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Speech Pathology Services
The brain controls many of the complex activities
that we perform on a daily basis. Many of these activities, such as communicating
and swallowing, are completed without needing much of our attention. We routinely
express ourselves to other people, understand conversations, read, write, eat
and drink without thinking about "how to" do these things. Frequently, the first
time that we think about these "how to" steps is when we encounter difficulty
performing the tasks. In this article, we'll talk about the resources available
to help patients with brain tumors and their families surmount these challenges.
We extend our gratitude to Sarah C. Stranberg, MA, CCC-SLP, Speech-Language
Pathologist at Fairview-University Medical Center, Minneapolis, Minnesota for
sharing this information with us.
COMMUNICATION AND SWALLOWING
If you have a brain tumor, you may experience difficulties with communication
and/or swallowing for various reasons. First, your tumor may be located in a
part of the brain involved with speech, language, thinking, or the control of
swallowing. Second, conditions associated with some brain tumors, such as seizures
or increased intracranial pressure, may also affect speech, language, thinking,
or eating. In addition, treatments such as surgery, radiation, or medications
can influence communication and/or swallowing.
TYPES OF COMMUNICATION AND SWALLOWING DIFFICULTIES
Aphasia is a disorder of language. There are two types of aphasia - expressive
and receptive.
Expressive symptoms of aphasia affect a person's ability to express one's
self. Signs of expressive aphasia include:
- difficulty
finding words to express thoughts
- difficulty with naming
objects
- using non-meaningful
speech
- difficulty putting
sounds together correctly to make the words
- difficulty with writing
Receptive symptoms of aphasia affect a person's ability
to comprehend others. Signs of receptive aphasia include:
- difficulty
following directions
- difficulty responding
to questions
- difficulty understanding
what others are talking about
- difficulty reading
Difficulties with speech can include dysarthria or apraxia.
Dysarthria is a speech disorder that can be caused by difficulty with
coordination, strength, or the range of movements necessary for speech. Speech
may sound "slurred," "soft - like your voice is not working," or "like it is
coming through your nose."
Apraxia is a speech disorder that occurs when it is difficult to begin,
sequence, or coordinate the complex movements needed to speak. Apraxia can sometimes
sound like "stuttering."
Cognitive deficits affect aspects of thinking. A person may have difficulty
with attention, orientation, memory/recall, problem solving, reasoning, judgment,
organization of thoughts, or slowed thought processing. Difficulty with aspects
of cognition affects one's ability to communicate.
Dysphagia is a disorder of swallowing that occurs at any point during
the swallowing process - taking food or liquid into the mouth, moving it to
the throat, or moving it down the throat to the esophagus and the stomach. The
major complications that arise from dysphagia are inadequate nutrition and/or
hydration as well as aspiration. Aspiration occurs when food or liquids enter
the passages to the lungs rather than those leading to the stomach. Food or
liquid in the airway - especially the lungs - can lead to serious, possibly
life-threatening pneumonia. Signs of dysphagia include:
- difficulty
taking food from a spoon or moving it around in the mouth
- difficulty chewing
- food/liquid leaking
out of mouth or coming out of the nose
- difficulty with starting
to swallow
- choking
- coughing during or
after eating or drinking
- clearing your throat
when eating or drinking
- feeling of food "sticking
in your throat."
Other signs of possible problems include repeated pneumonias,
reflux/heartburn, or weight loss.
THERE IS HELP...
ABOUT SPEECH-LANGUAGE PATHOLOGY SERVICES
A speech-language pathologist (SLP) is a professional who is trained to evaluate
and treat disorders of speech, language, cognition, and swallowing. Speech-language
pathologists have a minimum of a Master's degree and complete extensive clinical
training prior to certification. In addition to national certification, most
states also require licensure or registration for clinical practice. Speech-language
pathologists practice in a variety of settings including hospitals, rehabilitation
centers, outpatient offices, home health agencies, and skilled nursing facilities.
If you would like to be evaluated by a speech-language pathologist:
- Talk with your doctor
If you have noticed changes in speech, language, thinking, or swallowing
abilities, the first step is to discuss your concerns with your doctor.
Describe your symptoms, how long they have troubled you, and how you manage
them. Your family or friends may be able to add to this history. A discussion
with your doctor is important for several reasons. First, changes in communication,
thinking, or eating may be related to your tumor or treatment. If so, your
doctor may wish to adjust your treatment plan. Second, your doctor can make
a referral for speech-language pathology services. Also, a doctor referral
or "doctor's order" is usually required by insurance companies and the rehabilitation
facility. It is important to understand that a referral does not necessarily
mean that your insurance will cover rehabilitation services you will need
to review your policy or speak directly with your health insurance representative.
- Locate services
Once you obtain a referral, you will need to contact a speech- language
pathologist. Your doctor or insurance/provider network may provide information
about rehabilitation programs within your hospital or provider network.
If you are already seeing a physical and/or occupational therapist, there
may be a speech-language pathologist in their department. If you are having
difficulties finding appropriate services, contact a social worker at ABTA
or your local support group.
THE EVALUATION AND TREATMENT PLAN
The speech-language pathologist will conduct an initial interview, possibly
including your family or caregivers, to learn about your communication and/or
eating patterns. Your own observations are important to the therapists and can
help identify problematic areas. After obtaining your history, more formal testing
will be done. Be sure to bring your glasses, hearing aids, dentures, etc., especially
if you regularly wear them. Your testing may include an evaluation of your face,
mouth, and tongue movements. Other parts of the exam may include listening,
talking, reading, and writing. Cognitive tests may be used to test your ability
to store and remember information. Sometimes the test questions seem very basic
or not related to your own problems - it is still important to complete all
of the tests to the best of your ability. This complete set of information is
necessary for identifying your challenges as well as your strengths. For a swallowing
evaluation, your therapist may ask you to sample various foods and liquids.
Sometimes, your therapist may recommend another type of swallowing evaluation
called a "videofluoroscopy" or a "modified barium swallow study." This is similar
to an x-ray and is done in the radiology department by a doctor and a speech
pathologist. You will be given a small amount of barium in different consistencies
to swallow. The radiology study will allow your therapist to see how the food/liquid
is going down your throat and if there is aspiration (food or liquid going into
the airway).
At the conclusion of these tests, your therapist will review the results with
you and discuss your communication or swallowing diagnosis. Your therapist may
make a recommendation for treatment. Treatment can be restorative with a focus
on improving function, or treatment may be compensatory with a focus on strategies
to "compensate" for difficulties. Most treatment programs are a combination
of the two. Restorative therapies may include exercises to increase lip and
tongue movement, improving your ability to listen and understand language, or
improving your ability to find the words to express your thoughts. Compensatory
strategies may include techniques such as note-taking, improving organizational
skills, modifying your environment, or using external memory aids such as calendars
or date planners. If you have dysphagia, your therapist may recommend a modified
diet that excludes items difficult for you to swallow or items that you may
aspirate. Dysphagia management can also include exercises to improve functioning
or learning to use strategies to compensate for your specific swallowing problems.
An important part of your program will be learning about your diagnosis, treatment
options, and the activities that you can do at home to practice what you are
learning in your treatment sessions. Regardless of your goals, however, remember
there are services, and professionals, to help you with difficulties in communication
or swallowing. Tap into them!
This article is the latest in the ABTA Quality of Life series
"Becoming Well Again Through…." Other topics include Cognitive Retraining, Managing
Fatigue, Rehabilitative Medicine, and Stress Management for Caregivers. If you
would like a copy of those articles, please call us at 800-886-2282.
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