Speech defect is a type of communication disorder that disrupts normal speech. Speech therapy is a rehabilitative procedure to help people with communication or swallowing problems. Speech defects are classified based on the sounds a patient can produce, whether sounds need demonstration to be stimulated, and sounds that cannot be produced. Major types include aphasia, dysarthria, dysphonia, cluttering, stammering, and apraxia. Diagnostic evaluations include history, physical exams of the head and neck, and tests like laryngoscopy. Management involves correcting underlying conditions, special education, and speech therapy techniques like remediation, language exercises, and swallowing therapy.

1. Practice
teaching
on
speech defect and
speech therapy
Presented by:
Ms. Hari singh nagar
M. Sc Nursing 1st year

2. Objectives
After completion of the class students will be able to
• Introduce the speech defect and speech therapy.
• Define speech defect and speech therapy.
• Enlist the Causes of speech defect
• Enumerate the classification of speech defect.
• Explain the types of speech defect
• Explain the diagnostic evaluation of speech defect
• Explain the management of speech defect .
• Explain the nursing management of speech defect.

3. Introduction
Speech is a primary method of
communicating with the others. An
impairment in speech can significantly
impact your ability to communicate. It
leads to affect all stage of life can lead to
social isolation, embarrassment and shame.
Speech therapy help the people to become
independent communicator speech, gesture
or communication aids as needed.

4. Definition
speech defect is a type of communication disorder
where normal speech is disrupted. Someone who is
unable to speak due to a speech disorder is
considered mute.
Speech therapy – it is a rehabilitative procedure
undertaken in order to help the people having any
kind of communication disorder or problems and
some swallowing problems.

5. Incidence
The incidence was higher in males. Delayed speech
was the commonest abnormality and was present
in 47.8%, defective articulation in 21.6%, stuttering
in 15.6%, multiple speech defects in 10.8%,
rhinolalia in 2.1% and aphasia in 1.9% of cases.

6. Anatomy and physiology of larynx
It is also known as “voice box” Until puberty there is
a little differences in the size of the larynx between
the sexes. Thereafter it grows larger in the male,
known as Adam's apple & generally the deeper voice.

7. Larynx structure
• The vocal cords are two folds of pale mucous
membrane
• the muscle controlling the vocal cords are relaxed,
the vocal cords are open & the passageway for air
is clear. Vocal cord said to be abducted or open,
that time the pitch of the sound is very low.
• When the muscle controlling the vocal cords are
contract, the vocal cords are stretch out tightly
across the larynx. Vocal cord said to be adducted
or closed, that time the pitch of the sound is very
high.
• When not in use, the vocal cord are adducted.

8. Function
• production of sound
• speech
• protection of the lower respiratory tract
• passageway of air
• humidifying , filtering , Warming

9. Etiology
• In most cases the causes is unknown.
• Others –
 Neurological disorder
 Brain injury, Trauma
 Vocal cord damage, paralysis, nodule
 Respiratory muscle weakness
 Strokes
 Cleft lip and palate

10. Association Areas

12. Classification of speech defect
Classifying normal and disordered speech is a more
problematic then it first seems.
By a strict classification only 5-10% people of the
population has completely normal manner of
speaking and healthy voice. All are other are
suffer from disorder or another.
1. Sound the patient can produce.
• Phonemic – can produce easily, using
meaningfully and constructively.
• Phonetic – produce only on request, not using
consistently, meaningfully, constructively not
used in connected speech.

13. Cont…..
2. Stimulate sound
• Easily stimulated
• Stimulate after the demonstration and
probing (using a tongue depressor)
3. can’t produce the sound
• Can't produce voluntarily
• No production ever observed.

14. PROCESS OF
SPEECH
ABNORMALITIES
HEARING
UNDERSTANDING
THOUGHT &
WORD PROCESSING
VOICE PRODUCTION
ARTICULATION
DEAFNESS
APHASIA
APHASIA
DYSPHONIA
DYSARTHRIA

15. Types of speech defect
1. Aphasia –
I. Fluent -Wernicke’s, Conduction/associative,
anomic/nominal/amnesia/Dysnomia/minimal
dysfunction syndrome, Transcortical sensory
aphasia
II. non fluent - Broca’s Aphasia, Transcortical motor
Aphasia, Global Aphasia.
2. Dysarthria – Flaccid, spastic, ataxic, hyperkinetic,
hypokinetic, mixed.
3. Dysphonia
4. Others – Cluttering, Stammering, Dysprosody,
Apraxia, Scanning, Staccoto .

