How Do We Speak?
It’s no news that the human body is a tremendously complex machine and we are still finding out lots about how it works and what processes our body goes through without us even having to think about it. Speech is one of the most complex things we do. In order to make ourselves understood, our brains have to get our mouth, lips, tongue and voice box all producing sounds in the right order while simultaneously working out what we want to say and how we want to say it.
Scientists have known that certain areas of the brain played a large part in speech and language since French doctor Paul Broca first identified an area in the prefrontal cortex of the brain (now known as Broca’s area) which played a large role in speech. We’re still trying to fully understand how language processing works but a greater understanding of the complex anatomy of the brain could bring new hope to those suffering from speech problems or other conditions such as stroke.
Brain Damage in Specific Areas
Paul Broca’s ground-breaking work established that Broca’s area was the part of the brain responsible for telling the voice what sounds to produce. He found that damage in this area of the brain could mean that patients’ levels of comprehension were not affected but producing coherent words and sentences was almost impossible. Damage to Wernicke’s area, slightly further back in the brain, means that the patient can talk fluently and at length but that the words they are saying make no sense whatsoever. It is also thought that damage to specific areas of the brain may play a role in other speech disorders such as stuttering. Aphasia – the name given to the medical condition involving communication difficulties – can be particularly acute after a stroke.
Learning to Speak Again
Helping people who have suffered a stroke to speak again is a complex process. Stroke affects everyone differently and patients will have different requirements and treatment plans. Experts divide aphasia into four main groups:
- Expressive Aphasia – patients know what they want to say but can’t.
- Receptive Aphasia – patients cannot process speech or writing
- Anomic Aphasia – patients have difficulty finding the right words or names for things
- Global Aphasia – patients have more severe brain damage and can neither speak nor understand speech.
Treatment plans for people suffering from aphasia will depend on what type of difficulties they are experiencing. There are many tried and tested therapies such as art therapy, associating words with pictures and encouraging the playing of word games. Making the brain work and establish new connections for speech may be highly effective, depending on the severity of the initial injury to the brain. It’s important to remember that although most commonly associated with stroke, aphasia can affect people who have had their brains injured in road traffic accidents or have had tumours and other types of brain injuries too.
Experts in strokes and other traumatic brain injuries know that if treatment can be started within a month of the injury the patient stands the best chance of regaining speech and comprehension abilities. Intensive speech therapy programmes seem to deliver the best results with patients having around five hours of treatment per day for five weeks. Making the brain work to reach for words or in other linguistic exercises can help recreate those paths between the neurons which have been lost in the injury. On a practical level though this isn’t always possible; patients who have suffered a stroke may be seriously ill in hospital for several weeks or may have to undergo other sorts of physiotherapy such as learning to walk again. Fitting in five daily hours of intensive speech therapy isn’t always possible but starting as early as possible and doing as many different exercises and activities is thought to be the best way back to fluent and coherent speech.
What experience do you have of working with patients trying to regain their voice?