Speech pathology
Introduction
What is communication?
Communication or verbal communication is the process of transferring and exchanging concepts and ideas between individuals and groups. The most important means of communication are auditory and visual means such as light and sound as a means of transmission and the eye and ear as a means of reception. Speech pathology is also considered one of the most important health sciences that deals with language, speech, pronunciation, voice, swallowing and breathing.
Speech pathology has been divided into four sections (language pathology, speech pathology, voice pathology, swallowing pathology).
First: Language pathology.
The mother or individuals surrounding the child can notice the presence of a language delay at an early age for the child by paying attention to the stages of language development in the child.
The child's language develops from the first year of birth and the formation of pre-language and what is called internal language and visual communication with the mother and gestures. The child also goes through vocal stages such as babbling, the child makes a connected or intermittent sound while playing (G ... .....)
Words differ from one child to another and from one society to another according to the importance of the word to the child, so that some children invent their own words that the parents understand.
The child then begins the stage of forming two words at the beginning of the eighteenth month, where the child makes a sentence of two words (Baba Bye - Mama Mum - I Mum ..............
Between the second and a half years and the third year, the most complex stage begins in grammar, sentence structure, answering questions, placing prepositions, linking tools, masculinity and femininity for the verb, and the average vocabulary of the child at this stage is five hundred words and his sentence is not less than three words in one sentence.
Language disorders have been divided into two diseases.
A- Delayed language development:
It is the lack of balance between linguistic age and chronological age, meaning that my child does not speak like his peers or the same age group.
There are four main requirements for proper language acquisition:
- Safety of sensory channels (hearing, vision)
- Healthy brain function.
- Psychological health.
- Stimulating environment for the child.
From the above, we note that my child may suffer from delayed language development as a result of hearing loss or weakness.
- Hearing loss and cochlear implants
After a medical examination and confirming the presence of the problem and determining the degree of hearing in the child and appropriate intervention for the child through drug treatment or hearing aids or cochlear implants.
The role of the speech therapist begins in developing the appropriate auditory rehabilitation program and then developing a language rehabilitation plan and an individual plan is made based on the individual's condition and chronological age that is consistent with his capabilities and strengths and weaknesses.
- Visual loss:
The blind person does not necessarily show a language delay, but with the absence of visual material, some sensory concepts slow down in development. The blind person quickly develops his language as a result of encounters, hearing and repeating the words of those around him, but he needs intervention to understand what is behind the words due to some weakness in thoughts and imagination.
Also, an individual treatment plan is made that suits his capabilities through a speech and language therapist. This is done after a medical examination by an ophthalmologist and an appropriate optician and placing the appropriate visual aids for the child's condition.
- Brain injury.
This injury may occur for reasons in the period before birth such as genetic factors or for reasons during birth such as lack of oxygen to the newborn and brain injury or in the period after birth such as various fevers and dehydration.
The location and severity of the injury varies from one person to another, which results in the level of mental abilities of the individual between simple, moderate, severe, and very severe mental disability.
The appropriate diagnostic procedures are carried out by an integrated medical team (neurologist, psychiatrist, speech therapist, psychologist, and speech therapist).
- Psychological disorders.
The most famous psychological disorders in speech pathology is autism.
Language and social delay are considered basic symptoms in autistic children. All autistic children are delayed in acquiring language and social skills, but to varying degrees from one child to another. Autistic children are divided in this field into two sections: a speaking child (i.e. uses verbal language) and a non-speaking child (uses non-verbal communication methods). In both sections, the speech therapist must choose appropriate strategies, according to each child's condition. Autism spectrum disorder is diagnosed by a group of specialized doctors, and they are trained and plans are developed Suitable for each child's condition after diagnostic tests and good observation of the child.
Environmental deprivation:
Environmental deprivation results when the child is in a poor environment (socially, economically, culturally and emotionally). The child's presence in an unstimulating environment may cause him to have delayed language development. We have noticed this problem in our Arab societies in the period after the Corona pandemic. Many of our children today have delayed language development resulting from social distancing in the most important periods of their developmental lives.
Specific Language Impairment-
They are a group of children who do not suffer from any disability or psychological disorder and show a high performance rate in non-verbal intelligence tests, but they have delayed language development.
It is a heterogeneous disorder accompanied by a delay in various linguistic aspects, whether related to form such as phonetics, structure, linguistic context and content such as semantics or aspects related to use such as the pragmatic component (beyond language) in the presence of normal cognitive, sensory and motor abilities. This disorder has several classifications that we will discuss in a special article.
Treatment of delayed language development:
First, the diagnosis is made through specialized clinics and centers.
