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Communication impairment
- 1. COMMUNICATION IMPAIRMENT By Prof. Dr.R.Kanagaraj, MPT(Ortho), M.Sc(Psychology) Prof.Dr.R.Kanagaraj 4/8/2021
- 2. COMMUNICATION 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. • The modalities by which we express information are referred to as expressive or • encoding processes and those used in the understanding and interpretation of symbols are receptive or decoding processes Prof.Dr.R.Kanagaraj 4/8/2021
- 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 Prof.Dr.R.Kanagaraj 4/8/2021
- 4. SPEECH • Speech disorders are classified under: • Aphasia • Dysarthria • Dysphonia Prof.Dr.R.Kanagaraj 4/8/2021
- 5. APHASIA Definition: It is a communication disorder caused by brain damage and characterized by an impairment of language comprehension, formulation and use. An aphasic patient may have difficulty in o reading (dyslexia), o writing (agraphia) and o calculation (acalculia). Prof.Dr.R.Kanagaraj 4/8/2021
- 8. DYSARTHRIA • 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. • Articulation, loudness, rate, phonation, resonance, pitch, rhythm and stress patterns are the aspects of speech to be noticed. Prof.Dr.R.Kanagaraj 4/8/2021
- 9. Types of Dysarthria • Flaccid Dysarthria • Damage to the nerves or their nuclei will result in speech characterized by a breathy voice, hypernasality, imprecisely produced consonants, slowness, incoordination of speech mechanism, reduced volume, and escape of air through the nose (nasal emission). • 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, hypernasality and occasional pitch breaks. Prof.Dr.R.Kanagaraj 4/8/2021
- 10. • 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. Clients may also display explosive speech or staccato peech. The voice can become monotonous in pitch and loudness, tremulous, and nasals are very soft. These dysarthric speakers usually exhibit irregular, imprecise consonant production, distorted vowel production, excessive loudness, variation and occasional harsh voices. • Ataxic dysarthria • is found in patients with Friedreich’s ataxia, multiple sclerosis and some patients with severe head injury. Prof.Dr.R.Kanagaraj 4/8/2021
- 11. • Hypokinetic Dysarthria • Patients with movement disorders also demonstrate unique dysarthric patterns. Parkinsonism is a neurological disorder of the basal ganglia and the rapidity of speech is often reduced. Hypo kinetic dysarthric individuals usually speak with reduced speech stress, short rushes of speech, inappropriate silence and reduced volume. The speech is typically monotonous. • Hyperkinetic Dysarthria: • Patients with movement disorders resulting in excessive motor activity, such as dystonia and chorea, exhibit hyperkinetic dysarthria, with fast paced speech Prof.Dr.R.Kanagaraj 4/8/2021
- 12. DISORDERS OF PHONATION • 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. Prof.Dr.R.Kanagaraj 4/8/2021
- 13. Primary objectives of voice evaluation are: • A detailed history of the phonatory problem • A physical examination of the laryngeal structures by a laryngologist • Evaluation of voice dysfunction • Evaluation of pitch, quality and loudness control • The identification of use and abuse patterns that are contributing to the disorder • The determination of the patient’s ability to modify phonatory patterns. Prof.Dr.R.Kanagaraj 4/8/2021
- 14. Laryngectomy • The term ‘Laryngectomy’ refers to the removal of the larynx (partial or total). • An incomplete laryngectomy may or may not influence voice quality. Prof.Dr.R.Kanagaraj 4/8/2021
- 15. COMMUNICATION FOR THE HEARING IMPAIRED Classification of Types of Hearing Impairment • hearing impairment means loss of 60 decibels or more in the better ear in the conversational frequencies. • Conductive impairments prevent transmission of sound to the cochlea. Such lesions occur in the outer or middle ear. • Sensorineural impairments prevent reception and transmission of sound stimuli to the brain. Such lesion occurs in the cochlea or auditory nerve. • Mixed or combined impairments - both conductive and sensorineural impairments are present. Prof.Dr.R.Kanagaraj 4/8/2021
- 16. 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 Prof.Dr.R.Kanagaraj 4/8/2021
- 17. Causes of Sensorineural Impairment • Noise induced hearing loss • Viral and bacterial disease of inner ear • Meniere’s disease • Consumption of ototoxic drugs, e.g. aspirin, quinine, neomycin • Tumors involving cerebellopontine angle. Prof.Dr.R.Kanagaraj 4/8/2021
