speech impediment dysarthria

• Patient Care & Health Information
• Diseases & Conditions

Dysarthria occurs when the muscles you use for speech are weak or you have difficulty controlling them. Dysarthria often causes slurred or slow speech that can be difficult to understand.

Common causes of dysarthria include nervous system disorders and conditions that cause facial paralysis or tongue or throat muscle weakness. Certain medications also can cause dysarthria.

Treating the underlying cause of your dysarthria may improve your speech. You may also need speech therapy. For dysarthria caused by prescription medications, changing or discontinuing the medications may help.

Products & Services

• A Book: Mayo Clinic Family Health Book, 5th Edition
• Newsletter: Mayo Clinic Health Letter — Digital Edition

Signs and symptoms of dysarthria vary, depending on the underlying cause and the type of dysarthria. They may include:

• Slurred speech
• Slow speech
• Inability to speak louder than a whisper or speaking too loudly
• Rapid speech that is difficult to understand
• Nasal, raspy or strained voice
• Uneven or abnormal speech rhythm
• Uneven speech volume
• Monotone speech
• Difficulty moving your tongue or facial muscles

When to see a doctor

Dysarthria can be a sign of a serious condition. See your doctor if you have sudden or unexplained changes in your ability to speak.

In dysarthria, you may have difficulty moving the muscles in your mouth, face or upper respiratory system that control speech. Conditions that may lead to dysarthria include:

• Amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease)
• Brain injury
• Brain tumor
• Cerebral palsy
• Guillain-Barre syndrome
• Head injury
• Huntington's disease
• Lyme disease
• Multiple sclerosis
• Muscular dystrophy
• Myasthenia gravis
• Parkinson's disease
• Wilson's disease

Some medications, such as certain sedatives and seizure drugs, also can cause dysarthria.

Complications

Because of the communication problems dysarthria causes, complications can include:

• Social difficulty. Communication problems may affect your relationships with family and friends and make social situations challenging.
• Depression. In some people, dysarthria may lead to social isolation and depression.
• Daroff RB, et al., eds. Bradley's Neurology in Clinical Practice. 7th ed. Elsevier; 2016. https://www.clinicalkey.com. Accessed April 10, 2020.
• Dysarthria. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/dysarthria/. Accessed April 6, 2020.
• Maitin IB, et al., eds. Current Diagnosis & Treatment: Physical Medicine & Rehabilitation. McGraw-Hill Education; 2020. https://accessmedicine.mhmedical.com. Accessed April 10, 2020.
• Dysarthria in adults. American Speech-Language-Hearing Association. https://www.asha.org/PRPPrintTemplate.aspx?folderid=8589943481. Accessed April 6, 2020.
• Drugs that cause dysarthria. IBM Micromedex. https://www.micromedexsolutions.com. Accessed April 10, 2020.
• Lirani-Silva C, et al. Dysarthria and quality of life in neurologically healthy elderly and patients with Parkinson's disease. CoDAS. 2015; doi:10.1590/2317-1782/20152014083.
• Signs and symptoms of untreated Lyme disease. Centers for Disease Control and Prevention. https://www.cdc.gov/lyme/signs_symptoms/index.html. Accessed April 6, 2020.
• Neurological diagnostic tests and procedures fact sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Neurological-Diagnostic-Tests-and-Procedures-Fact. Accessed April 6, 2020.

Associated Procedures

• EEG (electroencephalogram)
• Electromyography (EMG)
• Lumbar puncture (spinal tap)
• Symptoms & causes
• Diagnosis & treatment
• Doctors & departments

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

• Opportunities

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press .

• Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence
• The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book
• Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance
• FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment
• Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book

Make twice the impact

Your gift can go twice as far to advance cancer research and care!

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Dilip Kumar Jayaraman ; Joe M Das .

Affiliations

Last Update: June 5, 2023 .

• Continuing Education Activity

Dysarthria is a neuromotor disorder that results from abnormalities in speed, strength, accuracy, range, tone, or duration required for speech control. Decreased speech intelligibility characterizes the disorder. The content of the spoken language remains intact, so the patient can write and comprehend spoken and written language. Dysarthria is a motor speech disorder seen with many neurological causes. This activity reviews the main subtypes, evaluation, management of dysarthria, and the role of the interprofessional team in evaluating and improving patient care.

• Identify the different subtypes of dysarthria.
• Determine the etiology of dysarthria in common neurological disorders.
• Implement a comprehensive initial history, physical, and speech evaluation for patients with dysarthria.
• Apply best practices for the interprofessional team to achieve the overall goals of holistic individualized treatment to facilitate communication, decrease isolation, and improve patient outcomes.
• Introduction

Dysarthria is a neuromotor disorder that results from abnormalities in speed, strength, accuracy, range, tone, or duration required for speech control. [1]  Decreased speech intelligibility characterizes the disorder. The content of the spoken language remains intact, so the patient can write and comprehend spoken and written language. Anarthria is the severe form in which there is a complete loss of motor speech production. [2]

Speech is a complex neuromuscular phenomenon achieved through the smooth coordination of 5 subsystems: respiration, phonation, resonance, articulation, and prosody. [3]  Muscular dysfunction affecting any of these subsystems causes impairments in audibility, naturalness, intelligibility, and communication efficiency. Dysarthria profoundly affects the patient and their families, as communication is integrally related to expressing personality and social relationships. Since there is overlap in the functioning of the muscles, feeding and swallowing difficulty in patients with dysarthria is common.

Various neurological disorders can cause dysarthria. Dysarthria can arise from disorders at various locations of the neuroaxis, including the cerebral cortex, basal ganglia, cerebellum, cranial nerve nuclei, or peripheral nerves, and from a primary motor disorder of the tongue, larynx, and pharynx.

Mayo Clinic Classification (commonly used - groups dysarthria based on the location) [4]

Etiopathological Causes

• Infections: Creutzfeldt–Jakob disease, acquired immune deficiency disease.
• Vascular disorder: Ischemic and hemorrhagic strokes, arterio-venous malformations.
• Neoplasm: Primary and metastatic brain tumors.
• Demyelinating: Multiple sclerosis, Guillain–Barre disease.
• Degenerative: PD, progressive supra nuclear palsy, corticobasal degeneration, multiple system atrophy, Huntington disease (HD), ataxia telangiectasia.
• Trauma: TBI, chronic traumatic encephalopathy, cerebral palsy.
• Toxic: Heavy metal poisoning (Minamata disease due to methylmercury poisoning can cause dysarthria), alcohol, drugs
• Genetic: Sensory ataxic neuropathy, dysarthria, and ophthalmoparesis (SANDO) due to a mutation in the gene encoding the mitochondrial DNA polymerase gamma enzyme (POLG1) [5] [6]

In addition to the neurological causes, nonneurological causes, such as cleft lip or palate and laryngeal tumors, also cause difficulty with articulation. However, the condition is not termed dysarthria if it stems from nonneurological causes.

• Epidemiology

The exact incidence of dysarthria is not known, and incidence varies based on the underlying cause. About 90% of patients with PD develop dysarthria during the illness. In ALS patients, dysarthria may predate limb weakness by about 3 to 5 years; dysarthria affects about 70% of patients with limb weakness. [7] [8]  

In one study evaluating stroke patients, 28% had both aphasia and dysarthria, and 24% had dysarthria only. In a study of children with neuromuscular diseases, the prevalence of dysarthria was 31.5%. [9]  It is estimated that 10 to 60% of patients with TBI have dysarthria. [10]

• Pathophysiology

The motor control of speech occurs at multiple levels. The cranial nerve nuclei receive cortical supply through the corticobulbar tract. All other cranial nerves are innervated bilaterally except for the lower face, which receives contralateral innervation. The facial nerve terminates in 5 branches; the branches that contribute to the muscles of speech are the buccal, mandibular, and, to an extent, cervical. The glossopharyngeal nerve (IX), through the stylopharyngeal nerve, innervates the stylopharyngeus muscle and, through the pharyngeal branches, innervates the muscles of the pharynx. [11]

Through the pharyngeal branches, the vagus nerve innervates the pharyngeal muscles, which elevate the palate and cause pharyngeal constriction. The glossopharyngeal nerve provides a sensory supply to the stylopharyngeus, which elevates the pharynx during speech. The cricothyroid muscle supplied by the vagus’ superior laryngeal branch is the vocal cords’ chief tensor. The recurrent laryngeal nerve separates the vocal cords and opens the glottis through the posterior cricoarytenoids, closes the glottis through lateral cricoarytenoids, and relaxes the vocal cords through the vocalis.

Hypoglossal nerve nuclei originating in the medulla provide motor branches to the tongue, supplying the intrinsic and extrinsic muscles (except the palatoglossus).

Suprahyoid muscles:  These influence tongue movements by altering the position of the hyoid bone.

• C1 fibers supply the geniohyoid muscle.
• The trigeminal nerve supplies the mylohyoid muscle and the anterior belly of the digastric muscle.
• The facial nerve supplies the stylohyoid muscle and posterior belly of the digastric muscle.

In the neuromuscular junction, acetylcholine produced in the presynaptic nerve terminal binds to receptors, ultimately creating an endplate potential strong enough to propagate action potential over the surface of the skeletal muscle membrane, resulting in muscle contraction. In myasthenia gravis, various autoantibodies interrupt these processes resulting in dysarthria and other symptoms. [12]

• History and Physical

Multiple neurological conditions cause dysarthria, so the natural course and clinical features can differ. The presentation can be acute in patients with acute ischemic stroke, whereas it can be delayed in neurodegenerative diseases like ALS.

Based on the Mayo classification, there are salient features of dysarthria [13]  described below:

Flaccid: Speech is slow, with hypernasality and breathy vocal quality. One of the most common examples in clinical practice is idiopathic peripheral facial paralysis, in which the patient presents with facial paralysis and drooling. Another common cause is Guillain–Barre syndrome.

Spastic:  Speech is harsh, with low pitch and constant errors. Speech evaluation shows hypernasality, reduced intelligibility, palatal elevation, and slow speech rate. Patients have signs of pseudobulbar palsy with dysphagia, hyperactive jaw jerk, and pseudobulbar affect. Patients with dysarthria-clumsy hand syndrome are noted to have facial weakness, dysarthria, and extremity dysmetria. [14]

Hypokinetic dysarthria:  This is seen in PD due to the loss of dopaminergic neurons. Speech is monotone and poorly articulated and tends to be quiet. Delays in speech initiation mixed with rushing of words can be seen. Other characteristic signs, such as masked facial features, resting tremors, cogwheeling, and festinating gait, can be observed at the examination.

Hyperkinetic dysarthria: This is seen with basal ganglia lesions and associated hyperkinetic movement disorders, such as HD. Speech is harsh, with variation in loudness and rate of speech. There are occasional stoppages while speaking.

Ataxic dysarthria:  This is commonly seen with disorders of the cerebellum or its connections. Speech has a “scanning” quality or irregular rhythm with the explosion of syllables. Prosody is impaired, with each syllable being pronounced slowly, and there is a pause after every syllable. There is decreased motor coordination manifested by axial and appendicular ataxia depending on the part of the cerebellum affected.

Mixed dysarthria:  Two or more central nervous system components are affected in this type. This can be seen with ALS and multiple sclerosis. Speech is slow, prosody is disrupted, voice is strained, and there is marked hypernasality.

A thorough history and a detailed physical examination are crucial in evaluating patients presenting with dysarthria. A comprehensive initial speech evaluation is comprised of (1) history, (2) oral motor/speech mechanism exam, (3) screening of subsystems (respiration, phonation, articulation, resonance, and prosody), (4) perceptual assessment, and (5) intelligibility evaluation.

The water glass manometer test provides a gross assessment of pressure-generating capabilities for speech production. The patient must blow into a water-filled drinking glass with the straw secured at a certain depth inside the glass. If the patient can maintain a stream of bubbles for 5 seconds, breath support is adequate for most speech purposes. To be valid, the patient must maintain velopharyngeal closure and a tight lip seal around the straw. [15]

Perpetual assessment of speech helps observe the function of all speech subsets. This assessment provides insight into deficits and serves as a comparison tool. Passages such as "my grandfather" and "caterpillar passage" help assess perceptual speech. [16] [17]  These passages help evaluate the speech repertoire, examine the subsystems of speech, contemporary vocabulary, and simple syntax, and assess polysyllabic word form.

The Caterpillar Passage

"Do you like amusement parks? Well, I sure do. To amuse myself, I went twice last spring. My most MEMORABLE moment was riding on the Caterpillar, which is a gigantic roller coaster high above the ground. When I saw how high the Caterpillar rose into the bright blue sky, I knew it was for me. After waiting in line for thirty minutes, I made it to the front, where the man measured my height to see if I was tall enough. I gave the man my coins, asked for change, and jumped on the cart. Tick, tick, tick, the Caterpillar climbed slowly up the tracks. It went SO high I could see the parking lot. Boy, was I SCARED! I thought to myself, "There's no turning back now." People were so scared they screamed as we zoomed fast and faster along the tracks. As quickly as it started, the Caterpillar came to a stop. Unfortunately, it was time to pack the car and drive home. That night I dreamt of the wild ride on the Caterpillar. Taking a trip to the amusement park and riding on the Caterpillar was my MOST memorable moment ever!" 

