3.6 Speech Changes |
Aphasia
Aphasia can be identified as difficulty with understanding and
expressing language. The major cause of aphasia is brain injury
sustained from a stroke. Other less common causes of aphasia are
head injuries, brain infections, brain tumors and other neurological
diseases. In the case of stroke, the normal flow of blood carrying
oxygen to the brain is cut off, which damages brain cells that control
speech and language function.
Symptoms: Aphasia is a multimodality language disorder.
All aspects of language including speech, comprehension, reading,
writing and even gesturing, may be affected. People who have recovered
from aphasia report the feeling of being thrust into a foreign country,
where they cannot understand what others are saying nor be understood.
Intellectual functioning, however, is generally not impaired in
aphasia. Often caregivers misinterpret symptoms and treat the aphasic
person as a child. Although language may be significantly impaired,
it is important to remember that the person with aphasia retains
interests at an adult level.
Effect on Behavior: Adults with aphasia may experience radical
mood changes. They may become easily frustrated, due to an inability
to verbally vent their feelings. They may display a phenomenon called
emotional liability which focuses on excessive and inappropriate
laughing and/or crying. An aphasic person may retain the ability
to produce clearly spoken words and use common phrases such as "hello"
and "how are you.""These phrases are automatic and represent
a very low level of expressive language. It is also common for an
aphasic person, who is usually incapable of verbal expression, to
use profanity fluently. Caregivers should be aware that profanity
is generally beyond the aphasic's control.
Treatment and Rehabilitation: A treatment program is administered
by a speech-language pathologist, who will thoroughly evaluate the
patient's communication strengths and weaknesses. A battery of tests
is given to assess the ability to comprehend speech, read, write,
speak, and do basic mathematical problems.
The prognosis from aphasia is difficult to predict. Factors that
tend to affect prognosis are: the amount of brain injury sustained;
the type of stroke suffered; the patient's motivation; the amount
of family support and cooperation; and the therapy program. Almost
all aphasic patients will profit from therapy.
Treatment sessions are both intensive and personalized. Their focus
is not on learning language, as in child language therapy, but rather
on recovering language skills such as speech, listening, reading,
and writing. Group aphasia therapy is also available to augment
individuals.
Group instruction can help the patient and family overcome the
psychosocial and emotional barriers that aphasia presents.
Some common types of aphasia and their effects
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Broca's aphasia or expressive aphasia affects both speech
and writing. Persons with Broca's aphasia know what they want
to say but are unable to find the words to express their thoughts.
Their speech pattern is labored and halting and consists of
rudimentary grammar such as "sit chair?" for "is
it all right if I sit in that chair?" People with Broca's
aphasia are able to think, but are unable to organize speech
movements to express their thoughts. Understanding of the spoken
word is only mildly impaired.
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Wemicke's aphasia or receptive aphasia is characterized by
the difficulty to understand spoken and written language. Persons
with Wemicke's aphasia can hear voices and see the written words,
but cannot understand or interpret these words. The individual
effortlessly produces speech that is usually devoid of meaning.
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The most extreme form of aphasia is known as Global aphasia.
Individuals with Global aphasia suffer from an almost complete
loss of functional ability to use speech and language. They
have severe difficulty in speaking, understanding the spoken
word, reading, and writing. Global aphasia directly relates
to widespread injury of the areas of the brain that control
speech-language functioning
Practical Suggestions
- Be a patient listener. Persons with aphasia take extra time
to communicate. Don't rush them or talk for them.
- Encourage non-verbal communication. Some patients may need
to gesture to express their basic wants and need.
- Be a language stimulator, not a teacher. Remember, the aphasic
individual does not have to learn language like a child.
- Treat the older adult with dignity and respect, without being
condescending. Speak a little slower to allow enough time for
the aphasic individual to understand what is being said. Communicate
one idea at a time and reduce the complexity of language. However,
keep the content at an adult level.
- Create opportunities in which the aphasic person can communicate
and use the language skills they are recovering.
- Get involved with a stroke group that may be meeting in your
area. Contact your local chapter of the American Heart Association
for information.
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Dementia or Generalized Brain Damage
Dementia or generalized brain damage can change one's mental abilities
and personality, thus making it difficult to communicate. Alzheimer's
disease is the most common cause of dementia, accounting for up
to 70% of all cases. Multi-infarct dementia is responsible for 20%.
Parkinson's, Pick's and Huntington's diseases and other conditions
account for 10%. The confused language pattern exhibited by dementia
patients usually results from damage to both hemispheres (halves)
of the brain.
