Progressive neurological diseases and disorders of the brain can have a huge impact on communication skills. There are a number of diseases that can affect the brain and communication, we discuss a few below:
Brain Tumour
Brain tumours may affect communication in different ways depending on the site, location and progression of the tumour. Some individuals will have no noticeable difficulties with communication, whereas others may have severe difficulties. If you are looking for information to facilitate communication following a tumour, perhaps start by looking at the online Resource Centre, as this gives different options and strategies to communicate if speech and language is compromised.
Dementia
Dementia presents with a slow loss of intellectual function. Dementia can be caused by a number of factors, but often there is no known cause. The prognosis of each individual will vary, but inevitably dementia will have a major impact on cognitive and communicative function. Often the essentials of grammar will remain intact, but vebalisations may be confused or out of context, and as the disease progresses understanding will become poorer. There are several different types of dementia:
Alzheimer’s disease
Alzheimer’s is one of the most common forms of dementia and it’s course is long (often around 10 years). This disease is mainly seen in people after the age of 60. The pathology of Alzheimer’s disease is often in the cerebral cortex. Alzheimer’s disease is usually diagnosed, when two or more functions are impaired, e.g. cognition and language. Diagnosis can also be made through the elimination of other disorders.
Early symptoms present with memory and orientation difficulties, and may include difficulties with executive functions (the ability to plan tasks and carry them out). As the disease begins to progress there are difficulties with language, visuo-spacial skills and calculation. Late symptoms also include physical difficulties such as rigidity, limb apraxia, and eating becomes a problem. Some individuals with Alzheimer’s disease become emotional or particularly depressed. Old memories are often unharmed but it is difficult for someone with Alzheimer’s to learn new information or recall things after a short delay.
Effects on communication
Alzheimer’s disease is often associated with apraxia of speech, word finding becomes difficult, and dysarthria: most commonly hypokinetic dysarthria. Some patients with Alzheimer’s disease become speechless or unresponsive in the late stages. An individual’s expressive language skills maybe intact, but their vebalisations may be confused or out of context, and as the disease progresses their understanding will become poorer.
Multi-infarct dementia (MID)
MID is caused by damage to different sections of the cerebrum due to a lack of blood supply to these areas. These as ‘mini strokes’ cause damage to different areas of the brain. The development of this type of dementia is often not consistently gradual, but has ‘step’ like stages of significant decline followed by periods of stability. One of the main symptoms of MID is difficulties with cognitive skills, but the type of difficulties depend on the area of the brain which has been affected. Executive functioning (the ability to plan and execute tasks), attention, judgement and memory difficulties can all be present. Symptoms also manifest in the form of physical disabilities including difficulties with gait. Intellectual decline may occur and become progressively worse after each episode. Emotional lability and swallowing difficulties have also been evident with this type of dementia.
Effects on communication
Specific symptoms associated with MID that affect speech and language are aphasia and dysarthria, most commonly spastic type dysarthria.
Picks disease (fronto-temporal dementia)
The pathology of this type of dementia is the degeneration of the frontal lobes. The course of Picks disease is gradual with a steady decline of functions. The main symptom of Picks disease is changes in behaviour, personality and cognition. This often causes deficits in social abilities and occupational functioning. Language changes are also an early symptom of this type of dementia. Patients with Picks disease become aloof, show a lack emotion, have an inability to change familiar routines and neglect their personal hygiene. The patient often does not recognise that they have a problem and therefore are reluctant to accept help.
Effects on communication
Specific language difficulties for those with Picks disease are expressive difficulties, in particular perseveration, severe naming and word finding deficits. Aphasia has been reported as common with Picks disease. The most common dysarthria associated with Picks disease is hypokinetic dysarthria.
Lewy Body disease
This disease affects neurons found in cortical and brain stem areas of the brain. The age of onset of this disease can range from 50 years upwards, and presents with memory, attention, alertness, hallucinations, visuo-spacial difficulties and periods of confusion. One of the main symptoms is cognitive deficit which causes difficulties with occupational functioning and social skills, these skills become progressively worse as the dementia develops. Physical symptoms resembling Parkinson’s disease can be found in the majority of patients with Lewy Body dementia at some stage over the course of the disorder.
Effects on communication
Hypokinetic dysarthria is the most common type associated with Lewy Body disease.
Strategies to improve communication following a diagnosis of Dementia
The extent and type of communication disorder may vary for individuals. Memory and planning skills appear to be a common deficit and using reminders, calendars, diaries and lists may help with day to day living skills in the earlier development of dementia. Using photos and pictures can be another way to help the individual remember and stay in context when you are talking to them. Speech therapists may also work on word finding strategies and social skills. Some conventional speech therapy techniques, such as those for facilitating dysarthria may not always be effective in the later stages of the disease because the individual will not understand why they are taking part in the therapy. A qualified speech and language therapist / pathologist will be able to help you develop a communication program.