Parents should go to the nearest clinic to diagnose the child correctly and follow the orders of the doctor and specialist. They understand that what matters to them is the interest of your child and helping you.
The diagnosis is made after knowing the medical history of the case and the family.
Prenatal, postnatal and postnatal history.
Ensuring the safety of sensory inputs such as hearing and vision.
Ensuring the health of the brain and mental processes.
Conducting standardized tests to know where to start, what the child needs, and the child's strengths and weaknesses.
After that, an individual plan is made based on the diagnosis of the case.
B - Aphasia
It is an acquired language disorder that occurs after the completion of language development and affects all different linguistic aspects: understanding, expression, reading, writing. It occurs as a result of a brain injury in the left hemisphere of the brain (the dominant hemisphere). This disorder occurs in adults after the age of language completion, i.e. after the age of eight years.
It occurs as a result of a brain injury (stroke, brain hemorrhage, exposure to an accident, sudden high blood pressure, diabetes, various heart diseases, smoking, old age, alcohol and drug abuse, sudden low blood pressure, malnutrition in adults)
Treatment
Family counseling is the first item in the treatment plan. The family is the main supporter of the patient, and their understanding of the patient's psychological, physical, linguistic and mental condition contributes greatly to his treatment.
To treat a blind patient, intervention is required within the first six hours of injury for proper drug intervention and diagnosis, early intervention to speed up treatment, and starting treatment sessions from four to six weeks from the time of injury, with no less than four weekly sessions for a period of six consecutive months.
To speed up diagnosis, we notice that the blind patient's injury is on the right side of the body, so we notice some symptoms such as difficulty moving the limbs of the right side of the body (right arm and foot).
After the correct diagnosis and measuring the degree of functional disorder and clinical examination and making the appropriate plan, work begins with the case to speed up recovery, God willing.
Second: Speech disorders
A group of diseases that affect the clarity and pronunciation of speech such as (stuttering - stuttering - stuttering - speech impulse - aphasia)
A - Stuttering:
Stuttering is one of the speech disorders that leads to difficulty in pronouncing one or more sounds.
The bite has nothing to do with a psychological or organic disease or heredity, but it is the result of learning the sound incorrectly from the beginning. There are also influential factors that may lead to the appearance of the bite, such as hearing loss, jaw defects, or palate. Hence, the causes must be treated before starting speech sessions, such as referring to a dentist to do braces to close the teeth well to improve the bite sounds. It is often the cause of the sigmoid bite (S).
The child can also be referred to an ear, nose, and throat doctor in the event of a tongue tie to treat it. The cause of the bite is always the sound of the letter Ra (R).
Bites are divided into types such as
Sigmoid bite (S)
It may be between the two teeth, pronounced (Th).
It may be pronounced lateral.
It may be pharyngeal.
Viral bite.
The letter Ra (R) may be pronounced Ya, Waw, or Lam (Y, W, L)
Converting the back sounds to the front.
As a pronunciation (K) - (T)
or (J) - (K)
or (Kh) - (H)
and so on
The younger the child, the better the result, as he has not been accustomed to incorrect pronunciation for a long time, but young people and older people can also be trained, but they need to be patient.
B - Khnf:
Open Khnf: is an increase in the nasal resonance of vowels and difficulty in pronouncing some consonants. Or in simpler terms, as if the individual is speaking through the nose.
- The audible emission of air from the nose and nasal snoring.
Causes of open snoring.
- It occurs as a result of a deficiency or weakness in the pharyngeal valve muscle.
- Or we notice its presence after tonsillectomy, where it is called functional snoring and the patient uses it in speech behavior as an attempt to overcome the pain resulting from the movement of the pharyngeal valve after the operation.
- Or the presence of a cleft in the roof of the mouth, which may be in the hard or soft palate, uvula, teeth, or lips, what is called a cleft lip, or all of them.
Diagnosis and treatment:
After the medical examination and surgical intervention in case the person needs it and is referred to the dentist, comes the role of speech training.
The patient is taught the correct direction of airflow during speech, or what is called correcting the air path from the nose to the mouth, as all sounds are consonants and oral vowels, except for the sound (m - n), nasal sounds that have a nasal resonance and nasality.
The child is trained to pronounce the sounds correctly, both consonants and vowels.
The patient must be trained in front of a mirror so that it is easy for the patient to imitate the speech specialist.
We ask the patient to exaggerate the opening of the mouth while speaking.
C- Stuttering or stammering:
Stuttering is: the speech does not flow naturally during speaking. We may notice the repetition of sounds, syllables or words. There may also be an extension of sounds within words or unjustified pauses.
Causes of stuttering.
There may be psychological causes such as anxiety and fear.
There may be genetic causes.
