Communication disorders with it's implications and it's management Defined communication processes. Have any doubt any lacking please drop in comment box

1. Communication
disorder
Dr. keerti gour (PT)
NEUROPHYSIOTHEREPIST

2. • Communication is a process by which information is exchanged
among individuals. It is primarily accomplished verbally, but non-
verbal gestures and written communication are also included.
• Communication comprises all of the behaviors human beings use
to transmit feelings and ideas, including gestures, pantomime,
and the processes of speaking, writing, reading, hearing, and
understanding visible and oral symbols.
• Modalities Of communication:-
1. Expressive.:-express information
2. Receptive.:-understanding or decoding processes.
3. Linguistics:-deals with among speakers of any language
INTRODUCTION :-

3. • Communication may be studied under the following
categories:-
• Speech and its disorders.
• Communication for the hearing impaired.
• Augmentative communication.
• Communication for the visually impaired.
• Other aids in communication.
Domains :

4. • Speech disorders are classified under:
• • Aphasia
• • Dysarthria
• • Dysphonia
• APHASIA
• Definition: It is a communication disorder caused by brain
damage and characterized by an impairment of language
comprehension, formulation and use.
SPEECH

5. • Global Aphasia: When a patient manifests with non-fluent
aphasia where there is a severe loss in comprehension and
repetition the aphasia is global. Severe deficits are found in
all language processes, including speech production, auditory
comprehension, reading and writing.
• Isolation Aphasia: All language processes are poor, except
for the ability to repeat.
• Broca’s Aphasia : Speech production is poor and slow, with
impaired articulation, and grammar. Comprehension is
relatively good except for complex sentences and reading is
superior to writing.
Types of Aphasia

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7. • Transcortical Motor Aphasia: The speech in some ways is similar to Broca’s
aphasia. However the main feature of this rare syndrome of aphasia is the
preserved ability to repeat fluently.
• Wernicke’s Aphasia: Speech is fluent with paraphasic errors (sounds in
words may be substituted). Comprehension of the spoken, written word is also
impaired. The fluent aphasic produces speech effortlessly. However, the content
of speech is not clear. Some aphasic patients produce jargon or repeated
unintelligible and stereotyped phrases (jargon aphasia). They are unaware that
they are not communicating to the listener.
• Transcortical Sensory Aphasia: This rare syndrome is similar to Wernicke’s
aphasia; however the ability to repeat words is preserved. The affected
persons have poor comprehension, but their speech is fluent and grammatical.
Aphasics do not use the correct word, but use another word of similar content
like ‘biscuit’ for ‘bread’.
• Conduction Aphasia: Spontaneous speech is relatively fluent with good
understanding of the spoken language, but there is selective loss of the ability
to repeat what somebody else says. The person is able to understand what is
spoken and is fluent in his speech with word substitution in the speech
production. Patients will display frequent errors during spontaneous speech,
substituting or transposing sounds
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8. • Anomic Aphasia: Speech is well articulated, grammatical
and fluent, but is marked by severe word finding difficulties.
The patient always seems to search for the right word for an
object, though he knows what its function is. Auditory
comprehension is good and reading and writing are variable.
Many aphasia tests are tests of intelligence adapted for use
with aphasic patients, without the benefit of standardization
on populations of aphasic patients. Aphasic tests are not
diagnostic. A retarded person, an illiterate, a Broca’s and
Wernicke’s areas in the brain.
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9. • Dysarthria refers to motor speech defects that results from
trauma or disease of the nuclei or fiber tracts in and adjacent
to the brainstem that sub serve the speech musculature. The
pattern of speech produced by a specific dysarthric individual
depends on the site and severity of lesion.
• Articulation, loudness, rate, phonation, resonance,
pitch, rhythm and stress patterns are the aspects of
speech to be noticed. Articulation is optimal when speech is
produced slowly.
DYSARTHRIA

10. • Flaccid Dysarthria: Damage to the nerves or their nuclei
will result in speech characterized by a breathy voice, hyper
nasality, imprecisely produced consonants, slowness,
incoordination of speech mechanism, reduced volume, and
escape of air through the nose (nasal emission). Flaccid
dysarthria occurs in patients with a brainstem lesion, stroke,
polio, myasthenia gravis or bulbar palsy.
• Spastic Dysarthria: If the site of neurological lesion
involves upper motor neurons, a spastic condition may result
in a speech pattern characterized by imprecise consonant
production, monotonous pitch, a strained-strangled voice
quality, hyper nasality and occasional pitch breaks. Spastic
dysarthria patterns are observed with spastic or athetoid
cerebral palsy and pseudo bulbar palsy.
Types of Dysarthria

11. • Cerebellar Dysarthria: Word selection is not altered, but the
melodic quality of speech is changed. Patients with cerebellar
disorders produce a characteristic speech pattern that includes
irregular breakdown and distortion of speech articulation. Prosodic
patterns are unusual in that some patients stress nearly all
syllables equally.
• Scanning speech is a typical example of cerebellar dysarthria.
Words or syllables are pronounced slowly, accents are misplaced
and pauses may be inappropriately short or long.
• Hypokinetic Dysarthria: Patients with movement disorders also
demonstrate unique dysarthric patterns.
• Hyperkinetic Dysarthria: Patients with movement disorders
resulting in excessive motor activity, such as dystonia and chorea,
exhibit hyperkinetic dysarthria, with fast paced speech.
Continue .

