Are you struggling to express yourself after a brain injury or stroke?
Have work-related tasks become a challenge to you?
Unable to swallow and enjoy foods like you used to?
The mind… is not the heart
Language is a complex symbol system used by humans to communicate to one another. There are several neurological systems involved that need to collaborate with exact precision in order for us to say a sentence. The language centres of the brain comprehends and formulates language content, while the cognitive structures enable us to make accurate conclusions and generate appropriate responses. The information between the mouth, ears and brain are sent via sensory and motor nerves, and muscles are programmed with extremely precise movements to articulate with clear speech. If any of these systems are affected, the person’s communication skills may be disturbed. Damage to these systems usually occur due to stroke (CVA), aneurism, transient ischaemic attacks (TIA), or trauma to the brain, referred to as traumatic brain injury (TBI), typically from motor vehicle accidents or falls. Progressive conditions such as Dementia or Parkinson’s Disease may also affect these brain areas. The different areas of the brain are each responsible for certain functions, therefore the site of the lesion determines what kind of difficulties a person may experience as a result of the brain injury. Speech therapists are part of the team assisting with the rehabilitation process after a brain injury. Typical conditions that we treat on a daily basis include:
Dysphagia (feeding difficulties)
Difficulty in chewing and/or swallowing is quite common after surgery or brain injuries. The structures involved in eating may be physically altered or swollen, or on a neurological level, the planning and coordination of the swallowing process may be slow or affected. Swallowing difficulties not only interfere with maintaining life and nutrition, but can also have a serious unpleasant effect on one’s social life, leading to avoidance of social events and isolation.
As speech therapists, we aim to achieve good quality of life despite these difficulties. We provide rehabilitation services in the form of dysphagia therapy, aiming to strengthen and improve the functioning of the swallowing mechanisms to allow for safe swallowing. We further teach and advise on compensation techniques to bypass swallowing difficulties, such as adaptations of posture and food consistencies. Where indicated, we accompany the patients to specialised video x-ray tests (videofluoroscopy) to see exactly what goes wrong during the swallowing process, and work out new treatment aims and methods based on the results. Hannelie Kroon is qualified in Myofascial Release Dysphagia Therapy, where specific techniques are used to strengthen the muscles of the swallowing mechanism. She and her teammates are responsible for the feeding and communication rehabilitation at the award-winning Sub-Acute facility, Care@Midstream. They also offer these services on an out-patient basis at both of their practices.
Aphasia
Aphasia results from damage to the language centres of the brain, and refers to an acquired impairment of language. Typically after a stroke, a person may find that “the words are just gone”, resulting in unusual pauses, word and sound substitutions, or broken speech. Word finding difficulties are one of the most common symptoms of aphasia. Aphasia is not an impairment in intellect, a memory problem or pronunciation difficulty – the affected language centres cause the speech to come out so strange as it was not planned correctly. People with aphasia struggle to come up with the appropriate words and to combine them into meaningful sentences. Often, patients with aphasia demonstrate that they still have relatively well-preserved thought processes or cognitive abilities.
Aphasia is a highly frustrating condition, both to the significant others, but especially to the patient. They often know exactly what they feel and what they would like to say, but can’t find the words or the planning to do it. They are aware of their difficulty and therefore highly upset with the impairment. They may even get depressed after the stroke. As speech therapists, we evaluate carefully to determine the degrees of comprehension and expression skills that are affected, and which abilities have remained functional that may be used to rebuild those skills. We provide intensive therapy assisting with compensation techniques, verbal and non-verbal expression and comprehension, and carer and family training to optimise communication between the patient and family and staff. Hannelie Kroon is trained in Supportive Communication for Aphasia and she and her team treats Aphasia on a daily basis.
Apraxia of speech
Apraxia of speech typically occurs after a stroke and is refers to a disorder in the planning of the movements for speech production. Different from Aphasia, this patient is able to plan the language around the message, but when the movements of the mouth is planned in the brain, errors occur, leading to mispronunciation of words. Sounds in words are substituted with other sounds, but the errors are inconsistent, so that repeated attempts at the same word come out differently on each attempt. These patients often have much better language comprehension than patients with Aphasia. Apraxia and Aphasia sometimes co-occur, depending on the site of lesion in the brain. We have treated numerous patients with Apraxia with great success following the principles of the Apraxia Program for retraining the motor planning of speech sounds.
Dysarthria
Dysarthria refers to unclear or unintelligible speech due to weakness, slowness of incoordination in the muscle groups responsible for speech. The muscle weakness and poor control typically result in imprecise articulation of speech, causing the sounds to be distorted. Speech can also be hypernasal, monotonous or with affected voice quality, depending on the lesion on the nervous system. The treatment for Dysarthria is mostly based on strengthening the muscle groups involved. We have helped several patients improve their speech intelligibility and use meaningful speech after a brain injury.
Cognitive linguistic difficulties
Typically after an injury to the frontal cortex of the brain, patients may present with difficulties in cognitive functioning and executive skills. We use these skills on a daily basis to interact with others appropriately, to work, to make decisions and to process information. These skills include memory, reasoning, categorisation, thought processing, attention, inferencing and summarising among others. Patients with these difficulties may behave inappropriately and may be unable to continue with their work or everyday responsibilities without intensive rehabilitation. Our team treat cognitive difficulties daily, ranging from basic thinking skills to advanced cognitive work in preparation of returning to work.