Speech Intelligibility Evaluation

Assessment of intelligibility in dysarthric speakers (AIDS), sentence intelligibility test (SIT), and word intelligibility test are used to assess speech intelligibility. AIDS is the most commonly used and comprises word and sentence tasks. The patient reads or imitates 50 unsystematically chosen words from 12 phonetically similar words for each word. In the sentence task, the patient reads or imitates two sentences each for 220 words. The sentences are chosen from a collection of 100 sentences of each length. The judge derives an intelligibility score based on the percentage of words transcribed accurately.

SIT is an improved Windows version of the sentence portion of AIDS. It examines the intelligibility of words and sentences and estimates efficiency by examining the rate of intelligible words per minute in sentences.

The onset and progression of dysarthria and associated neurological complaints, such as tremors, dysphagia, and gait instability, can provide clues for the diagnosis. A medication list review should include potential overdoses and exposure to toxins, such as alcohol and cocaine. Having the patient count from 1 to 100 can bring out respiratory muscle fatigue in myasthenia gravis. Counting numbers without interruption (1–30) is another bedside tool to assess respiratory status. [18]  Sustaining an "ah" sound is a functional bedside test to assess laryngeal function.

Imaging techniques, such as computed tomography (CT) of the head and magnetic resonance imaging (MRI) of the brain, are helpful initial tools in evaluation. In patients suspected of neuromuscular junction disorders, electromyography (EMG) and nerve conduction studies (NCS) are indicated. CBC (complete blood count), basic metabolic profile (BMP), and urine drug screening are indicated based on history and pretest probability. If GBS is suspected, evaluation of pulmonary function (vital capacity and negative inspiratory force) is indicated. [18]

Speech Assessment Tools

Frenchay Dysarthria Assessment is one of the most commonly used commercially available tools for dysarthria assessment. It was initially devised in 1980 and revised in 2008. It incorporates a series of tasks used to identify the dysarthria subtype. Speech pathologists rate the patient's speech employing a 5-point scoring system on the following (a) reflexes, (b) respiration, (c) lips, (d)palate, (e) laryngeal, (f) tongue, and (g) intelligibility, (h) influencing factors. [19]

For subjective assessment, self-report questionnaires such as Living with Neurologically Based Speech Difficulties (Living with Dysarthria - LwD) may be used. The severity of dysarthria may not always correspond to the extent of perceived communicative difficulties. [20]  

• Treatment / Management

The overall goals of speech and language treatment are to facilitate the recovery of communication, to assist patients in developing strategies to compensate for communication disorders, and to counsel and educate people in the patient's environment on assistive communication supports to facilitate communication, decrease isolation, and meet the patient's wants and needs.

When developing the plan, it is essential to consider dysarthria's cause, severity, and underlying co-morbidities. Speech-language pathologists and physicians work together to formulate an individualized approach for the patient. Recent studies indicate that speech rehabilitation significantly improves speech in adults with stroke-related dysarthria and that interventions such as Lee Silverman Voice Treatment are effective for hypokinetic dysarthria in individuals with PD. [21] [22]

Broadly, types of therapy could be grouped as follows:

• Therapy targeting the speech-production subsystems
• Communication strategies
• Environmental adaptations
• Augmentative and alternative communication (AAC)
• Medical/surgical interventions.

Targeting the Speech-Production Subsystems

Speech pathologists can target the five individual subcomponents that produce speech.

Lee Silverman Voice Treatment and Pitch Limiting Voice Treatment target phonation; the former is a program that improves loudness and intelligibility and has been widely studied in PD, while the latter increases vocal loudness without increasing pitch. [23] [24]  Articulation can be improved by increasing loudness, pausing, exaggerating articulation, and altering pitch variation. Respiratory muscle strength training supports breathing by altering posture to target respiration.

Communication Strategies

Providing feedback, clarifying, and encouraging are practical approaches for the partner. For the patient, setting up the conversation by gaining the partner's attention, slowing and repeating the phrases, and using nonverbal gestures, such as eye contact and facial expressions, are helpful strategies.

Speech supplementation, such as alphabet, syntactic, and topic, are helpful strategies. In alphabet supplementation, the speaker uses an alphabet board to identify the first letter of the spoken word. In topic supplementation, a phrase or cue word is uttered before speaking. Information about the grammar or word class is provided with each spoken word in the syntactic supplementation.

Behavioral communication intervention techniques such as biofeedback are shown to improve intelligibility. In stroke patients, biofeedback techniques increased the volume, decreased the speed, and improved the intelligibility. [25] [26]

Environmental Adaptations

Setting up optimal environmental conditions to increase understandability includes ensuring a quiet conversation background, intimate seating, and face-to-face interaction.

Augmentative and Alternative Communication (AAC)

AAC may include low-tech aids, such as picture boards or pen and paper, or high-tech aids, such as smartphones, voice synthesizers, digital records, and speech-generating devices. [27]  

Computer-based interventions offer an exciting step toward dysarthria management. Some examples are:

• A mobile application for PD patients. It includes an assessment of the speech in addition to various other aspects of disease management [28]
• Feedback and individual practice using computers were as effective as traditional therapy in patients with stable dysarthria [29]
• Improvement in articulation and intelligibility was assessed in Virtual articulation therapy [30]

These small studies hold good promise for further expansion of computer-based interventions.

Medical/Surgical Interventions

Medical therapy should target the underlying neurological cause. In dysarthria arising from PD, therapy should focus on repleting dopaminergic therapy. The effects of PD drugs on dysarthria are variable. Subthalamic nucleus stimulation has some efficacy among surgical treatments, but speech intelligibility worsens, as with most surgical interventions in PD. [31]  Improving spasticity in ALS with baclofen, tizanidine, and botulinum toxin type A has been tried. [8]

Laryngoplasty is an option if hoarseness is associated with recurrent laryngeal nerve palsy and does not improve with conservative management. Palatal lift improves resonance by surgically lifting the weak palate. Since the 2019 COVID pandemic, telehealth has become more relevant than ever. Telerehab (TR) is less expensive and equally effective in improving functional stroke outcomes, including speech, compared to traditional rehab. [32]  

In another review of speech therapy administered via teletherapy in patients with PD, the patient reported overall increased satisfaction due to increased convenience and accessibility. Further research is needed, however, as the studies lacked double blinding, and there was heterogeneity in the protocol. [33]

• Differential Diagnosis

The differential diagnoses for dysarthria include aphasia, apraxia of speech, and aphemia.

Apraxia, in general, is a dysfunction of a learned motor task. Patients need help initiating speech and transitioning between sounds; they speak through trial and error, and their errors are inconsistent. When patients are asked to repeat a phrase exactly, especially a polysyllabic word (eg, television), different errors are noted in each attempt. Isolated apraxia of speech is rare; it is usually seen with aphasia. Imaging might show lesions in the dominant insula and Broca’s area. [34]

Aphasia is a language impairment. Depending on the location, language comprehension or production may be impaired. Patients also have difficulty writing and reading. [35]

Aphemia is a motor speech disorder resulting in near muteness. Patients have normal comprehension, reading, and writing.

Dysarthria is described as chronic if persistent for greater than 5 years. Dysarthia is considered stable in patients with nonprogressive etiologies.

Recovery also appears to be dependent on the etiology. One study evaluating dysarthria following stroke showed recovery in about half of the patients. [36]  No estimates of the long-term prognosis of various diseases are available. However, from various anecdotal reports, it is evident that dysarthria is progressive in most neurodegenerative diseases.

Functional Communication Measures (FCMs) refer to rating scales used to define an individual’s functional abilities. They are seven-point rating scales, ranging from least functional (Level 1) to most functional (Level 7). They help measure a patient’s functional communication and swallowing abilities throughout speech-language pathology intervention.

• Complications

Speech difficulty can have a significant impact on the patient’s psychosocial life. Patients report stigmatization, changes in self-identity, and social and emotional disturbances due to post-stroke dysarthria. In children, behavioral problems and lack of access to education can lead to decreased future employment opportunities. Tools such as the Dysarthria Impact Profile (DIP) are available to assess the psychosocial impact of dysarthria. [37]  Given the possibility of far-reaching effects, timely intervention should be the goal.

Dysarthria Impact Profile is used to assess the psychosocial impact of dysarthria. [38] Patients report how their condition hinders them in multiple circumstances, such as talking to people they do not know and ordering a meal in a restaurant. The tool is used for outcome measurement and for planning interventions. Communicative Participation Item Bank (CPIB) is a self-reported tool designed for adults with various communication disorders; this tool has clinical and research applications. [39] Patients report how their condition hinders them in multiple circumstances, such as talking to people they do not know and ordering a meal in a restaurant.

• Consultations
• Neurologist
• Speech and language pathologists
• Physiatrist (physical medicine and rehabilitation)
• Deterrence and Patient Education

When the patient or family first notices dysarthria, they should immediately bring it to the attention of an appropriate medical practitioner. Acute onset might be a symptom of stroke; hence, rapid evaluation in the hospital is warranted. If symptoms are progressive, patients are typically assessed by a primary care clinician and referred to specialists. Patient and caregiver strategies help during rehabilitation. [40]  

Paying attention to the speaker, speaking in a quiet area with good lighting, repeating phrases that are not understood, and clarifying unclear statements by asking yes-or-no questions are some valuable strategies for caregivers. Patients should begin with one word or phrase before proceeding to complete sentences. Speaking slowly with frequent pauses helps ensure understanding. Frequently ensuring listeners understand and using pictures and writing are also helpful strategies. When tired and frustrated, dysarthria worsens. When necessary, using alternative methods of communication is warranted. Educating the listener about dysarthria improves recognition of the condition and their attitude toward the patients. [41]

• Pearls and Other Issues

The International Classification of Functioning, disability, and Health (ICF) is a classification system of health and health-related conditions developed by the World Health Organization (WHO) and published in 2001. It is a framework that addresses functioning and disability related to a health condition within the context of the individual’s activities and participation in everyday life.

The table below maps a patient with ataxic dysarthria due to a cerebellar stroke:

Activities and Participation Environmental and Personal Factors

• Enhancing Healthcare Team Outcomes

Dysarthria is among the most common neurological complaints and can arise from many primary neurological and nonneurological conditions. Collecting detailed history, including onset, progression, associated neurological symptoms, and collateral history from family and friends, is essential.

If dysarthria is a presenting symptom, extensive workup may be required to diagnose the underlying cause. Nurses are often the first to recognize speech difficulties in an inpatient who develops dysarthria and should inform the clinician and make recommendations for interventions. An interprofessional team, including a neurologist, physiatrist, nurses, and speech–language pathologist, must make the diagnosis and formulate a treatment plan. Social workers may assist in locating support groups and local resources for patients and families.

Conventional speech therapy and high-tech AAC devices can assist with functional communication when natural speech is not understandable. The Academy of Neurologic Communication Disorders and Sciences (ANCDS) and the American Speech–Language–Hearing Association (ASHA) published four practice guidelines between 2001–2004 to support the treatment of dysarthria. Various societies, such as the ANCDS, the National Parkinson’s Foundation, the Multiple Sclerosis Society, and the ALS Association, have practical guidelines for managing patients with dysarthria.

The Speech–Language Pathology Medical Review Guidelines published by ASHA focus on specific components of the speech production process, such as improving muscle strength and control, reducing consonant imprecision, and improving respiration for producing an adequate voice. [Level 5] ASHA has an evidence maps section highlighting the most recent evidence-based research in dysarthria. Emerging evidence suggests TR improves costs and patient satisfaction compared to traditional in-person therapy. The study evaluated post-stroke patients’ quality of life and motor, speech, and cognitive function. [32] [Level 1]

The prognosis of dysarthria depends on the cause. Proper consultation with specialists and education of family members and friends is required to optimize patient treatment and allow patients to regain their most significant level of independence. The treatment regimen is highly individualized and requires an extensive interprofessional team. Hence, prompt consultation with interprofessional specialists is recommended to improve outcomes.

• Review Questions
• Access free multiple choice questions on this topic.
• Comment on this article.

Disclosure: Dilip Kumar Jayaraman declares no relevant financial relationships with ineligible companies.

Disclosure: Joe M Das declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Jayaraman DK, M Das J. Dysarthria. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

In this Page

Bulk download.

• Bulk download StatPearls data from FTP

Related information

• PMC PubMed Central citations
• PubMed Links to PubMed

Similar articles in PubMed

• Review Disorders of communication: dysarthria. [Handb Clin Neurol. 2013] Review Disorders of communication: dysarthria. Enderby P. Handb Clin Neurol. 2013; 110:273-81.
• A phonation therapy approach for Mandarin-English bilingual clients with dysarthria. [Clin Linguist Phon. 2009] A phonation therapy approach for Mandarin-English bilingual clients with dysarthria. Lee T, McCann C. Clin Linguist Phon. 2009 Oct; 23(10):762-79.
• Validation and cross-linguistic adaptation of the Frenchay Dysarthria Assessment (FDA-2) speech intelligibility tests: Hebrew version. [Int J Lang Commun Disord. 2022] Validation and cross-linguistic adaptation of the Frenchay Dysarthria Assessment (FDA-2) speech intelligibility tests: Hebrew version. Icht M, Bergerzon-Bitton O, Ben-David BM. Int J Lang Commun Disord. 2022 Sep; 57(5):1023-1049. Epub 2022 Jun 17.
• Review Hypokinetic Dysarthria in Parkinson's Disease: A Narrative Review. [Sisli Etfal Hastan Tip Bul. 2023] Review Hypokinetic Dysarthria in Parkinson's Disease: A Narrative Review. Atalar MS, Oguz O, Genc G. Sisli Etfal Hastan Tip Bul. 2023; 57(2):163-170. Epub 2023 Jun 20.
• Speech treatment for Hebrew-speaking adolescents and young adults with developmental dysarthria: A comparison of mSIT and Beatalk. [Int J Lang Commun Disord. 2022] Speech treatment for Hebrew-speaking adolescents and young adults with developmental dysarthria: A comparison of mSIT and Beatalk. Carl M, Levy ES, Icht M. Int J Lang Commun Disord. 2022 May; 57(3):660-679. Epub 2022 Apr 1.

