Dysarthria and Aphasia.

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Dysarthria and Aphasia

Running Head: DYSARTHRIA AND APHASIA

Dysarthria and Aphasia

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Dysarthria and Aphasia

Dysarthria

Definition

Dysarthrias or commonly known as Dysarthria, refers to a group of speech problems where sounds may be slurred, and speech may be slow or effortful. Noticeable changes in pitch, volume, and tempo of speech occur. Speech can become nasal, and the voice can sound either breathy or harsh.
Dysarthria occurs in both children and adults. Yorkston, Strand, Miller, Hillel, and Smith (1993) found reduction in speaking rate to be the strongest predictor of decrease in speech intelligibility.

Etiology

Dysarthria is related to neuromuscular diseases such as cerebral palsy, Parkinson’s, Lou Gehrig's disease, or later stages of multiple sclerosis. It can also occur from stroke, brain injury, and tumors. The exact speech problem that occurs depends on the part of the nervous system that is affected. Degenerative disease due to the effects of upper and lower motor neuron changes; the speech of individuals with ALS is classified as mixed (spastic and flaccid) dysarthria (Duffy, 1995).

A number of subsystems must work together, for speech to be clear. A weakness in any of the systems or lack of coordination between systems can result in dysarthria.

If the respiratory subsystem is fragile, then speech may be quiet and formed one word at a time. If the laryngeal system is weak, speech may be breathy, too quiet and slow. If the velopharyngeal subsystem is not working, speech may sound too nasal or nasal sounds may be missing. If the articulatory subsystem is not working, speech may sound slurred, may have many errors and may be slow and labored.
Treatment

Treatment varies depending on the source, category, and intensity of the problem. The main objective of treatment by a speech-language pathologist is to help a person be able to communicate as clearly and efficiently as possible. Treatment may involve teaching a person ways to compensate for restrictions in muscle movement by techniques such as talking in short sentences or emphasizing key sounds in words. Changes in positioning of the body also may increase clearness.
For some people, speech is not a viable option. Substitutes or augmentative systems are frequently used. As speech intelligibility begins to decline, intervention focuses on maintaining functional communication versus attempting to reduce speech impairment (Yorkston, Miller, & Strand, 1995). Direct speech intervention is not recommended for a number of reasons. First, exercise to fatigue may hasten neurological deterioration. Speech drills may be so tiring that speech adequacy for functional use in other settings would be compromised. Finally, speech exercises emphasizing optimum performance can only prove to be a discouraging reminder of increasing loss of ability.

Therapy for dysarthria focuses on maximizing the function of all systems. Compensatory strategies are often used. Individuals with dysarthria may be advised to take frequent pauses for breath, to over-articulate, or to pause before important words to make them stand out. If there is muscle weakness, they may benefit from performing oro-facial exercises. This helps to strengthen the muscles of the face and mouth that are used for speech.

Most dysarthric speakers need more time to get their message across. It helps to allow them extra time and to listen face to face. When you have not understood what ...

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Most dysarthric speakers need more time to get their message across. It helps to allow them extra time and to listen face to face. When you have not understood what they have said, it is better to say so than to pretend you have understood. It helps to repeat the part that you did not understand, as a question, so they only have to repeat the part you did not get. For example, if you hear "I would like a XX"; rather than saying pardon and getting a repetition that may sound the same, try asking. “You would like a...?" with rising inflection, or "What would you like?"

If a person is using an augmentative device, consider it to be valid and equal to speech. Do not insist that they "say it" if you have understood the message they sent by the augmentative system. If there is weakness of speech muscles, the speech-language pathologist teaches speech more intelligible to compensate for the muscle weakness.

Aphasia

Definition

Aphasia is a language disorder that results from damage to the section of the brain that is responsible for language. For most people, these are parts of the left side (hemisphere) of the brain. Aphasia usually occurs abruptly, frequently as the result of a stroke or head injury, but it may also expand slowly, as in the case of a brain tumor. The disorder damages the expression and understanding of language as well as reading and writing. Aphasia may occur with speech disorders such as dysarthria or apraxia of speech, which also result from brain damage.

