Adults lose their speech or ability to swallow as a result of a neurological (brain) event such as a stroke (CVA). This can be a sudden and devastating change to health and well being.
Losing the ability to communicate is one of the biggest losses that people can face. People who have dyspraxia (apraxia) may not be able to talk or read. It can even be difficult to gesture accurately, as parts of the body do not respond to instructions from the brain accurately.
As well as facing a major illness, the loss of communication causes further loss of independence and frustration. People face a frightening future.
When someone has dyspraxia (apraxia) as a result of a sudden illness, Speech Pathologists are usually involved in the hospital (or acute) phase. A Speech Pathologist will assess a patient as early as possible, especially to see if swallowing is affected. This is called a Dysphagia assessment. If it is, then the Speech Pathologist will recommend nil by mouth, or food and fluid that is safe to swallow.
If a patient has dysphagia (swallowing difficulty) this may resolve over the next few days or next few weeks, and regular re-assessments will be made. In addition, if a patient is awake enough and able to follow instructions they may be given exercises to help them gain control over the movement of the larynx which may help the swallow.
A speech and language assessment will be able to identify the extent of the speech impairment. The Speech Pathologist will be able to find out if there are any difficulties with comprehension and advise others on how to best communicate with the patient. Often it is more effective to give the staff and families strategies to use than to put pressure on the patient.
Sometimes speech will improve over the next few days. However, often extensive speech therapy will be needed.
Speech difficulties may be considered mild, moderate or severe. In severe cases, people are unable to talk at all or can’t talk enough to be well understood.
It can be very difficult to get speech started (initiating). Treatment will often involve helping people to get started.
Automatic speech, or well-rehearsed phrases are usually easier to say than other more spontaneous speech. Automatic speech includes, for example, saying the days of the week or the months of the year. Dyspraxia treatment will often use this automatic speech to extend to other kinds of talking.
Phrases that are well-known are also easier to say, so dyspraxia treatment may use paired words such as “bacon and…?” or “shoes and …?” or completing proverbs. It often helps someone with dyspraxia if a sentence is started for them.
Treatment for dyspraxia often uses tune, either in songs or the natural pitch variations that occur in speech. Teaching someone how to exaggerate this natural tune can often help to make speech easier.
Using gesture and actions to go with words also helps the words to come easier.
By the time an acute phase has passed, a person may be left with either a considerable or a minor deficit. Talking may still be very difficult. If at all possible, speech therapy should be found to continue a course of treatment. Some health services will offer rehabilitation, and this should be accepted whenever offered. Every little bit of therapy helps.
Rehabilitation can help to build up the sounds and words that a patient can say, increase the length of the phrases or sentences, and, most importantly, make it easier to say what needs to be said.
Therapy may need to be long term. A Speech Pathologist can also give strategies that can be used in everyday life with a focus on making speech functional. Clients and families can work with the Speech Pathologist to set and achieve realistic goals that make a difference.
Dyspraxia treatment (apraxia treatment) is most effective when commenced within the first week of onset. However, treatment commenced even years after the initial event can be effective and improve communication for someone with dyspraxia.