Verbal communication disorders are commonly seen in patients in cerebral neurology and geriatrics. Speech communication disorders are particularly common due to brain lesions, especially cerebrovascular lesions, and are generally more severe in nature. Language communication disorders are closely related to hearing or speech defects or loss, the treatment of language disorders need to be based on the etiology and pathology from hearing and/or speech to correct, foreign countries in the 1920s was established in the study, diagnosis and treatment of language disorders of a specialized discipline called “speech pathology and audiology”. The work of speech therapy in China was developed only after the liberation, and some work has been done in the areas of stuttering correction, examination and treatment of aphasia in stroke, and language training for deaf children.
I. Definition
The terms “speech” and “language” are often used together in Chinese, but strictly speaking, there is a difference between the two. Speech refers to the spoken language, while language includes not only speech, but also written, gestures and expressions to express meaning. Speech-language communication disorders are deficits in the ability to communicate one’s thoughts, feelings, opinions, and needs through spoken or written language or gestures (mainly speaking, listening, and fixing). Speech-language therapeutics refers primarily to treatment that restores the patient’s ability to speak normally.
II. Patterns and Disorders of Language Formation
There are three stages of language formation, in the order in which they occur.
1, input (input) through the visual and auditory modal sensory transmission to the center.
2. Integration: The center synthesizes, compares, and integrates the incoming information.
3.Output: After synthesis and analysis, it responds to the incoming information with language. The first step of output is the formation of concepts, i.e., thinking about, or deciding and organizing the concepts to be expressed (words to say, words to write, gestures to make); the second step is to transform these concepts into neural information for output; the third step is to constitute language through the movement (contraction or relaxation) of the articulatory organs or hand muscles or expression muscles, or writing words, or gestures and expressions, ultimately to express thoughts, feelings, opinions and needs. emotions, opinions and needs.
If any one of the three links of language formation is damaged, pathological speech or language disorders can occur.
Three, language disorders and the type and nature of determination
(A) types of speech disorders
Can be divided according to the four elements of speech composition, namely.
① vocalization.
(ii) phonological composition.
③ language (vocabulary, grammar, logical organization).
④ Fluency.
1, voice abnormalities related to laryngitis, thickening or paralysis of the vocal cords, etc.. Its performance is further divided into.
① abnormal sound quality (hissing sound, breath sound or excessive nasal sound, etc.).
② volume abnormalities (too large or too small)
(3) abnormal pitch (too high, too low, abrupt changes).
2. Dysarthria is commonly caused by dysarthria or structural abnormalities of the organ of composition.
3.Language abnormalities are commonly seen in aphasia after cerebrovascular lesions.
4.Fluency abnormalities such as stuttering and reverberation disorder.
As for the causes of language disorders, they can be divided into congenital, acquired, organic, functional, etc.
(B) The nature of speech disorders are determined
According to the anatomical and physiological basis of speech behavior, and the psychological structure of speech behavior to determine the nature of speech disorders, can be broadly grouped into the following three categories.
1.Aphasia refers to the organic damage to the cerebral hemispheres, the higher part of the nervous system, which causes a dysfunction in one or several aspects of the speech communication process, such as perception and recognition, comprehension and reception of language, and organization and use of language for expression.
2, certain major mental processes (consciousness, memory, thinking, etc.) of dysregulation of the psychological abnormalities caused by speech disorders and psychiatric disorders of speech, including.
① Speech disorders are the secondary consequences of dysregulation of consciousness, thinking, and memory of certain organic brain diseases. For example, in coma, the patient often lacks all interactive activities to the outside world, including speech. (b) In the case of dysfunctional thinking and memory, the patient’s verbal interactions often appear to be unrealistic and logically confused.
(ii) Intellectual impairment: Congenital cerebral hypoplasia and intellectual deficits often interfere with and impede the normal development of speech before the individual’s speech ability is acquired. Acquired organic encephalopathies of intelligence disorders often destroy the acquired speech abilities.
(iii) Abnormalities of speech in psychiatric disorders.
(iv) hysterical aphasia and aphasia.
⑤ Stuttering is the more common oral language disorder. About 1% of the social population suffers from stuttering disorder, and the prevalence rate of children alone is as high as 6-6, 6%. It is an important element of speech therapy. The cause of stuttering, there is still no uniform understanding, but in general is a psychological disorder. Stuttering is manifested as a lack of fluency in speech, repetition of word sounds, especially the first word sound at the beginning of a sentence is important for more, word sounds are prolonged, the flow of speech is interrupted, the rhythm of speech is disturbed, often accompanied by emotional tension. Excessive movements of the face and body.
3. Injuries to the central and peripheral nerves of the non-cerebral hemispheres, the auditory and visual organs, the articulatory organs, the hand muscles and other functional units of speech caused by damage to the vocal cords, the resonating organs, the oral speech motor muscles, and the motor nerves of the peripheral and brainstem central innervated speech motor muscles can cause speech disorders and affect written oral communication, especially auditory disorders have a great impact on oral communication, and hand motor In particular, hearing impairment has a great impact on oral communication, while hand motor and nerve lesions affect writing and cause impairment in written speech.
Among the above three types of speech disorders, aphasia and dysphasia caused by brain injury are the most complex speech disorders in nature. It is the main object of speech rehabilitation, but also the main content of neurological rehabilitation.