Anyone can get aphasia, but most people who have aphasia are in their middle to late years. Men and women are equally affected.

Etiology

Mostly, the cause of the brain injury is a stroke. When, for some reason, blood is unable to reach a part of the brain, a stroke occurs. Other causes of brain injury are severe blows to the head, brain tumors, brain infections, and other conditions of the brain.

Individuals with Broca's aphasia have damage to the frontal lobe of the brain. These individuals frequently speak in short, meaningful phrases produced with great effort. Broca's aphasia is characterized as a nonfluent aphasia. Affected people often skip small words such as "is," "and," and "the." In contrast to Broca's aphasia, damage to the temporal lobe may result in a fluent aphasia, Wernicke's aphasia. Individuals with this disorder may speak in long sentences that have no meaning, add unnecessary words, and even create new "words.”

A third type of aphasia, global aphasia, results from damage to extensive portions of the language areas of the brain. Individuals with global aphasia have severe communication difficulties and may be extremely limited in their ability to speak or comprehend language.

Treatment
Most people believe that the most effective treatment begins early in the recovery process. Some of the factors that influence the amount of improvement include the cause of the brain damage, the part of the brain that was damaged, the degree of the brain injury, and the age and health of the individual. Additional factors include motivation, handedness, and educational level. The frequency of family education efforts has been suggested by P. Wahrborg (1991). He recommended that information about the nature of the acquired communication disorder and the appropriate communication strategies be provided to the family member at the onset.

Aphasia therapy strives to improve an individual's ability to communicate by helping the person to use remaining abilities, to restore language abilities as much as possible, to compensate for language problems, and to learn other methods of communicating. Treatment may be offered in individual or group settings. Individual therapy focuses on the specific needs of the person. Family support is a key factor in good recovery from such conditions as stroke (Glass & Maddox, 1992). The support network of the person with an acquired communication disorder will do much to determine his or her ultimate community reintegration.

Speech Therapy as a Treatment for Aphasia

The speech-language pathologist works on drills and exercises to improve specific language skills affected by damage to the brain. For example, the person may practice naming objects, following directions, answering questions about stories, etc. These exercises differ depending on personal needs, and become more multifaceted and demanding as ability improves.

The speech-language pathologist teaches the person ways to make use of stronger language skills to make up for weaker language skills. For example, some people may find it easier to express their ideas through gestures and writing than with speaking. The speech-language pathologist may teach this person to use both writing and gestures to help remember words for conversation.

The person may take part in group therapy sessions to practice conversational abilities with other persons with aphasia. Group members may role-play common communication circumstances that take place in the community and at home, such as talking on the telephone, ordering a meal in a restaurant, and talking to a salesperson at a store.

In due course, persons may participate in individual or group outings to practice their use of communication approach in real life situations. They are asked to plan, organize, and carry out these trips using the compensatory strategies they have learned. For example, group members may practice functional reading and writing skills by using a telephone book to find the phone number of a restaurant and write it down

Later on in recovery, the speech-language pathologist may work with a vocational specialist to help the person return to work or school, if suitable. The speech-language pathologist works with employers and/or educational specialists to apply the use of compensatory strategies in these settings. This professional may work with them to alter work/school environment to meet language needs.

References

Duffy, J. R. (1995). Motor speech disorders: Substrates, differential diagnosis, and management. St. Louis: Mosby.

Glass, T.A., & Maddox, G.L. (1992). The quality and quantity of social support: Stroke recovery as psycho-social transition. Social Science and Medicine, 34: 1249-1261.

Wahrborg, P. (1991). Assessment and Management of Emotional and Psychosocial Reactions to Brain Damage and Aphasia. San Diego: Singular Press.

Yorkston, K. M., Miller, R. M., & Strand, E. A. (1995). Management of speech and swallowing disorders in degenerative disease. Tucson, AZ: Communication Skill Builders.

Yorkston, K. M., Strand, E., Miller, R., Hillel, A., & Smith, K. (1993). Speech deterioration in amyotrophic lateral sclerosis: Implications for the timing of intervention. Journal of Medical Speech-Language Pathology, 1(1), 35-46.