what is communication ? Types of communication problems and how to identify communication problems and their ways of management and multi disciplinary TEAM approach

2.  Patients who seek rehabilitation services
usually suffer from multiple disabilities.
 These are secondary to complex conditions
following CVA,TBI,C.P & other neurological
diseases.
 Many of individuals also suffer from speech
and communication problems which add up.

3.  “Kya hai yeh communication”???

4.  “it’s a process by which the information is
exchanged among individuals”
 Primarily --- verbally
 But Non – verbal gestures & written
communications are also included.
 Why do we have to communicate???
 Whats the NEED???

5.  It comprises of all of the behaviors of human
beings use to transmit
 Feelings & ideas.
 Including gestures
 Pantomime
 Process of speaking ,reading ,writing and
understanding visible and oral symbols.

6.  It consists of two process
 1)EXPRESSIVE ORENCODING
PROCESSES.
 2)RECEPTIVE OR DECODING
PROCESSES.
 1-the modalities by which we express
information is referred as expressive or
encoding process.
 2- those used in understanding &
interpretation of symbols are receptive or

7.  Linguistics- the science that deals with
message transmission, among speakers of any
language is called linguistics.
 Phonology- study of ??
 Semantics- study of meaning of words in the
language including the relationship between
language ,thought & behaviour.
 Syntax---???
 Etymology– study of origin of words, and how
their meaning have changed over time.

8.  Speech and its disorders
 Communication for the hearing impaired
 Augmentative communication
 Communication for the visually impaired
 Other aids.

9.  Aphasia
 Dysarthria
 Dysphonia

10.  It is an communication disorder caused by
brain damage .
 Characterized by an impairment of language
comprehension, formulation and use.
 It affects the sounds, vocabulary or grammar
both in speaking ( expression) and in
understanding ( reception).

11.  It excludes those language disorders
associated with visual or hearing defects,
M.R or psychiatric conditions.
 An aphasic also may have
 difficulty in reading
 Writing
 calculation

13. o Global Aphasia:- severe loss in fluency,
comprehension and repetition the aphasia is
global.
o Deficits are found in all language processes,
including speech production, auditory
comprehension, reading & writing.

14.  Isolation aphasia:- all language processes
are poor , expect for the ability to repeat.
 Broca’s aphasia:- SPEECH PRODUCTION
IS SLOW & POOR.
 With difficulty in articulation and grammar.
 Comprehension is relatively good except for
complex sentences and reading is superior
to writing.

15.  Trans cortical motor aphasia:- similar to brocas
aphasia.
 However the main feature of this rare syndrome is
the preserved ability to repeat fluently.
 Wernicke s aphasia:- speech is fluent with
paraphasic errors ( sounds in the words are
substituted)
 Comprehension is also affected.
 Content of speech is unclear
 Repeated unitelligible words and sterotyped
pharses called “jagron aphasia”

16.  They are unaware that they are not
communicating to the listener.
 Trans cortical sensory aphasia:- it also same
as that of wernicke s aphasia but the ability
to repeat is preserved.
 They have poor comprehension , but their
speech is fluent and grammatical.
 They do not use the correct word.
 But use similar content like words.

17.  Conduction aphasia:- spontaneous speech
is relatively fluent with good understanding of
the spoke language, but there is selective
loss of ability to repeat that somebody else
says.
 Anomic aphasia:-speech is well articulated,
grammatical and fluent , but there is marked
by severe word finding difficulties.

18.  Many aphasic tests are tests of intelligence
adapted for use with aphasic patients.
 Aphasic tests are not diagnostic.
 A retarded patients, illiterate, non native
English speaker might fail items on aphasia
test

19.  MTDDA
 PICA
 MTDDA Is the most comprehensive and
accepted of the tests for aphasia.
 On an average examiner takes 3 hrs to
administer.
 It consists of 46 subtests divided in to 5
sections.

20.  Namely
 Speech and language
 Auditory disturbances
 Disturbances of numerical & arithmetic
processes.
 Visual & reading disturbances.
 Visuomotor and writing disturbances.

21.  Refers to motor speech defects – resulting
from trauma or disease of the nuclei / fiber
tracts adjacent to the brainstem – serving the
speech musculature.
 The pattern of speech produced by a specific
dysarthric individual depends upon the site &
severity of lesion.

22.  Articulation,
speech,loudness,rate,phonation,resonance,p
itch,rhythmand stress patterns are the
aspects of the speech to be looked .
 Articulation is optimum when speech is slow.
 Disorders of rhythm and stress are peculiar
to cerebellar lesions.

23.  If the patient is asked to speak more rapidly,
disarthric symptoms will usually become
more apparent.
 Mechanism responsible for dysarthria is
 Inability of the muscles of larynx to initiate or
stop contractions quickly.
 Hypotonicity of larynx could produce a
slurring in pronounciation of consonants,slow
speech.

