Aphasia & Adult Communication Problems

We have talked about speech and language disorders that affect primarily children; but adults can have communication problems, as well, and it can be frustrating for the patient and for the family. There are a few things that can cause communication problems in adults, including stroke, head injury, head-neck cancers, dementias, and various progress neurological diseases such as amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). These are generally patients who once had an intact speech and language system, and now are faced with an inability to speak or communicate effectively.

Damage to the brain can be from a blockage of the blood to regions of the brain or bleeding in the brain. Depending upon where these issues happened in the brain, the results can be very different. Broadly speaking, damage in the left hemisphere often causes a loss or partial loss of communication – either loss of speech, loss of specific words, and/or loss of the language. The loss or impairment of communication is called aphasia. Aphasia can range from fairly fluent speech with a few errors, to fluent speech that is meaningless, to little or no attempt to speak at all. The patient may or may not be aware of his deficits.

Often speech improves as the blood recedes, swelling is reduced, and/or blood supply is returned to the area; but spontaneous recovery is seldom complete. A speech pathologist may be called in at the hospital, rehabilitation center, and referred to one when he leaves facilities. There are many evidence-based, therapy techniques for treating aphasia, each designed to address the specific deficits exhibited by the patient. Progress can be slow, requiring repetition and work, and may not restore speech to “normal”. If speech does not return to a functional level, and depending upon the damage done to the language system, a voice-output augmentative communication device may be recommended. These are computerized devices and apps that produce speech when the words, letters or icons are activated. More about these devices in the next article.

ALS and other progressive diseases can cause gradual loss of speech, the ability to swallow, and other motor problems. It is important to get with a speech pathologist early in the diagnosis to evaluate and recommend an appropriate voice-output augmentative communication device with multiple access options. The device can provide communication with doctors and family, ensuring proper treatment as the disease progresses and continued connection with family and friends.

Verbal communication is a distinctly human activity. We inform each other, confide in each other, encourage each other and maintain closeness with each other through communication. Loss of the ability to communicate is devastating. This is just a reminder to get important information, papers, passwords, accounts, etc. together in one place. Make sure someone knows where things are and ideally that someone can legally act on your behalf in case of disability. Watch your blood pressure, quit smoking, and know the name of a good speech-language pathologist!

What is a Speech-Language Pathologist?

They work with “r,” right? They work with “s,” right? They are in the schools, right?

Yes, we do work with “r” and “s,” and yes, we are found in schools, but that is only the beginning. Speech-language pathologists work in hospitals, skilled nursing facilities, rehabilitation facilities and private practice. Let’s talk about who might need a speech-language pathologist.

Children who are difficult to understand is the first thing that usually comes to mind. When should you consult a speech-language pathologist? Broadly speaking, a 3-year-old should be understood by a total stranger 75-90% of the time. There is more to it than just speech sounds, though 3-year-olds should speak in complete sentences, with pretty good grammar, on a wide variety of topics. They should ask a lot of questions and answer many questions. If your child is not talking like others his same age, consult with a speech-language pathologist. A speech and language evaluation will reveal whether your child is behind others or not.

Another speech problem that children (and adults) present is stuttering. Stuttering is difficulty getting the words out; they feel “stuck.” It may sound like repetition of the first sound in a word or sentence or repeating whole words. It may sound like silence as they struggle to get the word out. They may hold onto a sound before getting the rest of the word out. Stuttering is not a result of something you did or did not do; it is neurological. There is no “cure,” but speech therapy can teach some control techniques. Many children will “outgrow” stuttering by 17 years of age; the problem is, we don’t have a way of predicting which ones will or will not “outgrow” it. Between the ages of two and four years, stuttering is very common, particularly when they are excited, and is probably nothing to worry about. If, however, the child appears to be struggling, if the stuttering is “most of the time,” or if their language use seems immature compared to other children, a consult with a speech-language pathologist may be valuable. In the meantime, just let them talk, don’t finish their sentences, and don’t act concerned. Tell everyone in their life (sitters, daycare, grandparents) how to handle the stuttering.

Some children appear to talk normally, but do not seem to understand complex language. They may not follow directions correctly, but think that they did. These children may get into trouble at school for not following directions, but do not understand why they are in trouble. These difficulties may be due to a receptive language problem, or difficulty understanding language.

