Acquired brain injury (ABI) refers to any injury acquired on a previously developed brain, regardless of its causal origin: traumatic, vascular, tumoral, infectious, anoxic, etc.
Speech therapy in the rehabilitation process aims to recover or maintain:
– Language, in its oral and written modalities, which is generally affected by aphasias.
– Speech, understood as the set of physical mechanisms (muscle control, phono-respiratory coordination, etc.) necessary to produce oral language and which, in cases of acquired brain injury, is compromised by dysarthrias.
– Social and communication skills, which can be affected after a brain injury, and which provide the person with tools that allow them to interact with their environment.– Swallowing, or the ability to swallow food, both liquids and solids, which is generally affected by dysphagias.
Thus, depending on the alterations presented by the affected person and the objectives set, the most appropriate speech therapy intervention will be designed to meet their needs. To do this, it is essential to have adequate training and be specialized to improve clinical care (Master’s in Myofunctional Therapy or Master’s in Clinical Speech-Language Pathology for Neurological Damage) and to be able to perform an adequate initial assessment and design the treatment for:
– Swallowing: consists of the activation and training of the muscles involved in the preparation of the food bolus through posture training, modification of food textures and volumes, etc.
– Voice: breathing exercises, vocal impostation, blowing, aimed at improving the intensity, tone, and timbre of the patient’s voice. In cases where voice recovery is not possible, there is the possibility of training and implementing alternative and/or augmentative communication systems.
– Speech: articulation exercises, rhythm, auditory discrimination, buccofacial praxias. In cases where speech recovery or intelligible speech is not possible, alternative and/or augmentative communication systems are trained and implemented (for example, voice synthesizers coupled to a tablet, where the affected person types certain content on the keyboard and it is reproduced with voice).
– Reading and writing: activities aimed at promoting both their mechanics and reading comprehension. Treatments of phonological, graphic, visuospatial aspects…
– Language: activities are carried out for oral comprehension, expression, naming, morphosyntax, phonological and semantic awareness, sentence and discourse structuring, etc.
On the other hand, in addition to traditional ABI intervention, at Aita Menni Hospital (Guipúzcoa, Spain), speech therapists have expanded their training in myofunctional therapy applied to neurological injuries. They use muscular neurophysiology as the basis of treatment, and through passive and active techniques, improvements in the rehabilitation of facial paralysis and oropharyngeal dysphagia are evidenced in a few months, depending on each case (Dolz Llandres, 2016).
This new form of treatment focuses on understanding the type of fibers we have in our face, either type I or type II, the distinction between isotonic, isometric, and isokinetic exercises, as well as the importance of thermal stimulation. (Dolz Llandres, 2016).
Current studies increasingly support the effectiveness of techniques such as electrostimulation. Through electrostimulation, using FES currents (functional electrical stimulation), stimuli are sent that promote laryngeal mobility (Dolz Llandres, 2016).
They also use the tapping method or neuromuscular taping (Kinesio Tape), which is based on tegumentary stimulation, providing constant and lasting stimuli to the afferent pathways of the primary sensory cortex, allowing better integration of the somatosensory system, facilitating a better motor response. Although its use in speech therapy is somewhat new and still little explored, some studies already demonstrate its effectiveness in therapies for temporomandibular disorders (TMD), facial paralysis, apraxias, facial asymmetries, hypotonia of facial muscles, and respiratory reeducation (Dolz Llandres, 2016).