NEWS JULY 2021! Speech and Language therapy international consensus recommendations – click here

The commonest functional speech and swallowing symptoms are:

Slurred Speech

Slurred speech (dysarthria) might be sometimes normal and sometimes not. It may sound a bit like you are ‘drunk’ even though you have had nothing to drink. If it gets worse with increasing tiredness your neurologists will often consider the diagnosis of myasthenia gravis, but it does also occur as a functional symptom.

Stuttering speech

People who have never had a stutter before may develop an acquired stutter. Speech may be hesitant, often with gaps in the middle of words rather than at the ends of words. There might be hesitancy at the start of every single word. Alternatively there may be a ‘telegrammatic’ type of speech in which words like ‘and’ or ‘the’ are missed out from the sentence

Word Finding Difficulty

This is really a ‘thinking’ (cognitive) symptom more than a speech symptom. You may find that:

• You are searching for the right word but it just won’t come
• You mix up words in a sentence
• Words come out wrong or as nonsense words, e.g,
  • ‘where is the train spation’ instead of ‘train station’
  • ‘I need to pay in the cheque at the plank’

Whispering/Hoarse Speech (Dysphonia)

This sounds like the kind of speech people have when they have a sore throat (laryngitis)  except it is not due to a sore throat or any other abnormality visible on the vocal cords and lasts for much longer. This is often called functional dysphonia. It is usually investigated by an Ear, Nose and Throat doctor (ENT, Otolaryngology) to make sure there is no identifiable cause. It may come and go and sometimes may even be triggered by a bout of laryngitis, but the vocal cords ‘forget to work’ properly after the virus has gone.

Occasionally people can lose their speech completely, this is called functional aphonia. Sometimes it will feel easier to speak in some situations than others.

Foreign Accent Syndrome

Foreign Accent Syndrome. Another rare functional speech problem is called foreign accent syndrome. This can be caused by a variety of neurological conditions but can also be a functional neurological symptom or part of FND. When the ‘melody’ of speech goes wrong then it can sound like someone has a new accent. In FND that problem can morph in to a fully formed accent of a different country or region. This can change people’s sense of identity and become self-perpetuating. There are two closed facebook groups here and here run by patients with this problem. There is also a site about foreign accent syndrome run by Bill Katz at the University of Texas at Dallas.

We did some research in Edinburgh on foreign accent syndrome in 2019 led by my colleague Laura McWhirter and with the help of Nick Miller, Professor of Speech Pathology at the University of Newcastle. You can find the article at this link. We’re really grateful to the 49 people with foreign accent syndrome from around the world who helped us with that research. We also wrote up the case of someone in Edinburgh who developed Foreign Accent Syndrome after a facial injury to give some insight in to how treatment might occur with speech and language therapy and psychological therapy to help retrain the speech and identity parts of the brain. There are some videos linked to the article which is at this link.

Foreign Accent Syndromes: The stories people have to tell by Jack Ryalls  and Nick Miller 

Swallowing problems (globus)

Typically, if a person with FND has related swallowing problems they will experience a sensation of something stuck in the upper part of their throat. This can occur even when they are not swallowing anything but can also make swallowing difficult. This symptom is often called globus or globus pharyngis. Swallowing problems are usually first investigated by an Ear, Nose and Throat doctor (ENT, Otolaryngology) to make sure there is no identifiable cause. People with globus quite commonly have acid reflux that is helpful to treat as well, although is not the whole cause of the symptom.

Cough

There are many causes of cough. Functional cough may be a loud barking cough or a tickly ‘hypersensitive’ cough. Cough is usually first investigated by a respiratory doctor to make sure there is no other respiratory disorder present.

Why are my tests normal?

In these kinds of speech and swallowing problems all the parts of the nervous system are there, they are just not working properly at certain times.

Your doctor will make this diagnosis after listening to your symptoms and examining you. The diagnosis is based on the presence of typical symptoms and examination findings which are specifically only present in functional disorders.

Normal scans and tests help to make the diagnosis, but the diagnosis is usually made by a neurologist; or an ENT doctor in the case of functional dysphonia; or a respiratory physician in the case of cough. Speech and language professionals (sometimes called speech and language therapists or speech pathologists) have particular expertise in examining speech and swallowing and in many places are closely involved in making or confirming the diagnosis.

What is the treatment?

Read more about the role of speech and language therapy on this page