12. • Aphonia refers to an absence of sound.
• Dysphonia refers to a number of phonatory disorders of
sound quality e.g. Vocal nodules, laryngitis, vocal polyps.
Dysphonia may also result from vocal cord paralysis or cancer
of the larynx. Primary objectives of voice evaluation are:
• The term ‘Laryngectomy’ refers to the removal of the larynx
(partial or total). An incomplete laryngectomy may or may not
influence voice quality. .
• laryngectomy results in complete loss of voice, and an
esophageal voice may be needed. An esophageal voice is
produced by vibration of the upper narrow portion of the
esophagus when air is ingested into the esophagus and
released.
DISORDERS OF PHONATION

13. • According to the PWD Act 1995, hearing impairment means
loss of 60 decibels or more in the better ear in the
conversational frequencies. Peripheral hearing impairments
can be usefully divided into three categories for rehabilitation
purposes, based on the side of the lesion responsible for the
hearing impairments.
• Causes for Conductive Impairment
• Congenital atresia of external auditory meatus
• Foreign bodies, e.g. tumor, cartilage or bone in external auditory
meatus
• Collapsed ear canal
• Otosclerosis
• Otitis media
• External otitis
COMMUNICATION FOR THE HEARING
IMPAIRED :-

14. • It is a measurement of hearing, the basic test to determine the
degree and type of hearing loss.
• An audiometer provides pure tones of selected frequencies.
The patient records the level at which the tones are heard and
the results of the test are recorded on an audiogram which
comes out as a graph showing hearing sensitivity. The range
between 10 dB and 25 dB in the audiogram is considered to be
within normal limits.
Continue..

15. • Management depends on type of loss, degree and age of
onset. Management falls into three categories:
• Surgical and medical intervention,
• Corrective amplification and
• Counseling.
• Speaking Aids:-
• Artificial larynx: The electro larynx is a sound source
implanted in the body. In these small devices, a reed is
vibrated by the exhaled air from the lungs. Another
technique is a surgical implant device placed in the area
where tissue was removed during laryngectomy.
Management of Hearing Impairment

16. • Hearing Aids
• A hearing aid (Figs 5.4 and 5.5) is any device that brings sound
more effectively to the ear of the listener. Hearing aids are
commonly classified by their location on the body. The types are:
• • Behind the ear:-is intended for those who present a mild to
severe loss of hearing.
• • In the ear:-aid—It is intended for those who present a mild to
moderate hearing loss. It entirely fits into the concha of the ear.
• • Eye glasses:-contains the three basic components and the
battery, thus forming a single monaural hearing aid.
• Auditory Prosthesis
• This is an implantable cochlear prosthesis for the hearing
impaired, which bypasses the non-functional parts and
stimulates the remaining viable parts of the auditory system, by
inserting flexible electrodes into the scala tympani through the
round window

17. • Cortical Stimulation
• Another type of auditory prosthesis attempts to bypass the
ear and the auditory nerve completely by electrically
stimulating the auditory processing areas of the cerebral
cortex.
• SPEECH THERAPY
• Speech therapy is the treatment administered by a speech
pathologist. A speech pathologist is an individual trained to
diagnose and treat speech disorders.
• Auditory Training
• Systematic training in speech discrimination in various
listening situations will be necessary for many persons with
sensorineural hearing impairments.
Continue ….

18. • Lip Reading
• The hearing impaired person looks for movements of face and
lips, which may be slightly exaggerated, with the face of the
speaker in full light. He then perceives learned patterns of
movement to form words and then associates these patterns
with meaningful concepts.
• Sign Language
• Is a mode of communication in which, a combination of hand
gestures, orientation and movements of the body and face
transmits visual signs to convey meaning.
Continue…

19. Cleft Palate
Mental Retardation and Cerebral Palsy
Autism
Bells Palsy
Drooling Management:-Drooling is the abnormal spillage of saliva from
mouth onto lips, chin, neck, clothing or floor. Minimal drooling is normal
until two and half years of age. Extensive drooling is often seen in
children with cerebral palsy.
Treatment Options
• Correct anatomical problems related to the oral cavity
• Behavior modification—keep reminding child not to drool
• Oro-neuromotor exercise and feeding program, stimulation of the oral
apparatus
• Surgery (e.g. repositioning of salivary duct).
Conditions Treated with Speech
Therapy

