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Difficulty coordinating breathing and voice production can occur in many neurological disorders, such as after a stroke or head injury and in multiple sclerosis. One or both vocal cords can become paralysed after neurosurgery, a stroke or a head injury. At first it may not be possible to produce any voice at all or the voice may be strained and hoarse. In Parkinson’s disease and motor neurone disease on the other hand the voice can be weak and whispery. Neurological diseases can also make control of the pitch and volume very irregular or monotonous.

In motor neurone disease, movement of the lips and tongue can become weak, making speech soft and slurred in quality. By contrast, strokes can sometimes make sounds too explosive. The term used to describe any speech difficulty where what is vocalised is unclear, but where content and meaning are normal, is dysarthria. Some strokes can result in a marked difficulty in directing the lips and tongue to move in the right way at the right time, despite having normal muscle strength. This makes speech laborious, groping and disjointed and is known as articulatory dyspraxia.

Often in dysarthria, the rate of speech becomes slower, possibly to accommodate the difficulties described so far. However, in some disorders, such as Parkinson’s disease, there is a difficulty with keeping speech at a regular pace - often people speed up and then slow down or speak so fast that they become difficult to understand. In diseases of the cerebellum, which is the part of the brain that is responsible for co-ordination, speech can become slurred.This may make the person sound as if they have had one drink too many.

Another common problem in dysarthria is an inability to control the air that comes down the nose during speech. This gives speech a ‘nasal’ quality, which can make it very difficult to understand.

A difficulty with speech production may be accompanied by a problem with swallowing. Often this is mild, although some people will require help. If sufficiently severe, nourishment may need to be administered by passing a fine tube into the stomach through which liquid feeds can be given. Swallowing problems are very common after stroke but usually get better within a few days or weeks.