Frequently asked questions
Here are some common questions people ask about communication and swallowing difficulties and what people can do to help. If you have any further questions then give our team a call – we are happy to provide some simple advice over the phone.
Aphasia is a communication disorder that results from damage to the parts of the brain that contain language (typically in the left half of the brain). Aphasia may cause difficulties talking, understanding spoken information, reading and writing, but it does not affect intelligence. A person may have impairments in all four of these areas and this is known as being globally aphasic.
Dysarthria is a motor speech disorder. It results from impaired movement of the muscles used for speech production, including the lips, tongue, vocal folds, and/or diaphragm. The type and severity of dysarthria depend on which area of the nervous system is affected.
Apraxia of speech is a motor speech disorder. The messages from the brain to the mouth are disrupted, and the person cannot move his or her lips or tongue to the right place to say sounds correctly, even though the muscles are not weak. The severity of apraxia depends on the nature of the brain damage. Apraxia of speech is also known as acquired apraxia of speech, verbal apraxia, and dyspraxia.
Dysphagia is the term used to describe when someone has difficulties swallowing. Some people have difficulties swallowing certain foods or fluids while others can’t swallow at all. Signs of dysphagia can include coughing and/or choking when eating and drinking, a sensation that food is stuck in the throat, persistent difficulties keeping saliva in the mouth, being unable to chew food effectively and a gurgly/wet voice when eating and drinking. If not managed safely dysphagia can result in recurrent chest infections or the more severe aspiration pneumonia, serious choking episodes, weight loss and dehydration.
It is important for both the person with dysarthria and the people he or she communicates with to work together to improve interactions. Here are some tips for both speaker and listener.
Tips for the Person WITH Dysarthria:
- Introduce your topic with a single word or short phrase before beginning to speak in more complete sentences.
- Check with the listeners to make sure that they understand you.
- Speak slowly and loudly and pause frequently.
- Try to limit conversations when you feel tired—when your speech will be harder to understand.
- If you become frustrated, try to use other methods, such as pointing or gesturing, to get your message across or take a rest and try again later.
Tips for the Listener:
- Reduce distractions and background noise.
- Pay attention to the speaker.
- Watch the person as he or she talks.
- Let the speaker know when you have difficulty understanding him or her.
- Repeat only the part of the message that you understood so that the speaker does not have to repeat the entire message.
- If you still don’t understand the message, ask yes/no questions or have the speaker write his or her message to you.
- Get the person’s attention before you start speaking.
- Maintain eye contact and watch the person’s body language and use of gesture.
- Minimize or eliminate background noise (TV, radio, other people).
- Keep your voice at a normal level. Do not speak loudly unless the person asks you to do so.
- Keep communication simple, but adult. Don’t “talk down” to the person with aphasia.
- Simplify your sentence structure and emphasize key words.
- Reduce your rate of speech.
- Give the individual time to speak. Resist the urge to finish sentences or offer words.
- Communicate with drawings, gestures, writing, and facial expressions in addition to speech.
- Encourage the person to use drawings, gestures, and writing.
- Use “yes” and “no” questions rather than open-ended questions.
- Praise all attempts to speak and downplay any errors. Avoid insisting that that each word be produced perfectly.
- Engage in normal activities whenever possible.
- Encourage independence and avoid being overprotective.
- Never hurry the person. Give them plenty of time to get their message across. Listen patiently and try not to finish off their sentences for them
- Don’t interrupt the person, or jump in too quickly with a guess about what they are trying to say (unless you know they are happy for this to happen)
- Do not pretend to understand the person if you don’t. Say that you are having difficulty and suggest they express their message another way. If you do understand the person, give them plenty of reassurance.
- Check that you are understanding the person by re-stating what they have already told you, e.g. ‘so, you are talking about…’ This is also helpful if the person is getting stuck on a certain part of the message they are trying to communicate. Let them know the bits you have understood so they only need to focus on the part that is difficult and not have to repeat the whole message again
- Encourage the person to use all available methods of communication, e.g. speech, gesture, drawing, writing, pointing and facial expression.
- Ask questions that require a ‘yes’ or ‘no’ answer – ask ‘do you want a cup of tea/juice/water?’ rather than ‘what do you want to drink?’
- Be aware that the person will tire easily. It can be hard work to communicate when you have difficulties. Also be aware that tiredness will affect the person’s ability to communicate.
There are several ways of managing a person who has difficulties swallowing. In hospital settings a person may be stopped from eating and drinking initially if there are significant concerns about their swallowing. They can be provided with fluids and meet their nutritional needs via alternative methods such as a nasogastric or PEG tube.
Once a formal swallow assessment has been completed, a Speech and Language Therapist may determine that a person may be able to swallow safely by having their food modified e.g. pureed, mashed down etc or by thickening their fluids using a thickening powder. A range of strategies can also be trialled to ascertain if they have a positive impact on a person’s swallow function.
If clinically indicated a Speech and Language Therapist can provide a range of swallow rehabilitation exercises in an attempt to achieve an improvement in the person’s swallowing.