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Neurological Disease and Communication Difficulties

 
 
 
See our Progressive Neurological Disease Home Page for a full list of information about progressive and degenerative neurological disease, and links to information and strategies relating to communication and cognitive functioning.
 
 
The brain is an exceedingly complex mechanism and is made up of many different working parts. When one or more of these parts stops operating efficiently because of a progressive neurlogical disease, the outcome might be speech, language and/or cognitive difficulty.
 
 
Difficulties with Speech, Language and Social Skills following Neurological Disease:

Dysarthria

Dysarthria is a motor speech disorder caused by a neurological injury or disease and it can affect one or more of the speech subsystems – respiration, phonation, resonance, prosody, articulation. Injury or disease to the speech musculature may also cause dysarthric like symptoms. When the part of the brain that controls speech production is damaged, the link from the brain to the muscles of speech is affected. Dysarthria can present in varying degrees of severity depending on localization and severity of brain damage. The production of speech sounds may be very difficult and in some cases speech may not be possible. The lips, tongue, palate, facial muscles, and the vocal folds (chords), may be uncoordinated or immobile. Further difficulties may occur if breathing is also affected as the lungs provide the energy for speech. An individual with dysarthria may have slurred, hoarse, jerky or strained speech and may be difficult to understand or completely unintelligible. Intelligibility may be further hindered by low volume, variable rate and rhythm, and irregular pitch. As well as traumatic brain injury, dysarthria can be caused by brain tumour, stroke, cerebral palsy, long term use of certain medication, or degenerative diseases such as Parkinsons and Multiple Sclerosis. Other co-occuring problems may include difficulties with swallowing and saliva control. There are different types of Dysarthria depending on the area, and type of brain damage. Treatment for dysarthria can be carried out by a speech and language therapist / pathologist and may involve strengthening or relaxing speech muscles, using compensatory techniques, or looking at assistive communication strategies or devices. For a more detailed explanation of Dysarthria and the compensatory strategies go to our online Downloads Section, or the Dysarthria page.

 

Dysphonia

Dysphonia is a hoarseness, weakness or loss of voice. Following a stroke, disease, or trauma to the larynx, there can be a paralysis of the vocal folds (often called the vocal cords) and weakness of the muscles relating to phonation (voice). Voice is powered by air from the lungs, the air passes through the larynx which contains the vocal folds. The vocal folds are 2 folds of muscle that meet together many times per second (approximately 125 per second for men and 210 times for woman) and produce voice. The meeting together of the vocal folds creates the voice which resonates in the pharynx (back of the throat), oral and nasal cavities, and is then shaped into words by the speech apparatus – the tongue, lips, facial muscles etc.
Following a stroke, injury, brain injury or the development of a degenerative disease, the vocal folds and the muscles that control them may become weak or paralysed. One or both vocal folds may be paralysed, and this will affect the voice and intelligibility. If there is a combined Dysarthria and/or difficulties with breathing, this will have a further effect on intelligibility. Compensatory strategies or alternative forms of communication may have to be considered to allow the individual to communicate effectively. A Speech Therapist/Pathologist can help you develop compensatory strategies or look at assistive communication options. See our section on Assistive Communication for more details about alternative forms of communication.

 

Aphasia

Aphasia (or dysphasia) affects an individual’s ability to use and understand language effectively, and is often a symptom of a degenerative disease. For some adults, the understanding of language will remain relatively well intact, but they may have more difficulties expressing their needs. For the individuals with these severe problems it is important to focus on a total communication environment. This means using every means possible to help with expression and understanding. Click this link to read more about Total Communication.

There are different types of aphasia, depending on the area of brain damage, and these aphasia’s present with different symptoms. Some neurological diseases leave language abilities intact, but commonly there is a deterioration in understanding, word finding, literacy skills and/or expression. Go to our Aphasia Section to read more.

Social Skills

Social skills difficulties can present following the progression of some neurological diseases. This may occur individuals loose the function to regulate thinking and behaviour. Difficulties with self-regulation can lead to impulsive behaviour or verbalisations and may present in several ways:

 

  • Making inappropriate remarks or statements
  • Being rude
  • Dominating the conversation
  • Continually talking about a certain subject
  • Not being able to stay on topic

A suitably qualified speech and language therapist/ pathologist may be able to help the indivdual have more awareness of these issues in the early stages of the disease, but ultimately, if a decline in social skills is part of the pattern of the disease, the above problems may occur.

For more strategies to facilitate communication skills following the diagnosis of a neurological disease, visit our online Resource Centre.