Fourth, the principles and purposes of language correction
(A) the principles of speech correction
1, before treatment to conduct a comprehensive and detailed speech function assessment. To clarify the patient’s degree of impairment in speaking, reading, listening and writing and the extent of the lesion, in order to make the treatment targeted, and to develop treatment procedures of varying difficulty.
2. If multiple aspects of spoken and written language, such as listening, speaking, reading and writing, are impaired at the same time, the focus and goal of treatment should first be on the rehabilitation of spoken language, because
① Spoken language is the minimum major form of communication that all human beings have, and the recovery of spoken language determines whether the patient can participate in normal social life and interaction.
(ii) The development of spoken language precedes the development of written language reading and writing, and written language is learned on the basis of spoken language.
The spoken language has a supporting role for the written language, and the recovery of the spoken language first helps the rehabilitation training of the written language.
3.At the same time of the spoken language training, with the same content of reading and writing, so as to strengthen the training.
4.The content of speech correction should be suitable for the patient’s cultural level and interest in life, and the topics chosen should be interesting to the patient, easy first, then difficult, and progressive.
5, grasp the patient’s interest changes, when the patient is depressed should shorten the treatment time or choose the patient’s hobby recreational activities, such as playing chess, poker, listening to recorded songs, or intermittent treatment. When the patient is in a full mood, the treatment time can be extended and the items and difficulties of treatment can be increased. When a certain therapeutic progress should be encouraged, firm confidence, training in the tips of the shortcomings help self-correction and self-training.
6, in order to stimulate the patient’s desire for verbal communication and enthusiasm, attention should be paid to the setting of a suitable language environment.
(B) the purpose of speech correction
1, mainly to improve the patient’s language comprehension and expression (including improving listening, reading comprehension and language expression, gesture expression and language writing), the ultimate goal is to restore the patient’s verbal communication ability.
2. Maintain the efficacy gained in regular, continuous therapy, which is administered after the patient has reached maximum recovery.
3. Facilitate the patient’s psychological and emotional adjustment to the speech communication disorder, for example, the patient’s unrealistic thoughts and wishes about treatment expectations should be eliminated.
V. Speech therapy and work content
The speech therapy work content within the rehabilitation and medical hub includes
(i) Examination of the patient’s language ability and diagnosis of the type of language disorder.
(2) To develop a treatment plan for those who are suitable for speech therapy.
(3) Provide speech therapy to the patient, or instruct the patient or family to carry out the treatment plan at home.
(d) Explain and educate the patient’s family about improving speech and language communication, for example, instructing the family of a patient with post-stroke aphasia on how to deal with speech and language communication disorders.
(v) Follow up with patients in treatment to assess the effectiveness of treatment.
(6) Instruct patients to order and use appropriate hearing aids or aids to speech and language communication devices.
(vii) Speech therapy professionals work with physicians and physical or occupational therapists or psychotherapists to arrange speech therapy in a comprehensive rehabilitation program, participate in specialty therapy group visits, meetings, or specialty clinics, and work with other therapists in the group to observe and evaluate functional changes in the patient.
(viii) Audiological examination (for departments with audiological examination equipment) Some speech therapy rooms do not have special hearing examination equipment.
(ix) Teaching work related to speech therapy.
(J) scientific research work related to speech therapy.
VI. Speech therapy methods and approaches
The common methods of speech therapy are as follows.
(A) articulatory organ exercise: such as tongue movement (forward extension, tongue movement to the left and right side, tongue roll, tongue rotation in the mouth) to overcome the inflexible tongue tip and tongue root movement; puffing exercises, vocal cord vibration exercises.
(2) Language training: point out the parts of speech that are pronounced, show the mouth shape and make the patient imitate them; make the correct speech and make the patient imitate them; find out the difficult sounds and the sounds that are easily mispronounced by the patient from the speech check and teach patiently to correct them, it is appropriate to use the individual counseling method, including the phonetic decomposition method and the phonetic method for training.
(iii) Language practice: correct the wrong language, patiently teach the daily language, and train through question and answer.
(4) Name the objects: Ask questions one by one with small objects or pictures for daily life. If the patient does not know how to answer, give guidance and make him or her imitate the name of the object and practice repeatedly.
(E) Word reading practice: Show the cards with words of different complexity and simplicity, and guide the patient to read the sound of the word.
(6) Conversation practice: Conduct short conversations in daily life, train the ability to “listen” and “speak”, give linguistic stimuli to elicit responses from patients, and pay attention to correcting phonological, lexical and grammatical errors during the conversation.
(vii) Reading exercises: read newspaper headlines or small passages from articles, correcting phonological errors and improving fluency.
There are several forms of speech therapy as follows.
(i) Individual therapy: A physician or therapist trains a patient to perform targeted speech therapy, which includes phonological training, phrasing exercises, and articulatory organ exercises, etc. Individual counseling is the basic form of speech therapy.
(ii) Group therapy: Usually a small group (5 to 10 people) of people with basically the same condition. The therapist leads the group and conducts conversation exercises. The therapist asks questions, and each patient takes turns to answer, such as asking name, date, name of hospital, etc. When one patient cannot answer, other patients can answer for him/her or add to it. This kind of conversation is more relaxed and can train both memory and speaking skills. Moreover, the patients inspire and encourage each other, which has a greater value of psychological and social rehabilitation.
(iii) Home therapy: The speech therapist will go to the patient’s home for counseling, or the patient will do language training at home by himself under the guidance of his family.