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Communication Difficulties

Communicating is complex. Our brain creates and understands language, our voice produces sound and our tongue, lips and teeth shape speech. Problems at any level impact a person’s ability to communicate, affecting quality of life.

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A speech-language pathologist specializes in working with patients and their families to improve communication abilities.

Here are some resources about common communication difficulties facing patients with cancer. A speech-language pathologist can also provide specific strategies related to your individual issue.

Not all patients with a brain tumour will develop aphasia. Whether or not a brain tumour impacts a person's ability to create and/or understand language will depend on where in the brain it is located.


Aphasia can be caused by pressure from the tumour itself, the impact of treatment in the area of the tumour (such as surgery or radiation), or by swelling in the area. These factors will also influence whether the aphasia is temporary or longer term.


It is important to remember that aphasia does not affect a person's intelligence or ability to make decisions. Communication strategies can help a person with aphasia to get across what he/she would like to say.


speech-language pathologist can work with patients to find helpful communication strategies and/or provide therapy to improve language (when possible).


A common complaint in cases of milder aphasia is word-finding difficulties (feeling like the word is at the tip of the tongue).


Here are some word finding strategies:

 

  • Be patient. You may find the word comes out on its own while trying some of these strategies. Don't rush yourself and ask your communication partner to give you time
  • Describe what you are trying to say. For example: If you were stuck on the word 'apple', instead of stopping, try describing. Here are some ideas:
    • Meaning – "It's a type of fruit that is grown on a tree"
    • Use – "You eat it"
    • Sounds like/starts with – "It starts with an /a/ sound"
    • Category – "A type of fruit"
    • Colour/Shape /Material – "It's round and can be red or green"
    • Association – "It reminds me off that tree in our backyard that we picked"
  • Use gestures – use your hands and body to act out the word. This can help your partner understand and can also help you get to the word yourself by activating a different area in your brain
  • Draw/Write – sometimes words or pictures come out more easily than speech. Keep a pen/paper with you
  • Try again later – if you can't come up with the word and these strategies aren't helping, try taking a little break and trying again later

Communication is a two way street. Here are some strategies for communication partners of people experiencing aphasia that can help support them to understand and express themselves:

 

For helping the person with aphasia get a message OUT:


  • Give reassurance, say "I know that you know" at appropriate times.
  • Ask yes or no questions instead of open ended
  • Ask one question at a time
  • Ask fixed choice questions such as, "do you want water or coffee?" instead of "what do you want to drink?"
  • Ask him/her to gesture, point to objects or pictures, or write key words, such as "Can you show me…"
  • Give him/her sufficient time to respond. Ensure that you aren't looking tense or rushed
  • Repeat the message to ensure that you have understood correctly ("let me make sure I understand")
  • Don't pretend to understand what the other person has said if you do not
  • Avoid interrupting or filling in words for a person (unless they have asked you to)

 

For helping the person with aphasia UNDERSTAND:


  • Use short, simple sentences
  • Speak slowly and clearly at a steady pace
  • Do not speak more loudly – remember that this is not an issue with hearing
  • If the person has not understood you, try saying your message in a different way
  • Use gestures in addition to what you are saying
  • Write down key words or topics, so that you can both see them together – e.g., PAIN, in large, bold print
  • Use pictures to illustrate an idea, and focusing on one picture at a time
  • Eliminate distractions whenever possible – one on one, turn off television or radio etc.
  • Take a break if you are both tired. Provide reassurance that you will keep trying
  • Be careful not to talk down to the person with a communication difficulty. Remember that the issue is not related to intelligence


 

Changes in vocal quality can happen for a variety of reasons. Common complaints are hoarseness (rough vocal quality), breathiness (losing extra air when speaking), voice loss (not being able to start or maintain your voice) or a strained quality. Dysphonia can result from cancer treatment (surgery or radiation) or from the impact of the tumour itself on the vocal folds or the nerves that supply the vocal folds.

 

Here are some strategies for helping to maintain a healthy voice:

 

  • Stay hydrated. Drink sips of water throughout the day and aim for 2-3 litres
  • Steam inhalations can also help hydrate the vocal tract and soothe discomfort. This can be inhaling steam over a bowl of boiled water with a towel over the head or a facial steamer. Don't add anything to the water
  • Pay attention to overall tension in the throat and/or body and find ways to help relax and/or relieve tension
  • Cut down or stop smoking
  • Reduce alcohol, coffee and tea which can be dehydrating
  • Avoid whispering as whispering can strain the muscles in the voice box
  • Try not to strain your voice to be heard over background noise
  • Avoid shouting
If you continue to experience hoarseness (a rough sounding voce), voice loss or discomfort (soreness, pain, tightness in throat) please speak to your doctor and request a referral to and ear, nose and throat doctor (ENT). An ENT will have a look at your larynx (voice box) and make a diagnosis. A speech-language pathologist will be able to provide voice therapy to help improve vocal function.


 

Not all patients with head and neck cancers will develop dysarthria/dysglossia (difficulty producing clear speech). Whether or not a patient will develop difficulties with speech sounds will depend on the location of the tumour as well as the impact of radiation or surgical treatment on the structures or nerves that are important for producing speech sounds. Sometimes, shorter-term side effects such as swelling can temporarily impact speech. 


speech-language pathologist can work with patients to improve or best compensate for these changes at any point during or after treatment.


Tips for improving speech clarity:

  • Maintain eye contact with your communication partner. Face to face will be most effective
  • Prepare your communication partner by gaining his or her attention and introducing the topic of conversation before speaking. "I'd like to talk about our weekend plans"
  • Slow down your rate of speech
  • Try to over-articulate. Move your lips and tongue in an exaggerated manner
  • Keep it short – use shorter sentences and focus on the most important words
  • Carry a pen and paper as a back up, even writing the first letter of the word you want to say can be very helpful for your conversation partner
  • Avoid talking over background noise (turn off TV, avoid noisy restaurants etc.)



SOURCE: Communication Difficulties ( )
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