24.  Flaccid dysarthria:- damage due to nerves
or their nuclei will result in speech
characterized by breathy voice, hyper
nasility, slowness, reduced volume.
 It occurs in patients with brainstem lesion,
stroke,polio,myasthena grevis or buibar
palsy.

25.  Spastic dysarthria:- it is seen in UMNL.
 Characterized by imprecise consonant
production, monotonus pitch , a starined –
strangled voice quality, hypernasility and
occasional pitch breaks.
 Seen in spastic or athetoid cerebral palsy.
 Pts with ALS will exhibit a combination of
both.

26.  Cerebellar dysarthria:- word selection is not
altered, but melodic quality of speech is
changed.
 They have characteristic speech pattern of
irregular break down and distortion of
speech.
 Scanning speech is a typical example of
cerebellar dyasrthria.

27.  Explosive speech or staccato speech – voice
becomes monotonous in pitch, loudness and
nasals very soft.
 Ataxic dysarthria is found in patients with
firedrich’s ataxia, multiple sclerosis and head
injury.
 Hypokinetic dysarthria:- slowness of speech
in parkinsonism.
 Reduced speech stress, short rushes and
inappropriate silence and reduced volume.

28.  Hyperkinetic dysarthria:- patients with
movement disorders.
 Fast paced speech.

29.  Aphonia ???
 Dysphonia refers to a number of phonatory
disorders of sound quality e.g, vocal
nodules,laryngitis,vocal polyps.
 It may also result from vocal cord paralysis
or cancer of the larynx.

30.  A detailed history of phonatory problem.
 A physical examination of the laryngeal
structures by a ???
 Evaluation of voice dysfunction
 Evaluation of pitch,quality and loudness
control
 Idenitification of use and abuse patterns that
are contributing to the disorder.

31.  The determination of the patients ability to
modify phonatory patterns.
 The term LARYNGECTOMY ???
 Partial or Total
 Incomplete may or may not influence voice
quality.
 Total results in complete loss of voice and
oesophageal voice may be needed.

32.  According to the PWD Act 1995..
 Hearing impairment means?????

33.  “Loss of 60 decibels or more in better ear in
the conversational frequencies”
 Peripheral hearing impairments are of 3
types.
 Conductive impairment
 Sensorineural impairment
 Mixed or combined impairment

34.  C.I: - PREVENTS the transmission of sound
to cochlea.
 Such as lesions in outer or middle ear .
 Causes:-
 Congenital atresia
 Foreign bodies
 Otosclerosis
 Otitis media

35.  S.I: PREVENT reception and transmission of
sound stimuli to brain.
 Lesions such as in cochlea or auditory n
 causes:
 Noise, viral and bacterial disease of inner ear.
 Meinere’s disease
 Consumption of ototoxic drugs e.g
aspirin,quinine,neomycin
 Tumours involving cerebellopontine angle

36.  It is a measurement of hearing,the basic test
to determine the degree & type of hearing
loss.
 An audiometer provides pure tones of
selected frequencies.
 The patient records the level at which the
tones are heard and results of the test are
recorded on audiogram.

37.  The range between 10 db to 25 db in the
audiogram is considered to be within normal
limits.
 Test results represent
 Air conduction
 Bony conduction

38.  Management depends on the type of loss,
degree and age of onset.
 Management can be done in 3 categories:-
 Surgical and medical intervention.
 Corrective amplification.
 Counselling.

39.  Conductive hearing loss usually respond to
medical & surgical Rx
 Cochlear implants.
 Post implantation rehabilitative is necessary.
 Conductive loss has better prognosis than
mixed losses.

40.  In a patient with mixed loss, the conductive
component of the loss can be removed, thus
restoring atleast a portion of the hearing
ability.
 e,.g tumour on 8 th cranial nerve , tumour
surgery may preserve some hearing, and
also there may be an additional advantage in
that it gives relief from vertigo

41.  Artificial larynx:- electrolarynx is a sound
source implanted in the body.
 In these reed is vibrated by the exhaled air
from the lungs.
 Intra oral
 Neck placement.

42.  A hearing aid is any device that brings sound
more effectively to the ear of the listener.
 Classified based on their location.
 Behind ear– mild hearing loss
 In the ear- mild to moderate
 Eye glasses

43.  According to function
 Monoaural– fits single ear
 Binaural- 2 amplifiers,receivers,microphones
separately.
 Pseudobinaural- each ear has separate
receiver but same amplifer & microphone

44.  It is the electrical stimulation of auditory
processing areas of the cerebral cortex.
 This technique is beneficial in hearing
impaired persons with a non- functioning
cochlea, a non- conducting nerve or a lesion
of the central nervous system.

