Speech is the physical act of producing sounds. There are four major categories of problems. One cause is a physical abnormality, such as a dental gap due to missing teeth or a gap between teeth. Some lisps are an example of this. Cleft palates and cleft lips can also result in speech that sounds different.

A second cause is apraxia of speech, or verbal apraxia, which is a sequencing problem. Sound clusters, such as "str" are reduced to just "s", and long words are rarely spoken the same way twice. In fact, some syllables of long words are omitted at times. People with this problem may learn to speak in short words as a way of hiding their difficulty.

Dysarthria of speech sounds slurred. It comes from a weakness of various muscles.

A fourth cause is idiopathic, or due to unknown causes.

Stuttering is a special case. Research has often shown genetic components and physical differences int he brains of stutterers. Other people believe there can be a psychological component, as when a person starts stuttering when feelingunder a lot of stress or after a traumatic event.

The two biggest causes of language problems are head injury, such as from car accidents, and strokes. Other causes also occur.

Depending on where in the brain the injury occurred, problems understanding language and difficulty expressing oneself may result. A person could receive long directions and follow them, but not say he needs a piece of equipment, for example.

Word-finding problems are a special example of difficulty expressing oneself. The word may be "on the tip of your tongue". Most people have occasional difficulty with this, but if it is severe, this should be investigated further.

There may also be poor executive functioning, such as time management and sequencing skills. (This could include setting priorities, getting places on time, etc.) Math skills, both in basic operations like adding, and in time and money skills, can be affected by head injuries and strokes.

Speech-language pathologists have the expertise to diagnose and treat these problems. They may work closely with your doctor, and often require a prescription from him before working with a client.

Help is available! Workers with these issues should talk to their physicians, and check with their health plans about coverage.