COMMUNICATION PROBLEMS FOLLOWING ACQUIRED BRAIN INJURY

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COMMUNICATION PROBLEMS FOLLOWING ACQUIRED BRAIN
INJURY

• Ailsa Paterson
• Speech Language Therapist

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COMMUNICATION PROBLEMS

• Complex and Diverse
• Social Isolation

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DYSARTHRIA/ANARTHRIA

• Disturbance of motor control
• Speech is slow, slurred and difficult to
  understand
• Imprecise articulation
• Phonatory weakness
• Reduction in pitch and loudness
• Hypernasality
• Rate of speech- slow or rapid
• Respiration affected - reduced lung volume
  /abnormal chest movements

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PREVALENCE OF DYSARTHRIA FOLLOWING TRAUMATIC
BRAIN INJURY

• Dresser et al 1973 8 - 100
• Oliver,Ponsford and Curran 1996 - Motor speech
  problems in 34 patients with TBI - 5 years post
  injury.

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DYSPRAXIA

• Strength and coordination of muscles is
  unimpaired but-
• Difficulty saying words in a consistent way
• Sound substitutions- ? Multisyllabic words
• Fast rate
• Variable Intelligibility

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DYSPHASIA

• Impairment of language affecting
• Comprehension- spoken and written word
• Expression - verbal output and written
  language

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DIFFERNTIAL DIAGNOSIS

• Disorders of communication can co-exist
• Dysphasia and dyspraxia

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EARLY INTERVENTION

• Work on feeding and swallowing before speech and
  language
• Indirect therapy to improve alertness, attention,
  orientation

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COGNITION

• May be broadly described as the mental
  activities or operations involved in taking
  in,interpreting,encoding,storing,retrieving and
  making use of knowledge or information and
  generating a response.
• 
  
• 
  Ylvisaker and Szekeres

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COGNITIVE IMPAIRMENT

• Poor planning
• Poor problem solving
• Reduced /poor short term memory
• Loss of insight
• Reduced attention span
• Confused in time and place
• Delayed responses

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PHYSICAL IMPAIRMENT

• Paralysis
• Hearing impairment
• Ataxia
• Balance problems
• Fatigue
• Visual difficulties
• Visually distracted
• Headaches

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EMOTIONAL IMPAIRMENT

• Rapid mood swings
• Lower tolerance
• Emotional lability
• Apathy
• Emotional flattening
• Anxiety/depressed mood
• Disinhibition

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ASSESSMENT

• To identify strengths and weaknesses
• Provide family,carers,team members with
  information regarding communicative abilities
• Establish therapy goals

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DYSARTHRIA

• Tone
• Head and trunk control
• Co-ordinate breathing with posture
• Facilitate vocalisation
• Reinforcement and repetition- MDT
• Establish core words
• Phonetic placement

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DYSPRAXIA

• Reduce rate
• Allow time for motor planning
• Encourage listening
• Improve self- monitoring

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AUGMENTATIVE COMMUNICATION

• As a back up to speech
• Writing, gesturing,drawing,typing,communication
  aid

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LANGUAGE ASSESSMENT

• COMPREHENSION
• Increased length of utterance
• Complexity of utterance
• Rate of utterance
• Can he/she retain information and at what level
• What helps comprehension

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EXPRESSION

• Ability to retrieve words - to name
  objects,pictures at single word level
• Can patient organise and express increasing
  amounts of information
• Can he/she express needs
• Can patient initiate conversation
• Is conversation competent and appropriate
• Topic maintenance

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GOAL OF THERAPY

• Varies according to patient
• Aim to progress to the most independent level of
  functioning possible
• Express needs by pointing to pictures
• Ability to express needs in simple verbal terms
• Improve ability to define words or describe
  consequences of actions

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ENVIRONMENT

• Quiet room
• Short frequent sessions
• Clear instructions
• Encourage and support

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• YES/NO SYSTEM
• May be appropriate in the early stages
• Patient requires full assessment
• What is their level of comprehension?
• SYSTEM MUST BE
• Reliable
• Everyone must use it and be consistent in its use
• It should be written down
• Natural system most effective eg. Nod/shake head
• Must be distinguishable from random movements

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HOW TO HELP IN EARLY STAGES

• Assume patient can comprehend something in what
  you say
• Gently touch and use their name to gain attention
• Speak softly, calmly, slowly.Use natural
  inflections- allow time to process what you are
  saying
• Use short, simple but age appropriate sentences
• Talk to patient
• Do not ask questions unless you are able to
  respond in some way and you are willing to honour
  the response
• Talk about here and now -objects or activities
  patient can see, hear

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HOW TO HELP IN EARLY STAGES

• Discuss what you are going to do,what you are
  doing, what you have just done
• Give frequent repetition of orienting information
• Give patient time to respond
• Be attentive for natural communicative gestures
• Yes/no system- use natural gestures before more
  novel communicative gestures
• Explore simple means of communication
• If patient uses inappropriate language - simply
  state facts correctly do not argue

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COMMUNICATION PROBLEMS FOLLOWING ACQUIRED BRAIN
INJURY

• Ailsa Paterson
• Speech Language Therapist
• Thank you
• Any Questions?