20. • Dysphagia or difficulty in deglutition is defined as any defect in the intake or
transport of endogenous secretions and necessary food for maintenance of life.
Tests may include:
• Barium swallow and upper GI series
• Chest x-ray
• Endoscopy
• Esophageal acidity test (used to test for gastroesophageal reflux disease)
• Esophageal manometery
Treatment would be aimed at
• Introduction of easily digestible food in slightly forward bent posture
• Facilitation technique, teach swallowing maneuvers
• Compensatory strategies—texture, taste, temperature and the right quantity
of food at the right time.
At times there is a narrowing or stricture of the esophagus, which may be
stretched or dilated surgically.
DYSPHAGIA

21. • Augmentative Communication
• The term augmentative communication refers to any approach
designed to support or augment the communication of individuals
who are not independent verbal communicators, and who cannot
speak. General Form of Communication and Environment Control
Aids
• A communication or control device has three main parts. In this
case, the user is at the input to the system, and device output is
applied to the environment. The user interacts with any of these
communication or control systems via the interface.
• Vocaid: Vocaid contains very simple vocabulary for use in hospital
settings. By pressing the keys, the user can generate a word or
phrase.The speech is of high quality because it consists of stored
code words.
• Autocom: The autocom is a computer-based direct selection aid
that can be configured to meet the specific needs of disabled
individuals. The aid has a programmable input vocabulary, with
either character or symbol based vocabulary.

22. • Deaf Blindness
• ‘The term “deaf blind” is used to describe a diverse group of
people who suffer from varying degrees of visual and hearing
impairment. Often these individuals are a major challenge for
rehabilitation because they have communication, developmental
and educational problems due to severe learning difficulties and
physical disabilities which accompany the primary impairment.
• Early Education must concentrate on Use of multi-sensory
approach and use of residual senses like smell and touch.
• Communication and language taught in meaningful natural
situations
• Development of bonding, body contact, awareness of self and
others.
• Parents are the active copartners in the teaching process.

23. • COMMUNICATION FOR THE VISUALLY IMPAIRED
• Blindness:The person with visual impairment faces limitations in
the range and variety of experiences, problems in mobility and
communication and lack of control of the environment he is in.
• Low Vision: WHO (1992) defines that a person with low vision is
one who has, even after treatment and / or standard refractive
correction, a visual activity of less than 6/18 to light perception or
a visual field of less than 10 degrees from the point of fixation.
• Legal Blindness: Legal blindness is defined as visual activity not
exceeding 6/60 or 20/200 (Snellen) in the better eye with the
correcting lenses or limitation of the field of vision subtending an
angle of degree 20 or worse
• Types of Visual Aids
• Optical aids Non-optical aids Electronic low vision aids
• Hand held magnifiers Enlarged print Closed circuit TV
• Stand magnifiers High intensity lamps Opaque projectors
• High contrast objects Slide Projection
• Telescopes Microfiche readers

24. • Tactile Visual Aids
• Braille: Braille (Fig. 5.8) is one of the oldest reading aids for the visually
impaired population.
• Tactile Vision
• Tactile vision means seeing by touching. It utilizes the direct conversion
of an optical input to a tactile output to provide direct accessibility to
printed text
• Auditory Vision System
• An auditory vision system, which produces a sound pattern from detected
letter shape, allows visually impaired people to hear what is being read.
• OTHER AIDS THAT HELP IN COMMUNICATION
• Writing Aids
• Pencil and Paper Aids : For those who have minor difficulties in holding
a pen or pencil aids that assist in handling are sometimes necessary.
Finger motion is needed to grasp the pencil while the tripod structure
supports the fingers.
• Aids Primarily Intended for Assisting Conversation Communication boards
are frequently used words and letters are shown on a display (Fig. 5.11)
and the patient points out to them in an effort to communicate

25. • Writing Aids Based on Microcomputers
• The graphical capabilities of microcomputers can give the
handicapped the ability to draw. A number of small computers
are now available, some of which have built—in multiline
displays, printers, and tape storage mechanisms. In addition
they can be used as a back up to voice output systems and
can also function as communication aids.
• Retrieval and Manipulation of Paper
• The handling of paper has always been a problem for the
physically handicapped population. Paralysis, amputations or
the lack of motor control makes the insertion and removal of
paper from typewriters very difficult without assistance. A
system is available that allows a severely disabled person to
manipulate a computer printout using a mouth stick and a
small key pad.

26. • S Sunder et al.,Textbook of Rehabilitation Third editionJAYPEE
BROTHERS MEDICAL PUBLISHERS (P) LTD 2002,page no. 83-103
References :-

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