COMMUNICATION AND LANGUAGE DISORDERS, I.E., NONAPHATIC SPEECH DISORDERS AND APHASIA
Speech disorders can arise as a result of: strokes (ischemic or hemorrhagic), brain and cranial injuries resulting from accidents, oncological, endocrine and neurodegenerative diseases, as well as any disease of neurological etiology. At Neurological and Senior Rehabilitation Center Neuroport, we specialize in the treatment of speech disorders.
NEUROLOGICAL DISORDERS. WHAT IS THE RESEARCH LIKE AT NEUROPORT?
In a neurological examination, speech should be examined first, as its abnormalities can make it difficult to take a history. In addition, the results of the speech examination contribute to the evaluation of higher neural functions, which allows for further diagnosis. Speech is a chain of links in which hearing, understanding, formulating thoughts and words and combining them, voice production, and articulation are examined. Examination of each link identifies abnormalities in patients, which can present in the form of deafness (hearing loss), aphasia (loss of language ability), dysphonia (loss of voice), or dysarthria (articulatory disorders). Damage to the central nervous system can result in speech disorders in the form of non-aphasic speech disorders or aphasia. Depending on which hemisphere of the brain has been damaged, the neurologist determines an individual therapy plan. However, let's start at the beginning.
DAMAGE TO THE RIGHT HEMISPHERE OF THE BRAIN
If the right hemisphere of the brain is damaged, we usually deal with nonapophatic speech disorders. This means the abolition of communicative competence in the form of aprosodia, failure to understand complex utterances, prosopagnosia, constructional apraxia, biased skip syndrome, as well as a problem with constructing text appropriate to the situation, person and purpose. It should be noted that in right-hemisphere dysfunctions patients do not lose the ability to produce speech, they generally speak correctly. Speech comprehension, or so-called passive speech, is also normal. Damage to the right hemisphere results in disorders from the area of communication, not language. And so aprosodia, is a disorder of understanding and producing intonation. Patients are unable to differentiate emotion-laden utterances, and have difficulty expressing their emotions themselves. Their speech is monotonous without proper rhythm, tempo, intonation, without proper prosody. Patients with pathology of the right hemisphere of the brain may have problems understanding long, elaborate speeches with a complex logical-grammatical structure, so they should be addressed with short messages with a simple grammatical structure. In addition, with deeper damage, patients may not recognize the faces of people, even those in the immediate vicinity. This type of disorder is called prosopagnosia. Often, patients have difficulty performing basic activities of daily living due to apraxia (impairment of purposeful movements), for example, they cannot dress themselves or use cutlery. Patients may also suffer from lateral skip syndrome, where the patient has limited vision on the opposite side of the lesion, so in the case of right hemisphere damage, patients struggle with limited vision on the left side. Caregivers of such patients should also keep in mind that patients may have great difficulty expressing themselves due to spatial orientation disorders and are unable to properly assess the reality around them, such as confusing activities, rooms, objects, etc. When planning speech therapy neurotherapy, it is necessary to focus on the most disturbed area and start rehabilitation proceedings from there, while keeping in mind that the right hemisphere of the brain is responsible for creativity, imagination, space, music and controls the left hemisphere.
DAMAGE TO THE LEFT HEMISPHERE OF THE BRAIN
Quite a different therapeutic approach applies to patients with damage to the left hemisphere of the brain. In this case, we are dealing with aphasia. Aphasia causes disruptions in the realization of the formal subsystems of language-phonological (perception of the sounds of language), morphological (variety of parts of speech and vocabulary) and syntactic (array of utterances). This means that patients have great difficulty in constructing utterances according to the rules of organization of the language they use. Unlike right-hemispheric damage, in which the consequence is the loss of communicative abilities, in left-hemisphere pathology there is a loss of linguistic abilities.
NEUROPORT - NEUROLOGICAL THERAPY BY TYPE OF APHASIA
In order to determine the method and methods of neurotherapy, it is necessary to determine the type of aphasia. Nowadays, aphasias are divided into Wernicke's aphasia, Broca's aphasia, conductive aphasia, transcortical sensory aphasia and transcortical motor aphasia, each of which may be accompanied by a nominal component (naming difficulties). In Wernicke's aphasia, patients will not understand speech; they will perceive it as a conglomeration of sounds, with their speech being fluent and articulately correct, but the words will carry no sense or meaning. In Wernicke's aphasia, patients lose the ability to repeat and name. In Broca's aphasia, on the other hand, patients retain speech comprehension, but have difficulty producing speech, so verbal (word) communication resembles gibberish, is scandalized, and often the interlocutor gets the impression that the patient is stuttering. Patients find it difficult to find the place of articulation, and this means that they are unable to arrange the articulators to realize individual sounds. In transcortical aphasia (damage to the arcuate bundle), patients retain comprehension and form speech correctly, but repetition is abolished, while naming may be partially preserved. In transcortical sensory aphasia (damage to the posterior parietal-occipital area), patients retain the ability to repeat, but speech comprehension and naming are lost. Here, as in Wernicke's aphasia, words spoken by patients carry no meaning. With transcortical motor aphasia, patients retain repetition while losing speech fluency, with naming severely impaired. When examining patients to determine a therapeutic program, there is a need to check writing and reading, since this is just as much a form of communication with the environment. In addition, it is very important to determine handedness, i.e. whether the patient is right or left-handed. The result of the test will help determine the dominant hemisphere of the brain.
NEUROLOGICAL AND SENIOR REHABILITATION CENTER NEUROPORT: WE HELP FIGHT SPEECH DISORDERS
In summary, aphasia therapy is very complicated and takes a really long time. With deep damage, patients do not regain full language abilities. The premise of therapy is to develop the best possible communicative abilities, often non-verbal. It is necessary to work with patients systematically in an outpatient setting, but also at home. We should also remember that the discussed group of patients requires special care and support. They cannot be left without help, as they too want to participate in everyday life in their immediate environment. Neuroport Neurological and Senior Rehabilitation Center helps them return to fitness. It gives its patients hope and the strength to keep going. Don't wait, trust us. We are your partner in recovery.
Sylwia Swidzinska, M.A.
Neurologist Neurological and Senior Rehabilitation Center Neuroport