Parkinson’s Disease
Parkinson’s disease is caused by a loss of nerve cells from the central nervous system. It is a progressive and persistence disorder and has increased in incidence, in line with increased longevity. Newer treatments now mean that some individuals can live for up to 20 years following diagnosis. Patients tend to present with symptoms after the age of 50 and then progression can be very variable depending on the individual.
Some symptoms include:
- Tremor – which is often more pronounced on one side
- Rigidity
- Akathesia – involuntary movements which may be continual
- Akinesia – inability to spontaneously move muscles
- Bradykinesia – slowness in repetitive movements
- Disordered locomotion – walking may be poorly co-ordinated, may be described as more of a ‘shuffle’. Some individuals may have difficulty starting to walk and then stopping
- Disordered speech
- Swallowing difficulties
Effects on communication
Speech is affected in most cases of Parkinson’s disease. Dysarthria is common and may be due to a combination of problems with respiration, phonation, resonance, prosody, and articulation. All these factors will lead to a decrease in intelligibility. Dysphonia may occur with the voice becoming weak, low in volume, or hoarse and rough and/or breathy. Sentences can be difficult to finish and articulation of consonants can become particularly disordered due to changes in both manner and place of articulation. Speech may be monotonous and some people with Parkinson’s experience palilalia, where words follow each other at a rapid speed, and some phrases may be repeated continuously. Some experience difficulties with resonance, due to a rigid palate and failure to close the nasopharynx causing hyper nasality.
Strategies to improve communication following a diagnosis of Parkinson’s disease
There are many ways to facilitate communication following the diagnosis of Parkinson’s disease. The most obvious communication difficulties appear to be those of speech and expression. There are a number of exercises and compensatory strategies that can be used to improve the intelligibility of speech when dysarthria occurs. A focus on breath control to facilitate volume and sentence length will help. Beyond speech, the use of simple or hi-tech assistive communication devices can also be used, such as an alphabet chart or an electronic device with speech output. A qualified speech and language therapist / pathologist will be able to help you develop a communication program as well as discuss assistive communication options. Visit our Assistive Communication section for information and hi, and lo-tech communication options.
Huntington’s Disease
Huntington’s disease is a rare progressive genetic disorder. Huntingdon’s causes a loss of cells from the basal ganglia and cerebral cortex in the brain causing chorea (sudden random, jerky movements), dementia and behavioural changes. The disease is degenerative, and a full course of the disease can last up to 15 years. The age of onset is usually between 30 and 50 years old.
The symptoms themselves generally take a specific course although the transition of stages is hard to predict or identify. The chorea stage, consists of rapid purposeless movements, these usually begin in the form of fidgeting and restlessness but soon turn into involuntary movements of the limbs, trunk and head. This eventually affects everyday activities such as walking, talking, speech and swallowing. In the late stage of the disease both involuntary and voluntary movements cease.
Effects on communication
Speech and breathing can become quite difficult for those with Huntington disease. Due to difficulties in co-ordinating voluntary movements the articulation of sounds becomes imprecise. Some individuals experience hypernasality, difficulties controlling the rate, loudness and pitch of speech. Aphasia and perseveration can be seen as the disease progresses and dysarthria is a common speech symptom, particularly hyperkinetic dysarthria.
Strategies to improve communication following a diagnosis of Huntington’s disease
Huntington’s disease can present with a number of communication and cognitive difficulties. There are always ways to improve communication skills, but this will become more difficult as the disease progresses because of the severe nature of the disease. Once diagnosis is made it is a good idea to plan ahead, put in place strategies at home to help with planning and memory, and look at ways of facilitating communication when speech becomes more difficult. A qualified speech and language therapist / pathologist will be able to help you develop a communication program as well as discuss various communication options.
Multiple Sclerosis (MS)
Multiple Sclerosis is an acquired and disabling disease involving the central nervous system. First symptoms often appear between the ages of 20 to 40 years of age. Although this disease can present with severe symptoms, this is not the case for many individuals with multiple sclerosis, who continue to lead full and active lives. The disease occurs because of de-myelination, which refers to the loss of myelin sheaths that run along the axons of nerve cells. This affects the efficiency of the signals that move along these axons taking information from one part of the body to another. There are a number of possible causes of MS including an hereditary genetic link, infections and possibly some environmental factors.
Early symptoms of MS are often mild or unnoticed. Common momentary symptoms include, blurring vision or pain in the eye, weakness and ataxia. These symptoms can be accelerated by exhaustion or stress. The course of disease is different for everyone with some people recovering from “attacks” of MS and having remission periods for weeks, months or even years. MS does not necessarily result in severe disability, but difficulties are more likely to occur in the later stages after a number of episodes. In approximately 20% of patients with MS however, a progressive course occurs, which causes more severe long lasting effects. The majority of patients with MS are able to continue with employment, and other everyday activities, however some relapses causes persistent disabilities. Physiotherapy can be beneficial after some disabling episodes.
