Speech and language disorders involve difficulty speaking,

understanding, reading, or writing and, unfortunately, they can

occur at any age. The causes include the following:
• Genetic problems or conditions present at birth
• Brain injury (e.g., caused by accident, infection, drug abuse,
or stroke)
• Disease
• Hearing loss
• Brain tumours
• Problems with the body structures used for speech
Clients with speech or language disorders should always have
a thorough health history taken, usually by a doctor or a nurse,
as soon as possible before treatment begins. The client’s
history will provide details that can help the health care team
better understand the health challenges the client has faced.
APHASIA
Aphasia is the partial or complete loss (a) of
speech and language skills (phasia) caused by
brain injury. Stroke (also called cerebral vascular
accident, or CVA), head trauma, and brain
tumours are the most common causes of aphasia.
Some people with aphasia regain some or all of
their language skills, but in some, aphasia is
permanent. For example, people with dementia
who develop aphasia do not typically regain
verbal communication skills. For communication
to occur, a message must be sent, received, and
interpreted. People with aphasia are unable to
send messages, unable to understand the message
received, or both.
Types of Aphasia
Receptive aphasia—difficulty
understanding language, including
both spoken and written words.
People with receptive aphasia
cannot
understand their own words or
others’, so their speech is mixed up
or muddled. They also mix up
sounds within words. A client trying
to say “hospital,” for example, may
say “posital.”
Expressive aphasia—difficulty speaking or writing. People with
expressive aphasia can understand spoken and written words,
but their speech or written language is jumbled or slurred and
difficult to understand. They think one thing but say or write
another. For example, a client may want food but ask for a
newspaper. People with expressive aphasia cannot think of the
right words or put the right sounds together to form words and
sentences. For example, a client trying to say, “Please give me a
glass of water” may actually say “Come. Come. Come. Come.”
Some may leave out connecting words. Others can produce only
meaningless sounds. Because people with expressive aphasia are
very aware of their mistakes since they can understand what they
are saying, they may become frustrated or depressed, leading
them to cry or swear for no apparent reason.
Expressive–receptive aphasia (also
known as global aphasia)—
difficulty speaking and
understanding written and spoken
language. Some people with
expressive–receptive aphasia can
say only “yes” and “no” and make
sounds such as “da da.” Some
others have lost all speech and
language skills.
APRAXIA
OF SPEECH
Apraxia of speech (verbal apraxia) is the
inability (a) to correctly move (praxia) the
muscles used to speak. People with this
disorder are not able to control their lip,
jaw, or tongue movements. As a result,
they are not able to say the desired sounds
and words. Apraxia of speech is caused by
brain injury resulting from stroke,
accident, brain tumour, or infection. Some
babies are born with this disorder. Apraxia
of speech can occur alone or with aphasia.
Understanding the speech of people with
apraxia of speech is difficult, as they usually
speak very slowly and may use words that
sound similar to but not be exactly what they
are trying to say. For example, a client may say
“me” instead of “see.” As well, the order of
sounds within words may be mixed up. For
example, a client may say “thootshub” instead
of “toothbrush.” Some people have problems
putting words in the right order or finding the
right words. Inconsistent speech is common—
that is, a person may say something correctly
one time and incorrectly another time.
DYSARTHRIA
 Dysarthria is difficulty (dys) speaking
clearly (arthria). It is caused by weakness or
paralysis in the muscles used for speech.
Common causes of dysarthria include
cerebral palsy, multiple sclerosis, head injury,
tumour, and infection.
People with dysarthria usually have
slurred, slow, and soft speech and speak in
flat, harsh, or nasal tones. They often have
problems forming words, spacing their words,
and breathing while speaking. Speech errors
are usually consistent and predictable, so you
may become familiar with a client’s speech.
 EMOTIONAL
EFFECTS OF
SPEECH
AND LANGUAGE
DISORDERS
 How would you feel if you were not able to
express your thoughts and feelings? How would
you feel if you were not able to understand what
others are saying? People with speech and
language disorders experience emotions such as
frustration, depression, and anger, as well as low
self-esteem, shame, and guilt.
Communication is important for functioning
and for maintaining relationships with others. Being
unable to communicate may cause a client to avoid
social situations, or family and friends may avoid
the client instead. Speech and language disorders
can be very stressful for families, as the relations
between all family members are usually affected.
 Many of us often find sharing our thoughts
and feelings with others difficult. It is even more
difficult for someone who has a speech or language
disorder since even everyday conversations require
great effort. People with speech and language
disorders may speak slowly, may struggle with
words, or may mispronounce words frequently.
These communication difficulties might be
frustrating for both the affected person and the
listener, who may have to struggle to understand.
