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Speech Therapy After Injury

Image of Bobbie Byrd
Bobbie Byrd

Communication skills are the foundation of human interaction, so sustaining an injury that impairs or deprives us of the ability to speak can be a devastating blow. That's why speech therapists have highly effective treatments available to help patients restore their speech and language capabilities to the maximum extent possible. 

In fact, traumatic brain injury (TBI) and neurological conditions such as Parkinson's disease, multiple sclerosis and Alzheimer's disease are common causes of cognitive communication disorders. So, because May is Stroke Awareness Month, join us in learning more about speech therapy and its opportunities for patients recovering from cerebrovascular injuries such as TBIs or stroke.

What Is A Speech-Language Pathologist?

A speech-language pathologist offers speech therapy for adults and children. By assessing and diagnosing a patient's challenges, including problems with social engagement, cognitive communication or difficulty swallowing, speech-language pathologists work with patients to prevent as well as treat language disorders and speech impediments. 

Differentiating, Speech, Language and Social Communication Disorders

People of all ages are vulnerable to speech disorders that interfere with the ability to create words, whereas trouble understanding others or sharing thoughts, feelings and ideas is a type of language disorder that affects the ability to actually comprehend spoken or written words. The cause of speech disorders can vary from cleft palate, a common birth defect, to brain damage that results in apraxia or dysarthria.

Difficulty with verbal and nonverbal communication may have a negative impact on a person's social interaction skills and are often prevalent among individuals with autism spectrum disorder. Here are several examples of social communication disorders:

  • Problems communicating socially
  • Difficulty adjusting verbal sounds to accommodate the setting and the listener
  • Problems following rules for conversation and telling stories

Cognitive Communication Disorders and Swallowing Disorders

According to ASHA, a cognitive communication disorder is any communication difficulty caused by a disruption in cognitive abilities. Potentially impaired processes may include attention span, memory, problem-solving and reasoning as well as executive functions which may negatively impact verbal and nonverbal communication, such as speaking, reading, writing, listening and social interaction. 

Speech Therapy For Traumatic Brain Injuries and Stroke

Anything that affects the way the brain works can cause language and speech disorders, disability or even death. Common causes of brain damage include tumors, traumatic brain injury (TBI), stroke and illnesses that may cause brain inflammation. It also isn't uncommon for someone to experience weight loss in the aftermath of a stroke because of difficulty with feeding and swallowing. In some scenarios, patients may require feeding tubes temporarily or permanently to maintain proper nutrition. All of these symptoms and effects of a TBI or stroke are what will ultimately determine the type of speech therapy that is needed. 

Dysarthria 

Typically following brain injury, dysarthria can be present in childhood as well. This condition is recognized by the weakening of muscles in the face, lips, tongue and throat, so much so that speech often becomes difficult to understand.

After evaluation and diagnosis, a speech-language pathologist treating a patient with dysarthria may prescribe a series of exercises to improve lip and tongue coordination, increase breath support as well as build up muscle power in the throat, tongue, jaw and mouth. Depending on the symptoms and severity of dysarthria, treatment may also include therapy that focuses on slowing speech, using more breath to speak louder or leveraging other ways to communicate entirely.

Apraxia

While apraxia can occur in other parts of the body, apraxia of speech is when the brain is unable to correctly send signals to the muscles needed to verbally communicate, resulting in pronunciation issues. It’s not uncommon to see both apraxia and dysarthria display in tandem, often stemming from the same brain injury.

For apraxia, treatment often includes repetitive exercises to improve pronunciation. In more severe cases, Augmentative and Alternative Communication (AAC) methods, which can incorporate hand gestures or assistive technology, may be considered.

Aphasia

This language disorder typically occurs when there is brain damage to the left half of the brain - commonly as a result of a stroke. While these injuries generally do not impair the ability to think clearly, the ability to understand, speak, read or write may be significantly affected to the point where communication proves difficult. 

Common indicators of aphasia may include:

  • Forgetting words, making up words or switching words around when speaking
  • Problems with comprehending what others are saying, especially when there are fast speakers and noisy environments
  • Difficulties reading books and screens
  • Struggling to spell words correctly
  • Trouble with basic math skills, such as adding and subtracting

From computer-based treatment that allows patients to communicate through technology to intensive programs such as Constraint-Induced Language Therapy (CILT) which discourages alternate forms of communication in an effort to develop verbal language skills, treatment options for aphasia vary widely and highly depend on the personal goals of the patient. Remarkably, there have even been instances where patients that can speak multiple languages are able to use a secondary language to relearn communication skills lost to aphasia.

Dysphagia

This swallowing disorder that affects over 50% of stroke survivors is a feeling of impending regurgitation of food or liquid stuck in the chest. It can impact the oral cavity, pharynx, esophagus or gastroesophageal junction and can have dangerous consequences that impact the patient’s overall well-being if left unaddressed. Those who live with dysphagia often need to be fed through a tube to maintain nutrition and hydration.

After a comprehensive assessment to determine the level of intervention needed, speech-language pathologists focus on developing a treatment plan that first prioritizes the patient’s quality of life, such as determining the optimal posture or assistance needed for comfort. Then, in order to improve function, forms of therapy or surgery are considered. Common treatment options and techniques include:

  • Biofeedback. Through specialized equipment, patients with sufficient cognitive skills can monitor their own abilities and make adjustments accordingly.
  • Diet modifications. Pureeing food to a viscosity that is comfortable and safe for patients to ingest orally is a common method of treatment.
  • Electrical stimulation. This encourages movement in swallowing muscles by applying a small electrical current to peripheral nerves.
  • Maneuvers and swallowing exercises. These specialized exercises of the lips, jaw, tongue, soft palate, pharynx, larynx and/or respiratory muscles may increase mobility as well as regain strength.
  • Medication. Some symptoms can be mitigated through anti-reflux and salivary management medications.
  • Surgery. From thyroplasty and airway stents to botulinum toxin injections, there are many forms of specialized surgery options that can improve functionality.
  • ​Complications. Notably, the placement of a breathing tube in the throat, called endotracheal intubation, can cause injury as well, resulting in post-extubation dysphagia. This form of dysphagia is not a result of brain injury but may require similar intervention.

Why Flexible Technology Matters For Speech Therapists

According to the National Institute on Deafness and Other Communication Disorders (NIDCD), about 7.5 million people in the United States experience trouble using their voices. On the other hand, The U.S. Bureau of Labor Statistics reports that there are approximately 158,100 speech-language pathologists currently employed. With such an unbalanced ratio of patients to therapists, speech-language pathologists are often overwhelmed and faced with the decision to sacrifice time dedicated to patients in order to manage the financial and clinical side of operating a practice.

Here at Raintree Systems, our technology-enabled solutions help streamline the day-to-day tasks of therapy and rehab practices as well as enable speech-language pathologists to deliver higher quality of care to more patients than ever through our highly configurable patient engagement platform, Connect. If you're interested in how our industry-unique Software-as-a-Relationship approach can make for a more efficient practice and personalized patient experiences, schedule a free demo today!


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