THE DIVERSITY OF MY THOUGHTS

Dysarthria, A Speech Disorder

In Cerebral Palsy, Family, Health, Medical on July 7, 2009 at 12:36 pm


Communication, understanding and patience, the three keys to success

Today, I went to Ariq’s school to get his school report. I was glad that he really improves well; however, there is a little note from his therapies that we had better give him more drills in two-way communication. I don’t mean to say that he cannot communicate his ideas or thoughts. In fact he does, although it is only those of habitual ones. He is able to say such things like “Kakak mau makan” (I want to eat), “Kakak mau minum susu” (I want to have some milk), “Kakak mau keluar” (I want to go out), “Pergi kemana” (Where are we going?), “Kakak mau mandi” (I want to take a bath) and many others. Ariq also understands simple commands like “Ganti baju” (Change your clothes), “Buka celana” (Pull down your trousers), “Tutup pintu” (Close the door), Ambil bukunya” (Get the book) and so on.


Ariq with Bimo, one of my nephews. An evidence that our son is able to communicate

The real problem begins when it comes to answering questions or even following instructions such as “Kakak mau makan apa” (“What do you want to eat?”)-usually, he only answers several foods he eats regularly, thus he cannot communicate new ideas. When we ask him to call out or summon someone, he will do as he’s told, it’s just that when we ask him to speak louder “Yang keras” (“Speak louder”), he will repeat the sentence “Yang keras” (“Speak louder”) or “Sambil teriak” (“Yell louder”) instead of doing what we have asked him to.

The note that says he must improve his communication skills, has somehow awakens us that we haven’t done enough for him. There are still plenty of rooms for improvements. We still have to try other methods to improve his skills. We always tell him not to repeat irrelevant words over and over again. Somehow our son often says several words, meaningful but nonetheless out of context.


The cheerful first son


Ariq sitting on his throne

Although the note doesn’t specify that our son needs a speech therapy, I found myself browsing the web looking for the exact explanation on what a speech therapy really is and how do we know whether or not our children need such a therapy.

So far, speech therapy or language therapy is the treatment for most kids with speech and/or language disorders. A speech disorder refers to a problem with the actual production of sounds, whereas a language disorder refers to a difficulty understanding or putting words together to communicate ideas. Speech Language Pathologists treat problems in the areas of articulation; dysfluency; oral-motor, speech, and voice; and receptive and expressive language disorders.

It is also stated that language disorders can be either receptive or expressive:

  • Receptive disorders refer to difficulties understanding or processing language.
  • Expressive disorders include difficulty putting words together, limited vocabulary, or inability to use language in a socially appropriate way.

In Ariq’s case, the real problem has been the combination of both receptive and expressive disorders just like mentioned earlier above. Actually, he enrolled in a speech therapy class few years ago after being diagnosed with Dysarthria but he then stopped since we decided that physiotherapy and sensory are far more important for him.

Dysarthria is a motor speech disorder affecting muscles in the mouth, face, and respiratory system. The condition normally results from a neurological injury, such as a stroke or other kind of brain injury. Dysarthria is also known as dysarthosis. It is a separate condition from, but sometimes confused with, another speech-related disorder known as aphasia (a disorder of the content of speech, an impairment (but not loss) of speech and of comprehension of speech)

Symptoms

The symptoms of Dysarthria may include all of these below (Ariq’s conditions are in bold):

Abnormal speech rhythm (intonation)
Audible breathing (breathiness)
Difficulty chewing
Difficulty pronouncing words
Difficulty swallowing
Drooling
Hoarseness
Limited jaw movement
Limited lip movement
Limited tongue movement
Poor articulation
Rapid speech rate with mumbling
Slow speech rate
Slurred speech
Soft speaking
Speech quality changes

Dysarthria may be caused by various conditions, including:

