Transcript COMMUNICATION PROBLEMS FOLLOWING ACQUIRED BRAIN …

COMMUNICATION PROBLEMS
FOLLOWING
ACQUIRED BRAIN INJURY
Ailsa Paterson
Speech & Language Therapist
COMMUNICATION PROBLEMS
 Complex and Diverse
 Social Isolation
DYSARTHRIA/ANARTHRIA
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Disturbance of motor control
Speech is slow, slurred and difficult to understand
Imprecise articulation
Phonatory weakness
Reduction in pitch and loudness
Hypernasality
Rate of speech- slow or rapid
Respiration affected - reduced lung volume /abnormal
chest movements
PREVALENCE OF DYSARTHRIA
FOLLOWING
TRAUMATIC BRAIN INJURY
Dresser et al 1973
8 - 100%
Oliver,Ponsford and Curran 1996 - Motor speech problems in
34% patients with TBI - 5 years post injury.
DYSPRAXIA
Strength and coordination of muscles is unimpaired but Difficulty saying words in a consistent way
 Sound substitutions-  Multisyllabic words
 Fast rate
 Variable Intelligibility
DYSPHASIA
Impairment of language affecting
 Comprehension- spoken and written word
 Expression -
verbal output and written language
DIFFERNTIAL DIAGNOSIS
 Disorders of communication can co-exist
 Dysphasia and dyspraxia
EARLY INTERVENTION
 Work on feeding and swallowing before speech and
language
 Indirect therapy to improve alertness, attention, orientation
COGNITION
‘May be broadly described as the mental activities or
operations involved in taking
in,interpreting,encoding,storing,retrieving and making use
of knowledge or information and generating a response’.
Ylvisaker and Szekeres
COGNITIVE IMPAIRMENT
 Poor planning
 Poor problem solving
 Reduced /poor short term memory
 Loss of insight
 Reduced attention span
 Confused in time and place
 Delayed responses
PHYSICAL IMPAIRMENT
 Paralysis
 Hearing impairment
 Ataxia
 Balance problems
 Fatigue
 Visual difficulties
 Visually distracted
 Headaches
EMOTIONAL IMPAIRMENT
 Rapid mood swings
 Lower tolerance
 Emotional lability
 Apathy
 Emotional flattening
 Anxiety/depressed mood
 Disinhibition
ASSESSMENT
 To identify strengths and weaknesses
 Provide family,carers,team members with information
regarding communicative abilities
 Establish therapy goals
DYSARTHRIA
 Tone
 Head and trunk control
 Co-ordinate breathing with posture
 Facilitate vocalisation
 Reinforcement and repetition- MDT
 Establish core words
 Phonetic placement
DYSPRAXIA
 Reduce rate
 Allow time for motor planning
 Encourage listening
 Improve self- monitoring
AUGMENTATIVE COMMUNICATION
 As a back up to speech
 Writing, gesturing,drawing,typing,communication aid
LANGUAGE ASSESSMENT
COMPREHENSION:
 Increased length of utterance
 Complexity of utterance
 Rate of utterance
 Can he/she retain information and at what level
 What helps comprehension
EXPRESSION:
 Ability to retrieve words - to name objects,pictures at single word
level
 Can patient organise and express increasing amounts of
information
 Can he/she express needs
 Can patient initiate conversation
 Is conversation competent and appropriate
GOAL OF THERAPY
 Varies according to patient
 Aim to progress to the most independent level of functioning
possible
 Express needs by pointing to pictures
 Ability to express needs in simple verbal terms
 Improve ability to define words or describe consequences of
actions
ENVIRONMENT
 Quiet room
 Short frequent sessions
 Clear instructions
 Encourage and support
YES/NO SYSTEM:
 May be appropriate in the early stages
 Patient requires full assessment
 What is their level of comprehension?
SYSTEM MUST BE:
 Reliable
 Everyone must use it and be consistent in its use
 It should be written down
 Natural system most effective eg. Nod/shake head
 Must be distinguishable from random movements
HOW TO HELP IN EARLY STAGES
 Assume patient can comprehend something in what you say
 Gently touch and use their name to gain attention
 Speak softly, calmly, slowly.Use natural inflections- allow time to process
what you are saying
 Use short, simple but age appropriate sentences
 Talk to patient
 Do not ask questions unless you are able to respond in some way and you are
willing to honour the response
 Talk about here and now -objects or activities patient can see, hear
HOW TO HELP IN EARLY STAGES
 Discuss what you are going to do,what you are doing, what you have just done
 Give frequent repetition of orienting information
 Give patient time to respond
 Be attentive for natural communicative gestures
 Yes/no system- use natural gestures before more novel communicative
gestures
 Explore simple means of communication
 If patient uses inappropriate language - simply state facts correctly do not
argue
COMMUNICATION PROBLEMS
FOLLOWING
ACQUIRED BRAIN INJURY
Ailsa Paterson
Speech & Language Therapist
Thank you
Any Questions?