HD~Communications

Chapter 3-The Physican's Guide to Management of HD

Movement Disorders

DYSARTHRIA

Dysarthria, a difficulty with the physical production of speech, results largely from impairment of voluntary movement. Speech becomes slurred, dysrhythmic, variable in volume due to inconsistent breath support, and increasingly difficult to understand.

TABLE 5: COPING STRATEGIES FOR COMMUNICATION

Allow the person enough time to answer questions.
Offer cues and prompts to get the person started.
Give choices. For example, rather than asking
"what do you want for dinner?" ask "do you want
hamburgers or meatloaf?"
Break the task or instructions down into small steps.
If the person is confused, speak more simply
and use visual cues to demonstrate what you are saying.
Ask the person to repeat phrases you did not under-
stand, or spell the words.
Alphabet boards, yes-no cards, or other communica-
tion devices may be helpful.

Furthermore, just as patients do not always appreciate the presence or degree of chorea, some patients do not seem to be aware of distortions in their speech. For others, articulation is a constant source of frustration.

No medications are known to be helpful, and dysarthria may be worsened by agents which suppress chorea. However, several interventions may enhance communication in these patients. The listener must do everything possible to promote successful communication, beginning with allowing enough time.

Many HD patients thought to be incapable of communication can be understood if the listener is patient enough. Patients may need to be moved to a quieter, calmer environment, and urged to speak slowly.

Patients can be asked to spell difficult to understand words. A communication board can also be useful in some cases.

A speech-language pathologist may be able to provide additional insights and management strategies.

Dysarthria may be compounded by cognitive problems found in HD, such as word-finding difficulty, difficulty initiating speech, or difficulty completing a sentence. Even those with severe cognitive impairments often respond to cues, such as asidng for the size, shape or color of an object. Even severely impaired patients may be able to respond accurately to a series of yes and no questions.

If unsuccessful attempts at communication become very frustrating, it may be better to take a break. The desire for social interaction generally remains, even in those with advanced HD, so strategies for communication should be a priority.

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Chapter 4-The Physician's Guide to Management of HD

Cognitive

Language

Communication, or the transfer of information from one person to another, requires a complex integration of thought, muscle control, and breathing. HD can impair all three of these functions. There are two main aspects to communication: getting the information IN (understanding) and getting the information OUT (talking). Both of these aspects can be impaired by HD, making communication a difficult task.

The most prominent language difficulties in people with HD are (1) speaking clearly (articulation), (2) starting conversation (initiation), and (3) organizing what's coming in and going out.

Misarticulation

Motor speech impairments are quite typical in HD. Persons with HD have even been accused of being drunk due to their sluggish speech articulation. A lack of motor coordination causes difficulties with enunciation and the breath control underlying speech.

Impaired Initiation of Speech

Word finding is often impaired, while knowledge of vocabulary is retained, because it takes the brain much longer to search and retrieve the desired object. Listeners sometimes fail to wait long enough for the brain to do its job.

In addition to speed limitations, the brain fails to regulate the sequence and amount of traveling information, resulting in impairments in starting and stopping.

When language initiation is compromised by HD, techniques such as phrasing questions with alternate choice answers (e.g., yes or no; lasagna or spaghetti) may help someone get started or retrieve the desired response.

Disorganization of Language Content

In contrast to the basic impairments in language output, the basic capacity to understand language remains relatively intact in HD. Even in later stages of the disease, language comprehension may remain when the ability to speak is significantly diminished. This fact is important to communicate to family members, staff at care facilities and other professionals involved.

Even if a patient cannot express herself, it is likely that she can understand what is being said. Difficulties with word usage are rare in persons with HD, as are frank aphasia or impairments in semantic memory. The trouble that occurs in persons with HD is an inability to organize the outgoing and incoming language, resulting in miscommunication.

To aid the person with HD in organizing language output and input it is best to rely on short simple sentences and to assess understanding frequently during important conversations.

========================================== Chapter 4-The Physician's Guide to Management of HD

Language

Misarticulation

Impaired Initiation of Speech

Disorganization of Language Content

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Chapter 4-The Physician's Guide to Management of HD