Recent Activity

• Dysarthria - StatPearls Dysarthria - StatPearls

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers

• Type 2 Diabetes
• Heart Disease
• Digestive Health
• Multiple Sclerosis
• Diet & Nutrition
• Supplements
• Health Insurance
• Public Health
• Patient Rights
• Caregivers & Loved Ones
• End of Life Concerns
• Health News
• Thyroid Test Analyzer
• Doctor Discussion Guides
• Hemoglobin A1c Test Analyzer
• Lipid Test Analyzer
• Complete Blood Count (CBC) Analyzer
• What to Buy
• Editorial Process
• Meet Our Medical Expert Board

Overcoming Speech Impediment: Symptoms to Treatment

There are many causes and solutions for impaired speech

• Types and Symptoms
• Speech Therapy
• Building Confidence

Speech impediments are conditions that can cause a variety of symptoms, such as an inability to understand language or speak with a stable sense of tone, speed, or fluidity. There are many different types of speech impediments, and they can begin during childhood or develop during adulthood.

Common causes include physical trauma, neurological disorders, or anxiety. If you or your child is experiencing signs of a speech impediment, you need to know that these conditions can be diagnosed and treated with professional speech therapy.

This article will discuss what you can do if you are concerned about a speech impediment and what you can expect during your diagnostic process and therapy.

FG Trade / Getty Images

Types and Symptoms of Speech Impediment

People can have speech problems due to developmental conditions that begin to show symptoms during early childhood or as a result of conditions that may occur during adulthood. 

The main classifications of speech impairment are aphasia (difficulty understanding or producing the correct words or phrases) or dysarthria (difficulty enunciating words).

Often, speech problems can be part of neurological or neurodevelopmental disorders that also cause other symptoms, such as multiple sclerosis (MS) or autism spectrum disorder .

There are several different symptoms of speech impediments, and you may experience one or more.

Can Symptoms Worsen?

Most speech disorders cause persistent symptoms and can temporarily get worse when you are tired, anxious, or sick.

Symptoms of dysarthria can include:

• Slurred speech
• Slow speech
• Choppy speech
• Hesitant speech
• Inability to control the volume of your speech
• Shaking or tremulous speech pattern
• Inability to pronounce certain sounds

Symptoms of aphasia may involve:

• Speech apraxia (difficulty coordinating speech)
• Difficulty understanding the meaning of what other people are saying
• Inability to use the correct words
• Inability to repeat words or phases
• Speech that has an irregular rhythm

You can have one or more of these speech patterns as part of your speech impediment, and their combination and frequency will help determine the type and cause of your speech problem.

Causes of Speech Impediment

The conditions that cause speech impediments can include developmental problems that are present from birth, neurological diseases such as Parkinson’s disease , or sudden neurological events, such as a stroke .

Some people can also experience temporary speech impairment due to anxiety, intoxication, medication side effects, postictal state (the time immediately after a seizure), or a change of consciousness.

Speech Impairment in Children

Children can have speech disorders associated with neurodevelopmental problems, which can interfere with speech development. Some childhood neurological or neurodevelopmental disorders may cause a regression (backsliding) of speech skills.

Common causes of childhood speech impediments include:

• Autism spectrum disorder : A neurodevelopmental disorder that affects social and interactive development
• Cerebral palsy :  A congenital (from birth) disorder that affects learning and control of physical movement
• Hearing loss : Can affect the way children hear and imitate speech
• Rett syndrome : A genetic neurodevelopmental condition that causes regression of physical and social skills beginning during the early school-age years.
• Adrenoleukodystrophy : A genetic disorder that causes a decline in motor and cognitive skills beginning during early childhood
• Childhood metabolic disorders : A group of conditions that affects the way children break down nutrients, often resulting in toxic damage to organs
• Brain tumor : A growth that may damage areas of the brain, including those that control speech or language
• Encephalitis : Brain inflammation or infection that may affect the way regions in the brain function
• Hydrocephalus : Excess fluid within the skull, which may develop after brain surgery and can cause brain damage

Do Childhood Speech Disorders Persist?

Speech disorders during childhood can have persistent effects throughout life. Therapy can often help improve speech skills.

Speech Impairment in Adulthood

Adult speech disorders develop due to conditions that damage the speech areas of the brain.

Common causes of adult speech impairment include:

• Head trauma 
• Nerve injury
• Throat tumor
• Stroke 
• Parkinson’s disease 
• Essential tremor
• Brain tumor
• Brain infection

Additionally, people may develop changes in speech with advancing age, even without a specific neurological cause. This can happen due to presbyphonia , which is a change in the volume and control of speech due to declining hormone levels and reduced elasticity and movement of the vocal cords.

Do Speech Disorders Resolve on Their Own?

Children and adults who have persistent speech disorders are unlikely to experience spontaneous improvement without therapy and should seek professional attention.

Steps to Treating Speech Impediment 

If you or your child has a speech impediment, your healthcare providers will work to diagnose the type of speech impediment as well as the underlying condition that caused it. Defining the cause and type of speech impediment will help determine your prognosis and treatment plan.

Sometimes the cause is known before symptoms begin, as is the case with trauma or MS. Impaired speech may first be a symptom of a condition, such as a stroke that causes aphasia as the primary symptom.

The diagnosis will include a comprehensive medical history, physical examination, and a thorough evaluation of speech and language. Diagnostic testing is directed by the medical history and clinical evaluation.

Diagnostic testing may include:

• Brain imaging , such as brain computerized tomography (CT) or magnetic residence imaging (MRI), if there’s concern about a disease process in the brain
• Swallowing evaluation if there’s concern about dysfunction of the muscles in the throat
• Electromyography (EMG) and nerve conduction studies (aka nerve conduction velocity, or NCV) if there’s concern about nerve and muscle damage
• Blood tests, which can help in diagnosing inflammatory disorders or infections

Your diagnostic tests will help pinpoint the cause of your speech problem. Your treatment will include specific therapy to help improve your speech, as well as medication or other interventions to treat the underlying disorder.

For example, if you are diagnosed with MS, you would likely receive disease-modifying therapy to help prevent MS progression. And if you are diagnosed with a brain tumor, you may need surgery, chemotherapy, or radiation to treat the tumor.

Therapy to Address Speech Impediment

Therapy for speech impairment is interactive and directed by a specialist who is experienced in treating speech problems . Sometimes, children receive speech therapy as part of a specialized learning program at school.

The duration and frequency of your speech therapy program depend on the underlying cause of your impediment, your improvement, and approval from your health insurance.

If you or your child has a serious speech problem, you may qualify for speech therapy. Working with your therapist can help you build confidence, particularly as you begin to see improvement.

Exercises during speech therapy may include:

• Pronouncing individual sounds, such as la la la or da da da
• Practicing pronunciation of words that you have trouble pronouncing
• Adjusting the rate or volume of your speech
• Mouth exercises
• Practicing language skills by naming objects or repeating what the therapist is saying

These therapies are meant to help achieve more fluent and understandable speech as well as an increased comfort level with speech and language.

Building Confidence With Speech Problems 

Some types of speech impairment might not qualify for therapy. If you have speech difficulties due to anxiety or a social phobia or if you don’t have access to therapy, you might benefit from activities that can help you practice your speech. 

You might consider one or more of the following for you or your child:

• Joining a local theater group
• Volunteering in a school or community activity that involves interaction with the public
• Signing up for a class that requires a significant amount of class participation
• Joining a support group for people who have problems with speech

Activities that you do on your own to improve your confidence with speaking can be most beneficial when you are in a non-judgmental and safe space.

Many different types of speech problems can affect children and adults. Some of these are congenital (present from birth), while others are acquired due to health conditions, medication side effects, substances, or mood and anxiety disorders. Because there are so many different types of speech problems, seeking a medical diagnosis so you can get the right therapy for your specific disorder is crucial.

Centers for Disease Control and Prevention. Language and speech disorders in children .

Han C, Tang J, Tang B, et al. The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: a systematic review and meta-analysis . Medicine (Baltimore). 2024;103(2):e36880. doi:10.1097/MD.0000000000036880

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, language .

Mackey J, McCulloch H, Scheiner G, et al. Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience . Brain Impair. 2023;24(2):168-184. doi:10.1017/BrImp.2023.9

Allison KM, Doherty KM. Relation of speech-language profile and communication modality to participation of children with cerebral palsy . Am J Speech Lang Pathol . 2024:1-11. doi:10.1044/2023_AJSLP-23-00267

Saccente-Kennedy B, Gillies F, Desjardins M, et al. A systematic review of speech-language pathology interventions for presbyphonia using the rehabilitation treatment specification system . J Voice. 2024:S0892-1997(23)00396-X. doi:10.1016/j.jvoice.2023.12.010

By Heidi Moawad, MD Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.

• Bipolar Disorder
• Therapy Center
• When To See a Therapist
• Types of Therapy
• Best Online Therapy
• Best Couples Therapy
• Best Family Therapy
• Managing Stress
• Sleep and Dreaming
• Understanding Emotions
• Self-Improvement
• Healthy Relationships
• Student Resources
• Personality Types
• Guided Meditations
• Verywell Mind Insights
• 2024 Verywell Mind 25
• Mental Health in the Classroom
• Editorial Process
• Meet Our Review Board
• Crisis Support

Types of Speech Impediments

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Phynart Studio / Getty Images

Articulation Errors

Ankyloglossia, treating speech disorders.

A speech impediment, also known as a speech disorder , is a condition that can affect a person’s ability to form sounds and words, making their speech difficult to understand.

Speech disorders generally become evident in early childhood, as children start speaking and learning language. While many children initially have trouble with certain sounds and words, most are able to speak easily by the time they are five years old. However, some speech disorders persist. Approximately 5% of children aged three to 17 in the United States experience speech disorders.

There are many different types of speech impediments, including:

• Articulation errors

This article explores the causes, symptoms, and treatment of the different types of speech disorders.

Speech impediments that break the flow of speech are known as disfluencies. Stuttering is the most common form of disfluency, however there are other types as well.

Symptoms and Characteristics of Disfluencies

These are some of the characteristics of disfluencies:

• Repeating certain phrases, words, or sounds after the age of 4 (For example: “O…orange,” “I like…like orange juice,” “I want…I want orange juice”)
• Adding in extra sounds or words into sentences (For example: “We…uh…went to buy…um…orange juice”)
• Elongating words (For example: Saying “orange joooose” instead of "orange juice")
• Replacing words (For example: “What…Where is the orange juice?”)
• Hesitating while speaking (For example: A long pause while thinking)
• Pausing mid-speech (For example: Stopping abruptly mid-speech, due to lack of airflow, causing no sounds to come out, leading to a tense pause)

In addition, someone with disfluencies may also experience the following symptoms while speaking:

• Vocal tension and strain
• Head jerking
• Eye blinking
• Lip trembling

Causes of Disfluencies

People with disfluencies tend to have neurological differences in areas of the brain that control language processing and coordinate speech, which may be caused by:

• Genetic factors
• Trauma or infection to the brain
• Environmental stressors that cause anxiety or emotional distress
• Neurodevelopmental conditions like attention-deficit hyperactivity disorder (ADHD)

Articulation disorders occur when a person has trouble placing their tongue in the correct position to form certain speech sounds. Lisping is the most common type of articulation disorder.

Symptoms and Characteristics of Articulation Errors

These are some of the characteristics of articulation disorders:

• Substituting one sound for another . People typically have trouble with ‘r’ and ‘l’ sounds. (For example: Being unable to say “rabbit” and saying “wabbit” instead)
• Lisping , which refers specifically to difficulty with ‘s’ and ‘z’ sounds. (For example: Saying “thugar” instead of “sugar” or producing a whistling sound while trying to pronounce these letters)
• Omitting sounds (For example: Saying “coo” instead of “school”)
• Adding sounds (For example: Saying “pinanio” instead of “piano”)
• Making other speech errors that can make it difficult to decipher what the person is saying. For instance, only family members may be able to understand what they’re trying to say.

Causes of Articulation Errors

Articulation errors may be caused by:

• Genetic factors, as it can run in families
• Hearing loss , as mishearing sounds can affect the person’s ability to reproduce the sound
• Changes in the bones or muscles that are needed for speech, including a cleft palate (a hole in the roof of the mouth) and tooth problems
• Damage to the nerves or parts of the brain that coordinate speech, caused by conditions such as cerebral palsy , for instance

Ankyloglossia, also known as tongue-tie, is a condition where the person’s tongue is attached to the bottom of their mouth. This can restrict the tongue’s movement and make it hard for the person to move their tongue.

Symptoms and Characteristics of Ankyloglossia

Ankyloglossia is characterized by difficulty pronouncing ‘d,’ ‘n,’ ‘s,’ ‘t,’ ‘th,’ and ‘z’ sounds that require the person’s tongue to touch the roof of their mouth or their upper teeth, as their tongue may not be able to reach there.

