COMMUNICATION CHALLENGES AFTER STROKE

               Aphasia is one of the communication disorders that a person can have after a stroke.
It affects comprehension,production of speech sounds,reading and writing.
Damage to left hemisphere can lead to aphasia.(depends on the dominant hemisphere)
                          It can be associated with dysathria,apraxia or dysphagia(difficulty in swallowing)

What cause aphasia?
                          Any damage to the brain can lead to aphasia

• Stroke (most common)
• Brain tumors
• Traumatic bran injuries (cause by road traffic accident,gun shot...)
• Infection 

What are the clinical features and symptoms ?

Patient will have difficulty to produce the next coming up word ,some of them answer with no connection to the question.
Unintened words or sound substitution ( Paraphaisa)
         it can be similar to the target word in terms of meaning  Ex: Chair for sofa, sister for wife  or can be a word from any of the person's known language (Neologism)

• Naming/word finding difficulty
• Fluency can be effected  (depend on the type of aphasia)
• Repetition ( depend on the type of aphasia)
• Memory,cognition and perceptual problems
• Psychological problems

DO YOU OR SOMEONE YOU KNOW SUFFER FROM CONTINUOUS "RINGING IN THE EARS"?

          Tinnitus is the medical term for ringing in the ear.May be it's not ringing exactly it can be a buzzing,hissing,whistling... It can be different from  person to person.This ringing sound can be a continuous or intermittent

 Most people with tinnitus also have some degree of hearing loss and also it can be occur in one or both ears

Causes

• Noise  exposure such as Loud music,Explosion (Above 85db)
• Ageing 
• Head injury
• Side effects from medication

Effects

• Long term sleep disruption
• Inability to concentrate
• Anxiety/ Depression

Management 

 There is no known cure for tinnitus but there are methods to be relieved from it .As long as you ignore the sound,busy your self or mask the tinnitus sound till then  you can avoid tinnitus that is a psychological fact. As much as you think about it you will feel it increase.

WHAT ARE COMMUNICATION AIDS?

Communication aids are also known as Augmentative and Alternative Communication (AAC).The main aim of using an ACC is to communicate his/her needs,wants,ideas... 

ACC feather divided in to 2 types
1) Aided 
2) Un- Aided 

Aided ACC require tools,equipment,circuit, aided Aided communication method can range from paper & pencil to a Voice out put device
Again we can divided in to

• Low tech ACC : Defined as those that do not need batteries,electricity or electronics

          Letters,Words,Picture,Symbols,communication board......

                                                                    -Communication board-

• High tech AAC : Use electronic devices

          Speech generating devices (SGD) or Voice output communication aids (VOCA)

                                                        - Stephen Hawking the with his ACC-

Un-Aided systems are those that don't need an external tool. It can be a gesture,facial expression,Vocalization or a sign language

                                                           -using sign language-

Who are the candidate for using an AAC?

Any person who have, 

• Speech and Language impairment.
• It includes patient with Aphasia, Cerebral palsy,Autism ,Acquired condition such as   amyotrophic lateral sclerosis and Parkinson's disease

TYPES OF HEARING AIDS

Today I’m going to talk more about the different types of hearing aids that a person with a hearing difficulty can use,you can't wear a hearing aid as you like,

An Audiologist is a person who can dispense a hearing aid for you,

However, the type of hearing aid is not the only parameter that audiologists  focuses on  before dispensing a hearing aid. Age,type of the hearing loss,degree of hearing loss,economical statuses…all of them matters

1) Body Worn Hearing Aids

These are the largest type of hearing aids.As implied by their name, they are worn somewhere on the body in a pocket,pouch around neck or on the belt.The receiver usually plugs into an earmold custom made for the individual’s ear canal and concha.

Features

·             The circuitry is analog and may be linear(1:1) or compression.

