Speech defect and speech therapy

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1. Practice teaching on speech defect and speech therapy Presented by: Ms. Hari singh nagar M. Sc Nursing 1 st year

2. Objectives After completion of the class students will be able to Introduce the speech defect and speech therapy. Define speech defect and speech therapy. Enlist the Causes of speech defect Enumerate the classification of speech defect. Explain the types of speech defect Explain the diagnostic evaluation of speech defect Explain the management of speech defect . Explain the nursing management of speech defect.

3. Introduction Speech is a primary method of communicating with the others. An impairment in speech can significantly impact your ability to communicate. It leads to affect all stage of life can lead to social isolation, embarrassment and shame. Speech therapy help the people to become independent communicator speech, gesture or communication aids as needed.

4. Definition speech defect is a type of communication disorder where normal speech is disrupted. Someone who is unable to speak due to a speech disorder is considered mute. Speech therapy – it is a rehabilitative procedure undertaken in order to help the people having any kind of communication disorder or problems and some swallowing problems.

5. Incidence The incidence was higher in males. Delayed speech was the commonest abnormality and was present in 47.8%, defective articulation in 21.6%, stuttering in 15.6%, multiple speech defects in 10.8%, rhinolalia in 2.1% and aphasia in 1.9% of cases.

6. Anatomy and physiology of larynx It is also known as “voice box” Until puberty there is a little differences in the size of the larynx between the sexes. Thereafter it grows larger in the male, known as Adam's apple & generally the deeper voice.

7. Larynx structure The vocal cords are two folds of pale mucous membrane the muscle controlling the vocal cords are relaxed, the vocal cords are open & the passageway for air is clear. Vocal cord said to be abducted or open, that time the pitch of the sound is very low. When the muscle controlling the vocal cords are contract, the vocal cords are stretch out tightly across the larynx. Vocal cord said to be adducted or closed, that time the pitch of the sound is very high. When not in use, the vocal cord are adducted.

8. Function production of sound speech protection of the lower respiratory tract passageway of air humidifying , filtering , Warming

9. Etiology In most cases the causes is unknown. Others – Neurological disorder Brain injury, Trauma Vocal cord damage, paralysis, nodule Respiratory muscle weakness Strokes Cleft lip and palate

10. Association Areas

11. Classification of speech defect Classifying normal and disordered speech is a more problematic then it first seems. By a strict classification only 5-10% people of the population has completely normal manner of speaking and healthy voice. All are other are suffer from disorder or another. Sound the patient can produce. Phonemic – can produce easily, using meaningfully and constructively. Phonetic – produce only on request, not using consistently, meaningfully, constructively not used in connected speech.

12. Cont….. 2. Stimulate sound Easily stimulated Stimulate after the demonstration and probing (using a tongue depressor) 3. can’t produce the sound Can't produce voluntarily No production ever observed.

13. PROCESS OF SPEECH ABNORMALITIES HEARING UNDERSTANDING THOUGHT & WORD PROCESSING VOICE PRODUCTION ARTICULATION DEAFNESS APHASIA APHASIA DYSPHONIA DYSARTHRIA

14. Types of speech defect Aphasia – Fluent - Wernicke’s, Conduction/associative, anomic/nominal/amnesia/ Dysnomia /minimal dysfunction syndrome, Transcortical sensory aphasia non fluent - Broca’s Aphasia, Transcortical motor Aphasia, Global Aphasia. Dysarthria – Flaccid, spastic, ataxic, hyperkinetic, hypokinetic, mixed. Dysphonia Others – Cluttering, Stammering, Dysprosody, Apraxia, Scanning, Staccoto .

15. Types of speech defect Aphasia – it is the acquired impairment in the use of language due to damage to certain parts of the brain affecting the production or comprehension speech and the ability to read and write. Types of aphasia Fluent aphasia – the inability to understand the language of others and produce the less meaningful speech then normal.

