Rehabilitation services are needed by people who have lost the ability to speak normally, often because of an injury, a stroke, an infection, a tumor, surgery, or a progressive disorder.
Aphasia
Aphasia is partial or complete loss of the ability to express or understand spoken or written words. It often results from a stroke or another brain injury that affects the language center in the brain (see figure When Specific Areas of the Brain are Damaged).
The goal of rehabilitation is to establish the most effective means of communication. For people with mild impairment, a speech therapist uses an approach that emphasizes ideas and thoughts rather than words. Pointing to an object or picture, gesturing, nodding, and relying on facial expressions are often sufficient for basic communication. For people with more severe impairment, a stimulation approach (frequently repeating words to the person) and a programmed stimulation approach (speaking words and presenting objects that can be touched and seen) help people regain some ability to use language. People with aphasia may use a letter or picture board to communicate.
Caregivers of a person with aphasia need to be very patient and to understand the person's frustration. Caregivers must also realize that the person is not mentally impaired and should not be spoken to in baby language, which is insulting. Instead, caregivers should speak normally and, if necessary, use gestures or point to objects.
Dysarthria
Dysarthria is the inability to articulate words normally because part of the nervous system that controls muscles used in speech is damaged.
Rehabilitation goals depend on the cause of the dysarthria. If the cause is a stroke, a head injury, or brain surgery, the goal is to restore and preserve speech. If dysarthria is mild, repetition of words or sentences may enable people to relearn to use facial muscles and the tongue for correct pronunciation. If dysarthria is severe, people may be taught to use a letter or picture board or an electronic communication device with a keyboard and message display (print or screen).
If dysarthria is caused by a progressive disorder of the nervous system, such as amyotrophic lateral sclerosis (ALS or Lou Gehrig disease) or multiple sclerosis, the goal of therapy is to maintain speech function for as long as possible. People are taught exercises that increase control of the mouth, tongue, and lips and are taught to speak more slowly and use shorter phrases. Poor control of breathing muscles may force people to take a breath in the middle of a sentence. Planning punctuation in a sentence can help. Doing breathing exercises can also help, sometimes by breathing through handheld assistive devices, which help dislodge mucus in the airways.
Verbal apraxia
Verbal apraxia is the inability to produce the basic sound units of speech because of an abnormality in initiating, coordinating, or sequencing the muscle movements needed to talk. Verbal apraxia is often caused by brain injury, as results from a stroke or head injury.
A therapist may have people practice making sound patterns over and over or teach them to use the natural melody and rhythm of common phrases. Every phrase has its own melody and rhythm depending on the mood of the speaker. For example, "Good morning! How are you?" has a particular melody and rhythm when the speaker is feeling cheerful than it does when the speaker is feeling unsociable. The therapist encourages people with verbal apraxia to exaggerate the natural melody and rhythm of phrases. As people progress, the exaggeration of melody and rhythm is gradually toned down.
If apraxia is severe, people may be taught to use a letter or picture board or a electronic communication device with a keyboard and message display (print or screen).