45.  Speech therapy is a treatment adminstered
by a speech pathologist.
 A speech pathologist is an individual trained
to diagnose and treat speech disorders.
 Treatment is aimed towards patient daily
language needs
 Sequence of learning tasks:-

46.  Imitation of gross body movts , by feeloing
movements and touching the articulatory
apparatus…??
 Repetition of small phonemes usually labial
syllables “ma” & “pa”.
 Listening to oral sound and attempting it
 Using alphabet boards and writing devices &
computers for speech in aphasic pts

47.  Lip reading
 Sign language
 Conditions treated by speech therapy
 Cleft plate
 M.R
 C.P
 AUTISM
 BELLSPALSY.

48.  Abnormal spilling of saliva from mouth on to
lips , chin , neck , clothing or floor.
 Minimal drooling is normal until two & half
years of age.
 Extensive drooling is often seen in children
with cerebral palsy.

49.  Correct anatomical problems related to the
oral cavity.
 Behaviour modification– keep reminding
child not to drool
 Oro – neuromotor exercise and feeding
program,stimulation of the oral apparatus.
 Surgery.

50.  What is dysphagia???
 Medical definition??

51.  Dysphagia or difficulty in deglutition .
 It is defined as any defect in intake or
transport of endogenous secretions and
necessary food for maintenance of life.
 The Swallowing process for liquids and
solids involves 3 phases???
 What are those??

52.  Oral phase
 Pharyngeal phase
 Esophageal
 Voluntary phase
 Involuntary phase

53.  What can be the problems??

54.  Food spillage.
 Lack of tongue action to form bolus.
 Pooling of food in anterior part of mouth.
 Lack of chewing, tongue thrust.
 Delayed and piecemeal swallow
 Nasal regurgitation
 Pooling of saliva
 These are associated with oral & pharyngeal
phase.

55.  Patients medical history
 Physical examination
 Various diagnostic tests like
 Barium sallow
 ???
 Esophageal acidity test – gastroesophageal
reflux.
 Esophageal manometry

56.  Aims:-
 Introduction of easily digestable food.
 Posture??
 Facilitation techniques
 Teach swallowing maneuvers
 Compensatory strategies- texture, taste,
temperature and right quantity of food at
right time.

57.  Any approach designed to support or
augment the communication of individuals
who are not independent verbal
communicators and who cannot speak.
 It refers to those techniques and
sepecialized equipment that are used by the
individual to convey a message to listerner
 It consists of request wants & needs.

58.  A communication or control device has three
main parts
 Input
 Output
 Interface
 User interacts with the interface.

59.  Vocaid : vocaid contains very simple
vocabulary for use in hospitals.
 By pressing the keys, user can generate a
word or phrase.
 The speech is of high quality because it
consists of stored code words.

60.  Autocom: 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.

61.  Diverse group of people who suffer with
varying degrees of visual and hearing
impairment.
 These individuals are a major challenge for
rehabilitation because they have
communication,developmental and
educational problems due to severe learning
difficulties.

62.  Blindness:- person with visual impairment
faces limitation in mobility and
communication and lack of control of
environment he is in.
 Low vision: WHO defines a person with even
after treatment / correction of standard
refraction a visual activity of less than 6/18 to
light perception or a visual field less than 10
degree from point of fixation.

63.  Legal blindness: visual acitivity not
exceeding 6/60 or 20/200 in the better eye
with correcting lenses or limitation of field of
vision subtending an angle of degree 20 or
worse.
 Causes of blindness??

64.  CATARACT
 GLAUCOMA
 CORNEAL ULCER
 XEROPTHALMIA
 RETINAL DETATCHMENT
 ASTIGMATISM
 OPTIC ATROPHY

65.  FOR Partially sighted low vision – aids like
magnifiers are useful.
 Use of tactile sense like braille to
communicate.
 Recent advances like auditory vision
 Spelled speech
 Directed stimulation of visual cortex.

66.  Oldest reading aid for visually impaired
population.
 Originally used during french revolution.
 Braille code has been in to exsistance for
about 150 years.
 Braille is a matrix of embossed dots on stout
paper which represents a letter or a
combination of letters.

67.  A braille cell consists of six dots in form of
two columns and three rows.
 Disadvantages:- reading speed is much
lower than that of the visual reading speed,
and there is a increased expense in
transcription .
 Braille is also bulky and expensive to store.

68.  Tactile vision means seeing by touching.
 TVSS is a electronic device that converts
visual information in to a pattern displayed
on a matrix of stimulators in contact with the
skin.
 Tactile reading device.
 Auditory vision system- produces a sound
pattern from detected letter shape.

69.  Writing aids:
 Pencil & paper aids
 Communication aids– boards with symbols
and patients points out.
 Writing aids with some microphones
 Retrieval & manipulation of paper.

70.  With advance technology , there are many
more avenues open for communication by
the person with disability.
 Judicious blend of commonsense + simple
engineering concepts can open up a lively
two way traffic .
 Turing “disabled to abled”