DNB - PMR
MD - PMR
FINAL EXAM…!!!
Q 1 A ) ENNUMERATE IN DETAIL VARIOUS TYPES OF COMMUNICATION PROBLEMS IN PATIENT WITH STROKE ?
B ) OUTLINE ITS MANAGEMENT PRINCIPLES ?
A 1 INTRODUCTION
1 A stroke is an injury to the brain -The
brain controls everything we do including everything we interpret and understand.
2 A stroke can cause problems with communicating if there is damage to the parts of the brain responsible for language.
A ) These functions are controlled by the left side of the brain in most people.
B ) As one side of the brain controls the opposite side of the body, many people who have communication problems after stroke also have weakness or paralysis on the right side of their body.
3 Stroke can also cause communication problems if muscles in the face, tongue or throat are affected.
4 The range of communication problems someone has will depend on where in the brain the stroke happened and how large an area was damaged.
5 A stroke can affect communication in different ways.
VARIOUS TYPES OF COMMUNICATION PROBLEMS ARE - The main conditions that can happen after stroke are -
1 aphasia
2 dysarthria
3 dyspraxia
1 Aphasia
A ) Aphasia (sometimes called dysphasia) is the name for the most common language disorder caused by stroke.
1 Aphasia affects speaking , ability to understand what is being said, and reading or writing skills.
2 It does not affect intelligence, although sometimes people think it does.
3 Aphasia can be very mild, and sometimes only affects one form of communication, such as reading.
Overall However, it is more common for several aspects of communication to be affected at the same time.
TYPES OF APHASIA
1 If problems are mainly with understanding what is being said, this is called receptive aphasia.
2 If you mostly understand others, but have difficulties expressing what you want to say, this is called expressive aphasia.
3 A combination of problems that changes all or most of your communication may be referred to as mixed aphasia, or global aphasia if the effects are severe.
EXAMPLES OF TYPES OF APHASIA ( CLINICAL SCENARIO)
A ) RECEPTIVE APHASIA
1 Not able to understand much of what other people say and feel as though others are talking in an unknown foreign language.
2 not understand when people speak in long, complex sentences and may forget the start of what they said.
3 not understand others if there is background noise or if different people are talking in a group.
4 be able to read newspaper headlines, but not understand the rest of the text.
5 be able to write but unable to read back what they’ve written.
B ) EXPRESSIVE APHASIA
1 not be able to speak at all. They may communicate by making sounds but not be able to form words.
2 have difficulty speaking in normal sentences. They may say only single words or very short sentences, missing out crucial words. They may write in a similar way.
3 speak with frequent pauses and be unable to find the word they want to say – yet it may be on the tip of their tongue.
4 answer ‘yes’ or ‘no’, but mean the opposite so their answers are not reliable
5 think of the word they want to say, but another word comes out – for example, ‘milk’ instead of ‘water’.
6 speak at a normal rate, but much of
what they say is unrecognisable and has limited meaning.
7 They may not realise this and others may wrongly think they are confused.
8 describe or refer to objects and places, but not be able to name them.
9 They miss out the words they can’t think of
10 say only a few set words in answer to any question. They may be emotional words, such as swear words.
11 get stuck on a single word or sound and end up repeating it.
2 DYSARTHRIA
A ) Dysarthria happens when a stroke causes weakness of the muscles you use to speak. This may affect the muscles you use to move your tongue, lips or mouth, control your breathing when you speak or produce your voice.
2 It does not affect your ability
to find the words you want to say or to understand others, unless you have other communication problems at the same
time.
3 In dysarthria voice may sound different and you may have difficulty speaking clearly.
4 There is also a difficulty in voice sounds - slurred, strained, quiet or slow.
5 Other people may find your voice hard to understand.
3 DYSPRAXIA
A ) Dyspraxia is a condition that affects movement and coordination.
B ) Dyspraxiaof speech happens when patients cannot move muscles in the correct order and sequence to make the sounds needed for clear speech.
C ) The individual muscles that are use to produce clear speech may be working well but cannot move them as and when you want to in the right order and in a consistent way.
D ) In dyspraxia, there is inability to pronounce words clearly, especially when someone asks you to say them.
E ) There is often a repetition As At timesIt can be frightening and distressing to have difficulty communicating after stroke.
F ) It can be difficult to join in conversations and this can be very frustrating.
G ) If the ability to read is affected, everyday activities such as choosing from a menu or reading signs or prescriptions can become problems.
4 MISCELLANEOUS
A ) Changes to the emotional content of communication
1 A stroke can sometimes cause subtle changes to emotional aspects of speech.
2 For example, tone of voice may sound ‘flat’ or your facial expression
may not vary.
3 difficulty in understanding humour or when to take turns in conversation
4 They are due to changes on the right sideof the brain and can be misinterpreted as depression.
B ) Changes to perception
1 A stroke can alter your vision and sometimes your hearing. This can make reading and writing problems
C ) Tiredness
1 Many patients find that they feel very tired after a stroke, both physically and mentally.
2 Having a conversation may also take more effort than it used to, and other people may not realise this.
3 The ability to communicate can vary significantly depending on how
tired or stressed someone is feeling.
4 Memory and concentration problems
A ) Stroke can affect your short-term memory and aspects of your thinking processes, such as the ability to focus and concentrate.
B ) This can make communication slower
and more difficult.
5 Physical problems
A ) Physical weakness or paralysis after stroke may affect facial expressions and body language.
B ) Physical problems can also make writing difficulties worse if your dominant hand is affected.
C ) Physical pain or discomfort can be a distraction.
D ) Swallowing problems are also common after stroke and often associated with dysarthria.
6 Changes to mood or personality
A ) It can be frightening and frustrating
if a stroke has affected your ability to communicate.
B ) Changes in the brain caused by the stroke can also affect mood, emotions and personality in other ways that can be difficult to control.
MANAGEMENT
1 COUNSELLING - It is the foremost and important aspect as in this we have to resolve anxiety and problems of the patients
A ) In this we have to look at all aspects of patients life , family life and society as a whole
B ) In this we have to establish a good patient relationship
2 COMMUNICATION AIDS - It includes Computer devices and software programmes that are designed to improve patient functioning and to develop an individual as a whole
A ) It assists in activities of daily living and it allows to make life simplier
B ) Is also useful in proper monitoring of the patient
3 Use of exercises to strengthen the oral and buccal mucosa and muscles in order to establish the appropriate tone
4 Teaching alternate ways of communication such as gestures to the patient
5 VOCATIONAL TRAINING - It imparts confidence in patients life as he / she can still earn and control their livelihood
A ) It gives financial support to the patient