Communication
Understanding Speech Disorders
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Aphasia
Aphasia is a defect or loss in the ability to comprehend or express words, often resulting from a stroke or another type of brain injury that affects the language center in the brain.
The goal of therapy for people with aphasia is to establish the most effective means of communication. For people with mild impairment, the speech therapist uses an approach that emphasizes ideas and thoughts rather than words. Pointing to an object or picture, gesturing, nodding, and relying on facial expressions are often sufficient for rudimentary communication. For people with more severe impairment, a stimulation approach (in which words are repeatedly spoken to the person) and a programmed stimulation approach (in which words are spoken and objects are presented that can be touched and seen) help the person reacquire language ability. Caregivers of an aphasic person need to be very patient and appreciate the person's frustration. Caregivers must also realize that an aphasic person is not demented and should not be spoken to in baby language, which is insulting. Instead, the caregiver must speak normally and, if necessary, use gestures or point to objects.
Dysarthria
Dysarthria is an inability to articulate words properly because of problems in muscular control caused by damage to the nervous system. Rehabilitation goals depend on the cause of the dysarthria.
If the cause of dysarthria is stroke, head trauma, or brain surgery, the goal is to restore and preserve speech. For mild cases of dysarthria, repetition of words or sentences may sufficiently allow the person to relearn how to use facial muscles and the tongue for proper pronunciation. For severe cases of dysarthria, a letter or picture board or electronic communication device may be helpful.
If the dysarthria is caused by a progressive problem with the nervous system, such as amyotrophic lateral sclerosis (Lou Gehrig's disease) or multiple sclerosis, the goal of therapy is to maintain speech function for as long as possible. The person exercises to increase control of the mouth, tongue, and lips and is taught more appropriate speech rate and proper phrase length. Poor control of breathing muscles may force the person to take a breath in the middle of a sentence. Breathing exercises and planning punctuation within a sentence are helpful.
Verbal Apraxia
A person with verbal apraxia cannot produce the basic sound units of speech because of an abnormality in initiating, coordinating, or sequencing the muscle movements needed to talk. Verbal apraxia is often caused by brain injury, such as occurs with stroke or head trauma. In one therapeutic approach, the therapist has the person practice making sound patterns over and over again. In another approach, the therapist teaches the person to use natural melodic patterns for common phrases. Every phrase has its own melodic rhythm depending on the mood of the speaker. For example, "Good morning! How are you?" can be said in a flat melodic patter if the speaker is not up in the mood. However, when these phrases are said in a very cheerful manner, there is almost musical melodic rhythm. In treatment of verbal apraxia, the practitioner encourages the patient to repeat very exaggerated natural melody and rhythm patter. As the patient progresses, melody and rhythm cues are gradually faded.