For patients whose primary concern is a loss of language abilities due to loss of cognitive abilities therapies to help improve cognitive function will be combined with exercises that ask the patient to perform various language tasks. Speech and language therapy is only a small portion of the many different specialists that any patient with a CNS dysfunction will need.
Aphasia is the result of damage to the language centers of the brain (ASHA 2007a). The location of the language center is typically on the left side of the brain. This is true for almost all right handed people and almost 1/2 of all left handers (ASHA 2007a). When the language center of the brain is damaged, either by disease or trauma, a person might lose their ability to speak, listen, read or write (ASHA 2007a). Any type of damage to the brain can cause Aphasia.
Language is generally divided into two parts. We take about expressive language, which is the ability to produce speech and communicate. We also talk about receptive language, which is the ability to understand what is said by others. A person with a CNS disease might have problems with either one of these areas of speech or they might have problems in both areas (ASHA 2007a). Speech therapy must concentrate on both areas of communication in order to maintain the goals of the therapy.
There are many factors that can affect the progress and success of speech and language therapy. The educational level, age, health status (ASHA 2007a) and stage of disease progression affect the type of therapy used. These factors can have an effect on the success of the treatment program. Persons with severe aphasia might understand little of what is said to them at all. They might be limited to simple one word phrases, such as "yes" or "no" (ASHA 2007a). In some cases, the person might have problems with spoken language, but might be able to read or write (ASHA 2007a). Anomia is a form of aphasia where the person has trouble finding the word that they wish to use (ASHA 2007a). Forgetting the word for an object does not mean that the meaning of the object itself disappears, only the word for it.
Expressive aphasia can take many forms. A person might omit smaller words of speech, such as a, and, of, and the. The patient might put the words in the wrong order or use incorrect grammar (ASHA 2007a). Sounds in words might be switched. For instance, a glass may be called a fork. The person might switch the words around. A typewriter might become a write typer. The patient might make up nonsense words, or might string together sentences that do not make sense.
Receptive aphasia has just as many variations as expressive aphasia. A person might need more time to process spoken language. They might misinterpret common phrases, taking them literal, such as let the cat out of the bag. Phrases such as these might be confusing to a person with aphasia. They might wonder why the cat was in the bag in the first place. They need long pauses in speech in order to understand it.
Apraxia is a motor speech disorder caused by damage to parts of the nervous system that are used in speech. Apraxia is also referred to as apraxia of speech, verbal apraxia, and dyspraxia (ASHA, 2007b). This disorder produces difficulties sequencing the sounds in syllables and words. It can differ in severity depending on the extent and type of brain damage. People with apraxia know which words they need to use, but their brains have difficulty putting the muscles together to say them. The result is that instead of saying what the person wants to say, they say something completely different or something that makes no sense (ASHA, 2007b). For example the person might want to say "hello" but will say something such as "balpo" instead.
With aphasia, the person knows that they made an error. They might try to correct themselves, but once again, make another error. Aphasia can be frustrating and difficult for the person affected (ASHA, 2007b) and for those around them. Aphasia has many distinctive features that distinguish it from other speech and language disorders. The person might have difficulty imitating sounds and non-speech movements (ASHA, 2007b). They might have trouble making facial expressions or sticking out their tongue. They will grope for sound, or might not have the ability to produce sound at all (ASHA, 2007b). Error might be inconsistent and unpredictable to the person.
A person with aphasia may have a slow rate of speech, making it difficult for others to follow. They have difficulty with "automatic speech" such as greetings (ASHA, 2007b) or exclamatory remarks. Apraxia can occur in conjunction with dysarthria, which is a weakness of the muscles affecting speech production. It can also occur in conjunction with aphasia, which involves neurological damage (ASHA, 2007b).
In people with apraxia, speech abilities need to be retrained in order to teach them to produce sound correctly. The person must repeat sounds and words over and over again until their brain and muscles relearn them (ASHA, 2007b). The person might need to learn to slow their speech in order to give their brain time to think about what they wish to say. The person with apraxia may need assistive devices, especially if their condition is expected to worsen continually.
Dysarthria occurs as the muscles of the face, mouth, and respiratory system become weak. They may move slowly, or fail to move at all. This results in slow or "slurred" speech called dysarthria (ASHA, 2007g). Dysarthria is characterized by speaking softly, or only being able to whisper. It can lead to mumbling, or abnormal intonation (rhythm). It can lead to changes in the quality of the sound, making it sound nasal or "stuffy." It can lead to hoarsenes, breathiness, drooling, or difficulty chewing or swallowing (ASHA, 2007g). Dysarthria can be caused by a number of degenerative diseases including tumors, Parkinson's disease, ALS, Huntington's disease, and multiple sclerosis (AHSA, 1007g). Dysarthria typically develops later in the disease progression, but can occur at any time. Treatment for dysarthria depends on the cause and severity of the symptoms.
Speech and Language problems in Huntington's Disease
Speech and language problems are a special problem in a person with Huntington's Disease (HD). With these persons, the speech and language centers are affected early in the disease cycle, as opposed to later with diseases such as Parkinson's or Alzheimer's. This is because Huntington's Disease typically attacks the left side of the brain first. Huntington's Disease usually begins in a part of the brain called the caudate nucleus and putamen (ASHA, 2007c). These structures are located in the center of the brain. The disease quickly spreads to surrounding structures, including the speech and language centers. Communication and swallowing problems might be one of the first symptoms to appear because of the close proximity to the damage center. Speech and communication will decline rapidly with Huntington's disease.
Everyone's symptoms will vary. Sometimes new symptoms will appear. In other people the same symptoms will remain throughout the course of the disease, but they will continue to worsen in severity (ASHA, 2007c). Speech and language problems associated with Huntington's disease can include dysarthria, apraxia, poor voice quality, difficulty coordinating breathing and voice, and difficulties finding words. They might only be able to respond with one or two words. They might mispronounce words, or demonstrate a lack of ability to initiate speech. They might become "stuck" on certain words or phrases, repeating them often or at inappropriate times (perseveration) (ASHA, 2007c). Other symptoms associated with Huntington's disease include echolalia (person keeps repeating back what the other person says), stuttering, or difficulty in switching topics in a conversation (ASHA, 2007c).
Cognitive problems add to the difficulties in someone with Huntington's disease. They might be affected by diminished memory, poor reasoning or judgment, difficulty sequencing or organizing ideas, poor concentration, or diminished ability to learn new material (ASHA, 2007c). A person with Huntington's Disease might have problems with numbers or computational skills (ASHA, 2007c). The variety of symptoms depends on the areas of the brain that are affected and in which order they are affected. The speech and language pathologist can help in all of the areas that are affected by Huntington's disease. The role of the speech and language pathologist is to help maintain the highest level of functional speech possible (ASHA, 2007c).
Vocal Fold Paralysis
Vocal fold paralysis can result from a number of causes including neck injuries, tumors, a number of diseases, surgery, stroke, or damage to the vagus nerve (ASHA, 2007e). The vagus nerve branches from the brainstem to the larynx and regulates movement of the vocal folds. Degenerative diseases can lead to vocal fold paralysis. The symptoms of vocal fold paralysis include hoarseness, a breathy voice, the inability to speak loudly, limited pitch and loudness…