Research Paper on a Communication Disorder

Abstract

This research paper is written in the context of communication disorder. Communication disorder is a condition in which a person loses his/her ability to send, receive or process verbal or non vocal concepts. Amyotrophic lateral sclerosis is one of the acquired communication disorders. This research paper starts with introduction of ALS followed by causes of ALS. The next part of the research paper explains effects of ALS on the person suffering from this disease. Role of a speech-language pathologist (SLP) added with social, educational and vocational effects on the routine of ALS challenged people are elaborated in the next session. This discussion ends with the answer of ‘How will I use my knowledge as an OTA/PTA.

Introduction

Amyotrophic lateral sclerosis (ALS) is an acquired communication disorder. It is also known as motor neuron disease (MND). In the US, the disease is also known as “Lou Gehrig’s disease”, after a famous baseball player who died of ALS. ALS is a neurologic disorder that causes increasing muscle weakness and eventually paralysis, which, in most cases, is fatal. It is resulting in degeneration of upper motor neuron as well as lower motor neuron which leads to muscle atrophy throughout the body. Majority of ALS victims died due to respiratory failure in about 3 to 5 years after the appearance of the first signs and symptoms of ALS. In terms of the effect of ALS on gender, men are affected more than women.

Causes, Effects

Causes:

• The actual cause of the ALS is unknown. Several possible causes are explained in the following part which is based on literature review.
• Chemical imbalance: The level of glutamate chemical is higher in people with ALS. Too much glutamate is responsible for some nerve cell damage in the brain and spinal cord.
• Protein misappropriation: Some proteins abnormally accumulate in the nerve cells, which leads to nerve cell death.
• Disordered immune response: Sometimes person’s own immune system attacks on his/her body’s normal cells which kills own nerve cells.
• Genetic mutation: Genetic mutation in SOD1 gene produces SOD1 protein. This protein is perhaps responsible for toxic effects on nerve cells. Some studies show that there are some risk factors for ALS. Smoking is a dose-dependent risk factor for this disease. Heavy metal exposure is also an important factor. Level of lead and manganese in blood and cerebrospinal fluid also increases the risk. The people who are related with electromagnetic occupation are also at higher risk for ALS.

ALS shows both upper motor neuron symptoms and lower motor neuron symptoms. Sign and symptoms are usually asymmetric when they start. Therefore they are on the one side of the body and they usually progress from distal to proximal muscles. As the disease progress, the patient loses the ability to control their muscles. This leads to weakness and eventually paralysis. The symptoms can be quite subtle at first and the disease affects everyone differently which can make it difficult to diagnose in some patients.

The first sign of ALS is muscle weakness or lack of motor control in the arms and legs. In some people, the disease may first affect the muscles of throat and tongue making it more difficult to swallow or speak. In some cases, the muscles of breathing are the first to be affected leading to shortness of breathing. ALS can affect muscles of tongue, lips, vocal cords and chest. This results in difficulty in speaking and fatigue of the voice which is known as dysarthria. It also presents difficulty in chewing, swallowing and vocalization words. As the disease progress, muscles required for speaking become weaker and so patient would be not able to speak clearly.

Topic analysis

Speech affection in ALS: It is characterized by slow, slurred and unclear speech. There is a nasal quality in voice. It becomes soft and faint. The patient shows difficulty in managing tone, pitch and rhythm of speech. It also presents some issues with pronunciation with certain words. As the disease progress, a patient may find himself exhausted with speaking particularly later in the day.

Role of a speech-language pathologist (SLP): The role of speech-language pathologist is to ensure the individual with ALS to maintain their communication ability by using compensatory strategies and augmentative and alternative communication methods (AAC). SLP would assess speech mechanism, function and swallowing mechanism. He would educate patients, family members and caregivers regarding compensatory strategies and tools to improve function and quality of life. So Evaluation, assessment and appropriate intervention for individual communication challenges are done by the speech-language pathologist.

Social, educational and vocational effects of this challenge: The patients of ALS suffer from the greatest communication issues. They lose the ability to communicate with society so they feel alone. Emotionally they become upset as they cannot talk with people and cannot communicate normally. They suffer from the variety of emotions like anger, grief, inadequacy and confusion. It affects the quality of life. Social interaction and educational opportunities decrease day by day for them.

Person suffering form it can understand written stuff and can read also but cannot express by speaking which makes them frustrated. They may also suffer from apprehension and hopelessness. Sudden cry or sudden laugh is being a part of the routine of the affected person. They get lots of difficulties when interacting with a people. Social isolation is one of the main issues for them. They may get fewer opportunities in education as their ability to convey messages is affected significantly. They struggle with job-related scopes. When they reach retirement age, they might not get all benefits as it is very hard to communicate with others.

How will I use this knowledge as OTA/PTA: I might work with a client with such a communication challenge at rehabilitation centers where people come after an injury to learn new skills or compensatory strategies to do tasks of daily life. Other places such as long-term care facilities, hospitals, clinical setup and speech pathologist’s office where I need to communicate with patients suffering from ALS and having communication difficulties. I can offer myself to all above mentioned places to serve people suffering from this disease. I would love to use my knowledge and help someone if it makes someone’s life more comfortable, easier and happier. There are some basic facts which I should remember while working with patients suffering from ALS.

Conclusion

The first one is that patients with ALS are not mentally affected. They have difficulties with their speech articulation. Their cognitive function remains normal. So when I start any exercise program, I need to understand that they can understand my instructions but if they have any issues during an exercise program, they would not able to speak clearly to me. So according to that, I have to adjust my communication methods. I should remember that patients with ALS may start sudden laugh or cry due to pseudo bulbar effect. So I will not be surprised or angry during my therapy session. They are not deaf. Their hearing is normal. So I would not talk loudly and slowly as well as I would inform to caregivers and family members about this.

I would modify my communication approaches while working with them. Firstly I would try for creating a comfortable atmosphere by keeping a client away from any kind of distractions so the we can do conversation easily. I would keep patience until he/she finishes the sentences and will never ask them to speak fast. As I know that they have to think to produce a sound for a word so it will take time to complete a sentence. So I would help them to slow down the rate of the speech for a clear talk.

During a therapy session, I will do face to face communication so I can adapt their non-verbal cues and see their expressions for further understanding. Another important aspect is regarding muscle weakness. They get tired quickly, so if they miss any words, I would not ask them for repetition every time because it will lead to fatigue only. Then I would provide yes/no/maybe questions-answers rather than open-ended questions to conserve an energy and prevent fatigue.

I will use whiteboard during a talk which would be helpful to them to point out the appropriate words rather than speaking and giving stress on weaken muscles. I will arrange a lesser pointer in combination with a letter board. So the speaker would project a lesser point on the word and that’s how I will understand them. My focus will be on energy conservation during communication or speaking tasks and reduce fatigue by reducing extra efforts for speaking. I would also make them use to gestures for their wants. In this way I would give my best to make an effective communication with patients with ALS.