·              Uses AA batteries which have a battery life of approximately 4 weeks

·              Has a volume wheel

·              Optional features of a telecoil(to hear the magnetic siganl naturally genetare in an older          telephone),and direct auditory input (DAI)

·            Omnidirectional microphone only

Advantages:

•          Earmold does not distort the cartilage of the ear
•         Controls are easy to manipulate
•         Appropriate for all types of hearing loss
•          Highest power available, for severe and profound losses
•         Feedback is less of a problem because of the separation of the microphone and speaker

Disadvantages

•  Cumbersome for the parent to place, remove, and use the body aid with infants 
• Rustling of clothing and body noise are amplified   
• Although amplification may be routed to one or both ears, the body aid can only be set for the hearing loss of one ear.
•  Difficulty in localization 
• Body baffle effect( Body act as a barrier to pass the sound)    
• Inconvenience of a cord going from the body aid in your pocket
• cloths noise and wind noise 
• Old technology 

2)Behind The Ear Hearing Aids (BTE)

The next smallest type of hearing aid is behind the ear aids which are the largest of the  
common types of hearing aids. 
This device has a module that fits behind the ear

 Advantages

•   The hearing aid fits over and behind the ear, so there is a great amount of flexibility as to what size or type of earmold fits in the ear or ear canal
• Ear molds can be made of hard of soft materials,can be modified or changes at will and for less expense that remarking the shell of an  in the ear type aid
• Can be used for severe and profound hearing losses
• Feedback is less likely 
• Sometimes less expensive than in the ear type aid
• More option can be selected such as connection for assistive listening  devices,and more recently,attachments for bluetooth technology
• Larger controls and battery size are available 

Disadvantages

• Some people find having a hearing aid that must go both in their ear (the mold) and behind their ear (the aid) to be cumbersome and difficult to put on and use.
•  BTEs are more visible for those without much hair
•  BTEs can be more inconvenient for physically active people
• BTEs are more susceptible to mositure and perspiration damage 

      3)RECEIVER IN THE CANAL (RIC)

•      currently, there is a trend in the hearing aid industry toward smaller and more discreet hearing aids, including the recent development of open fit hearing aids (also known as open ear hearing aids). 
•     Open fit hearing aids have one major limitation, however; they are not appropriate for many people with a more severe hearing loss
•        Best used by those with high frequency hearing loss and normal low frequency hearing. 
  

Advantages

•     Help 90% or more of hard-of-hearing  
•     Low visibility    
•     Get an instant fit as no custom step required 
•      Improved ear ventilation
•      Natural low freq sounds enter ear
•      Greatly reduced occlusion effect
•     High freq AND/OR low freq boosted
•     High power o/p possible if needed
•     Very comfortable fit
•     Same day fitting possible
•      Ideal all Mild to Severe hearing loss

              The Fitting Range

•     For a wide range hearing loss would be a maximum of 60dB in the low frequencies
•     80dB in the high frequencies.

    4)IN THE EAR HEARING AIDS (ITE)

•    Most ITE aids are custom devices,with the components built into a shell made from an impression of the user's ear
•      ITE aids are further divided into full concha & Half concha
•      Full concha aid fills the entire concha, and is the most common type 

•   Patients with greater than 70 dB hearing loss may experience feedback problems with  ITE devices, because the microphone is adjacent to the receiver.

      Advantages    

•      Has better retention in ear since it can lock in place in the outer ear.
•      Room for a large vent, to reduce occlusion.
•     Room for advanced circuitry and circuit options   
•       Easier to handle and adjust
•         Usually less expensive the canal aid or CIC 
• 
  

      Disadvantages 

•      ITEs are in the ear, but they can be seen easier than the ITC and CIC
•      Higher repair rate than BTE, because of wax getting into speaker

        5) IN THE CANAL HEARING AIDS (ITC)

•      In-the-canal (ITC) hearing aid is similar to the ITE device, except the components are small enough to fit entirely within the external auditory canal.
•       ITC hearing aids are custom-molded  
•       High cosmetic appeal
  

    Advantages 

•          Reduced gain / output requirements.
•       Cosmetically more appealing
•       Greater high frequency gain
•        Improved performance in noise

  

     Disadvantages

•         More prone to repairs when compared to BTE
•     Maximum output is less when compared to BTE therefore cannot aid severe degree of hearing loss
•         Difficulty in inserting and removing specially for patients with dexterity problems
• 
  

   6)COMPLETELY IN THE CANAL (CIC)

•     The CIC hearing aids were introduced in early nineties and have succeeded the ITC as the tiniest, least visible hearing aid

      Advantages

            Small and discreet for cosmetic purposes

•  ·    Efficient in delivery of high frequencies. (Outer ear collects and focuses high frequency sound waves to the opening of the ear canal).
   ·         You may be able to use a telephone or headsets normally, because the aid is recessed in the ear.
•      Sound can be reproduced without driving the speaker into distortion, as speaker is near the eardrum      

       Disadvantages 

•      Most expensive ,because of small size .

