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 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 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.
I can joke and laugh with my friends and family.
Thank you so much to Hannelie for supporting me in therapy since 2015. I had a stroke while running a marathon for Tata Nelson Mandela and I could not speak at all afterwards. Despite therapy, my speech did not improve, until my family found Hannelie. I literally had to learn to speak from scratch again, and Hannelie taught me step by step. Today I am working again as a Senior Advisor and I am able to communicate with my colleagues effectively. Furthermore, I can joke and laugh with my friends and family – just like in the old days.
Frequently asked Questions
Do the medical aids cover the treatment?
The sessions are billed as speech therapy services rendered, which are covered by medical aids provided that your funds are not depleted.
How long will the patient need therapy?
The brain is extremely complex and takes months to recover when injured. Every patient’s prognosis is unique, depending on the site and extent of the brain injury. Although the recovery differs so widely among patients, one thing remains true: The first six months after a brain injury are the most crucial for therapy and have the biggest impact on the extent of the recovery. Therefore you can expect that therapy will be recommended for a few months until we feel that we have reached a plateau. Sometimes in cases of mild injuries, patients are discharged much sooner once their feeding or communication is satisfactory.
Can you train us on how to manage the patient at home?
Yes – training to family and carers is crucial and strongly encouraged. We can train care staff and significant others on how to optimise feeding and communication at home, what to look out for, what to alter at home and when to do follow up testing. We also provide individualised home programs worked out according to the patient’s skill levels.
When a person gets a stroke that affected the language centre in the brain, they have what we call “Aphasia” – a communication disorder due to language impairment. The person does not necessarily struggle to use his/her mouth to speak, but rather to remember the...