Apart from speech impediments, people with ankyloglossia may also experience other symptoms as a result of their tongue-tie. These symptoms include:

• Difficulty breastfeeding in newborns
• Trouble swallowing
• Limited ability to move the tongue from side to side or stick it out
• Difficulty with activities like playing wind instruments, licking ice cream, or kissing
• Mouth breathing

Causes of Ankyloglossia

Ankyloglossia is a congenital condition, which means it is present from birth. A tissue known as the lingual frenulum attaches the tongue to the base of the mouth. People with ankyloglossia have a shorter lingual frenulum, or it is attached further along their tongue than most people’s.

Dysarthria is a condition where people slur their words because they cannot control the muscles that are required for speech, due to brain, nerve, or organ damage.

Symptoms and Characteristics of Dysarthria

Dysarthria is characterized by:

• Slurred, choppy, or robotic speech
• Rapid, slow, or soft speech
• Breathy, hoarse, or nasal voice

Additionally, someone with dysarthria may also have other symptoms such as difficulty swallowing and inability to move their tongue, lips, or jaw easily.

Causes of Dysarthria

Dysarthria is caused by paralysis or weakness of the speech muscles. The causes of the weakness can vary depending on the type of dysarthria the person has:

• Central dysarthria is caused by brain damage. It may be the result of neuromuscular diseases, such as cerebral palsy, Huntington’s disease, multiple sclerosis, muscular dystrophy, Huntington’s disease, Parkinson’s disease, or Lou Gehrig’s disease. Central dysarthria may also be caused by injuries or illnesses that damage the brain, such as dementia, stroke, brain tumor, or traumatic brain injury .
• Peripheral dysarthria is caused by damage to the organs involved in speech. It may be caused by congenital structural problems, trauma to the mouth or face, or surgery to the tongue, mouth, head, neck, or voice box.

Apraxia, also known as dyspraxia, verbal apraxia, or apraxia of speech, is a neurological condition that can cause a person to have trouble moving the muscles they need to create sounds or words. The person’s brain knows what they want to say, but is unable to plan and sequence the words accordingly.

Symptoms and Characteristics of Apraxia

These are some of the characteristics of apraxia:

• Distorting sounds: The person may have trouble pronouncing certain sounds, particularly vowels, because they may be unable to move their tongue or jaw in the manner required to produce the right sound. Longer or more complex words may be especially harder to manage.
• Being inconsistent in their speech: For instance, the person may be able to pronounce a word correctly once, but may not be able to repeat it. Or, they may pronounce it correctly today and differently on another day.
• Grasping for words: The person may appear to be searching for the right word or sound, or attempt the pronunciation several times before getting it right.
• Making errors with the rhythm or tone of speech: The person may struggle with using tone and inflection to communicate meaning. For instance, they may not stress any of the words in a sentence, have trouble going from one syllable in a word to another, or pause at an inappropriate part of a sentence.

Causes of Apraxia

Apraxia occurs when nerve pathways in the brain are interrupted, which can make it difficult for the brain to send messages to the organs involved in speaking. The causes of these neurological disturbances can vary depending on the type of apraxia the person has:

• Childhood apraxia of speech (CAS): This condition is present from birth and is often hereditary. A person may be more likely to have it if a biological relative has a learning disability or communication disorder.
• Acquired apraxia of speech (AOS): This condition can occur in adults, due to brain damage as a result of a tumor, head injury , stroke, or other illness that affects the parts of the brain involved in speech.

If you have a speech impediment, or suspect your child might have one, it can be helpful to visit your healthcare provider. Your primary care physician can refer you to a speech-language pathologist, who can evaluate speech, diagnose speech disorders, and recommend treatment options.

The diagnostic process may involve a physical examination as well as psychological, neurological, or hearing tests, in order to confirm the diagnosis and rule out other causes.

Treatment for speech disorders often involves speech therapy, which can help you learn how to move your muscles and position your tongue correctly in order to create specific sounds. It can be quite effective in improving your speech.

Children often grow out of milder speech disorders; however, special education and speech therapy can help with more serious ones.

For ankyloglossia, or tongue-tie, a minor surgery known as a frenectomy can help detach the tongue from the bottom of the mouth.

A Word From Verywell

A speech impediment can make it difficult to pronounce certain sounds, speak clearly, or communicate fluently. 

Living with a speech disorder can be frustrating because people may cut you off while you’re speaking, try to finish your sentences, or treat you differently. It can be helpful to talk to your healthcare providers about how to cope with these situations.

You may also benefit from joining a support group, where you can connect with others living with speech disorders.

National Library of Medicine. Speech disorders . Medline Plus.

Centers for Disease Control and Prevention. Language and speech disorders .

Cincinnati Children's Hospital. Stuttering .

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, and language .

Cleveland Clinic. Speech impediment .

Lee H, Sim H, Lee E, Choi D. Disfluency characteristics of children with attention-deficit/hyperactivity disorder symptoms . J Commun Disord . 2017;65:54-64. doi:10.1016/j.jcomdis.2016.12.001

Nemours Foundation. Speech problems .

Penn Medicine. Speech and language disorders .

Cleveland Clinic. Tongue-tie .

University of Rochester Medical Center. Ankyloglossia .

Cleveland Clinic. Dysarthria .

National Institute on Deafness and Other Communication Disorders. Apraxia of speech .

Cleveland Clinic. Childhood apraxia of speech .

Stanford Children’s Hospital. Speech sound disorders in children .

Abbastabar H, Alizadeh A, Darparesh M, Mohseni S, Roozbeh N. Spatial distribution and the prevalence of speech disorders in the provinces of Iran . J Med Life . 2015;8(Spec Iss 2):99-104.

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Search form

Clinical services, what are motor speech deficits.

Acquired motor speech deficits may occur after a stroke, tumor, brain injury, or other neurological damage. These deficits result in difficulty with planning and performing speech movements. These deficits usually result in difficulty speaking. There are two different potential disorders in this area; dysarthria and apraxia of speech.

Dysarthria results from impaired movement of the muscles used for speech production, including the lips, tongue, vocal folds, and/or diaphragm. The type and severity of dysarthria depend on which area of the nervous system is affected.

A person with dysarthria may exhibit one or more of the following speech characteristics:

• "Slurred," "choppy," or "mumbled" speech that may be difficult to understand
• Slow rate of speech
• Rapid rate of speech with a "mumbling" quality
• Limited tongue, lip, and jaw movement
• Abnormal pitch and rhythm when speaking
• Changes in voice quality, such as hoarse or breathy voice or speech that sounds "nasal" or "stuffy"

Apraxia of Speech

Apraxia of speech (AOS) is a neurologic speech disorder that reflects an impaired capacity to plan or program commands in the brain necessary for directing muscles for speech movements. Individuals with apraxia of speech know what words they want to say, but their brains have difficulty coordinating the muscle movements necessary to say all the sounds in the words. As a result, they may say something completely different or make up words (e.g., "bipem" or "chicken" for “kitchen"). The person may recognize the error and try again—sometimes getting it right, but sometimes saying something else entirely. This situation can become quite frustrating for the person.

A person with apraxia of speech my exhibit one or more of the following speech characteristics:

• Difficulty imitating and producing speech sounds, marked by speech errors such as sound distortions, substitutions, and/or omissions;
• Inconsistent speech errors
• Groping of the tongue and lips to make specific sounds and words;
• Slow speech rate
• Impaired rhythm and prosody ( intonation ) of speech
• Better automatic speech (e.g., greetings) than purposeful speech
• Inability to produce any sound at all in severe cases.

Assessment and Treatment

Assessment of motor speech deficits includes the use of standardized tests or informal evaluation along with client interview. This identifies strengths and weaknesses along with outlining areas for treatment. Treatment then works to address impairments and provide strategies to support areas impacted. The focus is on functional outcomes, making an impact in quality of life and helping clients return to activities they love.

Associated Faculty

Jacqueline Daniels, MA, CCC-SLP  - Lecturer and Supervisor; Neuro Unit Coordinator Leslie Kot, MS, CCC-SLP  - Lecturer and Supervisor Mike Burns, PhD, CCC-SLP  - Senior Lecturer and Supervisor; Researcher Kelsey Leighton, MS, CCC-SLP  - Lecturer and Supervisor Shaye Kawashima, MS, CCC-SLP  - Lecturer and Supervisor Kristie Spencer, PhD, CCC-SLP - Professor and Associate Chair; Researcher

Additional Resources

American Speech-Language-Hearing Association

The Mayo Clinic

Dysarthria: What to Know About Slurred Speech from Nerve Damage

This article will address your most pressing questions about the motor speech disorder dysarthria, including what it is, what causes it, and what treatment options are available.

By Ability Central

12 February, 2024

The motor speech disorder dysarthria is a condition in which nerve damage weakens the muscles used for speech. People with dysarthria have difficulty speaking. Their speech may be slurred, breathy, strained, or otherwise difficult to understand.

This article answers your biggest questions about dysarthria, including:

What is dysarthria?

What causes dysarthria, what are the different types of dysarthria, what are the early signs and symptoms of dysarthria, how does dysarthria affect adults, how is dysarthria diagnosed and treated, how can someone with dysarthria communicate more clearly, what are tips for listeners while talking to someone with dysarthria, where can i find help for dysarthria.

Dysarthria is a motor speech disorder. A person with dysarthria may be unable to control the muscles used for articulation, speed, and pitch of speech, generally due to nerve damage.

Dysarthria is not the same as aphasia, although each is a communication disorder, and you can have the conditions at the same time. Dysarthria is a speech impairment or speech disorder, while aphasia is an expressive language disorder or specific language impairment where the person has difficulty understanding words or putting them together in a sentence. 

A nerve, brain, or muscle disorder may cause dysarthria as the muscles that control the mouth, tongue, larynx, or vocal cords become weak or paralyzed. 

Developmental dysarthria is the result of brain damage during fetal development or at birth. Conditions like cerebral palsy, epilepsy, or carbon monoxide exposure can cause developmental dysarthria in young children. 

Acquired dysarthria is the result of brain damage later in life. Stroke , Parkinson’s disease, and amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) are common causes of acquired dysarthria.

Other conditions that may lead to dysarthria include:

• Brain cancer
• Brain injury
• Brain tumor
• Cerebral palsy
• Guillain-Barre syndrome
• Head injury
• Huntington's disease
• Lyme disease
• Multiple sclerosis
• Muscular dystrophy
• Myasthenia gravis
• Severe spinal injury
• Traumatic brain injury
• Wilson's disease

Dysarthria can also be a side effect of certain medications, like certain sedatives or epilepsy medications. 

Beyond categorization as developmental or acquired, dysarthria can appear as one of six types: 

• Ataxic dysarthria , caused by damage to the cerebellum, which helps coordinate muscle movement. A person with ataxic dysarthria may have trouble pronouncing letters and emphasizing the right parts of a word when speaking.
• Flaccid dysarthria,  caused by damage to the lower motor neurons. This causes speech to be breathy and nasal.
• Hyperkinetic dysarthria , caused by damage to the basal ganglia, the brain structure responsible for muscle movement. Hyperkinetic dysarthria causes fast, hyper-sounding, and often unpredictable speech.
• Hypokinetic dysarthria is also caused by damage to the basal ganglia, but with hypokinetic dysarthria, speech is slowed, monotone, or rigid.
• Spastic dysarthria , caused by damage to the upper neurons on one or both sides of the brain. This causes speech to be strained or harsh.
• Mixed dysarthria includes a mix of two or more of the other five types.

The primary symptom of dysarthria is unclear or garbled speech. Other symptoms include:

• Difficulty moving the mouth, tongue, or lips.
• Slurred speech.
• Unusually slow or unusually fast speech.
• Difficulty controlling voice volume.
• A nasal, strained, or monotone voice.
• Hesitation in talking.
• Speaking in short bursts instead of complete sentences.

Dysarthria can cause communication problems that lead to social difficulties, depression, and social isolation. It can also cause problems at work or in school, particularly in roles that require public speaking. 

Depending on the severity of the disability, people with dysarthria may qualify for certain protections under the Americans with Disabilities Act (ADA). The ADA protects people with disabilities from discrimination in the workplace, on public transit, and in public businesses. 

Ask your employer about potential accommodations for dysarthria, such as using email and text messages instead of phone calls or face-to-face meetings. 

There are many technologies that can help people with dysarthria communicate. An easy first step is a cell phone with accessibility features designed for dysarthria. Many people with dysarthria find programs like text-to-speech apps helpful for communication.

Generally, the first test for dysarthria is a physical exam from a primary care physician (PCP) or speech-language pathologist (SLP). Depending on the results of the physical exam, doctors may call for further testing to find the underlying cause of the dysarthria symptoms.

This series of tests may include:

• MRI or CT scans of the brain, head, or neck to check for physical abnormalities.
• An electroencephalogram (EEG) to check for abnormalities in brain activity.
• Electromyography to test the electrical function of the muscles and nerves.
• Blood or urine tests to see if there is an infection or inflammation.
• A spinal tap, also known as a lumbar puncture, to check for tumors or infections.
• Barium or videofluoroscopic swallow studies to test the muscles used for swallowing. 

Dysarthria treatment depends on the cause, severity, and type of dysarthria. Treatment options include:

• Speech and language therapy to improve communication and, if possible, regain normal speech.
• Speech strategies to give the best chance of being heard and understood.
• Surgery, if necessary to remove a tumor or fix an injury that’s causing dysarthria.
• Nonverbal communication strategies, like writing or sign language.
• Other accommodations and modification strategies for school or the workplace.

Much of managing dysarthria symptoms involves finding new or adaptive methods of communication. These might include:

• Using hand gestures or sign language.
• Writing by hand. 
• Typing on a computer or cell phone.
• Using text-to-speech software. 

