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Voice/Speech & Language

Overview

The functions, skills, and abilities of voice, speech, and language are related but different. Functional limitations have very different sources and impacts and it is important to distinguish among them.

Humans express thoughts, feelings, and ideas orally to one another through a series of complex movements that alter and mold the basic tone created by voice into specific, decodable sounds. Speech is produced by a precisely coordinated large collection of muscle actions in the head, neck, chest, and abdomen. Speech development is a gradual process that requires years of practice. During this process, a child learns how to regulate these muscles to produce understandable speech. ¹

Voice (or vocalization) is the sound produced by using the lungs and the voice box. Voice is not always produced as speech. Infants babble and coo; animals bark, moo, whinny, growl, and meow; and adult humans laugh, sing, and cry—it’s all voice.

Limitations of the voice involve problems with pitch, loudness, and quality.

• Pitch is the highness or lowness of a sound.
• Loudness is the perceived volume of the sound.
• Quality refers to the character or distinctive attributes of a sound.

Many people who have normal speaking skills have great difficulty communicating when their vocal apparatus fails. This can occur if the nerves controlling the larynx are impaired because of an accident, a surgical procedure, a viral infection, or cancer.

Language

Language is the expression of human communication through which knowledge, belief, and behavior can be experienced, explained, and shared. This sharing is based on systematic, conventionally used signs, sounds, gestures, or marks that convey understood meanings within a group or community. Recent research identifies "windows of opportunity" for acquiring language—written, spoken, or signed—that exist within the first few years of life. ²

Who Is Affected

Voice and Speech

• Approximately 7.5 million people in the U.S. have trouble using their voices. ³ Many people who have normal speaking skills have great difficulty communicating when their vocal equipment fails. This can occur if the nerves controlling the larynx are impaired because of an accident, a surgical procedure, a viral infection, or cancer. This does not include developmental delays such as mental retardation and autism.
• By the first grade, roughly 5% of US children have noticeable speech limitations. The majority of these speech limitations have no known cause. One type of speech limitation is stuttering which is characterized by a disruption in the flow of speech and affects more than 3 million Americans. Speech limitations also may occur in children who have “developmental disabilities.”

Language

Between 6 and 8 million people in the United States have some form of spoken language limitation. Limitations of spoken language affect children and adults differently. For children who do not use spoken language normally from birth, or who acquire a limitation during childhood, spoken language may not be fully developed or acquired.

Many children who are Deaf in the United States use American Sign Language (ASL) which is a symbolic language that is not signed English. A person who is Deaf may have a spoken language limitation but is fully capable in a non-English language known as ASL. People who are Deaf or hard-of-hearing and do not have full access to one language or another are at risk of having a language limitation.

Many adults acquire limitations of language because of stroke, head injury, dementia, or brain tumors. Language limitations also are found in adults who have failed to develop language skills because of mental retardation, autism, hearing loss, or other congenital or acquired impacts on brain development. About 1 million persons in the United States currently have aphasia (a loss of the ability to use or understand language). ⁴

Examples of Conditions Causing Limitations

Stroke, Cancers, Dementia and Brain Tumors

Stroke is the number one cause of the inability to speak. Sometimes people only partially regain the ability to articulate sound. Cancers of the throat and larynx also affect speech and may improve after treatment or treatment may actually become worse due to tissue losses of surgery and radiation. Dementia and brain tumors can also affect voice or language processing.

People with Concussion & Traumatic Brain Injury (TBI)

Inability to articulate clearly, recall words, process auditory information well, process text well are just some of the injuries a person may have. These symptoms usually are temporary but sometimes are long-lasting.

Cerebral Palsy

Cerebral palsy—also known as CP—is a condition caused by injury to the parts of the brain that control our ability to use our muscles and bodies. "Cerebral" means having to do with the brain, and "palsy" means weakness or problems with using the muscles. Often the injury happens before birth, sometimes during delivery, or, soon after being born. CP can be mild, moderate, or severe. A person may have partial or limited control over the muscles of speech. If accompanied by spasticity, the person’s quality of control may be inconsistent. ⁵

Tourette Syndrome

Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The most dramatic and disabling tics include vocal tics including coprolalia (uttering swear words) or echolalia (repeating the words or phrases of others).

Looking at the Impacts

Voice and Speech

There are a number of ways that problems with speech can affect the sounds of words. Speech limitations include the inability to produce sounds intelligible to others:

• ataxia (incoordination or slurring of speech or sounds others cannot discern)
• stuttering and stammering
• aphasia (the loss of ability to use or understand language) is the most common limitation of language and can be acquired throughout life but most commonly occurs in middle to late years. The ability to express and receive language can become limited by stroke, gunshot wounds, blows to the head, and other sources of brain damage. A person may speak only in single words (e.g., names of objects) or in short, fragmented phrases.
• anomic or nominal aphasia (word-finding problems thing, thingy, it, you know) is a form of aphasia (loss of language capability caused by brain damage) in which the subject has difficulty remembering or recognizing names which the subject should know well.
• dyspraxia (a motor speech limitation) affects the organization of movements related to speaking
• dsyarthia (the muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all) can happen after a stroke or other brain injury

Language

Language limitations are limitations in the ability to discriminate the sound elements of language or to discern words.

• Auditory Processing Difficulties: Following instructions - from simple to complex; Speed of processing instructions; Listening in distracting environments—e.g. noisy or visually busy rooms; Discerning the hierarchy of information when someone is talking, e.g. they focus on details and lose track of the main point or the reverse, (For short-term auditory memory difficulty see Cognitive Functions)
• Visual Processing Difficulties: Words on a page, squirm around and/or following the alignment of lines is difficult; words or letters reverse order; visual distractions make it difficult to focus on other areas of perception, such as speech discrimination.

These limitations would have implications in all the interactions that might take place when serving survivors, from initial intake to any materials produced supporting or publicizing the program. There are also issues that could be after-effects of violence and assault.

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