Epidemiology and Prognosis of Speech and Language Disorders

The relationship of speech to language and communication is so transparent in everyday human life – that the significant ability of a man to produce speech and influence understanding can be easily overlooked – even though not every man is capable of displaying this basic skill.

Speech and language skills are needed when communicating and exchanging information. Speech is a system that relates meaning with sounds. It consists of articulation (i.e., the physical production of sounds), voice (i.e., the quality, loudness and resonance of sounds), and fluency (i.e., the smooth and rhythmic flow of sounds and words). Meanwhile, language is a socially shared code for representing concepts through the use of arbitrary symbols and rule-governed combinations of those symbols.

Now that you have a sharp insight on the concepts of speech and language and how pivotal they are to human existence, there are circumstances in which individuals find it utmost difficult to socially get along with fellow men in the society because of their inability to exhibit oral communication skills due to impediments – speech sound and language disorders.

A speech and language disorder refers to an impairment in a person’s articulation of speech sounds, fluency, voice, comprehension and use of spoken, written or other symbol systems. According to the Individuals with Disabilities Education Act, “speech-language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance” (Individuals with Disabilities Education Act, 2004).

In the same vein, speech and language disorders can be divided into three major categories; Articulation disorders, impairment of speech fluency (stuttering or stammering) and language impairment. Articulation disorders involve the production of defective speech sounds and sound combinations that may be distorted, omitted, substituted, or added as accessory sounds. Sometimes articulatory disorders are the result of neurogenic disorders and dysarthria.

Meanwhile, the impairment of speech fluency – also known as stuttering or stammering is characterized by repetition of sounds, syllables, words, or phrases; sound prolongations; irregular pauses (hesitations) and word substitution.

The third category – language impairment is a linguistic disability, or faulty symbolization, which refers to disorders in both expression of thought through verbal language and its comprehension. This category includes various disorders, ranging from delayed/deviant language development to neurogenic disorders known as aphasia.

The Pattern of Development

Infants start learning in uterus. The fetuses can hear external sounds before birth. Their brain and sensory systems begin to prepare for the speech and language system in their environment. Newborns can make fine discriminations among the speech sounds they hear and prefer the sounds of the language they have been exposed to. Children soon acquire the phonemic (i.e., sound), phonological, morphological, semantic, syntactic, and pragmatic components of their native language.

Furthermore, cognitive, biological and social changes during infancy impact communication development. Children experience several milestones as they develop speech and language skills. At two months of age, children begin cooing and have intentional communication. At six months, their tongue and pharynx elongate resulting in production of consonant-vowel combinations (e.g., /da/). At twelve months, there is more dissociation of gross motor movements, greater dissociation of oral and pharyngeal structures resulting in more varieties of sound productions.

Children universally have their first words at approximately twelve months of age. Also at twelve months. At eighteen months, children are able to jargon, produce most vowels, and produce many consonants. They are able to use 5 to 10 single words and comprehend about 50 words. By twenty four months, fast-mapping occurs and vocabulary expands to 50 words with the production of two-word combinations. This speech and language development continues throughout childhood.

However, children with speech and language delays and disorders have difficulties understanding what is said to them and have difficulties expressing their thoughts. According to the American Speech-Language-Hearing Association, signs of speech and language impairment include: Problems understanding what others say, difficulties following directions and recalling information, problems saying words and expressing thoughts, difficulties producing sounds that are clear and intelligible, troubles playing and interacting and problems reading and writing.

The Mainsprings of Speech & Language Disorders

A range of environmental, biological, genetic, and perinatal conditions may be associated with adverse developmental outcomes that result in speech and language impairments. Advances in medical technology make it possible for high risk children to survive. Some risk causes of speech and language disorders in children include; Low Apgar score, low birth weight, premature birth, chronic otitis media, family history of speech and language disorders, exposure to environmental toxins, stroke, brain injuries, cancer (e.g., laryngeal, oral) and limited language exposure. These mainspring causes may result in children with delayed cognitive skills, limited attention, hearing loss, neurological disorders, intellectual disabilities, and physical impairments such as cleft palate, that negatively impact speech and language development.

The Headway

Speech-language pathologists make evidence-based approaches for intervention, counselling, collaboration with family members and other professionals, and identification of individuals at risk for or presenting with speech-language disorders. Speech-language pathologists are trained to follow specific diagnostic procedures needed for differential diagnosis that consider the impact of cultural, ethnic, regional, linguistic, dialectical differences and socioeconomic factors that may impact speech and language learning and use.

Hence, parents should seek the services of speech-language pathologist when they are concerned about their child’s communication abilities. Even if it is grossly admitted that there is a national shortage of speech-language pathologists in a country like Nigeria, yet it is a thing of joy to know that a professional setup like hEarMax Centre is readily available to provide solutions to your speech-language concerns. This, is the only headway!

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The Impact of Covid-19 on Auditory Rehabilitation in LMIC

Low and middle income countries have long been known to have deficient health systems when compared to developed countries owing to the inability of LMIC’s to possess a working system of health insurance that provides financial protection for specific sections of the population, increase healthcare service utilization and improve quality and lastly non- existent synergy with private entities to extend the reach of the health system. It cannot be overlooked that over the last few years, there have been some level of improvement in healthcare system in LMIC’s especially with the survival rates in areas of geriatric care that had previously led to increased deaths. The healthcare systems now have the capacity to
considerably manage some of the conditions hence reducing mortality; however an area of the health system that is seriously lagging is the provision of continuous care for patients that require rehabilitation services post-survival.

