating the matter and can prevent excessive fatigue.

Slurred speech is a condition characterized by abnormal or slow speech that is not comprehendible by the listener. Slurring of the speech can be a temporary or a permanent disorder and it is generally caused by some underlying disorders. Most commonly it is caused by certain neurological disorders that lead to impaired nerve conduction, weakness in muscles and lack of coordination between the brain and the muscles of speaking. Slurring of speech can cause inconvenience in carrying a normal life and while communicating with close contacts. If left uncorrected, slurred speech can lead to depression, frustration and psychological trauma. In certain cases, psychological counselling may be required for emotional and moral support.