Symptoms: Individuals with dementia may be confused and
disoriented. They are unable to learn new information, and have
a tendency to undergo personality changes, become apathetic and
withdraw from society.
Effect on Behavior: Language patterns can fluctuate from
being unintelligible to inappropriately eloquent. Confused individuals
tend to dwell on one idea and may repeat the same phrase over and
over again.
Activities of daily living and self-care skills, such as dressing,
eating and toileting may be impaired. Short-term memory is typically
affected.
Treatment and Rehabilitation: Consult a speech-language
pathologist. He or she will suggest appropriate methods to facilitate
communication with the confused person.
Practical Suggestions
- Structure questions so that they can be answered simply with
a yes/no response.
- Increase visual cues such as pointing and gesturing.
- Avoid clinches and other abstractions. Be direct, literal and
to the point.
- Repeat words and phrases as often as needed.
- Get the person's attention before communicating. Establish eye
contact.
- Follow a strict daily routine. A consistent pattern of everyday
activities will help the confused individual in memory and orientation.
- Present information one piece at a time. Break down tasks into
small steps.
- Attend meetings of the Alzheimer's Association in your area.
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Dysarthia
Dysarthia is a speech disorder that results from weakness and/or
in coordination of the nerves and muscles that control speech. Dysarthria
can be caused by progressive neurological diseases such as Parkinson's
or Lou Gehrig's disease; or by conditions such as stroke or head
injuries.
Symptoms: In dysarthria, the speech mechanisms that control
respiration, voice production, resonation and articulation are affected.
Many individuals with dysarthric speech patterns also have difficulty
swallowing. Dysarthric speech ranges from being slightly distorted
to unintelligible. Persons with dysarthia are usually able to understand
spoken and written language.
Treatment and Rehabilitation: Speech therapy programs, which
teach individuals ways to improve overall speech intelligibility,
can be effective. In more severe dysarthria augmentative communication
devices, such as picture boards, computers and speech synthesizers,
may be helpful.
Practical Suggestions
- Be a careful, patient listener. Allow extra time for communication.
- Reduce background noise that may compete with the person's speech.
- Consider using augmentative communication devices for the person
with severe dysarthria.
- Observe facial expressions, body language, and lip and tongue
movements to enhance your understanding capabilities.
- Encourage the person with dysarthria to modify this speech pattern.
This can be done by asking him to speak slower, louder and in
short sentences.
- Consult a licensed speech-language pathologist.
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Cancer of the Larynx
Cancer of the larynx (or voice box) is linked to cigarette smoking
and heavy alcohol consumption. A laryngectomy, or surgical removal
of the voice box, is performed in one third of these cancer cases.
Symptoms: The symptoms of laryngeal cancer are: persistent
and progressive hoarseness; change in voice pitch; persistent sore
throat and/or earache; difficulty in swallowing; or lump in the
throat.
Treatment and Rehabilitation: For most laryngeal cancer
patients, early diagnosis and treatment will ensure that the larynx
is saved and normal speech is preserved. Radiation therapy is effective
for small localized cancers. For more advanced cases, surgery is
the preferred treatment. A single vocal cord or the entire larynx
may be removed. If a laryngectomy is performed, several physical
changes will occur. In addition to voice loss, the patient will
be unable to breathe through his nose or mouth. Instead he must
take in air through a small opening, or stoma, made in the base
of the neck. The senses of taste and smell will no longer be as
keen. Intelligible speech, however, may be restored with speech
therapy. Following surgery, the laryngectomee will usually learn
to use an artificial larynx, a hand-held battery-powered device
that enables him to transmit sound. The laryngectomee uses the sound
produced by this device as a voicing source. To produce intelligible
speech, he must carefully pronounce and articulate words and phrases.
The newest technique in voice restoration involves creating a small
opening between the trachea and the esophagus. A prosthetic device,
which is inserted into this space, directs air to the structures
of the esophagus and throat that are vibrated to produce voice
Practical Suggestions
- Learn to accept the mechanical sound of the artificial larynx.
- Be patient with the new laryngectomee. In the initial stages
of therapy, his speech will be difficult to understand. Reduce
background noise that will compete with the low volume of the
laryngectomee's voice.
- Remember that the only things that have changed about the laryngectomee
are alterations in speech and breathing.
- If you do not understand the message, be honest. Do not fake
understanding.
- Speak naturally to the laryngectomee. Do not whisper, shout,
or speak in a condescending manner.
- Do not talk for the laryngectomee. Avoid looking to someone
else to answer questions for him.
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