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, this will impact on speech, language and cognition.

Difficulties with Speech, Language and Social Skills

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, and degenerative diseases such as Parkinsons. Other co-occuring problems may include difficulties with swallowing and saliva control. There different types of Dysarthria depending on the area of 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 see the Speech and Language Folder of our online Downloads Section.

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 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) when we want to produce voice. The meeting together of the vocal folds creates the voice which resonates in the pharynx, 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 may become 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.

Social Skills difficulties can present following the progrssion 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 Download Centre.

Difficulties with Reading and Writing

A decline in literacy skills may also be a symptom of a neurological disease. There are a few options to consider in these cases:

• Talking Books - to bring back some of the pleasures of reading

• Page turning machines - if you are able to read, but not physically able to access the book

• Voice activated software - that allows you to write text by speaking

• Assistive devices that allow you to access reading and writing options through the use of scanning, eye-gaze or special switches

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 are a common problem 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 (often with some forms of 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.

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

• Use timers and a Dictaphone for reminders

• Use step by step checklists

• 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