Brain feeds on movement

"A patient sometimes talks like a hooligan, even though he or she is a well-educated, cultured person. He does not use polite forms, often swears and is not even aware that something is wrong,” according to neurologopedist Ewa Zaniewska.

TVP WEEKLY: Let's start with an apparently obvious question: what is the difference between a speech therapist and a neurologopedist?

EWA ZANIEWSKA:  Both specialists deal with broadly understood speech therapy. Speech therapists work on correcting speech defects, such as a lisp or an inability to articulate the "r" sound. Also, they often deal with speech disorders such as when a child on reaching the age where she or he should start talking doesn’t speak or speaks minimally. Neurologopedists on the other hand deal with speech disorders caused by neurological issues, that are the result of brain damage. 

You mean brain injury?

This is generally the case, but not solely. The most common neurological speech disorder in adults is aphasia, --  loss of the ability to comprehend and formulate what you want to say. In most cases, it is caused either by head trauma or a stroke. The other common disorder is dysarthria, which is caused by some dysfunction of the speech apparatus, such as tongue, palate or larynx ... 

By definition, a neurologopedist should have wider knowledge and more skills than a speech therapist. However, given that their competences are similar to a larger extent, the decision on which specialist to consult should be made on a one-to-one basis depending on the specific case. 

A neurologopedist also works with people who don't speak at all. However, even when someone's brain is damaged to the extent that it is unable to regain the power of speech, there is still a lot it can do. Two patients of mine can serve as examples. One of them is an elderly lady who, after three strokes, has quadriplegia. When working with her, my aim was to enable her to eat normally, i.e. to take meals in her mouth, not enterally. Primarily, this required lowering the muscle tensions in her face and neck area. 

  The other patient was a young man recovering from a serious accident. I wanted his face to stop looking mask-like. I wanted him to be able to make the simplest facial expressions again, to smile, frown, to raise his eyebrow... 

So in this case your aim is to help the patient with his non-verbal communication with the world? The concept of ‘non-verbal communication’ is quite broad, isn’t it?  A person can be bad at it even when able to talk. Isn't that correct? Like for example Sheldon Cooper in the popular TV series "The Big Bang Theory" ...

Yes, patients diagnosed with pragnosia (a defect in the pragmatics of communicative style) often have issues with contextual understanding. For example, a patient is able to talk and communicate, but due to damage to the right hemisphere of his brain (after a stroke for example), he cannot understand jokes or is unable to adapt his style of expression to the person he is talking to. In some instances, such a patient talks like a hooligan, despite being a well-educated and cultured individual. He is not able to use polite forms, often swears and is incapable of understanding that something is wrong. Nor does his family understand what is happening. We can help such people in a professional manner. 

We usually know why children require a speech therapist. They often need help to learn how to pronounce sounds like "r", "c" or "sz" (Polish equivalent of "sh"), and the cause of their troubles may be as prosaic as bottle-feeding for too long. But what is the difference between the problems of adults and children?

It is easier to help the little ones because they have yet to experience all the issues adults are burdened with, such as malocclusion, improper structure of the palate, muscle tension or contractures, the habitual incorrect working of the tongue ... In the case of a child, a lot can be done without asking for the help of an orthodontist. However, it is easier to cure a lisp in an adult patient than a child. An adult is more motivated, he is ashamed, wants to work, do the exercises.
Teodoro Leazma had a stroke as a result of Covid-19. The 61-year-old is regaining mobility, but he realised that the disease had also caused him dyslexia and other cognitive disorders. He is now undergoing therapy with neurologopedist David Romero, who uses a special program to help him speak. Grupo 5 Cian clinic in Alcala de Henares near Madrid, September 10, 2020. Pablo Blazquez Dominguez / Getty Images
Some actors, such as Zbigniew Zamachowski,  have overcome their speech impediment with hard, intensive work with a speech therapist or phoniatrist.

This is true. On the other hand, adults seek therapy very rarely. They have become used to their flaws, even made them part of their personal  charme . For example, they burr, pronouncing the "r" in a French, guttural manner, which is not typically Polish. (In the past, aristocrats as well as wealthy and educated people would pronounce "r” in this way). Sometimes, we can see it in in show business. 

I have already mentioned that the two most common speech disorders are aphasia (loss of the ability to speak) and dysarthria (speech problems caused by the muscles not working properly). Patients suffering from one of these two disorders have no problem with finding words, or planning their statements, or expressing their feelings. However, their speech is blurred and in extreme cases even incomprehensible. In children, the most common reason for this is cerebral palsy, in adults -- Parkinson's disease or multiple sclerosis. 

What can cause speech disorders in adult people and how can they be helped? Is the brain of an adult or an elderly person still flexible enough to heal. Can exercises help? 

As already mentioned, injuries, brain diseases and strokes are main causes. I have patients who are mute after being in serious road accidents. One of my patients, Katarzyna, has glioblastoma (a brain tumor) and after the surgery she started having speech problems. Unfortunately, strokes are often accompanied by right-sided paresis of the body. 

And finally, diseases of the nervous system, such as epilepsy, Parkinson's disease, multiple sclerosis. When a person has a progressive disease, speech disorders may appear as one of its symptom. In Parkinson's disease, for example, pronunciation is slurred due to muscle stiffness. 