 

Difficulties with Reading and Writing

A decline in literacy skills may also be a symptom of a neurological disease. However, nowadays technology provides many options to help with reading and writing. Below are a few examples:

  • Recording Pens – these pens can record lectures or meetings while you take notes. You can then concentrate on note writing and listen back to the meeting later to compare with your notes. Other pens just record a 10 second message, but this can be useful if you have an idea – you can record it, and then if you forget the idea before you have finished writing it, you can play it back.
  • Page turning machines – if you are able to read, but not physically able to access the book, these machines can turn the page at a touch of a button.
  • Talking Books – many books are now in an audio version so you can still listen to stories and non-fiction books if you cannot read them.
  • Speech Recognition/Dictation software – if you have trouble writing, you can use different software which will type your dictation for you on a computer*.
  • Reading Pen – this is a pen that scans a line of text and reads it to you.
  • Eye Gaze technology – this will allow you to control the cursor on a computer screen, type, access the internet etc – all with the movement of your eye
  • Accessibility Options – computers and laptops have accessibility options which provide tools such as magnifying, narration, and changing the mouse and keyboard functions. To find out more about these options, see our Accessibility Options page.

* Versions of Microsoft Windows provide a free version of speech recognition/dictation software – To access – click the “Start” button, choose the “All Programs” Menu, Choose “Accessories”, choose the “Ease of Access” menu and there you will see a number of options that may help including, Magnifiers, Narrators (to read what is on the screen), and Windows Speech Recognition.

See our section on Assistive Communication options for more details about hi-, and lo-tech options to help with communication and literacy skiils.

 

There are also some simple strategies to use if your literacy difficulties are less severe. For instance, write a note or keywords in the margin with a pencil to refer to if you have difficulty remembering what you have just read. Or,summarise the important aspects of what you have read into a Dictaphone and then play them back next time you open the book. If you have difficulty with writing, get someone else to proof read your work to make sure it is correct and makes sense.

Visit our Download Centre for a free information sheet containing strategies to facilitate reading and writing.

 

Difficulties with Memory, Attention and Planning

Memory difficulties sometimes occur following the onset of some neurlogical diseases. Memory works in several stages and difficulties may occur at some, or all of these points:

  • An individual may have difficulty holding information as they hear it because they have difficulties concentrating or attending.
  • Difficulties may occur when the individual is processing information. The information needs to be held, processed, and then stored.
  • The individual may be able to hold and store information, but then not be able to access it.

 

Sometimes long term memory often remains more intact (this can be the case with dementia), but there is a problem with short term memory and storing new memories. Remembering the right words and word finding difficulties may also be a common problem. There are many strategies to put in place to help memory, and it is important to put these in place soon after diagnosis:

 

  • Get into a routine so things become a habit.
  • Use a diary, calendar and lists and get used to checking them several times a day. Write everything you need to remember. Put lists down the side of the page and tick the things off as you do them. Put the diary somewhere obvious so you can see it.
  • Have systems for everything, have a filing system for paperwork, use calendars, sticky notes, noticeboards, set alarms on your mobile phone as a reminder for appointments etc.
  • Always put things in the same place – diary, keys etc.

 

For a more detailed list of strategies to facilitate memory skills visit our online Download Centre.

 

Executive Functioning refers to those skills and abilities that enable us to accomplish goal-directed activities. There are several steps to completing a task:

  • Planning – knowing and / or planning the steps for an activity
  • Initiation – starting an activity
  • Doing the task – carrying out your plans and at the same time, self monitoring and self regulating
  • Evaluating – looking at the results of your work
  • Changing and improving – looking at ways of making the task easier next time and avoiding any mistakes

 

We use these executive functions for all sorts of everyday tasks such as cooking, doing our laundry and shopping. To accomplish a task we must initiate each step, organise and follow through, and while this is going on we need to monitor and adjust our actions as necessary. Most of us do these things without much thought or planning. A neurological disease may impact on our ability to perform tasks efficiently. We can implement strategies and systems to help us with our executive functioning difficulties:

 

  • Daily planners and organisers
  • Home information centre – noticeboards, calendars etc
  • Set aside time each day for planning
  • set timers and a mobile phone alarm for reminders
  • Use step by step checklists

For a more detailed list of strategies to facilitate executive functioning skills visit our online Download Centre.

 
Attention
We are all equipped with a very complex and dynamic system of attention. These skills allow us to go through life attending to the things that are important and blocking out the stimuli that is not important. Our attention skills allow us to do more than one thing at a time, or switch between 2 different activities. These skills are often compromised following the development of a neurological disease. Attention skills are important because we need them to carry out most daily tasks and to communicate effectively.

  • Sustained attention – this skill is needed to maintain attention over a period of time to complete a task.
  • Selective attention – this skill enables you to attend to something without being easily distracted by background noise, or movement.
  • Alternating attention – this skill allows you to switch between 2 activities and not just focus on one and forget the other.
  • Divided attention – this skill allows you to divide your attention between 2 tasks e.g. driving and talking at the same time

 

Difficulties with attention have affects on communication and day to day tasks such as driving and cooking. However, there are many strategies you can use to facilitate attention and concentration, such as monitoring your fatigue, trying not to multi-task, and eliminating distractions when you are talking to someone. For a more detailed list of strategies to facilitate attention skills visit our online Download Centre.

 
 
For more information about communication difficulties, and ideas and strategies to help communication, see our Resources, or for specific fact-sheets about progressive and degenerative neurological diseases and information and strategies for improving communication and cognitive functioning go to the Downloads Section.

 

Recommended Reading

 

 

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