Language and speech are controlled in the brain in linked to the laryngeal muscles by nerves. The vocal cords are supplied by recurrent laryngeal nerve. Any anomaly to these structures may affect speech characteristics of an individual (Douglas, 1999).

The patient presented above has Dysarthria (motor speech disorder), a problem with the motor tract that innervates muscles that are responsible for speech. Cranial nerve X is involved in speech as it innervates the muscles of the larynx. When the nerve (CN X) is damaged, vocal folds become paralyzed thus affecting the volume of the voice and swallowing. As a speech language pathologist, I will look for the movement of the lips, the tongue and the facial expression during the speech. Moreover, I will assess the breath support adequacy during the speech. Motor speech disorder can result from injury of the brain structures in patients with the following conditions; stroke, brain tumors, Parkinsonism, cerebral palsy multiple sclerosis among others (Douglas, 1999). Parkinsonism is associated with lesions in the substantia nigra which affects dopaminergic and cholinergic pathways to be unbalanced. Two areas in the left hemisphere of the brain play a key role in speech. The Broca’s area is located in the frontal part of the left hemisphere of the brain. It is involved in language production. Proper use of spoken and written language is all attributed to this area. (Douglas, 1999).

The patient has no difficulty in comprehending any spoken language or speech evidence by the fact that he can follow instructions as the clinician directs. His difficulty in voice volume can be directly associated with damage of the recurrent laryngeal nerve. Combination of dysphagia and low voicing can be attributed to neurogenic voice disorder.

After identifying the communication and swallowing requirements of the patient, as a speech therapist I will identify ways to improve communication in patient’s socialization. The family members or the caregivers will be included in therapy. They are together counseled on communication pattern and swallowing difficulty of the patient and ways to involve him in dialogue at home (ASHA, 2004).

As a speech therapist, it is important to observe the patient closely as he goes through the process of spontaneous recovery. The patient may have the residual effects of the damage to the Broca’s area and may express that he wanted to finish the words he initiated but he could not. The speech therapist should engage the patient in repetition of words and phrases that are easier for the patient to pronounce. To compensate for the lost language function, the speech therapist may use drawing that the patient can easily understand and use to communicate. The aim of speech therapy is to enable free communication and understanding between the patient and the family members (Roberts, 2014).

Music and melodic intonation are also used in speech therapy in patients with Broca’s aphasia. The patients are able to sing out a complete song with the complete phrases. Singing capability is controlled by the right hemisphere. Utilization of the technique enables the patient to use the right hemisphere to compensate for the lost function in the left hemisphere. Consequently, certain nonmusical outcomes are achieved by the patient such as complete pronunciation of a phrase (Wilson, 2006).

Speech therapists also use constraint induced aphasia therapy which uses the principle that a patient will have a compensated action to the one that is lost. The patients are involved in language context game where they are encouraged to use verbal abilities in order to succeed in the game. Constraining the patient has neuroplasticity effects on the patient and it is believed to re-establish the lost neuropathways, and form new pathways hence reacquire the lost functions of the brain. Therapy by constraining can be more effective if it is combined with drugs that affect the neurotransmitters in the central nervous system (Douglas, 1999).

The patient needs to be referred to a neuroscientist in order to include pharmacotherapy in conjunction to speech therapy. The drugs affect the neurotransmitter receptor and regulate the stimulation by the chemicals. They target the catecholamine and acetylcholine receptors of the central nervous system. The drugs commonly used includes; Bromocriptine, Piracetam, cholinergic drugs and dopaminergic psychostimulants. Piracetam interacts with the cholinergic and glutamic receptors to increase the plasticity of the cerebrum which increases the capability to use language functions. Bromocriptine, which interacts with the catecholamine system, increase the language fluency and word retrieval (Xavier, 2007).

In addition, a specialist in ear, nose and throat (ENT) should be consulted to detect other factors to the larynx that may affect the movement of vocal cords. He may diagnose presence of cyst, granuloma, hemorrhage, hyperkeratosis or nodules in the vocal folds and determine the therapy to follow (Deirdre, 2012).

References

Douglas, B., (1999). Broca’s area. Neuroscience of communication (2): 321-341

Roberts (2014). In Encyclopædia Britannica. Retrieved from http://www.britannica.coma. Accessed on 30^th June, 2014.

Wilson, (2006). “Preserved Singing in Aphasia: A Case Study of the Efficacy of Melodic Intonation Therapy”. Music Perception 24 (1): 23–36.

Xavier, (2007). “Pharmacotherapy of aphasia: Myth or reality?” Brain and Language 102 (1): 114–125.

Deidre, D., (2012). Types of voice disorders. Retrieved from: www.lionsvoiceclinic.umn.edu. Accessed on 2^nd July, 2014.

ASHA, (2004).Making effective communication a human right accessible and achievable for all. Retieved from: www.asha.org. Accessed on 2^nd July 2014.