Rehabilitation in LMIC
There is little evidence on access to rehabilitation services in LMIC’s, however access is expected to be quite limited considering the workforce of rehab professionals which is a key component that determines access to services. In addition to that, review of healthcare systems in LMIC’s reported a similar challenge including limited knowledge of disability
services, guidelines and accreditation standards, and non-coordination amongst health sectors. The WHO estimates that there are less than 10 skilled rehabilitation practitioners per 1 million population in LMIC’s. With specific reference to hearing care professionals there is less than 1 practitioner per 1 million people in Nigeria while less than 5% of people requiring assistive hearing devices have their needs met. Needless to mention that unmet needs for rehabilitation has devastating impacts on individuals and their families, a huge economic burden to the country and a reduce in quality of life experienced.

State of Audiology in LMIC
The unavailability of Ear and hearing care services is thought to be associated to the non-existent comprehensive healthcare system in LMIC’s. This poses a significant challenge to the growing number of persons who require these services thus giving rise to the emergence of the Audiology profession in these climes recently. Approximately 80% of the 466 million persons living with disabling hearing loss are resident LMIC’s most of which lack the human or other infrastructural resources required to effectively combat the hidden disability that can easily go undetected and have compounding effects on quality of life.

Challenges in Audiological Service provision due to Covid-19
The pandemic has been an eye opener towards many new ways in which service delivery can be implemented remotely in the healthcare sector as questions surrounded how patients’ needs could be met without flouting Covid-19 response orders and putting the professional and others at risk. For the Audiologist, meeting up with the needs of clients posed a challenge at first as they constitute a specific section of persons whose therapeutic
activities were tied around having human contact. The response measures put in place to control the spread of the Covid-19 only amounted to isolating the already isolated. Social isolation has been a marker of hearing loss, thus the physical distancing measures put in place to manage Covid-19 further reinforced the feelings of loneliness experienced by persons with
hearing loss. In addition, the mandatory use of face masks which serves as an ally in the fight against Covid-19 presents a great challenge for persons with hearing loss as they reduce acoustic transmission of sounds and prevent speech reading. Asides the above, patients have reported that there is a high risk of knocking of their hearing devices when taking off their
facial coverings. Lastly, the increased reliance on remote communication technologies inadvertently segregates these category of persons as it may be difficult for them to follow the conversation due to sound distortion in these technologies.

Way Forward
Hearing rehabilitation professionals can continue to meet patient needs by making use of telehealth services when possible although this can never replace face to face professional services. Professionals can also continue to support their clients and families by reaching out to them to show solidarity and make them aware of their availability to support their communication needs in ways that align with safety precautions. Furthermore, persons with hearing loss can reduce the functional impact of Covid-19 by making use of Masks with a plastic panel over the mouth, make use of speech-to-text mobile apps and written scripts to aid communication challenges.
In conclusion, improving access to rehabilitation care in LMIC’s need to be seen as a priority area and this can be done by ensuring there is a sincere leadership and governance structure that promotes disability-inclusive development, strong partnerships in health sector, investment in infrastructure/human resources and research.

Language Disorders

Language acquisition is a cornerstone to adequate child development and occurs in stages. Childhood language disorders occurs as a result of a deviation in the normal course of language development and may affect the language comprehension and/or expression of children. They are manifested as difficulties in producing and/or understanding complex sentences, conveying thoughts and feelings to people. Childhood language disorders affect the way children use and process language.Childhood language disorder is a risk factor for children’s later development, being associated with enhanced behavioral, emotional, and social difficulties. The behavioral and emotional disorders often have implications on social interactions and communication, literacy difficulties, including both reading and writing; and reduced levels of academic achievement. Childhood Language Disorder is one of the most common types of special education needs. For example, rates of childhood language disorders among children in kindergarten (5–6 years) were reported as 12.6% by Beitchman et al. (1986) and 7.4% by Tomblin et al. (1997) in large-scale epidemiological studies in Canada and the US, respectively.The study in New Zealand found a prevalence of 7.6% among 3-year-old children (Silva, 1980). There is a strong gender effect with prevalence higher for boys than girls in all of these studies, for example, 8% boys, 6% girls in the Tomblin et al. (1997) sample, and this gender discrepancy has been consistently found in other research (Conti-Ramsden and Botting, 1999; Dockrell and Lindsay, 2000) and in the national statistics collected through the School Census of all children in state-funded schools in England. Childhood language Disorder is also more prevalent among children from more socially disadvantaged backgrounds (Department for Education, 2015).There is need for early intervention in the management of childhood language disorders. Parents of children with language disorders would require the service of health care professional that would carry out a holistic assessment to rule out certain health conditions such as hearing loss. Also, professionals such as psychologists, speech-language pathologist would assess such child using various assessment scales. Parents should pay attention to the overall development of their children so they can identify possible red flag of childhood language impairment and provide such children with the needed intervention from professionals.