Alcohol intoxication
Amyotrophic lateral sclerosis (ALS, a.k.a. Lou Gehrig’s disease)
Botulism
Dementia
Cerebral palsy
Dentures which fit poorly
Facial trauma
Head cancer surgery
Head trauma
Huntington’s disease
Multiple sclerosis (MS)
Myasthenia gravis
Neck cancer surgery
Nervous system (neurological) disorders affecting the brain
Neuromuscular disease
Parkinson’s disease
Side effects of certain medications affecting the central nervous system (CNS)
Spinocerebellar ataxia type 2
Stroke
Transient ischemic attack (TIA)

Causes

The causes of dysarthria can be many, including toxic, metabolic, degenerative diseases such as Parkinsonism and Ataxia etc, traumatic brain injury, or thrombotic or embolic stroke. These result in lesions to key areas of the brain involved in planning, executing, or regulating motor operations in skeletal muscles (ie. muscles of the limbs), including muscles of the head and neck (dysfunction of which characterizes dysarthia), which then block the nervous system’s ability to activate motor units and effect correct range and strength of movements.

Treatment

Articulation problems resulting from dysarthia are treated by speech pathologists, using a variety of techniques. Techniques used depend on the effect the dysarthia has on control of the articulators. Traditional treatments target the correction of deficits in rate (of articulation), prosody (appropriate emphasis and inflection, affected eg. by apraxia of speech, right hemisphere brain damage, etc.), intensity (loudness of the voice, affected eg. in hypokenetic dysarthrias such as in Parkinson’s), resonance (ability to alter the vocal tract and resonating spaces for correct speech sounds) and phonation (control of the vocal folds for appropriate voice quality and valving of the airway). These treatments have usually involved exercises to increase strength and control over articulator muscles (which may be flaccid and weak, or overly tight and difficult to move), and using alternate speaking techniques to increase speaker intelligibility (how well someone’s speech is understood by peers).


Various drills given during Speech Therapy sessions.

In speech therapy, the drills might vary, ranging from physical ones such as strengthening oral motor muscles (blowing candles, drinking through straws or blowing trumpets) to oral drills in the form of articulation exercise, practicing vowels and consonants or even getting the children to understand things around them through the use of cue cards or flash cards. Flash cards consist of several pieces of card board with pictures. The designs are usually colorful so that the children are interested. The therapist will show one of the cards while mentioning the name of the thing and asks the children to repeat what he/she says. The use of flash cards is not for those with speech disorder only; instead, they also help children communicate better during early age. Here are some samples of flash cards:


Colorful designs to attract children’s attention


Flash cards designed to help babies communicate


DIY flash cards


Flash cards in French language

Recently, Lee Silverman Voice Therapy (LSVT) develops speech techniques for those with Parkinson. These therapies are based on the principles of motor learning that aim to retrain speech skills through building new generalized motor programs so that the treatment will be more effective since they designate any methods based on the motoric weakness of the patients.


Books for parents who live with children suffering communication or speech disorder

In reference to Ariq’s case, I guess we have no other choice than to enroll him back in Speech Therapy class as discussed previously with my wife. In the mean time, I’ll get more information about this program including consulting one of my aunties who used to be a Headmistress in school for children with special needs. Living with a child with special needs is indeed never been easy but absolutely not impossible. What we need is patience, understanding and guidance. Some publishers or schools for special needs provide the necessary guide books for parents so that their children don’t get misguided. These books will teach parents everything that they need to know about such disorder. Bismillahirrahmanirrahim, hopefully spending more time in speech therapy classes might improve his speech skills rapidly.


Ratna and Ariq

Be strong, don’t give up hope, you are on the right track already. Dad and Mom will always be there for you to give support, spirit and courage.

Images are courtesy of flickr

Sources:

http://kidshealth.org/parent/system/ill/speech_therapy.html

http://www.dysarthria.info/

http://en.wikipedia.org/wiki/Aphasia

http://en.wikipedia.org/wiki/Dysarthria

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