16. Cont….. Types of fluent aphasia Wernicke’s – person having difficulty or Inability to understand the others speech, produce meaningless speech and unable to repeat the words. It is produced by damaged to the wernicke’s areas of the brain.

17. Cont….. Transcortical sensory aphasia – similar to wernicke’s aphasia but repetition is intact. Conduction or associative aphasia – it is characterized by intact auditory comprehension, fluent speech production but poor speech repetition or difficulty in repeating something someone has just told. Amnesic aphasia - In this the individual has word retrieval failure and can’t express the word they want to say.

18. Cont….. II. Non-fluent aphasia – difficulty in producing the fluent, articulated or self initiated speech. Broca’s aphasia- in this having trouble speaking fluently but their comprehension can be relatively preserved. Patient having difficulty in producing grammatical sentence and their speech is limited to short. Producing the right sound or Finding the right words is a laborious process. E.g. - Mary give john balloons.

19. Cont….. B. Transcortical motor aphasia – repetition ability is intact. It is related to impair verbal output. People with this aphasia doesn’t speak unless they are strongly encouraged to do so and when they speak it is labored and non-fluent. C. Global aphasia – it is characterized by severe depression of all language functioning. non-fluent, naming, repetition, comprehension all are impaired.

20. Cont….. Dysarthria – it is characterized by slurred speech or slow speech that can be difficult to understand due to defect in articulation. Flaccid – it results from the damaged to the PNS. Depending on the which nerve is damaged it affect the respiration, phonation, resonance and articulation. It causes muscle weakness, low muscle tone and diminished reflex. Spastic – it causing excess tone and limited range in muscle movement. In this speech is labored and word may be prolonged.

21. Cont…. III. Ataxic – it is characterized by slurring and incoordination of sound because of damage to the cerebellum. IV. Hyperkinetic – in this there is a too much involuntary movement. It is quite during sleep. It interrupt the speech movement as well. V. Hypokinetics – in this there is a less or reduced movement leads to reduced vocal loudness and abnormal speaking rates. VI. Mixed – in this combination of two or more dysarthria.

22. Cont…. 3. Dysphonia – it is also known as hoarse voice. It refers to the inability to produce voice. 4. Others Cluttering – it is a rapid rate of speech, which makes the speech difficult to understand. It is also known as tachyphemia or tachyprasia. Stammering/stuttering – in this flow of speech is disrupted by involuntary repetition and prolongation of sound as well as involuntary silent pause in which the person unable to produce the sound.

23. Cont…. III. Dysprosody – it refers to the loss of normal regulation or melody of speech. IV. Apraxia – involve inconsistent production of speech sound and rearrangement of sound in a words (“potato” may become “topato” or “totapo”) V. Scanning speech- it is a type of ataxic dysarthria. It involve incoordination of tongue, in this syllables of words are separated by pause. VI. Staccato speech – it is due to incoordination of larynx muscle of articulation. In this each syllable is uttered separately.

24. Diagnostic evaluation History Physical examination - head, neck and larynx examination. Laryngoscopy – it is an examination to look at the back of your throat, your voice box (larynx) , and vocal cords with a scope (laryngoscope)

25. Mirror examination – it is used for visualizing the interior of the larynx, and especially the vocal folds.

26. Videostroboscopy - It provides a magnified view of the larynx, and simulates slow-motion vibration of the vocal cords.

27. Laryngeal electromyography – electrical activity in the laryngeal muscle.

28. Cont…. Voice lab functioning test – computer based technique used to make voice recording which are analyzed by a computer to obtain quantitative measurement of voice abnormalities. Test for reflex Other test - X- ray, CT- scan, MRI

29. Management

30. Cont….. It can be done by correcting the organic condition and psychotherapy. Place the patient in special education programme those who suffer from speech impairment. speech therapy Many of these disorder can be treated by speech therapy. It is given by the speech therapist are professionally educated in the study of human communication, it’s development and disorder. It assess the speech, language, communication problems, swallowing problems and best way to treat them.

