Dysarthria

Also called Slurred speech, Difficulty speaking

Speech that is hard to produce because the muscles are weak, not because the words are lost. Intelligence and understanding are unaffected.

What it is

Difficulty speaking because the muscles used for speech are weak, slow or poorly coordinated.

It is essential to distinguish it from aphasia, which is a language problem: difficulty finding, understanding or arranging words. In dysarthria, the language is intact. The person knows exactly what they want to say and can understand everything said to them; the problem is producing the sounds.

That distinction has a direct practical consequence, because dysarthria is routinely mistaken for confusion, drunkenness or reduced intelligence, and people are then talked down to, talked over, or assumed to lack capacity.

Causes include stroke, Parkinson's disease, multiple sclerosis, motor neurone disease, cerebral palsy, brain injury, myasthenia gravis and progressive supranuclear palsy.

**Sudden slurred speech is a stroke until proven otherwise** and is a 999 call.

Treatment is speech and language therapy, which improves intelligibility, teaches strategies, and provides communication aids where speech becomes insufficient.

Because the same muscles are used for swallowing, dysarthria often accompanies dysphagia, and a new dysarthria should prompt a swallow assessment.

Signs you might notice

Slurred, slow, quiet or strained speech.

A nasal or monotone voice, or one that fades away by the end of a sentence.

Difficulty moving the tongue, lips or jaw.

Drooling, and difficulty controlling saliva.

Speech that is worse when tired, which is characteristic in myasthenia gravis.

Frustration, because the person knows precisely what they mean.

999: sudden onset of slurred speech, with or without facial droop or arm weakness. Use the FAST test. See stroke.

Urgent: speech that is worsening over days or weeks, or accompanied by choking, coughing on food or drink, or weakness elsewhere.

How it can affect day-to-day life

The social cost is severe. People stop using the phone, stop speaking in groups, stop ordering in shops, and withdraw, and the withdrawal is often mistaken for depression or cognitive decline when it is avoidance of a humiliating experience.

Being finished off mid-sentence, being asked to repeat over and over, and having others answer for them are the three things people report most.

Fatigue makes speech worse, so afternoons and the end of a long appointment are the hardest times, which is worth planning around.

In Parkinson's, volume drops without the person perceiving it; specific intensive therapy programmes exist and work well.

Communication aids range from an alphabet board to a speech-generating device, and voice banking, recording a person's own voice before it deteriorates, is available for progressive conditions and is deeply valued. It has to be done early.

Assumptions about capacity are the most damaging consequence. Somebody who cannot articulate is not somebody who cannot decide.

Supporting someone well

Treat sudden slurred speech as a stroke and call 999.

Ask for speech and language therapy referral early, not when speech has already failed.

Give time. Do not finish sentences, do not fill silences, and do not switch to talking to their companion.

Reduce background noise and face the person.

Ask yes or no questions when it is hard, and confirm by repeating back what you understood.

Do not raise your voice; this is not deafness.

Ask about voice banking early in progressive conditions.

Never assume reduced capacity from unclear speech. See mental capacity.

Ask for a swallow assessment if speech has changed, and watch for coughing at mealtimes.

Where to get help

999 for sudden slurred speech.

A GP practice or the neurology, stroke or rehabilitation team for referral to speech and language therapy.

Royal College of Speech and Language Therapists explain what to expect and list independent practitioners.

Stroke Association on 0303 3033 100 for communication support after stroke.