Speech is a complicated phenomenon. Lots of elements, brain, muscles, teeth, even hands and the whole face, have to cooperate.

Over 70 per cent of human communication is non-verbal. After a stroke, facial muscle disorders, including those of eyelids and the mouth area, are very common. Muscle tension is abnormal. A good speech therapist, therefore, will always examine a patient’s primary functions first. Then, for example, the work might be to teach the patient where to keep the tongue on the roof of the mouth in order to be able to swallow properly. Speech is just the icing on the cake ... The starting point is to stimulate the muscles of the face and neck area with various methods.
Neurologopedist Marlys Meckler exercises with elderly patients who have neurological problems. Photo Rick Meyer / Los Angeles Times via Getty Images
When treating a child, a speech therapist usually plays with him or her and uses special toys, games and puzzles. How can you reach an adult?

Well, in my case at least, the basis of working with adults also involves some kind of fun game. I have to feel good with my patients and they have to feel good with me. I like to learn about their world and their interests. If a patient comes to me for exercises three times a week for three years we can't do the same boring exercises all the time! So, for example, I subscribe to a weekly humor magazine and I ask my patients to read jokes aloud. Quite a challenge given that our goal is for them to speak clearly and fluently. The patient must therefore read slowly so as not to stutter, but with enough intonation to convey the joke. 

I often sing with my patients. Of course, I always choose the repertoire according to their temperament and age. I ask them to exercise their facial muscles in front of the mirror, pretending we are rehearsing for a mini play. For example, when I say "mother-in-law is coming" we stretch our faces into an artificial smile, and then pretend we proceed to give our imaginary mother-in-law an exaggerated kiss. 

Movement is extremely important, both while working with children as well as with adults. Our brain feeds on movement, and it is our brain that we want to regenerate. A daily dose of exercise is essential. Of course the amount depends on a particular patient. If a patient can stand up and walk, he/she should do so as often as possible. If he/she can't, physiotherapy is still not enough! Peeling potatoes also means movement! It is impossible to overestimate all the good effects of starting any new activities, of departing from routines, getting out of one’s comfort zone. It is all about forcing one’s brain to create new nerve connections. 

What about disabled patients who cannot move?

In this case, a modern therapeutic solution, the so-called eye-feel, can help a lot. It works when a patient focuses on a specific object on the screen.

Eye-feel? Oh, I think I heard of it. They call it C-Eye or "Consciousness Eye"?

Yes, that's it. 

Is it true that thanks to the cooperation of cameras tracking the movement of an eyeball and software, a patient can "point to the screen" an appropriate drawing, photo, or letters, and formulate whole words and even sentences?

Amazing, isn't it? Yes, the C-Eye puts patients in touch with the world, reduces confusion and helplessness, and even improves brain function by stimulating cognitive processes. But in general, how many patients, so many methods. This is why my job is so fascinating. I can't fall into a routine. I have to look constantly for new ways to improve the patient's quality of life. I have to keep on looking at him or her as a whole being and keep on influencing their life so that they can return to normal.

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How can a patient's family help him/her if they don’t have any expertise on how to deal with such situations?

I am supposed to help the family, rather than them helping me. I am working on guiding the family in such a way that my patient gets the best possible support. I do not torment the family nor my patients with "words to repeat". I simply ask for constant contact between the family and the patient. For performing daily tasks jointly and sharing joys, i.e. for doing things, such as planting flowers on the balcony or going to a concert, together. 

When I listen to you, I think about the protagonist of the movie "The King’s Speech", the father of the present British Queen Elizabeth II, George VI. According to historians, his speech defect had a psychological background. It was associated with childhood traumas. The therapy shown in the film is more the work of a psychologist than a speech therapist. Is it really so often that a psychologist is needed as well?

Yes, of course. For example, my patient Mrs. Iwona remembers the events from before the stroke perfectly, but often cannot recall what happened to her a day ago. In addition, she has a huge problem with building sentences or finding words. I asked a neuropsychologist for help because I know that such an expert will be able to work with her memory more effectively than I. A psychologist is also needed when an adult has suddenly lost his/her full fitness because of stroke, brain damage or other situation discussed above. In such a situation, a psychologist will help them rediscover the meaning of life in changed conditions. They need to have the world explained to them again. Somebody has to help them tame it. 

–Magdalena Kawalec-Segond

TVP WEEKLY. Editorial team and journalists

–Translated by Agnieszka Rakoczy
Photo from the private archive of Ewa Zaniewska
 Ewa Zaniewska  is a speech therapist for children and adults at the "Ogrodowa" Health Center in Wrocław. She focuses on diagnostics and conducts therapy for children with delayed speech development and for people with speech impediments. She also treats aphasia in people after a stroke or trauma. She holds an MA in Polish filology, and has a postgraduate diploma in neurologopedics. Her expertise is not only in work with speaking and cooperating patients but also with those who do not cooperate as a result of various disorders. 
Main photo: It is easier to cure an adult than a child from a lisp. Photo BSIP / Universal Images Group via Getty Images
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