31. Cont….. Remediation - It means reserving or stopping to become severe. In this therapist work with the patients one on one, or in a small group or directly in a classroom to overcome the difficulties. Therapist use a variety of strategies including Language intervention activities – the therapist interact with the patient by talking, using pictures, books, object , ongoing events to stimulate language development. The therapist may also correct the pronunciation and using the repetition exercise to build speech and language skills.

32. Cont ….. 2. Articulation therapy – articulation or sound production, exercise involve having the therapist to correct sound and syllable for a patient, often during the activities. The therapy will physically show the patient how to make certain sounds such as the ‘r’ sound and demonstrate how to move the tongue to produce specific sounds.

33. Cont ….. 3. Swallowing therapy – it will use a variety of oral exercise including facial message and various tongue, lip and jaw exercise to strengthen the muscle of the mouth. The therapist also may work with different food textures and temperatures to increase a patient oral awareness during eating and swallowing.

34. Nursing Management

35. Nursing diagnosis – impaired verbal communication related to impaired function of the muscle as evidence by the impairment in speech. Goals : improve the verbal communication. Intervention : Assess the patient for impaired verbal communication. Maintain a patient calm approach, listen attentively and allow the time for communication. Maintain a calm environment so the client can concentrate on communication efforts, doesn’t speak loudly and able to hear the others clearly.

36. Ask the question that require short answer, eyeblink or nod of head if the patient is having speaking difficulties. Schedule rest periods before visiting hours and speech therapy session to maximize communication. Regarding the impairment consult with the speech therapist to reinforce the exercise and technique recommended. If the patient is unable to communicate, encourage the other person and staff to communicate with them.

37. 2. Nursing diagnosis – impaired social interaction related to trouble speaking as evidenced by observation. Goal : minimize disruption of social interaction. Intervention - Help the patient to identify the inner strength. Give knowledge to people nearby about speech impairments. Encourage the patient to talk or communicate with the other person. Encourage the patient to maintain contact with the friends. Give positive reinforcement on the results\ achieved by the patient.

38. Study related to speech defect identifying children at risk for speech and hearing disorders - a preliminary survey report from Hyderabad, India The school teachers were given an orientation to use the questionnaire to elicit information on features considered as risk factors, for speech and hearing problems and other disabilities. 6591 children were screened using the questionnaire developed for the study. The results of the study show the percentage of children identified at-risk for hearing loss was 15.96%, for speech and language problems it was 1.89 % and for other disabilities it was 0.76%

39. Summary speech defect is a type of communication disorder where normal speech is disrupted. Speech therapy – it is a rehabilitative procedure Classification Sound the patient can produce. Phonemic Phonetic 2. Stimulate sound Easily stimulated Stimulate after the demonstration and probing (using a tongue depressor) 3. can’t produce the sound Can't produce voluntarily No production ever observed.

40. Summary Types Aphasia – Fluent - Wernicke’s, Conduction, anomic, Transcortical sensory non fluent - Broca’s Aphasia, Transcortical motor Aphasia, Global Aphasia. Dysarthria – Flaccid, spastic, ataxic, hyperkinetic, hypokinetic, mixed. Dysphonia Others – Cluttering, Stammering, Dysprosody, Apraxia, Scanning, Staccoto .

41. Summary D/E History Head, neck and larynx examination Laryngeal electromyography Voice lab functioning test Test for reflex Other – X-ray. CT- scan. MRI Management Correct the condition Education programme Speech therapy – remediation

42. References “ brunner and Suddarth’s ” text book of medical surgical nursing, twelth edition,Wolters publication, Page no. 591-592 “Saunders” comprehensive review for the NCLEX RN examination, fifth edition, elsevier publication, page n0. 392 www.authorstream.com www.slideshare.com www.nursenanda.com