Accurate differentiation of acquired speech and language disorders for positive rehabilitation outcomes

Abstract

Loss of speech due to acquired brain injury causes long-term disability in those affected and substantial caregiver burden (1,2,3*). Patients rely heavily on caregivers for managing day-to-day affairs; they become socially isolated, are forced to sacrifice life goals, and are at higher risk for depression and suicide. Effective healthcare management requires robust diagnostic procedures and subsequent diagnosis-specific intervention to optimise restoration of speech. Such procedures are currently lacking for acquired speech disorders; hence the major aim of this project is to deliver accurate diagnosis that will result in appropriate and effective treatment. Acquired speech disorders fall in to two major categories: disordered oral-facial control and disordered cognitive-linguistic skills. While this appears straightforward, the motor control disorder of Apraxia of Speech (AOS) and the cognitive-linguistic disorder of aphasia most often co-occur within patients and symptoms of each are frequently conflated (4*,5*,6*). Reliable detection of AOS against a backdrop of aphasia is critical to rehabilitation success when the desired outcome is improved ability to speak. A rehabilitation program structured around linguistic constructs will fall short if the patient cannot control the oral-facial structures that are required to articulate a response. In such cases, the rehabilitation strategy must conform to principles governing motor system learning (7,8*,9*). (AU)