16. Types of speech defect
1. Aphasia – it is the acquired impairment in the
use of language due to damage to certain
parts of the brain affecting the production or
comprehension speech and the ability to read
and write.
Types of aphasia
I. Fluent aphasia – the inability to understand
the language of others and produce the less
meaningful speech then normal.

17. Cont…..
Types of fluent aphasia
A. Wernicke’s – person having difficulty or
Inability to understand the others speech,
produce meaningless speech and unable to
repeat the words.
It is produced by damaged to the wernicke’s
areas of the brain.

18. Cont…..
B. Transcortical sensory aphasia – similar to
wernicke’s aphasia but repetition is intact.
C. Conduction or associative aphasia – it is
characterized by intact auditory
comprehension, fluent speech production but
poor speech repetition or difficulty in
repeating something someone has just told.
D. Amnesic aphasia - In this the individual has
word retrieval failure and can’t express the
word they want to say.

19. Cont…..
II. Non-fluent aphasia – difficulty in producing
the fluent, articulated or self initiated speech.
A. Broca’s aphasia- in this having trouble speaking
fluently but their comprehension can be
relatively preserved. Patient having difficulty in
producing grammatical sentence and their
speech is limited to short. Producing the right
sound or Finding the right words is a laborious
process. E.g. - Mary give john balloons.

21. Cont…..
B. Transcortical motor aphasia – repetition
ability is intact. It is related to impair verbal
output. People with this aphasia doesn’t speak
unless they are strongly encouraged to do so
and when they speak it is labored and non-
fluent.
C. Global aphasia – it is characterized by severe
depression of all language functioning. non-
fluent, naming, repetition, comprehension all
are impaired.

22. Cont…..
2. Dysarthria – it is characterized by slurred
speech or slow speech that can be difficult to
understand due to defect in articulation.
I. Flaccid – it results from the damaged to the
PNS. Depending on the which nerve is
damaged it affect the respiration, phonation,
resonance and articulation. It causes muscle
weakness, low muscle tone and diminished
reflex.
II. Spastic – it causing excess tone and limited
range in muscle movement. In this speech is
labored and word may be prolonged.

23. Cont….
III. Ataxic – it is characterized by slurring and
incoordination of sound because of damage to
the cerebellum.
IV. Hyperkinetic – in this there is a too much
involuntary movement. It is quite during sleep.
It interrupt the speech movement as well.
V. Hypokinetics – in this there is a less or reduced
movement leads to reduced vocal loudness and
abnormal speaking rates.
VI. Mixed – in this combination of two or more
dysarthria.

24. Cont….
3. Dysphonia – it is also known as hoarse voice. It
refers to the inability to produce voice.
4. Others
I. Cluttering – it is a rapid rate of speech, which
makes the speech difficult to understand. It is
also known as tachyphemia or tachyprasia.
II. Stammering/stuttering – in this flow of
speech is disrupted by involuntary repetition
and prolongation of sound as well as
involuntary silent pause in which the person
unable to produce the sound.

25. Cont….
III. Dysprosody – it refers to the loss of normal
regulation or melody of speech.
IV. Apraxia – involve inconsistent production of
speech sound and rearrangement of sound in a
words (“potato” may become “topato” or
“totapo”)
V. Scanning speech- it is a type of ataxic
dysarthria. It involve incoordination of tongue,
in this syllables of words are separated by
pause.
VI. Staccato speech – it is due to incoordination
of larynx muscle of articulation. In this each
syllable is uttered separately.

26. Diagnostic evaluation
• History
• Physical examination - head, neck and larynx
examination.
 Laryngoscopy – it is an examination to look at the
back of your throat, your voice box (larynx) , and
vocal cords with a scope (laryngoscope)

27. Mirror examination – it is used for visualizing
the interior of the larynx, and especially the
vocal folds.

28. Videostroboscopy - It provides a magnified
view of the larynx, and simulates slow-motion
vibration of the vocal cords.

29. Laryngeal electromyography – electrical
activity in the laryngeal muscle.

30. Cont….
• Voice lab functioning test – computer based
technique used to make voice recording which are
analyzed by a computer to obtain quantitative
measurement of voice abnormalities.
• Test for reflex
• Other test - X- ray, CT- scan, MRI

31. Management

32. Cont…..
It can be done by correcting the organic condition
and psychotherapy.
Place the patient in special education programme
those who suffer from speech impairment.
speech therapy
Many of these disorder can be treated by speech
therapy.
It is given by the speech therapist are professionally
educated in the study of human communication,
it’s development and disorder.
It assess the speech, language, communication
problems, swallowing problems and best way to
treat them.