In some dysarthria cases where the underlying condition also affects the muscles used to write and type, people with dysarthria can use tools like alphabet boards to communicate via touching and pointing. 

When speaking, many people with dysarthria find they communicate more clearly by:

• Speaking slowly.
• Using short phrases.
• Pausing between sentences to check for listener comprehension.
• Starting a conversation with a single word so the listener knows what you’re talking about. For example, saying “travel” before discussing travel logistics.

Friends, family, or coworkers of people with dysarthria can make communication easier by:

• Eliminating background noise, such as turning off the TV or moving to a quieter room.
• Facing the speaker and sitting close enough to understand visual cues.
• Making eye contact.
• Ensuring good lighting.
• Asking yes or no questions.
• Repeating what they’ve said to make sure you understand.

If you don’t understand someone with dysarthria, do not pretend you do. This can be frustrating and embarrassing for both the speaker and the listener. Instead, ask them to repeat themselves or find an alternate communication method like writing down what they’re trying to say. 

Your primary doctor is an excellent first step to receive testing for dysarthria. In addition, Ability Central has a searchable database of non-profits that can help with everything from diagnosis to treatment.

For more information on conditions that impact speech, see: 

• Aphasia and Dysphasia: Why Do People Stop Using and Understanding Language?
• Expressive Language Disorder: Symptoms, Challenges, and Treatments
• What Should I Do After a Muteness Diagnosis?
• Receptive Language Disorder: Why Can’t I Understand What People Say?

Article Type:

Keep in touch with us.

Sign up for emails to stay in the loop with Ability Central.

Your data security and privacy is important to us. Read our Privacy Policy.

Dysarthria (difficulty speaking)

Dysarthria is where you have difficulty speaking because the muscles you use for speech are weak. It can be caused by conditions that damage your brain or nerves and some medicines. Speech and language therapy can help.

Immediate action required: Call 999 if:

• somebody's face droops on 1 side (the mouth or eye may have drooped)
• a person cannot lift up both arms and keep them there
• a person has difficulty speaking (speech may be slurred or garbled)

These can be signs of a stroke, which is a medical emergency. The symptoms of a stroke usually come on suddenly.

Check if it's dysarthria

The main symptom of dysarthria is unclear speech. This can make it difficult for you to make yourself understood.

Your speech may only be slightly unclear, or you may not be able to speak clearly at all.

Other symptoms include:

• difficulty moving your mouth, tongue or lips
• slurred or slow speech
• difficulty controlling the volume of your voice, making you talk too loudly or quietly
• a change in your voice, making it nasal, strained or monotone
• hesitating a lot when talking, or speaking in short bursts instead of full sentences

Being stressed or tired may make your symptoms worse.

Dysarthria is not the same as dysphasia, although you can have both conditions at the same time. Dysphasia, also known as aphasia , is where you have difficulty understanding words or putting them together in a sentence.

Non-urgent advice: See a GP if:

• you've noticed gradual changes to your or your child's speech and you're worried

They'll examine you and may refer you to a specialist for further tests.

Causes of dysarthria

Dysarthria is usually caused by damage to the brain or conditions that affect the nervous system. It can happen at any age.

Common causes include:

• stroke , severe head injury and brain tumours
• Parkinson's disease , multiple sclerosis and motor neurone disease
• cerebral palsy and Down's syndrome

It can also be a side effect of certain medicines, such as some medicines to treat epilepsy.

Treatment for dysarthria

If you have dysarthria, you'll usually be referred to a speech and language therapist. They'll offer therapy to help your speech and communication.

The therapy you're offered will be different depending on the cause of your dysarthria and how severe it is.

Some people may find therapy does not help their symptoms, or their speech may get worse as their condition progresses. Their therapy may focus on helping communication in other ways.

Speech and language therapy may include:

• exercises to strengthen the muscles used for speech
• strategies to make your speech easier to understand, such as slowing down when you're talking
• using communication aids, such as an alphabet board or a voice amplifier

Find out more

• Headway: communication problems after brain injury
• Stroke Association: communication tools

Page last reviewed: 17 February 2023 Next review due: 17 February 2026

What is Dysarthria?

 4 min read

Dysarthria is a motor-speech disorder that results in unclear speech. This inability to speak clearly is because of weakness, slowness, or lack of coordination in the muscles of the mouth, voice, and lungs.

Dysarthria results from damage to the nervous system. There are several different types of dysarthria. The type of dysarthria a person has is determined by the area of the nervous system that’s damaged.

In unilateral dysarthria, just one side of the face and tongue is weak. In spastic dysarthria, the muscles on both sides are stiff and uncoordinated. With flaccid dysarthria, the muscles are loose and floppy. In ataxic dysarthria, muscle movements are uncoordinated. Hyperkinetic dysarthria involves involuntary muscle movements, while hypokinetic dysarthria features muscle movements that are slow to start. There are also many mixed dysarthrias that include features of more than one type.

Dysarthria can be a mild annoyance, or it can have a devastating effect on a person’s ability to make him or herself understood.

Download a Free Patient Education Handout about Dysarthria

Get your free PDF summarizing what dysarthria is, what you might notice, & how you can help . A perfect handout for families.

In addition to receiving your free download, you will also be added to our mailing list. You can unsubscribe at any time. Please make sure you read our  Privacy Policy  and  Terms & Conditions .

What Causes Dysarthria

Dysarthria can be caused by a stroke, head injury, or brain tumor. It can also be caused by a congenital disorder such as cerebral palsy (CP), or a degenerative disease such as motor neurone disease (MND / ALS) or Parkinson’s disease (PD). Dysarthria can also be a symptom of autoimmune disorders like myasthenia gravis (MG), multiple sclerosis (MS), or Guillain–Barré syndrome (GBS).

Dysarthria is NOT a problem with speech caused by a structural problem, such as a cleft palate or tongue resection. These speech problems are classified as dysglossias . Dysarthria must involve the brain (central nervous system) or nerves (peripheral nervous system).

What You Might Notice

Dysarthria affects different people in different ways.

Some people sound like they’re mumbling or slurring their words. Some sound like they’re talking through their noses, while others sound stuffed up.

Some speak in a monotone, while others make extreme pitch changes. Some speak slowly, some speak very quickly, and some fluctuate. Some speak loudly, some speak softly, and some are irregular in volume. Their voices may sound unusually hoarse, breathy, or strained.

Dysarthria can affect more than just speech. Someone with dysarthria may look like his or her face is drooping. They may have difficulty swallowing, or get food caught in the cheeks. Due to limited movement of the tongue, lips, or jaw, the person may drool or have trouble keeping dentures in place. Even breathing may be irregular, if the lungs are affected.

If You Have Dysarthria

If you have dysarthria, you may find talking to be difficult and frustrating. Take your time and follow these tips:

• Sit up and face your listener if possible. It’s important to make eye contact so your listeners can understand you better by watching your lips. You might want to avoid wearing a moustache that hides your upper lip.
• Speak slowly and loudly, exaggerating how each word is supposed to sound. Pause to take a breath when you need one.
• Use facial expressions, gestures, drawing, and pointing to help get your message across.
• If your listener has trouble understanding you, try using different words if repeating the exact words hasn’t worked.
• If you need to, write down what you want to say or key words. You can also point to the first letter of words on a  letter board .
• Swallow before speaking to clear your mouth of saliva. Clear your throat if you need to so your voice will be clear.
• Try to relax and stay calm. If you have trouble, it’s okay to give up and come back to the subject later. Avoid important conversations when you’re tired or feeling emotional.

5 Ways to Help a Person with Dysarthria

A person with dysarthria can improve a great deal through speech therapy. Meanwhile, you can help the person communicate by taking a few simple actions:

• Make sure your surroundings are quiet and well lit. Turn off the TV and radio, and shut the door, so you won’t be interrupted. Be sure the lights are on or the curtains are open.
• Sit across from the person, so you can make eye contact. His or her body language and lip movements can tell you a lot.
• Establish the topic, so you both know what you’re discussing.
• Be patient. Give the person plenty of time to speak.
• If you don’t understand what the person is trying to say, don’t pretend you do. Instead, say what you do understand, using his or her exact words. Then ask specifically for the words that are unclear.

Want to learn more about dysarthria or other communication disorders in adults? Visit our  Learn  section to discover helpful resources. We also have a wide variety of  apps for dysarthria therapy  you can download to get started on improving communication today. 

If you liked this article, Share It !

Megan S. Sutton , MS, CCC-SLP is a speech-language pathologist and co-founder of Tactus Therapy. She is an international speaker, writer, and educator on the use of technology in adult medical speech therapy. Megan believes that technology plays a critical role in improving aphasia outcomes and humanizing clinical services.

More in ‘ What Is ’

What is the Communication Problem?

Learn about the 4 types of acquired communication disorders that may affect the way a stroke survivor speaks. Find out what you can do once you understand what's happening.

What is Brain Injury?

Damage to the brain can result in problems in every area of life. Learn more about the types, causes, and effects of brain injury, as well as how SLPs can help to recover function.

 6 min read

What is Dysphagia?

Dysphagia means difficulty swallowing. Learn more about the causes, symptoms, diagnosis, and treatment of dysphagia for people with swallowing disorders.

 5 min read

What is a Stroke?

Find out the types, causes, how to prevent a stroke, how to spot one happening, and what happens afterwards as survivors try to recover through rehabilitation.

What is Apraxia?

Apraxia of speech is common after a stroke, leaving the patient with impaired communication. Find out what this acquired disorder is all about & what to do.

What is a Cognitive-Communication Disorder?

After a stroke, brain injury, or in dementia, communication can suffer along with cognition. Learn why and what to do for cognitive-communication disorders.

 7 min read

What is Primary Progressive Aphasia?

PPA is a type of dementia that gradually impairs the ability to use language over time. Learn what it is, how it is diagnosed & treated, and what you can do to help.

What is Global Aphasia?

Global aphasia is the most severe and devastating type of aphasia. Learn what it is and how you can better communicate with a person who has global aphasia.

What is Fluent Aphasia?

Fluent aphasia is a disorder with effortless but largely meaningless speech. Learn what it is, see a video, and find out how to help Wernicke's-type aphasia.

What is Broca’s Aphasia?

Learn what Broca's aphasia is, see a video of what it sounds like, and find out how to help a person with the frustrating condition of expressive or non-fluent aphasia.

What is Aphasia?

Aphasia is a language disorder after a stroke. Learn what causes it, what you can do when you meet a person with aphasia, and how it can vary.

What is Left Neglect?

A step-by-step guide to visual scanning treatment, an evidence-based cognitive therapy technique to improve visual attention for right or left neglect.

 8 min read

How Speech Language Pathologists Treat Patients with Dysarthria

Becoming a speech pathologist offers the opportunity to address a variety of disorders and injuries that affect your patients’ daily lives and communication skills. Dysarthria is one of the more common speech disorders you’ll encounter in this profession, and it’s an ailment that has the potential to severely impact a patient’s quality of life. Successful treatment of dysarthria means you’ve been able to help your clients regain their ability to make themselves heard again, and with it, regain a sense of autonomy.

But what is dysarthria and how can you treat it as a speech pathologist? Let’s go over the different types of dysarthria, what causes it, and the available methods for helping your patients clearly communicate once again.

• Emerson College - Master's in Speech-Language Pathology online - Prepare to become an SLP in as few as 20 months. No GRE required. Scholarships available.
• NYU Steinhardt - NYU Steinhardt's Master of Science in Communicative Sciences and Disorders online - ASHA-accredited. Bachelor's degree required. Graduate prepared to pursue licensure.
• Arizona State University - Online - Online Bachelor of Science in Speech and Hearing Science - Designed to prepare graduates to work in behavioral health settings or transition to graduate programs in speech-language pathology and audiology.

What Is Dysarthria?

If you haven’t come across this literal tongue-twister of a disorder, you may be wondering “What is dysarthria and dysphagia?” Dysarthria is a motor-speech disorder, where permanent brain and/or nerve damage impacts speech-related muscles. It’s often accompanied by dysphagia, which is an impairment that affects the ability to swallow. These issues show up together frequently, since the muscles and nerves for both skills being are closely located and related in the body and brain.

Individuals with dysarthria know what they want to say, but the muscles responsible for getting the words out won’t respond correctly due to damage. These muscles either go limp and loose or become tight and rigid, causing symptoms such as:

• Slurred or indistinct speech
• Slow speech or rapid, incomprehensible speech
• Uncontrollable vocal volume (e.g., only being able to whisper or shout)
• Uneven vocal patterns
• Stiff facial muscular movement

What causes dysarthria to develop? Some causes for dysarthria include brain tumor or injury, stroke, nervous system disorders such as cerebral palsy or Guillain-Barre syndrome, certain medications such as seizure medicines. It may appear suddenly, as with brain trauma, or gradually, with progressive neurological disorders.

Dysarthria affects both adults and children, though it’s often misidentified in kids as childhood apraxia of speech, as they may only show weakness in speech-associated muscles without any other evident weakness (unlike what is common in adults). In addition, young children don’t always understand or fully cooperate with the activities necessary for accurate assessment and diagnosis.

Those who share their experience with dysarthria often feel that they’ve lost an integral part of their personality. As a  speech-language pathologist , your primary job will be helping your patients regain or hold onto speech skills using compensatory methods. At times you’ll also be called on to support dysphagia-related swallowing issues that develop alongside speech issues. You’ll probably be one of multiple professionals working to help patients improve their quality of life, and especially improve their ability to communicate with loved ones.

