Welcome to the TBI-HELP Live Chat

Today's topic is: "Rehabilitation of Speech and Language Disorders"

Our Guest is: Danielle Claps, MACCC/SLP, Jamaica Hospital Medical Center

[19:04:16] Mod: Good evening and welcome to our chat room. Tonight we have with us Ms. Danielle Claps, MACCC/SLP from Jamaica Hospital Medical Center. Welcome Danielle.
[19:05:06] Danielle: thank you ..hi everyone
[19:05:52] Mod: Danielle, what are some of the problems you see regarding speech in TBI patients?
[19:06:14] Danielle: it is creating a way for the patient to communicate
[19:06:57] Danielle: that seems to be the most important for families
[19:07:36] Danielle: a lot of the TBI patients have either language or motor deficits and the therapist need to find the most effective to facilitate communication
[19:09:39] Danielle: swallowing is also another important aspect that needs to be addressed
[19:10:15] Mod: Joey: How do you communicate with the patients?
[19:10:30] Danielle: first a formal evaluation is done to assess the degree of deficits and then it is the therapist's responsibility to determine what strategies need to be employed
[19:11:25] Danielle: example ,.a simple picture board or high tech devise
[19:12:00] Danielle: the eye blink is high tech... that patient needs to be cognitively intact
[19:12:41] Danielle: joey...computers for therapy or communication
[19:13:46] Mod: Patti: What alternate methods are there. I read a book that was dictated entirely by blinking. The man was totally paralyzed expect for one eye, locked in syndrome.
[19:14:43] Danielle: the eye blink uses a specific computer....a cognitively intact patient can scan a letter board with it and also control his environment
[19:15:12] Danielle: example are light switches
[19:15:35] Danielle: of course the more elaborate the more expensive...
[19:16:07] Mod: Bernard: What is the difference between aphasia and dysarthria?..
[19:16:35] Danielle: aphasia is a disorder of language. a persons ability to express needs and comprehend info
[19:17:03] Danielle: dysarthria is more of muscle weakness. speech sounds slurred
[19:17:29] Danielle: a person may have both dysarthria and aphasia
[19:17:41] Danielle: if you need further clarification let me know.....
[19:17:59] Mod: What is "Apraxia"?..
[19:18:25] Danielle: apraxia is more of a motor planning disorder....a person with pure apraxia will know what they what to say but the messages sent from the brain to mouth are being interrupted
[19:25:46] Danielle: however a patient can have aphasia and apraxia and that gets really tough
[19:26:35] Danielle: the more combinations one has, the more complicated it gets..
[19:26:45] Mod: Patti: Why are most patients given puréed food first and then can work their way to hopefully chopped and then real food. Why are thin liquids usually thickened with thickit? I know its easier to avoid aspiration this way but how?
[19:27:42] Danielle: USUALLY....puree and thick liquids are the easiest to manage because it remains in a more cohesive bolus,  while thin liquid spills quickly
[19:28:26] Danielle: the person needs more muscle strength and control and after a stroke or head injury, muscles are weak...
[19:30:07] Mod: Bernard: In some cases of cerebral hemorrhage, the removal of blood clots provide relief and the ability to improve deficits in an aphasic person. Are there other types of situations where there can be a disappearance of aphasia?
[19:30:46] Danielle: in an acute head injury, especially if there is diffuse damage as the brain tissue heals, sometimes you can see a lot of recovery from aphasic symptoms
[19:31:26] Danielle: example word finding
[19:31:36] Danielle: also a person with a "mini stroke" aka TIA ..  aphasia may be for a short while and during spontaneous recovery period along with therapy may improve patient's language skills...

[19:33:44] Mod: Patti: So its more for ease of self feeding than swallowing and chewing?
[19:34:17] Danielle: its not just ease if you can't create or control bolus the liquid may spill prematurely prior to the swallow
[19:35:11] Danielle: if that occurs the protective mechanism to close off the airway is not triggered in time
[19:35:42] Danielle: and in terms of puree and chopped there may be pocketed material in the mouth
[19:36:16] Danielle: that a person may take a deep breath or lay down at which time gravity allows to food to go to the back of the throat with swallowing, resulting in choking
[19:41:08] Mod: Patti: I've been reading that the first year phase of recovery from TBI is the most rapid because that's when more active therapy occurs. New studies are showing the recovery can continue for 10 years but it is more of a relearning of new skill, that once the acute phase is over it becomes more of an educating process than medicine. would that apply to speech as well do you think?
[19:37:35] Danielle: I find once the acute phase is over there is still periods of slow recovery and that is when you would teach compensatory stratagies
[19:38:39] Danielle: so it also applies to speech
[19:42:15] Danielle: recovery is a long on going process. there is plenty of education and new learning in all disciplines
[19:43:17] Mod: What are some of the do's and don'ts for aphasic patients?
[19:43:44] Danielle: always encourage patient to speak with forcing them speak a bit slower, using short sentences
[19:44:27] Danielle: don't interrupt the patient, and give enough opportunity for the person to speak
[19:44:56] Danielle: encourage socialization, and discourage isolation
[19:45:18] Danielle: talk to patient even if he doesn't respond....
[19:45:49] Mod: Carter: Has any use of video games been looked at in helping patients?..
[19:46:22] Danielle: I would suggest those that we are typically familiar with
[19:46:33] Danielle: however there are specific speech games that are being used to help in word finding, articulation
[19:47:44] Danielle: there are a lot of new programs coming out....
[19:48:04] Mod: Welcome Esther: What type of work do you need to do with the family so that they can understand and cope with the patient sometimes struggling to learn?..
[19:48:40] Danielle: a lot is mostly educating, and it really helps when family sits in on sessions to see how the patient is doing and what modifications were made to environment to facilitate communication
[19:49:34] Danielle: there are also support groups for families...
[19:51:05] Mod: Esther: How do they patient and family psychodynamic negativity or positively effect your interventions. How do you deal with this?
[19:51:41] Danielle: sometimes families interfere by being to over protective and doing everything for patient
[19:52:03] Danielle: the patient then has no need to communicate wants and needs
[19:52:25] Danielle: also family may put on a lot of demands on the patient that he can't handle which becomes frustrating
[19:53:05] Danielle: If a family can create a positive environment that is always helpful .. they should foster communication....
[19:54:00] Mod: Patti: What contributes to excessive saliva and drooling?
[19:54:34] Danielle: that is a sign of decreased management of secretions
[19:54:58] Danielle: patient may not be initiating swallow enough times and muscle weakness in the mouth also contributes to it....
[19:56:26] Mod: Rocky: I'm reading your response to Esther's question an I logged on to ask if sometimes the expectations of the family are not in line with the abilities of the patient. How can we deal with this so that we can help both understand and accept the situation?
[19:56:46] Danielle: there is often a discrepancy between ability and expectation
[19:57:20] Danielle: I find the best way families realize is when they sit in on all the therapies
[19:57:38] Danielle: also can't forget counseling with that
[19:57:52] Danielle: accepting does not occur over night. families grieve as well as the patient, and families could use support al well
[20:00:45] Mod: Patti: Abilities sometimes change and the expectations should too.
[20:01:20] Danielle: of course. that is why it is always a learning process....
[20:01:41] Danielle: as the patient changes families will need to adapt as well....
[20:01:40] Mod: Well, I see that our time is up and I want to thank Ms. Claps for a wonderful session and invite her back for another one. Thank you all and have a good week and be safe! Good Night
[20:02:38] Danielle: thank you