33. Cont…..
Remediation - It means reserving or stopping to
become severe. In this therapist work with the
patients one on one, or in a small group or
directly in a classroom to overcome the
difficulties.
Therapist use a variety of strategies including
1. Language intervention activities – the therapist
interact with the patient by talking, using
pictures, books, object , ongoing events to
stimulate language development. The therapist
may also correct the pronunciation and using
the repetition exercise to build speech and
language skills.

34. Cont…..
2. Articulation therapy – articulation or
sound production, exercise involve having
the therapist to correct sound and syllable
for a patient, often during the activities.
The therapy will physically show the patient
how to make certain sounds such as the ‘r’
sound and demonstrate how to move the
tongue to produce specific sounds.

35. Cont…..
3. Swallowing therapy – it will use a variety
of oral exercise including facial message and
various tongue, lip and jaw exercise to
strengthen the muscle of the mouth. The
therapist also may work with different food
textures and temperatures to increase a
patient oral awareness during eating and
swallowing.

36. Nursing
Management

37. 1. Nursing diagnosis – impaired verbal
communication related to impaired function of
the muscle as evidence by the impairment in
speech.
• Goals: improve the verbal communication.
• Intervention:
• Assess the patient for impaired verbal
communication.
• Maintain a patient calm approach, listen
attentively and allow the time for communication.
• Maintain a calm environment so the client can
concentrate on communication efforts, doesn’t
speak loudly and able to hear the others clearly.

38. • Ask the question that require short answer,
eyeblink or nod of head if the patient is having
speaking difficulties.
• Schedule rest periods before visiting hours and
speech therapy session to maximize
communication.
• Regarding the impairment consult with the speech
therapist to reinforce the exercise and technique
recommended.
• If the patient is unable to communicate, encourage
the other person and staff to communicate with
them.

39. 2. Nursing diagnosis – impaired social interaction
related to trouble speaking as evidenced by
observation.
• Goal: minimize disruption of social interaction.
• Intervention - Help the patient to identify the inner
strength.
• Give knowledge to people nearby about speech
impairments.
• Encourage the patient to talk or communicate with the
other person.
• Encourage the patient to maintain contact with the
friends.
• Give positive reinforcement on the results achieved by
the patient.

40. Study related to speech defect
identifying children at risk for speech and hearing
disorders - a preliminary survey report from
Hyderabad, India
The school teachers were given an orientation to use
the questionnaire to elicit information on features
considered as risk factors, for speech and hearing
problems and other disabilities. 6591 children
were screened using the questionnaire developed
for the study. The results of the study show the
percentage of children identified at-risk for
hearing loss was 15.96%, for speech and language
problems it was 1.89 % and for other disabilities it
was 0.76%

41. Summary
speech defect is a type of communication disorder
where normal speech is disrupted.
Speech therapy – it is a rehabilitative procedure
Classification
1. Sound the patient can produce.
Phonemic
Phonetic
2. Stimulate sound
Easily stimulated
Stimulate after the demonstration and probing (using
a tongue depressor)
3. can’t produce the sound
Can't produce voluntarily
No production ever observed.

42. Summary
Types
1. Aphasia –
I. Fluent -Wernicke’s, Conduction,
anomic, Transcortical sensory
II. non fluent - Broca’s Aphasia, Transcortical motor
Aphasia, Global Aphasia.
2. Dysarthria – Flaccid, spastic, ataxic, hyperkinetic,
hypokinetic, mixed.
3. Dysphonia
4. Others – Cluttering, Stammering, Dysprosody,
Apraxia, Scanning, Staccoto .

43. Summary
D/E
History
Head, neck and larynx examination
Laryngeal electromyography
Voice lab functioning test
Test for reflex
Other – X-ray. CT- scan. MRI
Management
Correct the condition
Education programme
Speech therapy – remediation

44. References
• “brunner and Suddarth’s” text book of medical
surgical nursing, twelth edition,Wolters
publication, Page no. 591-592
• “Saunders” comprehensive review for the NCLEX
RN examination, fifth edition, elsevier publication,
page n0. 392
• www.authorstream.com
• www.slideshare.com
• www.nursenanda.com