•     Usually too small to having a volume control that can be used while in the ear.
•     Not appropriate for severe to profound hearing losses. 
•     Not appropriate for high frequency (ski-slope) type hearing loss. (Too much occlusion)
•     Not suggested for children, as their ears grow too fast
•    Difficult to use and operate for persons with dexterity or eyesight problems.(Small size and battery)
•      Highest repair rate compared to other hearing aid types. 

HEARING AIDS

 

What is a Hearing aid?  

Now a days its an electronic device that is able to makes some sounds louder so that a person with hearing difficulty, can listen,communicate and Participate more fully in daily activities

                For an example think of an assembly,microphone will pickup the sound and it send the amplifier to increase the sound of the original sound,we can hear the sound via a Loud speaker.Same circuit is used inside the hearing aid with lots of modification  

Should we afraid/shy to use a Hearing aid?

Not at all

Why? Because 

• It's Wearable like a spectacle 
• Easy to use
• Improving the hearing & speech comprehension

What is the Main function of a Hearing Aid?

Hair cells are responsible for hearing,They are located deep inside the ear.If any damage Occurs to hair cells,it results in hearing loss.This is when  hearing aid come to action. The role of hearing aids is to amplify sound  vibrations entering the ear. Surviving hair cells detect the larger vibrations and convert them into neural signals that are passed along to the brain. The greater the damage to a person’s hair cells, the more severe the hearing loss, and the greater the hearing aid amplification needed to make up the difference.

**An Audiologist is a trained professional in fitting and dispensing a hearing aid.Kindly consult your nearest Audiologist for hearing related needs**

Hearing aids generally improve the quality of life and will help you

• Get a better relationship with your family
•                 Feel better about yourself
•          Get better mental health
•            Feel more independent and secure
•           More able to participate in social gatherings

           

                                                                       

      A hearing aid consist of

      Microphone
      Receiver
      Amplifier 
      Battery 
      Volume control

Types of Hearing Aid

**More details on my next post **

WHICH ALL SOUNDS ACHIEVED 1st?

Speech Sound Development Chart

Most of the parents complain that there child does not speak or its delayed. Usually child will speak his/her 1st meaningful word by at the age of 1-1.4 years.Word are consist with different sound so lets check out which sounds develop first. 

A i mention above today we are talking about at which particular speech sounds are used at what particular age.Researchers have studied larger groups of children & they summarize what is typical of an average child at a particular age

In this Diagram they mainly talk about the consonants (Speech sounds that is not a vowel) 

Below Speech sounds are given in International Phonetic Alphabet (IPA),but you can understand it with the example given there

References: Templin, M.(1957). Certain language skills in children.Minneapolis:University of Minnesota Press.

AUTISM SPECTRUM DISORDER (ASD)

DEFINITION

"The term ASD/PDD is an umbrella term which refers to a broad group of neurobiological and neurodevelopment disorders.They are characterized by  impairments in social interaction, communication skills and presence of repetitive behaviors"
                                                                -AUTISM SOCIETY OF AMERICA (1995)-

• We can diagnosed a child with autism only after  18 month of age

 Autism is characterized by severe and pervasive impairment in  3 main  areas development

•       Social interaction
•      Communication skills
•      Stereotyped/Unusual behavior

 Severity can be varies on a spectrum of mild to severe

           Social interaction

• Lack of interest in interaction with peers
• Absence of facial expressions and body language
• Poor eye contact with people
• May not demonstrate emotional attachments to family members & friends
• May not seek approval from adults or peer
• Poor play skills(Pretend or social play)

              Communication

• Speech and language are profoundly disordered
• Difficulty expressing basic wants and needs
• Fail to maintain topics of conversation.
• Produces language that is stereotypical,  repetitious or idiosyncratic.
• Echolalia (repetition of another person's spoken words)
• Poor vocabulary development

              Stereotyped/Unusual behavior

• Flapping arms
• Extra attention to particular music or sound
• Problems dealing with changes in routine
• withdraw
• Using objects in unusual ways (toy car,child only play with wheels or any other small object on it)
• No fear of real dangers
• Feeding difficulties(selects foods,refusing certain food textures)

                 CAUSES OF AUTISM 

       Biological

§Genetic cause

§Neurological causes

§Brain lateralization dysfunction

§Brain systems that control arousal

§Dysfunction of other brain mechanism

§Biochemical abnormalitie

Environmental

•doesn't play a role means not yet scientifically proved