Neurogenic Disorders Strokes, Trauma, Diseases
About Neurogenic Communication Disorders
The classification of neurologically based communication disorders is a broad area that encompasses any disruption in the production of speech and/or the use of language for talking, reading, writing, listening and gesturing. Major types include but are not limited to: aphasia, apraxia of speech and dysarthria. Aphasia is a loss a language skills as a result of brain damage. This may mean that the person has difficulty understanding what is said to him/her and/or difficulty in expressing his/her wants and needs. This type of problem is most commonly caused by an interruption in blood flow (stroke) to the left side of the brain. Apraxia of Speech means that while the person knows what s/he wants to say, s/he has trouble finding how to start the words (how to program the speech structures to successfully organize and produce the movements needed to say the message) and/or how to sequence multiple syllables. This person would typically try many times to correct their attempted message and long words like "multiplication" would be especially difficult. Their problem is not caused by lack of strength or difficulty in moving a muscle but in "programing" the movement. Like aphasia, apraxia of speech is most often caused by a stroke in the left side of the brain. Dysarthria refers to a group of disorders that all have in common difficulty in pronouncing words clearly. In this case the person will know what they want to say and how to say it but will have trouble moving the muscles to produce the sounds. For example, the person may not be able to move their tongue and lips well because the nerves that connect to these muscles are not working normally. This would make it difficult for them to speak clearly and cause communication to breakdown.. Dysarthrias can be caused by a number of neurological problems such as , a stroke, a head injury, a severe infection that affects the nervous system, a brain or nerve tumor, a disease such as Parkinson’s disease. These illnesses or injuries often cause changes in strength, speed, range, and accuracy of muscle movement. Since we use many of the same muscles/structures to swallow food and liquid as we do to speak, persons with speech problems may also experience difficulty with swallowing(the technical term for swallowing difficulty is "dysphagia"). In some cases a person may have a combination of problems including such coexisting symptoms as "aphasia and apraxia of speech", "aphasia and dysarthria"or aphasia, dysarthria and swallowing problems.
Assessment of Neurogenic Communication Disorders
When you come to the Auburn University Speech and Hearing Clinic for an evaluation of a Neurogenic communication problem you can expect to spend 1.5 to 2.0 hours in the initial visit. A physician referral is typical but not required. Most often your primary medical diagnosis has already been made, (i.e., stroke, multiple sclerosis, or traumatic brain injury). There are times however, when we may assist the physician is confirming a suspected problem by reporting the speech or language profile of his/her patient. While rare, there are occasions when a medical diagnosis has not been sought and the person comes to us because the first signs of their problem are showing up in their speech, language and/or swallowing.
Prior to your evaluation you will be asked to complete a case history and we may request permission to correspond with your prior health care providers. During the evaluation we will ask for additional information as needed. Some of the typical questions include: Have you been diagnosed with a specific problem by your physician? Have you been hospitalized for this? When? Where? Have you received prior speech/language therapy? When? Where? From whom?
How has your speech/language changed? What previous medical history might be pertinent? What medications are you currently taking? What are you hoping to accomplish with this assessment and possible treatment?
Major components of the assessment will include a hearing screening, a visual inspection of the muscles and structures for speech, specific oral motor tasks to perform, (i.e., "stick out your tongue", "take a deep breath and say ‘ah’ for as long as you can"), questions about language comprehension and expression, a conversational sample of your speech and questions about how well you are swallowing food and liquids. From this overview additional test batteries may be selected and administered specifically for language difficulties or for speech difficulties.
Specific language testing for aphasia will involve a number of tasks that assess language comprehension, repetition, naming, information content, fluency, reading , writing and gesturing. In the language comprehension sections it is likely that you will be asked to identify objects as they are named by the examiner, to answer simple and complex yes/no questions, to follow 1, 2, and 3 step commands and to answer questions about paragraphs that have been read to you. Repetition tasks include saying single words, phrases and sentences after the examiner. In the naming section you will be asked to name items in a category and identify objects and/or pictures by their name. You will also participate in a conversation and the examiner will listen to the amount of information you provide in your responses (information content) and the ease with which you express yourself and the length of your messages (fluency). You can also expect to be given material to read and either answer the questions or follow the directions and asked to write information like your name and address and to write a description of a picture. The reading and writing sections will only be assessed if you were reading and writing prior to the onset of your language problem. Finally you may be asked to provide gestured messages, (i.e., "Show me how you would wave goodbye." Pretend to use a key to open a door."). At the conclusion of this testing the graduate clinician and the certified clinical supervisor will review your performance and determine the need for any further testing and additional referral. They will also outline your language profile in terms presence, type and severity of aphasia, determine your preliminary prognosis for improvement and make any recommendations regarding treatment options. See Treatment for Language Problems or Motor Speech Disorders Following Stroke.
Specific motor speech testing often includes the reading of single words, sentences and a paragraph and completion of a number of relatively simple tasks that permit assessment of a number of speech production systems: respiration, phonation, resonance, articulation and prosody. Respiratory assessment looks at the adequacy of your breath support for speech. Phonatory evaluation requires the clinician to listen to the quality, pitch and loudness of your voice. The assessment of resonance means that the clinician will compare consonant sounds that are to be made with air flowing through your nose (i.e., "m", and "n") with consonants without air flow through the nose (i.e., "p", "b"). Articulation assessment typically involves the review of the accuracy and clarity of production of all the sounds in English. Prosody means the inflections of your voice and the stress and duration changes in your sound production. This may be used for example to signal a question versus a declarative or to indicate your emotion, such as acceptance versus displeasure. At the conclusion of this testing the graduate clinician and the certified clinical supervisor will confer and determine your motor speech profile type and severity. They will discuss the need (if any) for additional referral, discuss probable prognosis for the improvement of your speech and make recommendations for treatment options which may include consideration of medical and/or speech treatment options.