Speech disorders after a brain injury, whether traumatic (car accident) or non-traumatic (stroke) can be debilitating. Going to a physical therapist after a brain injury is always a primary focus, but what about the talking? Many people feel that after a brain injury, coping with a change in the way they communicate can alienating.
Changes in communication after a brain injury can be characterized many different ways from dysarthria and apraxia – considered to be motor speech disorders – to aphasia – a language disorder.
Often, motor speech disorders and language disorders go together making rehabilitation that much more complicated.
Today we will be focusing on verbal apraxia.
Let’s start with Broca’s Area –
This is an area of your brain located in the frontal lobe that is responsible for the production of speech. Typically, when someone has an injury to Broca’s area, they are able to understand speech, but have significant difficulty with finding their words and getting their thoughts out. I have found that people that have injuries in this area have a combo of expressive aphasia (the language side of communication which we will explore more in-depth in another post) and something call ‘verbal apraxia’.
Now, apraxia is a motor planning deficit. It is when your body knows that it wants to do something, but has a difficult time sequencing the motor movements needed to ultimately complete the desired task. It can occur anywhere in the body, but for our purposes, we want to focus on the verbal kind. This just means that once your brain knows what it wants to say (word-finding, organizing thoughts into sentences), it then has a miscommunication with your mouth (telling your tongue, lips, jaw, voice how to work together to make speech).
Speech is a VERY fine motor task, meaning, it has to happen in a very particular order for it to make sense. Consequently, it doesn’t take a whole lot for us to notice when it’s not coming out quite right, that’s why it is something that is easily impacted by fatigue. I often compare verbal apraxia to tying a shoe.
Bear with me, it makes sense, I promise.
When you go to tie your shoe, there is very little thought involved. It is a task you have been doing throughout your entire life and usually, you are able to do it automatically. Let’s say, for some reason, you get distracted mid-tie, and can’t immediately remember the next step. Amazingly, you get stuck and have to stop what you are doing and give real attention to the task at hand, maybe even start over so you can get your ‘flow’ back. Verbal apraxia is what happens when your mouth doesn’t know what to do next. Your brain knows EXACTLY what it wants you to say, but your mouth isn’t cooperating. This may result in hesitations, blocked speech, producing the completely wrong sound, or simply not producing anything.
Knowing that you’re dealing with verbal apraxia of speech after a brain injury is only half the battle, what do we do to start recovering? Here are a few of my favorite tasks for working with verbal apraxia:
***Please keep in mind, depending on the presence or absence of language deficits including, reading, writing, understanding commands, and word finding (just to name a few), these activities may not be appropriate***
1. Label Everything! Our brains thrive off of information. For people struggling with verbal apraxia it can be helpful to see the word they are trying to produce while linking it to the item (e.g. label silverware, toothbrush, hair brush, shirt etc.).
2. Use a mirror. Make a list of words (I like to start with family members’ names) and practice saying them in front of a mirror. It may help to write the words on notecards or write them on the mirror with a dry erase marker so you can watch yourself say them. The key is providing your brain with a little extra help by letting it see what it needs to do. It serves as an additional reminder of where to put your tongue or how to form your lips for different sounds – ideally, try to have a mirror partner (a loved one without apraxia) to use as a model.
3. Write or draw on a white board. This is a good bridge for helping with the communication break down when you’re trying to get your message across in real-time. Basically, we use this for “communication anyway possible”. If you are struggling when trying to tell someone something, try writing it down or drawing it. Once you get it figured out, write it down and add it to your practice list to try in front of the mirror later.
The most important thing you can do is practice. I find this to be a challenge for a lot of my clients because it is SO frustrating and often becomes a very emotional task. Find a safe time to work on it when you won’t feel rushed or when you can be alone and mess up without feeling judged, just don’t avoid it. This, like many other skills, is something that you have to work at consistently to see improvement and the only person that can do it is you.
If you are having difficulty getting started or finding the motivation to work on your communication, please don’t hesitate to reach out. Life Beyond Rehab is here to provide you the support and individualized ‘tips and tricks’ for creating a plan that will help your through the next steps of your rehabilitation process.
We want to post what you care about. Take the time to visit our website
www.lifebeyondrehab.com
scroll to the bottom and let us know what topics are most important to you by filling out our “Contact Us” form.
If you or your caregiver need help navigating life after brain injury through education, support or individualized strategies, don’t hesitate to pick up the phone and give us a call at
480-881-1487
for your free 15 minute consultation – we’re here to help guide you through LIFE BEYOND REHAB.
Comments