Phonation, strictly defined, is the production of vocal sounds without word formation; it is entirely a

function of the larynx.

Speech consists of words, which are articulate vocal sounds that symbolize and communicate ideas.
Articulation is the enunciation of words and phrases; it is a function of organs and muscles
innervated by the brainstem.

Language is a function of the cerebral cortex. Language and speech are uniquely human attributes.

Speech is as dependent upon the interpretation of the auditory and visual images—and the
association of these images with the motor centers that control expression— as it is upon the motor
elements of expression.

In neurologic patients, the speech abnormalities most often encountered are dysarthria and
aphasia. The essential difference is that aphasia is a disorder of language and dysarthria is a
disorder of the motor production or articulation of speech. The common vernacular phrase “slurred
speech” could be due to either.

Aphasia usually affects other language functions such as reading and writing. Dysarthria is
defective articulation of sounds or words of neurologic origin.

A good general rule is that no matter how garbled the speech, if the patient is speaking in correct
sentences— using grammar and vocabulary commensurate with his dialect and education—he has
dysarthria and not aphasia.

In dysarthria there are often other accompanying bulbar abnormalities—such as

dysphagia—and a brainstem lesion is usually a prominent clinical consideration.

Disturbed language function is always due to brain disease, but dysfunction limited to the speech
mechanisms may occur with many conditions, neurologic and nonneurologic.

ANATOMY AND PHYSIOLOGY OF ARTICULATION

Sounds are produced by expired air passing through the vocal cords. Properly articulated speech
requires coordination between the respiratory muscles and the muscles of the larynx, pharynx, soft
palate, tongue, and lips. All of these components are referred to as the vocal (oral) tract.

Respiratory movements determine the strength and rhythm of the voice.

Variations in pitch are accomplished by alterations in the tension and length of the vocal cords and
the rate and character of the vibrations transmitted to the column of air that passes between them.

Modifications in sound are produced by changes in the size and shape of the glottis, pharynx, and
mouth, and by changes in the position of the tongue, soft palate, and lips.

The oropharynx, nasopharynx, and mouth act as resonating chambers and further influence the
timbre and character of the voice.

Articulation is one of the vital bulbar functions. Several cranial nerves (CNs) are involved in speech
production, and an adequate appraisal of speech requires evaluating the function of each.

The trigeminal nerves control the muscles of mastication and open and close the mouth.
The facial nerves control the muscles of facial expression, especially the branches to the orbicularis
oris and other smaller muscles about the mouth that control lip movement.

The vagus nerves and glossopharyngeal nerves control the soft palate, pharynx, and larynx, and the
hypoglossal nerves control tongue movements.

Other factors include the following: the upper cervical nerves, which communicate with the lower
CNs and in part supply the infrahyoid and suprahyoid muscles; the cervical sympathetic nerves that
contribute to the pharyngeal plexus; and the phrenic and intercostal nerves, which also contribute to
normal speech.

TYPES OF SPEECH SOUNDS

Voiced sounds are produced by narrowing the glottis so that the vocal cords are approximated.

Voiceless sounds are made with the glottis open. Either type of sound may be modulated by
adjusting the size and shape of the vocal cavities.

Speech sounds may be placed in different categories related to the place of articulation (e.g.,
labiodental, interdental, alveolar, palatal, alveopalatal, velar, and uvular).

1. Articulated labials (b, p, m, and w) are formed principally by the lips.

2. Modified labials (o and u, and to a lesser extent i, e, and a) are altered by lip contraction.
3. Labiodentals (f and v) are formed by placing the teeth against the lower lip.
4. Linguals are sounds formed with tongue action. T, d, l, r, and n are tongue-point, or alveolar,
sounds, formed by touching the tip of the tongue to the upper alveolar ridge.
5. S, z, sh, zh, ch, and j are dentals, or tongueblade sounds.

Normal articulation depends on proper function and neuromuscular control of the vocal tract.
Normal development of the tongue, larynx, and soft palate, and adequate hearing are essential to
proper pronunciation.

No two individuals possess the same speech patterns. This is true not only for pitch and timbre but
also for the quality, duration, and intensity of tones and sounds and for the ability to pronounce
certain words and syllable.