There may be neurological causes related to hyperactivity of dopamine in the brain.
And many other causes.
Diagnosis and treatment.
Stuttering is diagnosed through a medical examination and then standardized tests that differ from a child to an adult.
-Treatment of stuttering in children:
- One of the most important points in treating stuttering children is changing the behavior of the environment around them towards their stuttering by giving some guidance to the parents.
- Guidance for families is considered an important stage of comprehensive treatment in any treatment program developed to treat stuttering patients.
Stuttering treatment in children is different from that in adults.
- The adult is the one who seeks treatment, but the child comes to treatment under the guidance of his parents.
- The adult implements the therapist's instructions on his own because he wants treatment, while children find it difficult to realize the existence of a stuttering problem, so the idea of treatment is not important to them.
D- Speech impulse.
It is a disorder in the flow of speech characterized by an increase or irregularity in the speed of speech with an increase in fluency disorder and often with other accompanying symptoms such as language disorders, pronunciation defects or attention disorder.
Causes of speech impulse:
It may be the result of an organic problem such as an increase in brain electricity or a brain injury in the speech area.
It may be due to genetic reasons.
It may be due to psychological reasons.
Symptoms that push speech.
Speech impulse may be observed in children or adults, males and females, but it is more common in males by a ratio of four to one than in females.
- Interrupting while speaking.
- Inability to wait for a turn while talking to others.
- Many unorganized sentences while talking, especially when angry.
- Speed in speaking to the point of deleting some sounds or some words and audio clips in the word.
- Not aware of the other's response when talking to him.
- Inability to control emotions, especially anger.
- Problems with attention in general and auditory attention in particular.
- It is often difficult for a patient with speech impulse to admit that he has a problem, and this is the most difficult point in his treatment.
Treatment of speech impulse.
- Treatment is done through family counseling sessions, and we may need psychological counseling for the patient.
- The patient is trained on proper breathing and trying to relax.
- Organizing his thoughts in an organized manner inside his head.
- Slowing down the speed of words within the sentence and trying to pronounce each sound in the word correctly.
N - Aphasia.
It is the comprehensive name for a group of speech disorders resulting from a defect in the nervous control of the speech mechanism due to an injury to the central or peripheral nervous system that leads to a defect in the basic processes responsible for speech.
Such as
Producing sound, pronunciation, breathing, resonance, and melodic framework.
Causes of aphasia:
The causes of aphasia vary depending on the location of the injury, as do the symptoms, but the cause is a brain injury that may occur due to:
- Bleeding due to high blood pressure.
- Stroke.
- Meningitis or a virus in the brain.
- Brain or brain stem tumors.
- Polio.
- Genetic causes.
- Head injury or accident.
- Parkinson's disease.
- Asthma.
Symptoms of aphasia.
We may notice that the symptoms differ depending on the patient's age and the location of the injury.
- The voice is very tense and choked as if the patient is crying.
- Slow speech rate.
- Lack of clarity of consonants such as the sounds (b, j, t, k, r, l) during speech.
- Excessive nasal resonance.
- Low voice pitch and speech at a single pace.
- Short sentences due to lack of ability to speak.
- Weakness in the muscles of the mouth such as the tongue or lips with drooling or weakness in the roof of the mouth or vocal folds.
Treatment of aphasia:
Aphasia is treated based on the symptoms present through speech sessions and speech and pronunciation symptom training after proper diagnosis and appropriate medical intervention.
Thirdly. Voice diseases
It is a difference in a person's voice resulting from an organic or functional injury.
Voice diseases are many, but the most famous of them is functional hoarseness, which is the result of the misuse of the vocal folds and is more common among people with specific professions such as (Imam of the mosque - Quran reciters - teachers - singers and actors - broadcasters) and everyone whose profession depends on the intensive use of the voice.
Hoarseness is treated after clinical examination, laryngeal imaging, determining the number of speech sessions needed for the person, and explaining important instructions to maintain voice quality.
Swallowing disorders:
It is a weakness in the muscles involved in pronunciation and speech that affects the eating process and may be the result of a brain injury.
The most common symptoms are difficulty swallowing solids such as vegetables and fruits and drooling. The patient may choke, leading to coughing when drinking liquids.
A patient with swallowing difficulties is diagnosed by an otolaryngologist with appropriate medical intervention and drug treatment, then sessions are held to train the speech and speech organs.
References
- Speech Pathology Book. Faculty of Medicine. Ain Shams University.
- Speech production in adults with aphasia, Ghada Shehata, Hassan Muslim, Hassan Abdel Karim, Kariman, Special Education Magazine
2023
- The nature of language and its disorders, Abdullah Al-Saqr, Special Education Magazine,
2016
