Communication Disorders

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Structure of the Brain

  • Left Brain 
    • Logic 
    • Reason 
    • Objective 
    • Verbal 
    • Self-oriented 
    • Categorical 
    • Detail focused 
    • Purposefulness
    • Mimicry 
  • Right Brain 
    • Intuition 
    • Emotions 
    • Subjective 
    • Visual 
    • Group orientated 
    • Relational 
    • Creativity 
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Structure of the Brain

  • Two hemispheres connected by the corpus callosum 
  • Four lobes are recognised within each hemisphere and different functions are associated with different lobes
  • Lobes are networked together, not independent units 
  • Injury in one can cause a weakness in another 
  • Lobes in the Left Hemisphere 
    • Frontal Lobe: production (Broca's Area)
    • Parietal Lobe: sensations
    • Temporal Lobe: comprehension (Wernicke's Area)
    • Occipital Lobe: vision, body language and reading 
  • A lesion to the Left Hemisphere will affect communicative ability 
  • Hemispheres are in contralateral relationship 
    • Left Hemisphere controls right side of body 
    • Right Hemisphere controls left side of body 
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Left Hemisphere Dominance

  • Wada Test 
    • Neuro-radiologist puts one side of your brain to sleep for a few minutes 
    • Inject an aesthetic medication into the right or left internal carotid artery 
    • If left side is injected, person cannot produce language 
  • Split Brain 
    • When split brain patients are shown an image in left visual field or hold something in left hand, they cannot vocally name it 
  • Dichotic Listening 
    • First response to auditory stimilus, from right ear which directly transfer to left hemisphere 
  • Paralysis on right side of body 
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Causes of Brain Pathology

  • Disease of Genetic Origin 
    • Interference with neural development (Downs Syndrome)
  • Congenital Malformation
    • Any strcutural defects in the nervous system present at birth such as Spina Bifida 
    • Nervous system hasnt matured 
  • Vascular Lesion 
    • Interference in the normal blood supply to the brain, bruising of the infant skull, reduced oxygen supply during delivery, embolism, stroke, carbon monoxide poisoning 
  • Trauma Injury 
    • Fall, blow to the head, impact injury as in a road accident 
  • Infection caused by bacteria 
    • Bacteria, viruses, fungi as in meningitis
    • Imflammation of membranous covering of brain and spinal chord 
  • Abnormal cell growth: Tumour
  • Metabolic, nutritional and toxic disorders 
    • Epliepsy, schizophrenia, DTs
    • Dementia which follows prolonged alcohol misuse 
  • Degenerative conditions 
    • Ageing, abnormal ageing of the brain systems as in Parkinson's disease and Alzheimer's disease
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Stroke

  • Brain is totally dependant on bloody supply
  • Clot/bullet/rupture - cerebrovascular accident 
  • Hemiparesis
    • Weakening of the limbs 
  • Hemiplegia 
    • Complete paralysis 
  • Hemianopia 
    • Loss of vision in 1/2 of visual field 
    • Typically right hand side
  • Aphasia (Dyphasia)
    • Focal brain damage to the language centres
    • Communication disorder caused by brain damage
    • Characterised by complete or partial impairment of language comprehension, formulation, use
    • Temporal lesion: Wernickes Aphasia 
    • Lack of comprehension
    • Therapist words are echoed
    • Little concept of object-label link
    • Own sentences are unrelated to current theme  
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Wernicke's Aphasia + Broca's Aphasia

  • Wernicke's Aphasia 
    • Sentences start but lead nowhere 
    • Confident, definite intonation 
    • Unawareness of the condition, person seems happy 
    • Pragmatic breakdown 
    • Hard for participants 
    • Dont realise you cant understand 
  • Broca's Aphasia
    • More common than Wernicke's Aphasia 
    • Opposite 
    • Frontal lesion 
    • Predominantly expressive, productive, motor, encoding
    • Non fluent 
    • Relevant answers are given 
    • Comrehension relatively okay 
    • Less stressful for participants 
    • Problems with output 
    • Grammar: incomplete utterances 
    • Agrammatic speech 
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Broca's Aphasia 2

  • Broca's Aphasia 
    • Intonation units are short with lots of pauses 
    • 'I can't say it' - involuntary 
    • Participant needs to respond 
    • Word finding difficulties 
    • Tip of the tongue 
    • Person is aware of limitations 
  • Broca's Aphasia 
    • Damage can't be repaired 
    • Some natural improvement 
      • Bruising diminishes 
      • Best results usually within 6 months 
    • Makes most of existing abilities 
    • Individual therapy programme 
    • Speech therapy for communicative needs 
    • Social worker: adapt new circumstances 
    • School/carer opportunities 
    • Occupational help 
    • Financial help
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Neurological Problems

  • Agnosia 
    • Perceptual disorder in which sensation is preserved but the ability to recognise a stimulus or know its meaning is lost 
  • Dyspraxia 
    • Neurological brain disorder in which messages from the brain to the muscles are disrupted
    • Can affect many different functions such as writing and speaking 
    • Motor planning and execution disorder 
  • Dysarthria 
    • Motor speech disorder resulting from neurological injury of the motor component of the motor speech system and is characterised by poor articulation of phonemes 
  • Nervous System
    • A complex network of nerves and cells that carry messages to and from the brain and spinal chord to various parts of the body 
    • Comprises the Central Nervous System and Peripheral Nervous System 
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Causes of Neurological Disorders