Effects on communication
Around 50% of patients with MS have speech difficulties, and dysarthria is common. Due to a vast array of affected areas of the central nervous system, any type of dysarthria is possible. There may also be problems with prosody, phonation and articulation with some patients. Characteristics of speech difficulties include harsh or breathy voice, difficulties with control of pitch, rate, and volume. Around 50% of people with MS are thought to have difficulties with articulation and 25% have some form of hypernasality.
Strategies to improve communication following a diagnosis of Multiple Sclerosis.
Dysarthria and dysphonia are common difficulties that occur following the progression of MS. There are a number of strategies to facilitate these communication difficulties. A focus on breath control to facilitate volume and sentence length will help. Speech muscle exercises, or relaxation exercises may also be useful to improve dyarthric speech. The use of simple or hi-tech assistive communication devices can also be used, such as an alphabet chart, E-Tran frame or an electronic device with speech output. A qualified speech and language therapist / pathologist will be able to help you develop a communication program as well as discuss assistive communication options. Visit our Assistive Communication section for information and hi, and lo-tech communication options.
Motor Neurone Disease (Amyotrophic Lateral Sclerosis)
The cause of Motor Neurone Disease (MND) is due to a loss of motor neurones from the brain and central nervous system. Following diagnosis individuals generally live between 2 to 5 years, although there are cases of some people living much longer. Symptoms develop according to which motor neurons are affected first. Common symptoms include muscle weakness and wasting, and fatigue. Upper motor neuron involvement causes symptoms of muscle weakness or paralysis and increased tone. Lower motor neuron involvement causes weak or wasting of muscles and decreased tone leading to flaccidity. Patients with MND often experience respiration and swallowing difficulties. Sensory skills and cognitive abilities are not affected with MND and the individual’s cognitive functions and senses remain intact.
Effects on communication
MND can cause difficulties with many muscles of the head and face that are used for speech production, including the tongue, lips, pharynx, jaw, and larynx. This causes articulation to become difficult and speech eventually becomes unintelligible. Specifically the lips and tongue become weak affecting labial, velar and dental sounds, the soft palate may also become weak, and speech can be nasal. Dysphonia is common, exacerbated by respiration difficulties. Phonation difficulties may cause the voice to become weak, hoarse, strained, breathy and/or monotonous. Dysarthria is likely to occur causing speech to become unclear. Spastic and/or flaccid dysarthrias are common due to upper and lower motor neurone involvement. As speech often becomes unintelligible alternative communication devices may need to be implemented as this can reduce the frustration of being unable to communicate messages to caregivers and loved ones.
Strategies to improve communication following a diagnosis of Motor Neurone Disease.
Because of the rapid nature of this disease it is important to plan ahead and look at alternative forms of communication early on. Through access to assistive technology and AAC devices many individuals with MND are able to continue to communicate with their loved ones long after they have lost the ability to communicate with speech. Cognitive skills generally remain intact for the duration of the disease, so individuals are still able to understand and express their thoughts, they just need a vehicle to do this. Through the use of special switches, scanning, eye-scanning, and voice output devices, individuals can continue to communicate their thoughts and needs. We have a section on our site dedicated to Assistive Technology and communication. This section focuses on a growing area, where the use of technology is helping many adults with acquired difficulties to communicate more effectively.
Epilepsy
Epileptic attacks can take several forms and may be quite mild or frequent and severe. Severe attacks over a long period of time may have long lasting effects on cognitive and communication skills. It is difficult to predict the long term effects of epilepsy on communication, but if you feel that your cognitive skills, memory, and /or communication may be deteriorating because of epilepsy, visit our online Resource Centre for information, strategies, and resources relating to communication difficulties.
Focussing on Communication
There are many types of progressive and degenerative diseases that have an impact on communication. Difficulties may be:
- Speech related – dysarthria, dysphonia, articualtion difficulties or a loss of speech
- Cognition related- difficulties with memory, attention, planning
- Language related – a deterioration of expressive language skills or understanding
Unfortunately there are no cures for most of these diseases, but there are ways to either delay the progression of communication difficulties, or find compensatory strategies to allow the individual to communicate and get the best quality of life.
The following pages on the icommunicate website will offer some guidance on how to facilitate communication following the diagnosis of a neurological disease or event:
Neurological Disease and Associated Communication and Cognitive Difficulties
Delaying the impact of communication problems from associated neurological diseases
Adapting to Neurological Disease
Assistive Technology & Assistive Communication (AAC)
Professional involvement following the diagnosis of a progressive neurological disease
For more information about communication difficulties, and ideas and strategies to help communication, see our Resources, or for specific fact-sheets about progressive and degenerative neurological diseases and information and strategies for improving communication and cognitive functioning go to the Downloads Section.
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