Family members may find themselves trying to
correct the person or becoming irritated with the
person if the same word or phrase is repeatedly
mispronounced. The person who cannot speak
clearly might be tempted to avoid speaking.
 People with speech or language disorders
may not be able to work, so they may suffer the
added stress of financial concerns. For some
people, even routine tasks like shopping,
cooking, paying bills, and doing household
repairs may be impossible, so they are forced to
depend on others to do what they used to be
able to do themselves.
Emotional reactions vary from client to client
and from family to family. Observe and listen to
your clients and their families. Put yourself in
their place. How would you feel and want to be
treated in their position? Accept and understand
displays of emotion.
TREATMENT FOR
SPEECH AND
LANGUAGE
DISORDERS
A speech therapist (also called a speech–
language pathologist) helps the client
with a speech disorder learn to
communicate and also helps family
members learn new communication
techniques. Methods used depend on the
disorder, its cause, and its severity.
Practice and exercises may help the client
relearn speech and language skills. In the
case of dysarthria, the client practises
muscle-strengthening exercises and
learns how to breathe while speaking.
People with speech and language disorders
also learn how to improve existing skills. For
example, a client learns to use body language
and facial expressions to make
communication more effective. Some people
learn new skills such as sign language. Those
with severe speech and language problems
may never regain their ability to speak and
understand language.
 Communication boards. These are boards with pictures or
words that show functions or tasks. There are pictures or
words related to activities of daily living, such as sleep, food,
drink, medicine, and glasses. The client points to the things
that are needed. The type of communication board depends
on the client’s needs. For those who can read, words rather
than pictures are often used. For those with quadriplegia who
are not able to speak or point, eye-gaze boards may be used.
The client indicates needs by gazing at the picture or word on
the board and either blinking or using another signal to
accept it.
Mechanical and electronic devices.
These devices range in complexity
and cost—from large computers
that cannot be moved easily from
place to place to handheld devices
such as electronic talking aids. The
client touches a picture displayed
on the screen, and the message is
then voiced by the device. For
example, the client touches a
picture of a sad face. A recorded
message says, “I am sad.” The
message may also be printed on a
screen, and some devices convert
words into pictures.
The Use of Computers That
Assist Clients
With Speech and Language
Challenges
A variety of communication tools are available to
assist clients who have speech and language
challenges to communicate more easily. For
example, people with verbal-expression
communication disorders (such as dyslexia or
verbal apraxia) often have difficulty reading or
writing. Electronic devices that use a combination
of screen reading, magnification systems, and
alternate input provide computing access to people
with such impairments. As well, electronic tablets
that are small, easy to transport, and easy for most
people to use can be customized with
downloadable applications to assist the client.
For clients who are unable to speak clearly but are
able to type in the correct words or identify
symbols that represent the words, there are
systems available that can speak for them. Most of
the software packages used for these applications
can operate with a speech synthesizer. The speech
that comes from the machine is electronically
generated but can be adapted for a male or female
voice. These computer assisted electronic aids are
expensive and may be difficult for some to carry
around, but they have proven to be invaluable in
improving the quality of life for those with speech
and language challenges.
SUPPORTING AND
COMMUNICATING
WITH CLIENTS
As a support worker, to effectively communicate
with your clients who have speech and language
disorders, you must first know how you
communicate in general. You may have to change
the way you speak. Follow the care plan and your
supervisor’s instructions. Use the communication
methods that are best for your client. While you are
speaking, you should remember to be mindful of
your facial expressions, as they can reflect any
impatience or frustration you feel with the client.
The effort of understanding others and making
oneself understood can be exhausting, especially to
clients with speech and language disorders, so they
often tire easily. Their other health problems may also
cause fatigue. Be alert for signs of fatigue, such as
drooping shoulders, irritability, lack of interest, and a
decline in understanding. Reduce surrounding
distractions (e.g., close doors and windows, turn
down the volume of a television or radio), which can
make concentrating difficult for the client. Some
clients with speech and language disorders will
appear withdrawn and uninterested. Spend extra time
with these clients. Social interaction can promote self-
esteem and recovery. Always include them in
conversations, even if they cannot understand you.
 Guidelines for
Communicating
With Clients With
Speech and
Language
Disorders
 Minimize
distractions.
Adjust the lighting.
Give the client
your full
attention.
• In the beginning of your
work relationship
with the client, you can
start by asking questions to
which you know the
answer.
Determine the
subject being
discussed.
Follow the
client’s
lead
• Speak slowly,
clearly, and in a
normal tone of
voice.
Give the
client time to
respond.
Use simple word
and short
sentences.
Be
patient.
Use positive
statements.
Use appropriate
questioning and
paraphrasing
techniques.
Provide cues,
as needed
Try other
communication
methods
Pay attention to your
own facial
expressions and
nonverbal cues.
Quiz tomorrow