  • Same range of causes as Aphasia 
  • Neurological diseases are diseases of the central and peripheral nervous system 
    • The brain, spinal chord, cranial nerves, peripheral nerves, nerve roots, autonomic nervous system, neuromuscular junction and muscles 
  • Epilepsy 
  • Alzheimer disease and other dementias 
  • Cerebrovascular diease including strokes 
  • Migraine and other headache disorders 
  • Multiple sclerosis 
  • Parkinson's disease
  • Trauma 
  • Tumour 
  • Infections 
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Agnosia

  • Brain cannot recognise similar objects, despite adequate sensory input 
  • Auditory 
    • Difficulty identifying two instances of the same word 
  • Pure word deafness 
    • Develop when the sound processing region of the brain is disconnected from its language centres
    • Reading, speaking and writing can be unaffected
  • Dont recognise sounds, cant translate them 
  • Can impact just one component of language 
  • Agnosia vs Wernicke's 
    • Agnosia: cant recognise sounds, cant translate them, recognition 
    • Wernicke's: cant recognise sounds but they dont know what they mean, interpretation
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Dyspraxia

  • DIfficulty in making and/or coordinating the precise movements required for the production of clear speech 
  • The person knows that they want to say but lacks control over the muscles required to perform the activity 
  • Involuntary activities seem unaffected 
  • No major neuro-physical or neuromuscular disability 
  • It is a disturbance of encoding (production) that is free of impairment of decoding (comprehension)
  • Sequencing Problem 
    • Coordination 
    • Timing 
    • When frustrated they can say it - involuntary 
  • Characteristics of speech
    • Hard to work out what the person wants to say 
    • No paralysis 
    • Ability to repeat a sequence of sounds is reduced 
    • Errors are inconsistent 
    • Perseveration may occur 
    • Erratic production of sounds 
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Dyspraxia 2

  • Similar to child language 
    • More difficulty with consonants 
    • Single consonants easier than clusters 
    • Clusters 
      • Omitted, substitutions, additions 
    • Place errors more common than manner or voice
  • Problem is at a phonological level
  • Rhythm is often slow and erratic 
  • There are problems atarting words, they can stutter
  • They can select the word they want but they cant form the sounds in sequence 
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Broca's Aphasia vs Dyspraxia

  • Broca's Aphasia 
    • Cant say what you want to say 
    • Lost the grammar 
    • Word finding difficulties 
  • Dyspraxia 
    • Grammar and vocabulary can be selected but there are problems with ordering sound sequences 
    • Word selection is fine 
    • No issues until putting sounds in 
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Dysarthria

  • Speech disorder arising from damage to the nervous system and manifests as poor motor control 
    • Breathing, phonation, resonance, articulation 
  • Affects speech production 
  • Physical problem 
  • Disturbance in voluntary control 
  • Vocal tract muscles are impaired 
  • May have problems moving the tongue - vowels 
  • Effort to imitate words 
  • Consistent difficulties 
  • May have no control over soft palate 
  • Flat prosody and slurred sequencing 
  • Facial grimaces 
  • Weakened muscles 
  • Self concious 
    • Bullying 
  • Hard to live knowing it wont pass 
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Dysarthria vs Dyspraxia

  • Both Dysarthria and Dyspraxia have a nervous system aetiology and difficulty in communicating on the productive side but with Dysarthria:
    • The vocal tract muscles are impaired 
    • Non target forms will be consistent 
    • Within range, there will be no difficulty controlling vocal organs 
    • Speech is slow and laboured 
    • No different between automatic and volitional speech 
    • Substitution errors are rare
    • All aspects of speech are affected in Dysarthria, but only articulation is affected in Dyspraxia 
  • Dysarthria 
    • Often associated with conditions such as Cerebral Palsy and Parkinson's Disease 
    • Variety of problems, varies in degree 
  • Cerebral Palsy
    • Group of disorders affecting a persons ability to move
    • Developmental problem 
    • Posture, listening, hearing, breathing, voice, articulation, language 
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Parkinson's Disease and Multiple Sclerosis

  • Parkinson's Disease
    • Progressive neurological condition 
    • Rigidity of movement and tremour 
    • Dysarthric symptoms 
    • Depressive symptoms 
    • Deficits in word finding 
    • Weakness in organisation of verbal information and memory 
    • Associated with the elderly 
    • Can come on at any age 
  • Multiple Sclerosis 
    • Progressive neurological disease
    • Subtle language problems 
    • Brain fog 
    • Word finding difficulties 
    • Dysarthric problems
    • Memory issues 
    • Not cognitively impaired
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Assessment and Plan

  • Individual therapy plan from a variety of sources 
  • Generla physical assessment 
  • Evaluative communicative status and recommend course of treatment 
  • Problem-nature-severity-communicative performance 
  • Medical 
    • Alleviate cause (pharmaceutical)
  • Surgical 
    • Operation
  • Prosthetic 
    • Construct lift for weakened soft palate 
  • Behavioural 
    • Modify neuro-muscular events 
  • Palliative
    • Lessen effect by acceptance 
  • Alternative mode 
    • Communication aids 
  • No cure 
    • Aim for the best each can achieve
    • Optimum method of communication and acceptance of the condition 
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