- 18. Audiometry • 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. • Bone conduction measurements must be performed with the judicious use of masking the signal to the other ear, which is not tested. • Through the bone conduction test an attempt is made to bypass the middle ear system and conduct sound directly to the inner ear. Prof.Dr.R.Kanagaraj 4/8/2021
- 19. Management of Hearing Impairment Management falls into three categories: • Surgical and medical intervention, • Corrective amplification and • Counseling. A cochlear implant is a device used by the hearing impaired which stimulates the auditory nerve inside the inner ear. Conductive losses have a better prognosis than mixed losses. Prof.Dr.R.Kanagaraj 4/8/2021
- 21. Speaking Aids • Artificial larynx : • The electrolarynx is a sound source implanted in the body. In these small devices, a reed is vibrated by the exhaled air from the lungs. • The speaker is a small earphone with a tube attached to direct In the ear • the sound into the resonant chamber in the back of the mouth. • Another technique is a surgical implant device placed in the area where tissue was removed during laryngectomy. Prof.Dr.R.Kanagaraj 4/8/2021
- 22. Hearing Aids • A hearing aid 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 Eye glasses They may also be classified according to function as monaural, binaural, and pseudo binaural. Prof.Dr.R.Kanagaraj 4/8/2021
- 24. 1. Monaural type fits a single ear. 2. Binaural type includes two microphones, two amplifiers and two receivers, which fit each ear separately. 3. In the pseudo binaural type, each ear has its own receiver but they both share the same microphone and amplifier. • The behind the ear hearing aid—It is intended for those who present a mild to severe loss of hearing. • The in the ear hearing aid—It is intended for those who present a mild to moderate hearing loss. It entirely fits into the concha of the ear. • One side of the eye glasses contains the three basic components and the battery, thus forming a single monaural hearing aid Prof.Dr.R.Kanagaraj 4/8/2021
- 26. • Auditory Prosthesis • This is an implantable cochlear prosthesis for the hearing impaired • 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 Prof.Dr.R.Kanagaraj 4/8/2021
- 27. 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. • The following is the sequence of learning tasks: • Imitation of gross body movements, by feeling movements of and touching the articulatory apparatus, comprising the mouth, lips and tongue. • Repetition of a small repertoire of phonemes, usually the labial syllables ‘ma’ or ‘pa’, which are incidentally the first words uttered by a new born. • listening to the oral production of a word and attempting to imitate it • matching identical objects, pictures, flash cards, • using alphabet boards and writing devices, and, more recently, computers as a substitute for speech for aphasic patients Prof.Dr.R.Kanagaraj 4/8/2021
- 28. Other managements • Auditory Training • Lip Reading • Sign Language Prof.Dr.R.Kanagaraj 4/8/2021
- 29. Conditions Treated with Speech Therapy • Cleft Palate • Mental Retardation and Cerebral Palsy • Autism • Bells Palsy Prof.Dr.R.Kanagaraj 4/8/2021
- 30. DYSPHAGIA 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. • Therapeutic Techniques for Dysphagia • Dysphagia is diagnosed through reviewing a patient’s medical history, • physical examination, and various diagnostic tests. 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. Prof.Dr.R.Kanagaraj 4/8/2021
- 31. COMMUNICATION FOR THE VISUALLY IMPAIRED • Common Eye Diseases • Cataract • Glaucoma • Corneal Ulcer • Xerophthalmia • Retinal Detachment • Astigmatism • Optic Atrophy Prof.Dr.R.Kanagaraj 4/8/2021
- 32. Types of Visual Aids Prof.Dr.R.Kanagaraj 4/8/2021
- 33. Tactile Visual Aids • Braille: • Braille is one of the oldest reading aids for the visually impaired population. Originally used during the French Revolution, the Braille code has been in existence for about 150 years. • Braille is a matrix of embossed dots on stout paper, which represents a letter or a combination of letters. A Braille cell is a six dots matrix is in the form of two columns and three rows. Large quantity of encoded Braille can be stored on a standard 60-min. cassette thus reducing paper storage requirements. • Disadvantages: • The tactile reading speed is much lower than that of the visual reading speed, and there is increased expense in transcription. Braille is also bulky and expensive to store. Prof.Dr.R.Kanagaraj 4/8/2021
- 36. OTHER AIDS THAT HELP IN COMMUNICATION • Writing Aids • Pencil and Paper Aids Prof.Dr.R.Kanagaraj 4/8/2021
- 37. Aids Primarily Intended for Assisting Conversation • Communication boards • Portable printers Prof.Dr.R.Kanagaraj 4/8/2021