Children who are struggling to learn to read may benefit from a language evaluation. Reading is a complex skill involving vision, hearing, memory, vocabulary, verbal reasoning, background knowledge, and language structures. Language therapy with a speech-language pathologist may help with reading difficulties.

Speech can be difficult for children with cerebral palsy, autism spectrum disorder, head-neck cancers, hearing loss and a number of syndromes. Speech therapy is often helpful; but if clear speech is not improving, there are computerized, augmentative communication devices that can provide communication for these children.

Adults can experience speech and/or language problems, as well. Stuttering can continue into adulthood. Speech/language may be lost or impaired as a result of head injury, stroke, head-neck cancer, and neuro-muscular diseases such as ALS. Speech therapy may result in improvement, but if not, as mentioned previously, there are several computerized, augmentative communication devices that can provide communication for individuals who are unable to speak.

Communication connects us. An inability to communicate or difficulty communicating isolates us. If you or a loved one has any difficulty with understanding or using speech and/or language, I encourage you to consult with a speech-language pathologist. Most will be happy to discuss your concerns before you schedule an evaluation, and will not recommend therapy if test results indicate “normal” or “average” speech and/or language skills.

When Should I be Worried About my Child’s Speech or Language?

First off, there is a wide range of “normal” among very young children. The information I will be giving you is based upon researched “averages.” Every child matures and develops at his/her own rate, and “average” does not apply to one individual child. Having said that, it is helpful to have some idea of what a child should be doing, and when to seek help.

Language is a means of communicating. It involves expressive language and receptive language or understanding language. A child should produce big smiles around three months of age and should make “cooing” sounds, especially in response to your talking to him. A child’s first words generally appear around one year of age, and he should use “jargon” or “babbling” that sounds like “real speech.” The child should begin to respond to requests around this age, as well, such as “Come here.”, “Do you want more?”, and should turn or look up when you say his name. You should look for 8-10 words by 18 months. These words may not be clear and people outside of the immediate family may not even recognize the words. If your child consistently uses a sound combination to mean one thing, that’s a word. For example, if your child consistently says “baba” for “blanket,” that is a word. You can expect around 50 words near two years of age, and he should begin to produce two-word combinations (“more cookie,” “mommy car,” “go bye-bye”). Between two-and-a-half and four years of age, your child should make most sounds correctly, with the exceptions of r, s, th and l. He should have 200-300 words, use two-to-three-word sentences and ask “why” questions (a lot!). He should be following conversations pretty well and point to named pictures while looking at books with you. The child should be understood by an unfamiliar listener 90% of the time.

All speech sounds should be correct by five to seven years of age. Your child should “sound like” other children in his same-age peer group, and he should use the same sentence structures as the family. He should understand most of what is said to him, follow conversations, and follow two-step instructions. He should enjoy playing with children in his same-age peer group.

If you notice any differences and are concerned, you might want to consult with a speech-language pathologist. She may recommend an evaluation to rule out a speech and/or language delay. The best way to know if your child has a delay is have an evaluation. The evaluation involves a hearing screening to rule out a hearing problem, a standardized speech sound test and a standardized language test. Testing will result in a standard score, which is obtained by comparing your child’s test performance with the hundreds of children of all ages tested around the country to determine the “normal” range for your child’s age. Testing may result in a score that is within the average range – remember, there is a wide range of “normal” among young children. In this case, no intervention is needed.

But what if your child’s speech or language development is found to be below average? The speech-language pathologist will probably recommend therapy for your child. This will likely involve one-on-one time spent with your child on activities designed to help your child learn the speech sounds and/or language structures that he is not using yet. It will likely involve some home practice activities AFTER the child is able to produce them correctly – just some extra practice at home.

Language problems can lead to misunderstandings, confusion and even behaviors due to frustration. Language problems can also have a negative impact upon learning to read. Speech problems can make it difficult for the child to express needs and wants, and to communicate effectively with teachers and peers, which can lead to frustration and social withdrawal. Early intervention is very important, as it is easier to correct problems when the child is very young; however, it is never “too late” to help your child.