From the description given, the patient has a motor speech disorder (Dysarthria ).
This problem may have been caused by a lesion to the nerve that innervates muscles responsible for speech. The Vagus nerve, the X cranial nerve, through the recurrent laryngeal nerve innervates muscles of the laryngeal region. These muscles are involved in speech, and any lesion to the nerve supplying these muscles causes muscle paralysis and problems in speech since the vocal cords will not resonate well. Lesions to the nerve also paralyze the vocal cords, thereby compromising normal phonation and difficulties in swallowing. The ventriculoperitoneal shunting must have tampered with the recurrent laryngeal nerve, leading to these manifestations in the patient. The nerve may also have been injured through other brain conditions that may have not been picked in this patient. Another possibility is that a mass in the neck of throat may be hindering normal movement of the vocal cords.
The patient does not have difficulty in comprehending speech since he can follow physician directions. These rules out lesions to the frontal love that are responsible for speech comprehension and production. The problem is difficulty invoice volume which implicates disorderd vocal cord function. The lesions to the recurrent laryngeal nerve may have been from surgical causes or due to secondary brain condition like parkinsonism and multiple sclerosis.. Lesions of the extrapyramidal and pyramidal tracts, the basal ganglia and the cerebellum may also lead to dysarthria. This wide array of possibilities requires a multisystem approach for diagnosis.
The role of a speech and language pathologist is to determine any derangements in speech and language, and establish the cause of these derangements. Speech is a complex procedure that involves resonance of the vocal cords. In order for the vocal cords to resonate, laryngeal muscles must move to move the cords. With the help of the tongue and lips, speech is produced to the outside.Apart from this, muscles of facial expression are used to finetune speech and express what one is saying more appropriately. Therefore, assessing speech impairment involves assessing the lips, the tongue and muscles of facial expression. As a speech pathologist of this patient, I will assess the movement of lips, the tongue and muscles of facial expression so as to assess speech adequacy. It would seem like the lips, tongue and muscles of expression are functioning properly, but there is impaired resonation of the vocal cords, implicating the paralysis of muscles around the vocal cords.
U[pon discovering the speech and swallowing problems, I will form a treatment plan for the patient, while at the same time referring the patient to an ENT surgeon and neuroscientists to aid in the diagnosis and definitive management. I will involve family memebers to teach them about the speech therapy so that they aid in the home management. As part of the therapy, the patient will be taken through word repetition. The patient will also be taught to use sign language so that he communicates with those around him as treatment is being done. The role of speech therapy is to return the patient to a normal status and facilitate free communication between them and those close by (Roberts, 2014).
This patients requires an interdisciplinary approach for management and diagnosis. Apart from the speech and language therapy to enable him have normal speech, a neuroscientist needs to be consulted to aid in the diagnosis. The neuroscientist may identify lesions that may have led to the motor speech impairment.While the impaired speech may be due to neck conditions that are in the confide of an Ear, Nose and Throat (ENT) surgeon, central causes may have led. The neurosurgeon will assess the 10th cranial nerve to establish whther a lesion to this nerve may have led to laryngeal muscle paralysis. Since the VP shunt was carried out well and successively, the neurosurgeon will assess whether there are brain conditions that may have led to the lesion. The neuroscientist further gives expert opinion about pharmacotherapy that needs to be used as an adjunct to speech therapy. Drugs like Bromocriptine, an ergot derivative, enhances language fluency and word fluency (Xavier, 2007). Cholinergic therapy like Piracetam enhances language functions by increasing the plasticity of the cerebellum. Bromocriptine, which interacts with the catecholamine system, increase the language fluency and word retrieval (Xavier, 2007). Neuroscientists have mastered central nervous drugs in terms of action, dosage and adverse effects and by assessing the patient’s lesions, they will be able to manage the patient well.
A ear, nose and throat (ENT) specialist will further aid in the management as they will assess factors that may possibly have impaired movement of the vocal cords, which is necessary for speech production. Conditions like neck masses, cysts, granulomas, haematomas and nodules may be hindering the normal movement of the vocal cords even if the muscles are working well. A ENT specialist futher will assess the airway patency which is necessary for speech h (Deirdre, 2012). The swallowing problems may also be diagnosed by the ENT surgeon, and should they rule out all of these, then it narrows down the diagnosis and management.
Deidre, D., (2012). Types of voice disorders. Retrieved from: www.lionsvoiceclinic.umn.edu. Accessed on 2nd July, 2014.
Roberts (2014). In Encyclopædia Britannica. Retrieved from http://www.britannica.coma. Accessed on 30th June, 2014.
Wilson, (2006). “Singing in Aphasia; a Case Study of the Efficacy of Melodic Intonation”. Music Perception 24 (1): 23–36.
Xavier, (2007). “Pharmacotherapy of aphasia: Myth or reality?” Brain and Language 102 (1): 114–125.