Types of Dysarthria

Different types of dysarthria result in varying symptoms and courses of treatment—some are accompanied by intellectual challenges, while others may present with additional speech issues like aphasia or ataxia. Knowing which types of dysarthria your patient is experiencing helps you create the best possible treatment plan.

Common types of dysarthria include:

• Ataxic dysarthria —This condition usually results from strokes or degenerative diseases. Your patient may exhibit classic, drunk-like symptoms: slurred speech, sudden increases in volume, and overall lack of coordination.
• Flaccid dysarthria —This type of dysarthria can happen after strokes, congenital disorders, ALS, cerebral palsy, tumors, MNS, or other traumas to the brain. Your patient might have low muscle tone and their speech can be breathy or nasal. Other signs include a jaw that tends to droop or hang open, and a stiff gait. They may also have swallowing difficulties.
• Hyperkinetic dysarthria —Hyperkinetic dysarthria results from diseases that attack the basal ganglia, such as Huntington’s Disease. You will notice excessive movement, strained or strangled-sounding speech, variations in volume, and changes in the rate of speaking.
• Hypokinetic dysarthria —Like its hyperkinetic counterpart, hypokinetic dysarthria also results from diseases that affect the basal ganglia, usually Parkinson’s Disease. In this case, individuals speak in short rushes with a lower volume, and at times with monopitch or monovolume. Out of all types of dysarthria, this is the only one that causes an increase in the rate of speech. You may also notice a resting tremor. Unfortunately, this form of dysarthria often comes with cognitive impairment, at times influencing treatment progress.
• Spastic dysarthria —This dysarthria is most often triggered by a stroke, although other events such as tumors, cerebral palsy, encephalitis, and primary lateral sclerosis may also cause it. You will notice spasticity, slow speech, harsh voice, weakness, and hyperactive reflexes. Depending on the root cause, the individual may show cognitive decline.
• Unilateral upper motor neuron dysarthria —This impairment most often results from stroke or neurosurgery, although tumors and traumatic brain injury are other possible causes. These patients are often easier to understand than other speech patients because only one side of the face is affected. This form of dysarthria is often only short-term.
• Mixed dysarthria —Essentially, mixed dysarthria is any combination of the above types of dysarthria. This condition tends to result from multiple strokes or diseases such as ALS, Wilson’s, and multiple sclerosis (MS). Mixed dysarthria occurs more frequently than single or “pure”, and you’ll notice symptoms from multiple categories. As such, you’ll need to tailor your treatment plan to address multiple types of dysarthria at once.

Treatment for Dysarthria

Treatment options vary among the types of dysarthria, though many therapies overlap. Some of the most common dysarthria speech and language therapy treatments include:

• Teaching the patient how to speak more slowly—this is because the brain is used to communicating verbally at a certain speed, but the muscles are no longer able to respond to that speed.
• Coaching your patient to move their tongue and lips often when not speaking, to encourage muscular redevelopment.
• Focusing on using their breath efficiently—either using more breath if their dysarthria has caused a reduction in power and volume or encouraging less breath for the reverse.
• Helping the patient learn to select alternative words and monosyllabic speech.
• Encouraging the patient to spell or over-articulate their words when they aren’t understood.
• Creating personalized communication cues for the patient and their caregiver. For example, you may have the patient start their conversation with the word “lunch,” which triggers the caregiver with a clue of what is coming next.

It’s helpful to have your patient’s family or caregiver present for some therapy sessions, as it’s important for them to learn and support the communication methods their loved one is learning so as to better understand them. For those with severe or progressive forms of dysarthria, you may also be training your patient to use augmentative and alternative communication. This includes all the types of communication that don’t involve speaking, such as writing, facial expressions, hand gestures, drawing, using photos, or even a speech-generating device.

Can Dysarthria Be Cured?

Though many dysarthria patients enjoy successful rehabilitation, it’s important to understand that depending on the severity and types of dysarthria your patient may have, they may never fully regain their pre-condition communication abilities. With treating dysarthria, your goal often isn’t to bring the damaged part of the brain back to health, but instead to find compensatory methods for the person to communicate.

That said, some types of dysarthria are easier to reverse, such as those caused by medications or by a very mild stroke.

Specializing in Treatment of Dysarthria

Though currently, you won’t find any industry certifications specific to dysarthria, there are a handful of other ways to enhance your ability to treat these patients, especially if you’re interested in deep-diving into specific neurological disorders.

One option is to pursue a Lee Silverman Voice Treatment (LSVT) LOUD certification. The  LSVT LOUD Certification training focuses on training SLP’s to work specifically with Parkinson’s patients, for whom dysarthria is often a symptom. ASHA offers continuing education credits for those taking LSVT courses, and they are now available fully online.

Because dysarthria is a neurological disorder, you may also want to consider pursuing  board certification from the Academy of Neurologic Communication Disorders and Sciences (ANCDS) . This certification tells patients and other medical personnel that you have advanced clinical expertise in these types of disorders and cements your reputation as a best-in-class practitioner.

To be eligible for this certification, you’ll need to fulfill the following requirements:

• Be a fully certified CCC-SLP
• Have five years of clinical experience with neurologic communication disorders
• Submit your CV or resume with three letters of recommendation from health care professionals familiar with your skills
• Complete the Board Certification Candidacy Application and pay applicable fees

The certification process involves submitting two case studies, giving an oral presentation, and taking part in a discussion following your presentation. The reviewers will then give you a “Pass” or notify you that your work “Does not meet standards.”

Additional options for specializing your treatment of dysarthria patients include:

• ASHA Continuing Education Webinars and E-Workshops : ASHA offers online workshops for both assessing and treating dysarthria.
• com Continuing Education Courses : This site offers continuing education credits for several courses, including ones related specifically to dysarthria. You can take an unlimited number of courses for an annual fee.
• The PROMPT Method : This therapy method is used with patients facing motor speech disorders, like dysarthria. ASHA offers CEU’s for this training.

Frequently Asked Questions About Dysarthria

Can dysarthria come and go.

Dysarthria doesn’t typically appear and then disappear, though improvement can wax and wane depending on how much the patient progresses in strengthening and controlling their facial nerves and muscles. Some causes of dysarthria, such as certain medications, may cause the condition to come and go if the patient goes back and forth on their use of the medicine.

Can anxiety cause dysarthria?

In short, no—anxiety is not a diagnosable cause for clinical dysarthria. It is extremely rare for anxiety to cause any kind of slurred speech or other verbal impairment. In the few cases that it does mimic these symptoms, they’re still wildly different than clinically diagnosed dysarthria, as the cause isn’t an actual issue with the facial muscles or nerves.

What type of dysarthria is associated with ALS?

Patients with amyotrophic lateral sclerosis (ALS) most often suffer mixed dysarthria—typically flaccid dysarthria, caused by damage to their peripheral nervous system, and spastic dysarthria, caused by damage in their motor cortex region. Symptoms of these types of dysarthria combined include slow speech, inarticulate constant pronunciation, and nasally vocalization.

Does dysarthria go away?

Dysarthria may go away with speech-language therapy, especially if it was caused by a treatable trauma, medication, or mild stroke. Some causes of dysarthria make it less likely that it will go away permanently, including degenerative neurological diseases and severe strokes.

What is apraxia and dysarthria?

Apraxia and dysarthria are both motor speech disorders. Apraxia is a brain and nervous system disorder that specifically causes an inability for patients to be able to put words together correctly. They may struggle to find the “right” word or speak words within a sentence in the wrong order, but they have no issues with their facial or vocal muscles forming and speaking verbal communication. Dysarthria, on the other hand, affects the facial muscles’ ability to form said words, rather than the brain’s ability to put words together. Dysarthria patients are physically impaired from being able to form and vocalize speech.

Be the Difference in a Dysarthria Patient’s Life

Speech-language pathologists are the key to helping dysarthria patients communicate with their loved ones again. It’s an incredibly rewarding career, and it starts with a robust education in speech-language disorders and treatment, as well as state certification to earn your clinical license.

Learn more about how to become a speech-language pathologist, including information on certification requirements, accredited SLP master’s programs, and more.

• How to Become a Speech-Language Pathologist
• Career Resources
• Both Sides of the Frenectomy Debate
• Certification
• State Licensing Overview
• Student Resources
• What is Speech-Language Pathology?
• CAA-Accredited Graduate Programs
• Directory of CSD and SLP Undergraduate Programs
• Master’s in Speech-Language Pathology
• SLP Clinical Fellowship
• SLP Thesis Track
• 2022 SLP Scholarship Guide
• 2022 Top SLP Master’s Programs
• Practice Settings
• Private Practice
• Telepractice
• Specialty Areas and Disorders
• Ankyloglossia (Tongue Tie) and Lip-Tie Issues
• Aphasia (Post Stroke)
• Apraxia of Speech
• Augmentative and Alternative Communication (AAC)
• Child Language Disorders
• Communication Competency Assessment
• Early Intervention
• Fluency Disorders
• Forensic Speech-Language Pathology
• Laryngeal Imaging
• Late Talkers
• Low-Incidence Disorders
• Multilingual Patients
• Occupational Therapy
• Otoacoustic Emissions Screening
• Patients with Autism
• Patients with Cochlear Implants
• Percutaneous Electrical Stimulation (E-stim)
• Public Health
• Rehabilitation
• Spasmodic Dysphonia
• Stuttering and Cluttering
• Swallowing and Feeding Disorders (Dysphagia)
• Transnasal Esophagoscopy and Pharyngeal/Esophageal Manometry
• Transgender Voice Modification Therapy
• Voice Therapy
• Dual Certification in SLP and Lactation Consultancy
• Continuing Education is Key to Career Versatility and Longevity in This Field
• Do You Speak with an Accent? … You Can Still Be an Outstanding SLP
• The Challenges and Rewards of Working with English Language Learners
• Some Advice on How to Approach Your Clinical Fellowship
• 4 Things a Job Description Can’t Tell You About the Profession
• 5 Things I Love Most About Being an SLP
• Your Guide to Getting Started in Telepractice
• Why Team Player SLPs are Even More Effective Than Superstars
• Why Working With the Entire Family Gets the Best Results in Kids Struggling with Speech-Language Issues

• Understanding Your Brain & Body

Dysarthria and Cerebral Palsy Fact Sheet

What is dysarthria?

Dysarthria is a motor speech disorder that affects how clear and understandable a person’s speech is. Speaking involves many muscles in the body, including those used for breathing, vocal fold movement, and movement of the face and mouth. When control of these muscles is affected by a person’s CP, it can result in dysarthria. Between 50-90% of people with CP have dysarthria. Dysarthria can be mild and have minimal impact on communication, or it can be severe enough that a person may not be able to produce any understandable words.

How is dysarthria diagnosed in children with CP?

Speech-language pathologists (SLPs) diagnose dysarthria by listening to a child’s speech and observing different features. SLPs listen for characteristics like a slow rate of speech, strained voice quality, low volume, hypernasal speech, and imprecise production of consonant and vowel sounds to diagnose dysarthria. SLPs may ask the child to perform different speaking tasks so they can observe the child’s speech in single words, sentences, and at different rates of speech. They may also make observations of how the child’s mouth moves when they are talking. SLPs can also use different tools to judge the degree to which dysarthria is affecting the child’s ability to effectively communicate. 

How does dysarthria change over time for children with CP?

All children learn to produce speech sounds and gradually improve their speech intelligibility (i.e., how much of their speech can be understood by other people) over the first several years of life. For many children with CP, dysarthria influences how their speech develops; however, speech intelligibility improves with development for most children with CP. Thanks to recent research, we have learned a lot about how speech develops in children with CP:

-    Many children with CP start talking later than children with typical development, and symptoms of dysarthria can be hard to detect at young ages.

-    Speech intelligibility increases the most rapidly between 3-5 years of age for most children with CP.

-    Children with CP who have both dysarthria and language difficulties tend to have lower speech intelligibility long-term than children with typical language abilities.

What treatments are there for dysarthria in children with CP?

Augmentative/alternative communication (AAC) systems and devices are an important component of maximizing communication independence for many children with CP and dysarthria. However, the majority of children with CP communicate verbally or use a combination of speaking and AAC to communicate.

There are a few speech intervention approaches that have been shown to improve intelligibility for children with CP, including:

1.    The Subsystems approach is an intensive treatment that focuses on each speech subsystem, starting with breath support.

2.    Speech Intelligibility Treatment is an intensive treatment that focuses on having children use a “loud voice” and “big mouth.”

3.    Lee Silverman Voice Treatment is also an intensive treatment, focused primarily on increasing loudness.

Overall, there is relatively little research on the effectiveness of speech interventions for children with CP, and a lot of variation in how well children respond to different strategies. More research is needed to learn how we can individualize speech treatment approaches to be most effective for individual children.

What are speech modification strategies for children with CP?

Speech modification strategies are techniques that speech-language pathologists use to help people with dysarthria improve their speech intelligibility. There are a few strategies that have been shown to be helpful for children and adolescents with cerebral palsy who have dysarthria and are components of the intervention strategies described above:

1.    Using a slow rate of speech. Slowing down speaking rate can help speakers produce speech sounds more clearly and precisely and give their communication partners additional time to understand their speech.

2.    Using a loud voice. It’s not good for anyone’s voice to scream; but, projecting their voice with healthy loudness can improve intelligibility for some children with dysarthria.

3.    Emphasizing key words. Some words in a sentence are more important than others to getting your point across. By focusing on emphasizing key words in a sentence, speakers can draw attention to and focus their effort on clearly producing the words most important to helping listeners understand their message.

