Speech

Rehabilitation
Amer Wasim
 APHASIA

 Aphasia: Language processing

disturbance that can involve
the expression of language, the
comprehension of language, or
both
 Word finding errors and difficulty
in understanding language are
classic indicators of aphasia.
CAUSES
Wernicke’s aphasia
Broca’s Aphasia
 REHABILITATION
 Aphasia rehabilitation is efficacious in the stroke
population
General models:
 stimulate intact language processes
 hierarchical cues and prompts
 refractory deficits  alternative & partner-
facilitated communication systems
 So, what are hierarchical cues ??
 A cueing hierarchy puts cues in order from least helpful
to most helpful, mixing the various types together. Here’s an
example:
 Target word: Money
 Function: you use this to buy things
 Rhyming: it rhymes with honey
 Written cue: m _ _ _ _
 Word spelled aloud or printed: m-o-n-e-y
 Sentence completion: I need to earn some ______
 First sound/syllable:
It starts with “muh…”
 Modeling:
Say money
 Errorless naming techniques ENT and gestural
training can promote recovery of word retrieval
 Errorless Naming: the participant views a target
picture and is given the name of the picture
along with multiple opportunities to rehearse the
correct name of the picture supported by oral
reading and repetition, while avoiding
production of errors during training.
 Gesture Training: adding gestures to ENT.
 The training of scripts  produce rehearsed
sentences
 Writing and copying biographical information
 Following simple or complex commands and
answering spoken questions correctly.
 Matching objects to written words, following
written directions, or reading functional
information (bills, environmental signs).
 Activities that involve attention training, problem
solving, and executive functioning.
OTHERS:
 Education of the patient, family and health care
provider.
 Environment modification. (use simple language,
talk slowly, turn down TV ..)
 Computer programs and smart phone
applications.
Example : Rehabilitation of Anomic Aphasia
Response to rehabilitation
 DYSARTHRIA
 Group of motor speech disorders associated with
muscle paralysis, weakness, or incoordination
 Dysarthria often is manifested as slurred speech
and does not involve language processes.
 They result from weakness, paralysis, or
dyscoordination of articular muscles.
Spastic Dysarthria Following Stroke
 REHABILITATION
 Treat the underlying cause: dopamine
agonists in patients with Parkinson.
 Prosthesis: Palatal lifts in patients with
Palatopharyngeal incompetence.
 Behavioral management:
1. Muscle strengthening exercises (Lip closure,
tongue protrusion and elevation ..)
2. Improvement of breath support
3. Modification of posture
 Compensatory techniques to slow the speech
rhythm and overarticulate ..
 In severe cases, alternative
communication (written words,
photos, gestures, or
smart phone applications .. )
APRAXIA

 Struggle to speak
 The speech is distorted (omissions, repetitions,
substitutions, & distortion ..)
 The problem is difficulty finding the correct
positions of articulators.
 not caused by muscle weakness, decreased
tone, or incoordination, nor is it the result of
linguistic disturbances
 APRAXIA
 They are aware of the speak errors and try to
correct them.
 Unable to follow commands correctly.
 But they can produce common phrases (i.e.
how are you?)
APRAXIA
 REHABILITATION
 Techniques to elicit accurate voluntary
speech production.
 Multimodality cues, such as modeling mouth
and lip movements, using verbal cues to
describe accurate tongue and lip placement,
and intoning words and sentences.
 Rate and rhythm control strategies.
 In severe cases, alternative communication
strategies.
 DYSPHONIA
 Reduction or alteration in voice quality.
 loudness, breathiness, hoarseness, or
harshness.
 Treatment of the underlying cause.
 Vocal Nodules: Voice hygiene education and
proper voicing techniques
 Reflex Laryngitis: Voice therapy
 Vocal cord paralysis: techniques to enhance
vocal cord approximation such as manual
laryngeal massage.
 REFERENCES
 Kortte, Jason H., and Jeffrey B. Palmer. “Speech and
Language Disorders.” Essentials Of Physical Medicine
And Rehabilitation: Musculoskeletal Disorders, Pain, And
Rehabilitation, 3rd ed., vol. 1, Saunders, 2015, pp. 833–
837.