Communication Disorders

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Communication Disorders

• Speech Language
• Therapy

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Communication Disorders

• Outline
• What is communication?
• Types of communication disorders neurology
• Role of SLT and therapy
• Strategies for communication
• Alternative communication
• Impact of communication disorders

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Communication Activity

• Get in pairs
• One person face away from screen
• Communicate information about the picture WITHOUT
  speaking

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What is communication?

• Giving and receiving a message by any available
  means
• What are the different ways we can do this?

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How do we communicate?

• Sending a message
• Speech
• Gesture touch
• Drawing
• Writing
• Communication aid/ chart
• Facial expression
• Body language

• Receiving a message
• Listening
• Eye contact
• Facial expression
• Body language
• Reading
• Context

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Speech Language

• How sounds are physically produced
• Needs intact nerve innervation and anatomical
  structures (e.g. lips, tongue)

• How we put our thoughts into words-what we say
• Includes grammar and meaning
• Includes understanding and expressing yourself
• Spoken or written forms

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Range of Communication Disorders

• Aphasia/dysphasia
• Anarthria/dysarthria
• Apraxia/dyspraxia
• Cognitive communication impairment

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Basic brain anatomy
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Dysphasia

• Loss or reduction in ability to use or understand
  language
• Comprehension difficulties- listening reading
• Expressive difficulties- speaking spelling
• Continuum from mild to severe
• Video - Bob

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Neurology of language disorders - Dysphasia

• Dysphasia is a specific language disorder
  resulting from damage to the dominant cerebral
  hemisphere for language
• The hemisphere dominant for language is usually
  the left side
• The type of dysphasia is dependent on the site of
  the lesion within the cerebrum
• NB. Damage to non-dominant hemisphere may result
  in RHLD, causing subtle higher-level language
  difficulties

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Types of dysphasia

• Brocas aphasia
• Damage to Brocas area
• The frontal lobe
• Responsible for the production and expression of
  fluent speech
• Non-fluent speech with possible word-finding
  difficulties

• Wernickes aphasia
• Damage to Wernickes area
• The temporal lobe
• Responsible for receptive aspects of speech and
  language
• Fluent and rapid speech but empty of meaning and
  detail

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Dysarthria

• Motor speech disorder
• Weakness, slow movement or lack of co-ordination
  of muscles involved in speech process
• Can affect breathing for speech, voice quality,
  articulation, nasality, prosody ( volume, speed,
  pitch)
• Video - Peter

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Neurology of speech disorders - Dysarthria

• Cranial nerves that control the tongue, throat,
  lips and lungs include the trigeminal nerve (V),
  the facial nerve (VII), the glossopharyngeal
  nerve (IX), the vagus nerve (X), and the
  hypoglossal nerve (XII)
• Neurological injury due to damage in the central
  or peripheral nervous system may result in
  dysarthria
• Characterised by weakness, paralysis, or a lack
  of coordination of the speech musculature

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Apraxia

• Motor planning disorder
• Difficulty in voluntary control of oral movements
• Groping, inconsistent speech
• Speech may be effortful
• May manage better with automatic speech e.g
  counting/ singing
• Often combined with dysphasia

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Neurology of speech disorders -Apraxia

• Brain damage to the neural connections,
  especially the neural synapses, during the stroke
  can lead to apraxia
• Damage can affect the brain's ability to
  correctly signal instructions to the body
• Apraxia is frequently encountered in association
  with insult to the frontal lobe of the left
  hemisphere (dominant hemisphere)
• Patients with verbal apraxia often have
  associated Brocas aphasia
• No muscle paralysis or weakness

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Cognitive Communication Impairment

• Often associated with frontal lobe or right
  hemisphere damage
• Reduced attention, concentration and memory
• Topic maintenance
• Tangential comments
• Inappropriate comments

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The Language Process-understanding
CAT
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The Language Process- expression
C-A-T
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When talking breaks down.
Communication Disorder
Level of breakdown
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Role of SLT

• Assessment and diagnosis
• Education
• Advice on new ways of communicating
• Support
• Therapy
• What we CANT do!

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The communication environment

• Seating
• Lighting
• Background noise
• Hearing / aid
• Vision/ glasses
• Privacy

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Strategies for Communication

• UNDERSTANDING
• Ensure attention both ways!
• Keep instructions simple
• Speak slowly without shouting/ patronising
• Give time for them to process what you say.
• Modify the communication environment
• Ask yes/no questions
• Point to objects in environment
• Use gestures and facial expression
• Try writing words down or using pictures

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Supporting Communication

• Pen Paper
• Drawing
• Writing
• Facial Expression
• Gesture
• Maps
• Photographs
• Communication Book

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Strategies for Communication

• EXPRESSION
• Give them opportunities to talk
• Allow lots of time, trying not to finish peoples
  sentences
• Check back to clarify that you have understood
  rather than making assumptions
• Ask for repeats if required
• Encourage use of gestures, facial expression
  writing, drawing
• Encourage choice making
• Use communication charts/aids with caution
• Video Bob using stategies

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Links with MDT

• Liaise with SLT regarding strategies or aids
• Encourage use in range of environments for
  carryover
• Joint goal setting
• Capacity assessments
• Supporting decision making

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Dysphasia Therapy

• Understanding
• Meaning of words / sentences
• Use of objects
• Reading single words, sentences and paragraphs

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Dysphasia Therapy

• Expression
• Word-finding
• Grammatical constructions
• Sentence Production
• Spelling single words to sentences
• Alternative communication

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Dysarthria Therapy

• Oro-motor exercises
• Articulation exercises
• Breathing exercises
• Rate / prosody work
• Strategies for intelligible speech
• AAC eg. Light-writer

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Dyspraxia Therapy

• Working on consistently producing different
  sounds to place into
• Sounds
• Syllables
• Words
• Sentences

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Impact of Communication Disorder

• Relationships
• Loss of role
• Lack of choices
• Employment
• Self esteem
• Social opportunities
• Video Peter - impact

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Practical Exercise

• Get into pairs.
• As before, try to communicate your message to
  your partner without speech
• Use the strategies discussed
• Your partner can ask you questions to try to work
  out the message.

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Any Questions?