1.     Nordberg A, Miniscalco C, Lohmander A, Himmelmann K. Speech problems affect more than one in two children with cerebral palsy: Swedish population-based study. Acta Paediatr [Internet]. 2013;102(2):161–6. 

2.     Mei C, Reilly S, Reddihough D, Mensah F, Morgan A. Motor speech impairment, activity, and participation in children with cerebral palsy. Int J Speech Lang Pathol. 2014;16(4):427–35. 

3.     Hustad KC, Allison K, McFadd E, Riehle K. Speech and language development in 2-year-old children with cerebral palsy. Developmental neurorehabilitation. 2014 Jun 1;17(3):167-75. 

4.     Schölderle T, Haas E, Ziegler W. Age norms for auditory-perceptual neurophonetic parameters: A prerequisite for the assessment of childhood dysarthria. J Speech, Lang Hear Res. 2020;63(4):1071–82. 

5.     Schölderle T, Haas E, Ziegler W. Dysarthria syndromes in children with cerebral palsy. Dev Med Child Neurol. 2021;63(4):444–9. 

6.     Hustad KC, Mahr T, Broman AT, Rathouz PJ. Longitudinal Growth in Single-Word Intelligibility Among Children With Cerebral Palsy From 24 to 96 Months of Age: Effects of Speech-Language Profile Group Membership on Outcomes. J Speech Lang Hear Res. 2020;63(January):32–48. 

7.     Mahr TJ, Rathouz PJ, Hustad KC. Longitudinal Growth in Intelligibility of Connected Speech From 2 to 8 Years in Children With Cerebral Palsy: A Novel Bayesian Approach. J Speech Lang Hear Res. 2017;63(September):2880–93. 

8.     Pennington L, Miller N, Robson S, Steen N. Intensive speech and language therapy for older children with cerebral palsy: a systems approach. Dev Med Child Neurol [Internet]. 2010;52(4):337–44. 

9.     Pennington L, Roelant E, Thompson V, Robson S, Steen N, Miller N. Intensive dysarthria therapy for younger children with cerebral palsy. Dev Med Child Neurol. 2013/02/28. 2013;55(5):464–71. 

10.     Levy ES, Chang YM, Hwang KH, McAuliffe MJ. Perceptual and acoustic effects of dual-focus speech treatment in children with dysarthria. J Speech, Lang Hear Res. 2021; 

11.     Levy ES, Chang YM, Ancelle JA, McAuliffe MJ. Acoustic and Perceptual Consequences of Speech Cues for Children With Dysarthria. J Speech, Lang Hear Res. 2017;60(6S):1766–79. 

12.     Boliek CA, Fox CM. Therapeutic effects of intensive voice treatment (LSVT LOUD®) for children with spastic cerebral palsy and dysarthria: A phase I treatment validation study. Int J Speech Lang Pathol [Internet]. 2017;19(6):601–15. 

13.     Fox CM, Boliek CA. Intensive Voice Treatment (LSVT LOUD) for Children with Spastic Cerebral Palsy and Dysarthria. J Speech Lang Hear Res [Internet]. 2012; 

Speech impediments (Aphasia, Dysarthria)

• Skip to Navigation
• Accessibility
• Enable Recite Me

Search our website

• GPs and clinicians
• Research and education

• Patients and visitors
• Our services
• Get involved
• Our performance
• News and events

Social media icons

A speech impediment occurs when the mouth, tongue, and vocal tract have difficulty working together to produce language.

There are a few types of speech impediments, but the best known are stammers or stutters, aphasia, and dysarthria.

Aphasia is caused by damage or injury to the left hand side of the brain, usually caused by something like a stroke or dementia.

Dysarthria can be both developmental, for example if you have cerebral palsy, or acquired, like aphasia.

The exact cause of stammering or stuttering is unknown, but it often occurs in children with neurological developmental disorders like autism.

A speech impediment doesn’t just affect speech, it may also affect reading, writing, typing and listening. With communication impaired, it can be lonely to have a speech impediment. Many people with speech impediments work with a speech and language therapist to improve their speech. If you have a speech impediment and are interested in learning more about them there are resources below to learn more.

• Speech and Language UK
• Snap Charity
• Aphasia NHS
• Dysarthria NHS
• Stammering NHS

Get connected

• Like us on Facebook
• Follow us on Twitter 
• Follow us on LinkedIn
• Review on NHS Choices
• Watch our videos

NHS image placement

This website uses cookies to improve your experience. For information on cookies and how you can disable them, please read our cookies policy .

Acoustic Effects of Speaker Sex, Speech Sample, and Mandarin Tone on Vowel Production of Poststroke Spastic Dysarthria

• Article contents
• Figures & tables
• Supplementary Data
• Peer Review
• Get Permissions
• Cite Icon Cite
• Search Site

Shengnan Ge , Qin Wan , Yongli Wang , Zhaoming Huang; Acoustic Effects of Speaker Sex, Speech Sample, and Mandarin Tone on Vowel Production of Poststroke Spastic Dysarthria. Folia Phoniatr Logop 2024; https://doi.org/10.1159/000538554

Download citation file:

• Ris (Zotero)
• Reference Manager

Introduction: Vowel production in dysarthria tends to be centralized, which is affected by many factors. This study examined the acoustic effects of speaker sex, tones, and speech samples (including sustained vowels, syllables, and sentences) and their interactions on vowel production in Mandarin speakers with poststroke spastic dysarthria. Methods: Twenty-eight patients with poststroke spastic dysarthria (18 males, 10 females) and 21 healthy speakers (11 males, 10 females) with no significant difference in sex and age with dysarthria were recruited. They were asked to read sustained vowels /a, i, u/, 12 syllables, and 12 sentences containing three vowels in four tones (bā, bá, bǎ, bà, bī, bí, bǐ, bì, pū, pú, pǔ, pù). Multiple spectral and temporal acoustic metrics were analyzed. Results: Results showed that regardless of the speech samples or tones, vowel production was more centralized in dysarthria than healthy controls, manifested as the decrease in F1 range, F2 range, vowel space area (VSA), and vowel articulation index (VAI). A similar performance was observed for male speakers compared to females, and vowel duration in males was shorter than females. F1 range, F2 range, VSA, VAI, and vowel duration were significantly different across speech samples and tones, decreasing in the order of vowel-syllable-sentence and T3-T2-T1-T4, respectively. Interactions of group, speaker sex, speech sample, and tone were more sensitive in VAI and vowel duration. Conclusion: VAI and vowel duration were recommended as the prior metrics to the assessment of vowel production. Specific influencing factors (speaker sex, speech sample, and tone) of vowel production need to be considered by speech and language pathologists in the assessment and rehabilitation.

Plain Language Summary

Mandarin speakers with poststroke spastic dysarthria often have vowel production deficits that affect articulation and speech intelligibility. Vowel production is influenced by many factors. This study explored the acoustic effects of speaker sex, tones, and speech samples and their interactions on vowel production in Mandarin speakers with poststroke spastic dysarthria and confirmed the existence of these effects. We found that regardless of the speech samples or tones, there were the reduced range of articulatory movements, centralized vowel production, and prolonged vowel duration in dysarthria compared to healthy people. The most sensitive and useful analysis measures were the vowel articulation index and vowel duration. Specific influencing factors (speaker sex, speech sample, and tone) of vowel production need to be taken seriously by speech and language pathologists and considered in the assessment and rehabilitation.

Individual Login

Institutional login.

• Access via Shibboleth and OpenAthens
• Access via username and password

Digital Version

Email alerts, citing articles via, suggested reading.

• Online ISSN 1421-9972
• Print ISSN 1021-7762

INFORMATION

• Contact & Support
• Information & Downloads
• Rights & Permissions
• Terms & Conditions
• Catalogue & Pricing
• Policies & Information
• People & Organization
• Stay Up-to-Date
• Regional Offices
• Community Voice

SERVICES FOR

• Researchers
• Healthcare Professionals
• Patients & Supporters
• Health Sciences Industry
• Medical Societies
• Agents & Booksellers

Karger International

• S. Karger AG
• P.O Box, CH-4009 Basel (Switzerland)
• Allschwilerstrasse 10, CH-4055 Basel
• Tel: +41 61 306 11 11
• Fax: +41 61 306 12 34
• Contact: Front Office
• Experience Blog
• Privacy Policy
• Terms of Use

This Feature Is Available To Subscribers Only

Sign In or Create an Account

• HEALTH & FITNESS

National Speech-Language Hearing Month aims to end stigmas

PHILADELPHIA (WPVI) -- May is National Speech Language Hearing Month.

Millions of Americans suffer from related disorders and, unfortunately, the stigmas surrounding them.

Robert M. Augustine, the former President of the American Speech Language Hearing Association, joined Brighter News to speak more about this.

Some high-profile names are helping bring awareness to aphasia, including President Joe Biden, who has discussed his late son Beau's struggle.

Biden has also spoken openly about how coping with a stutter was one of his greatest challenges as a young person and that he still sometimes struggles with halting speech in his public appearances.

Pennsylvanian Senator John Fetterman has also battled aphasia, as well as actor Bruce Willis and talk show host Wendy Williams.

Hearing loss is another disorder that is not just an older person problem. Many younger Americans battle it and the stigmas that come with it.

Augustine talks about where can adults with communication disorders can find help. For more, watch the interview above.

Related Topics

• HEARING AID
• SIGN LANGUAGE
• U.S. & WORLD
• JOHN FETTERMAN
• WENDY WILLIAMS

Top Stories

Parking tickets coming for illegally tinted windows in Philadelphia

Protest at Penn enters 8th day; petition to end encampment delivered

Local Chinese-American community feels targeted in identity theft scam

Pa. father seeks answers after son dies following alleged game of tag

Ulta theft suspect stole $1,126 worth items within minutes: Police

• 43 minutes ago

Sixers fans urged to not sell tickets to Knicks fans for Game 6

Rabid raccoon discovered in Camden County

• 44 minutes ago

More than 16K pounds of ground beef recalled

• 2 hours ago

'Violent protest is not protected,' Biden says of college campus unrest

The president faced pressure from Republicans to step up his response.

President Joe Biden on Thursday spoke out from the White House on college protests happening across the nation in connection with the Israel -Hamas war.

"We've all seen images, and they put to the test two fundamental American principles," Biden said from the Roosevelt Room. "The first is the right to free speech and for people to peacefully assemble and make their voices heard. The second is the rule of law. Both must be upheld."

It marked the first time Biden directly addressed the issue since his brief comments to reporters on April 22, before the escalation of suspensions and arrests at several campuses. At the time, he said he condemned both antisemitic actions and those who didn't understand the plight of Palestinians in Gaza.

MORE: Biden faces pressure from Republicans to speak out on college protests

Biden faced harsh criticism from Republicans, who are seizing on party unity against perceived liberal university leaders -- and portraying themselves -- as staunch supporters of Israel -- to go after divided Democrats, to step up his response to recent events.

The president is well aware the protests present a real political liability for him, as Donald Trump also looks to capitalize on the moment, ABC News Chief White House Correspondent Mary Bruce reported.

Trump, the presumptive Republican nominee, said on the campaign trail Wednesday that what was unfolding on college campuses was a "shame and Biden should speak out ... because nobody knows where he is."

"We've often faced moments like this because we are a big, diverse, free-thinking and freedom-loving nation," Biden said on Thursday. "In moments like this, there are always those who rush in to score political points. But this isn't a moment for politics. It's a moment for clarity."

"So, let me be clear. Violent protest is not protected, peaceful protest is," Biden said.

Later Thursday, when pressed by ABC News' Karen Travers on the timing of Biden's remarks and whether he was feeling pressure to speak out after Trump's remarks, White House press secretary Karine Jean-Pierre pushed back.

"It has nothing to do with anybody following anyone's lead," Jean-Pierre said during a gaggle with reporters on Air Force One. "The president, if anything, has been a leader on this."

At the White House, Biden called out vandalism, trespassing, forcing the cancellation of graduation or intimidating people as not constituting peaceful protest. People should be able to earn a degree, he said, without fear of being attacked on their campus.

Related Stories

Biden says 'order must prevail' during campus protests over the war in Gaza

• May 2, 12:19 AM

Biden faces GOP pressure to speak out on protests

• May 1, 5:47 PM

Morehouse won't rescind Biden commencement invite

• Apr 30, 12:51 PM

"It's basically a matter of fairness," the president said. "It's a matter of what's right. There is the right to protest but not the right to cause chaos."

Biden also emphasized there is "no place for hate speech or violence of any kind," including antisemitism, Islamophobia or discrimination against Arab Americans and Palestinian Americans.

MORE: Speaker Johnson, House Republicans ramp up criticism of 'out of control' college protests

As he left the room, Biden responded to two questions shouted by the press.

When asked if the protests have made him reconsider his policies in the region, Biden said "no."

ABC News Senior White House Correspondent Selina Wang asked Biden whether the National Guard should be activated, to which he also responded "no."

Biden has tried to balance strong support for Israel with sympathy for Palestinians killed and suffering in Gaza, but has faced criticism from some Democrats and many Republicans on his approach to the fraught issue.

"I understand people have strong feelings and deep convictions," Biden said on Thursday. "In America, we respect the right to protest, the right for them to express that. But it doesn't mean anything goes. It needs to be done without violence, without destruction, without hate and within the law."

ABC News' Molly Nagle contributed to this report.

