Rehabilitation of Communication Disorders

Abstract

Speech, communication and language disorders are many and heterogeneous. The modalities of communication affected include spoken understanding and expression, reading, writing and gesture. The three predominant speech and language disorders that can be acquired post-stroke are as follows: AphasiaAphasia is a language disorder affecting understanding of spoken language; the ability to express thoughts verbally, including difficulties with word retrieval (anomia), and sentence production; the ability to read and understand written words and sentences and the ability to write including spelling and structuring written sentences. These difficulties result from damage to the left side of the brain in the majority of people. The extent of impairment to each of the four language domains varies from person to person depending on the locations and extent of neurological damage. Flowers et al. (2013) estimated the incidence of aphasia post-stroke to be 30%. DysarthriaDysarthria is a motor speech disorder resulting from impaired movement of the muscles used for the production of speech. The main parameters of speech are respiration, phonation, resonance, articulation and prosody. One or more of these parameters can be affected leading to reduced speech intelligibility and reduced communication effectiveness. These parameters can be impaired in different ways (for example muscles may be more or less paretic, become hypotonic or hypertonic), and they may each be impaired to different extents. This results in different dysarthria profiles (e.g. Darley et al. 1975). Flowers et al. ( 2013) estimated the incidence of dysarthria post-stroke to be 42%. ApraxiaApraxia of speech (AOS), also known as verbal apraxia or dyspraxia, is also a motor speech disorder. AOS results from a reduction in the ability to co-ordinate the gestures required for speech leading to difficulty producing the right sounds in the right order when speaking. It is characterised by multiple different attempts to articulate words accurately. AOS can occur in isolation, but frequently coincides with expressive aphasia. AOS is acquired with lower frequency following stroke than aphasia or dysarthria.Aphasia, dysarthria and apraxia are not mutually exclusive, and more than one speech and language disorder may need to be treated.Communication impairments affect everyday activity, for example the ability to have conversations, make phone calls, listen to the radio, write letters, construct emails and text messages and read for pleasure, for information or for work. They may also affect the use of sign language for people in the deaf community. In turn, they restrict participation: the ability to carry out pre-stroke employment, loss of roles within the family and community and withdrawal from participating in usual activities both outside of and within the family. These changes affect the wellbeing of both the person with a communication disability and their family/carer with increased frustration, misunderstandings and breakdown/strain on relationships. For the care...

Discapacidad cognitiva in-visibilizada: rutas de evaluación y certificación en Costa Rica

“…Existen estudios que han determinado que el Mini Mental State Examination (MMSE) no resulta lo suficientemente sensible ni específico para esta población (Sivakumar et al, 2014;Van Heugten et al, 2015). En el caso de personas que presenten déficits de comunicación leves o moderados puede utilizarse también el MoCA; sin embargo, en pacientes con déficits severos son necesarios instrumentos especializados como el Test de Afasia Comprensivo (Palmer & Pauranik, 2021).…”