Related Topics

• College Protests
• President Biden

GOP ramps up criticism of college protests

• Apr 30, 3:41 PM

The Latest | Israeli airstrikes on Rafah kill at least 22 people

• Apr 29, 2:36 AM

ABC News Live

24/7 coverage of breaking news and live events

Get JTA's Daily Briefing in your inbox

I accept the JTA Privacy Policy .

By submitting the above I agree to the privacy policy and terms of use of JTA.org

Biden on campus pro-Palestinian protests: ‘Dissent must never lead to disorder,’ but don’t call federal troops

WASHINGTON ( JTA ) — In his first address about the pro-Palestinian protests rocking campuses nationwide, President Joe Biden said “order must prevail” but rejected proposals to bring in federal troops.

“Dissent must never lead to disorder, or to denying the rights of others so students can finish the semester and their college education,” Biden said Thursday in the four-minute speech. “It’s basically a matter of fairness. It’s a matter of what’s right. There’s the right to protest, but not the right to cause chaos. ”

Biden did not announce concrete proposals to deal with the unrest. He rejected calls from Republicans to call in the National Guard , shouting “No!” at a reporter who asked whether such a step was appropriate.

Biden is under pressure from Republicans to address the turmoil after law enforcement agencies in multiple cities have moved in to disperse pro-Palestinian encampments, sometimes resulting in violence. Hundreds of students were arrested this week across several campuses including Columbia University, City College of New York and the University of California, Los Angeles.

The first encampment, at Columbia, was formed to protest as the school’s president testified about campus antisemitism before a Republican-led congressional committee. This week, congressional Republicans announced plans to massively expand oversight of funding and tax exemptions for universities, among other measures, and accused Biden of not doing enough to make campuses safe for Jews. Biden alluded to those moves.

“Throughout our history, we’ve often faced moments like this because we are a big, diverse, free-thinking and freedom-loving nation,” he said. “In moments like this are always those who rush in to score political points. But this isn’t a moment for politics, it’s a moment for clarity. So let me be clear, peaceful protests in America — violent protest is not protected, peaceful protest is.”

Biden recited a litany of allegations that some Jewish students and other have described on campuses. He had previously condemned reports of antisemitism at the protests in multiple statements, including one this week that said calling for an “intifada” amounted to hate speech .

“Destroying property is not a peaceful protest,” he said in Thursday’s speech.

“It’s against the law. Vandalism, trespassing, breaking windows, shutting down campuses, forcing the cancellation of classes and graduations. None of this is a peaceful protest” Biden said. “Threatening people, intimidating people. instilling fear in people is not peaceful protest. It’s against the law.”

He directly addressed alleged intimidation targeting Jewish students, some of whom have claimed to have been singled out and harassed for being visibly Jewish, or to have been interrogated by other students, unsolicited, on their views about Israel.

“There should be no place in any campus, no place in America for antisemitism, or threats of violence against Jewish students,” he said. “There is no place for hate speech or violence of any kind, whether it’s antisemitism, Islamophobia, or discrimination against Arab Americans or Palestinian Americans.”

Share this:

Recommended from jta.

Brown University board to vote on Israel divestment following agreement with protesters

House passes bill that would enshrine contentious and popular antisemitism definition into US law

Marjorie Taylor Greene says she opposed antisemitism bill because it rejects ‘Gospel’ that ‘the Jews’ handed Jesus to executioners

Biden to deliver speech at US Holocaust museum ceremony on Yom HaShoah as campus protests roil nation

White House condemns student takeover of Columbia U building and protesters’ use of ‘intifada’

• International

Trump hush money trial

University protests

Biden weighs in on protests disrupting colleges across the US

By Chandelis Duster, Ramishah Maruf, Rachel Ramirez, Holly Yan and Samantha Delouya, CNN

LA Public Defender's office: "essential that due process and the presumption of innocence are upheld"

From CNN's Elizabeth Joseph

The Los Angeles County Public Defender’s office announced on-the-ground support for individuals who were arrested on the UCLA campus during an operation to remove the protest encampment there.

While his office hasn’t been briefed on what charges, if any, arrestees may face, LA County Public Defender Ricardo D. García stressed the importance of “the fair treatment of all individuals involved."

“We are closely monitoring the situation and have deployed our Rapid Response Team to provide on-the-ground support to arrestees," he said in a statement. "It is essential that due process and the presumption of innocence are upheld. We will work diligently to protect the rights of our clients throughout."

Over 130 arrests were made on the UCLA campus, authorities said Thursday.

More arrests possible after people ran away from Portland State University library, sergeant says 

From CNN’s Cindy Von Quednow 

More arrests stemming from the occupation of a library at Portland State University are possible after people ran away from the building as officers were clearing it, Portland State Bureau Sgt. Kevin Allen said. 

The library is still an active scene and authorities are investigating any crimes that were committed, he added. 

Inside the building, officers found what appear to be improvised weapons, hollow bamboo sticks, buckets full of ball bearings, unspecified tools, paint balloons, spray bottles filled with ink with a note that said they were meant to be deployed at officers and cups of paint, Allen detailed. He said a soap or slick substance was on at least one floor of the building making it difficult for the officers to walk. 

Portland Mayor Ted Wheeler, who also oversees the Portland Police Bureau, said those arrested will be prosecuted. 

Multnomah County District Attorney Mike Schmidt echoed that destructive behavior will not be tolerated. 

“Things like spraying graffiti, breaking windows and setting fires, I condemn these criminal acts,” Schmidtsaid, adding that charging decisions will be made once evidence is collected and reviewed.  

University President Ann Cudd said Thursday that the campus is closed and the buildings were locked down. 

She reiterated that she tried to negotiate with students who remained in the library, and let them know that staying inside was considered trespassing. 

She is still open to meeting with students and hearing their concerns, but those arrested will face consequences.  

“This was a traumatic event for everyone in our campus community,” she said. “It is tragic that some of our students, along with others from outside, have so badly damaged our library and taken away that essential learning space.”

Why Biden addressed campus protests today, according to White House officials

From CNN's Kayla Tausche

When President Joe Biden returned to the White House on Wednesday evening from a campaign event at the nearby Mayflower Hotel, he requested his advisers assemble a basic outline of remarks on the protests — if he were to deliver them.

Three White House officials say Biden and his closest aides went back and forth to incorporate Biden’s edits, with a final decision and final draft produced early Thursday morning. 

Senior advisers have for weeks been tracking the developments in the protests through official channels with local governments and law enforcement. Behind the scenes, younger West Wing staffers – many recent graduates themselves or with contemporaries pursuing post-graduate degrees – also sought to raise awareness from firsthand accounts they were receiving from friends on campuses, with alerts that grew in intensity in recent days. 

In particular, the escalation at Columbia and UCLA – and the increasing involvement of law enforcement on campuses nationwide – piqued the President’s desire to speak in public, beyond written statements and the commentary offered by spokespeople on his behalf.

12 arrested as police clear Portland State University library, sergeant says

From CNN’s Cindy Von Quednow

A total of 12 people were arrested Thursday as police worked to clear a library at Portland State University, Portland Police Bureau Sgt. Kevin Allen said during a news conference. 

Of the 12, only four are students at the university, the rest do not appear to be affiliated with the school, the sergeant said. 

Officers entered the building around 6 a.m. and “slowly, carefully, deliberately” worked their way from the top floor to the bottom, clearing the library as they went, Allen said. 

Officers encountered barriers that caused them to slow down as they went through the building, and it took a “couple of hours” to clear, he added. 

Breaching the bottom floor proved to be the most difficult, and as officers got through, a group of people ran from the library, Allen said. 

At one point, a custody van was blocked from leaving the scene by a group of protesters, he added. 

There were “some” confrontations and uses of force, and two officers suffered minor injuries, the sergeant said. One officer was sprayed with a fire extinguisher, while another was allegedly hit with a shield. 

Anti-war student protests could be "Biden's Vietnam," Sen. Bernie Sanders tells CNN's Amanpour

The anti-war student protests unfolding across US campuses could be "Biden's Vietnam" moment, Sen. Bernie Sanders of Vermont told CNN, warning that President Joe Biden's stance over Israel's war on Gaza may have alienated young voters.  

During an interview with CNN's Christiane Amanpour on Thursday, Sanders drew a parallel between the current protests and those that occurred during the presidency of Lyndon B. Johnson in the late 1960s when American students protested against the Vietnam War.  

"In terms of his campaign, I am thinking back and other people are making this reference that this may be Biden's Vietnam. Lyndon Johnson, in many respects, was a very, very good president... He chose not to run in 68 because of opposition to his views on Vietnam," Sanders said. 

"I worry very much that President Biden is putting himself in a position where he has alienated not just young people but a lot of the Democratic base in terms of his views on Israel and this war," Sanders added.  

The Independent senator highlighted the need to remember why students are demonstrating in such huge numbers, saying: "They are out there not because they are pro-Hamas. They are out there because they are outraged by what the Israeli government is now doing in Gaza."  

Sanders said he believes students who are protesting against sustained US aid to a "right wing extremist Netanyahu government" are doing so "for the right reasons."  

The politician told CNN that he hopes from both a "policy point of view and a moral point of view" that President Biden "stops giving a blank check to Netanyahu" and realizes that US support to Israel "has not been helpful."  

Rutgers University set a deadline to remove encampment by 4 p.m. Thursday

From CNN’s Rebekah Riess and Rachel Ramirez

After meeting with students representing the protest encampment in Rutgers University in New Brunswick, New Jersey, on Thursday, school leadership informed protest organizers they must remove their tents from the campus' Voorhees Mall by 4:00 p.m. today or face consequences, according to a statement released Thursday afternoon.

“We were disappointed to learn that overnight, Students for Justice in Palestine called for a significant rally on the Voorhees Mall, coinciding with the beginning of the exam period, specifically intended to disrupt finals for our students," according to the statement from the university's president and chancellor.

The letter noted that the buildings surrounding Voorhees Mall are where hundreds of final exams are set to take place, underscoring that "students are rightly concerned about their ability to take exams in this environment." The school announced early this morning that it was postponing or relocating final exams scheduled today.

According to the university, the protest group’s morning rally disrupted 28 scheduled exams and impacted more than 1,000 students. 

“We understand the importance of exams and the impact that any disruptions can have on our students’ academic progress. We are committed to doing everything in our power to provide a safe and secure environment for our students to learn and succeed,” their statement said.

If protesters fail to comply and clear their tents, school officials warned they “will be considered to have trespassed, and we will be left with no other option than, with the assistance of law enforcement, to remove the protesters and their belongings.”

Los Angeles Mayor: “Harassment, vandalism and violence have no place at UCLA”

CNN's Kevin Flower

Los Angeles Mayor Karen Bass on Thursday condemned violence and vandalism surrounding protests at UCLA.

“Every student deserves to be safe and live peacefully on their campus. Harassment, vandalism and violence have no place at UCLA or anywhere in our city,” Bass said in a statement. “My office will continue to coordinate closely with local and state law enforcement, area universities and community leaders to keep campuses safe and peaceful.”

Map: Where university protesters have been arrested across the United States

 From CNN's Alex Leeds Matthews, Krystina Shveda, Amy O'Kruk and Renée Rigdon

As pro-Palestinian protests have erupted on college campuses nationwide , protesters — including students and faculty —  continue to be arrested  since the first demonstrators were  detained at Columbia University  two weeks ago. Nearly 200 protesters were arrested on May 1, after April 30 saw the largest number of arrests in a day since protests began with at least 418, according to a CNN review of university and law enforcement statements.

More than 2,000 people have been arrested on college and university campuses since April 18 as schools prepare for spring commencement ceremonies, according to CNN’s review. The  University of Southern California , where nearly 100 protesters were arrested April 24,  canceled  its primary commencement event. Protesters have been arrested on more than 40 campuses across at least 25 states. Many other schools have experienced protests without arrests.

Protest demands  vary  from campus to campus, but a major focus is that universities divest from companies with financial ties to Israel amid its war with Hamas. There have also been counter-protests, resulting in  clashes at UCLA .

CNN is monitoring campus protests and will continue to update this map with any new arrests.

Biden speaks out about campus protests. Here's what else happened today

CNN's Ramishah Maruf

President Joe Biden delivered his most extensive remarks yet about the unrest on college campuses on Thursday.

• He said both the right to free speech and the rule of law must be upheld as protests roil college campuses across the country. The US isn't an “authoritarian nation” where dissenting voices are silenced, but he also said the US was a “civil society” where “order must prevail.”
• When asked if the protests have forced him to reconsider American policies toward the Middle East, Biden said "no."
• Asked whether states should call in their national guard to intervene in protests on college campuses, President Joe Biden responded: "No."

Meanwhile, on campuses across the country:

At Portland State University , Portland police officers in riot gear were in a standoff with protesters Thursday outside the school's library, as authorities worked to clear pro-Palestinian protesters from the premises. The Portland Police Bureau made at least  two arrests  early this morning.

At George Washington University , dueling protests — a group of pro-Israel protesters and another of pro-Palestinian protesters — are taking place about four blocks away from each other.

At the University of California, Los Angeles , cleanup begins after police broke down a barricade and arrested over 100 protesters. CNN reported hearing flashbangs on the UCLA campus Thursday morning and said that authorities appeared to fire rubber bullets.

At the University of Florida , the school said it plans on going ahead with commencement and its Chancellor said protests "will not be tolerated."

At the University of New Hampshire , twelve people were arrested Wednesday night during protests.

At the University of Texas at Dallas , 17 people were arrested as police cleared an encampment.

Please enable JavaScript for a better experience.