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The importance of differentiating speech intervention based on the deficits that arise as a result of brain injury and problems that may arise in the age of development and adolescence.

I wrote a lot on this blog about issues related to developmental age and adolescence; in this article I would like to discuss what my specific professional field is, compared to adulthood and the pathologies arising from organic lesions that cause cognitive deficits, with the attempt to bring to light some differences between the two worlds.

I would like to do so following a thread, a thought that I try to carry forward by highlighting the fundamental differences that exist when in speech therapy we talk about rehabilitation.

Speaking of “rehab”, I immediately come up with a question: How correct it is to speak of logopaedic rehabilitation in children who do not find themselves having to recover a function lost due to a pathology or a brain damage, but a capacity that during the development has found a problem, or that has emerged subsequently but without obvious reasons of organic origin?

In many cases we are not talking about children who had these abilities and then lost them, but children in whom the need to intervene emerged during their development. Then of course, having recognized the problem, we act to ensure that the child can find their way to express themselves at their best and face all the difficulties.

It happens that following brain events (strokes, head trauma, brain tumours) or neurodegenerative pathologies I find myself having to rehabilitate patients with speech deficits, dyscalculia’s, attention deficit or executive function deficits (logical reasoning, planning, verbal abstraction, working memory).

Perhaps for many it can be taken for granted but for me it is essential to point out the difference that there is, that exists between the various situations in which the speech therapist performs their intervention.

It seems to me appropriate to specify that there is a difference between a person who has deficiencies in some areas and those who present those deficiencies as a result of an appropriately identified organic lesion following an instrumental investigation. Highlighting this difference is crucial.

When I explain to a person what are the difficulties that occur as a result of a stroke, for example, (the deficits that the person I take care of presents after the disease event) I try to make it clear that the injury caused deficits that were not there before and that with rehabilitation we will do our utmost if not to make them disappear (sometimes for a series of reasons they regress hugely), at least to find alternative strategies to “cheat” the problem and be able to return to live as autonomous and independent as possible.

The logopaedic therapy for patients who come to me after a brain injury makes use of specific techniques to deal with the functional relapses that a damage, a brain injury has caused; when I speak of “techniques” I mean a series of exercises aimed at recovering or strengthening a certain cognitive area. So, I know that if I have to rehabilitate a person who has aphasic, attention or memory deficits (just to give a few examples), I can do it by subjecting it to specific training.

This does not mean in the most absolute way that to do so, I do not have to establish a therapeutic alliance based on trust, sensitivity and interhuman relationship. My profession cannot and must not disregard this. Never.

Going back to the world of children and adolescents, where the origin of the problems does not concern brain injury or deficits resulting from genetic modifications that can be found, in my opinion the approach should be different. Simply because there are different causes.

When I see a person with a specific brain damage, in a certain area of the brain I already know what will be (in general) their difficulties. Knowing anatomically the domains of our brain areas, it’s hard for me to ask, “Why this deficit and not another one?”

Of course! Anyway, each person has their own uniqueness and often the difficulties are intertwined with their attitude, family, with their emotional state and it is necessary to take it into account every time you set up a treatment plan.

We get to the point… when I have a child in front of me, I always ask myself the question: “Why is there this difficulty?”. It is never enough for me to know that they have a diagnosis of DSA (Specific Attention Disorders), that they have attention problems, do not concentrate or fail to study. In front of a child I feel a strong need to go and see something that not even the best technological tool in the world can find.

I feel the obligation to help them by necessarily taking charge of their family, their social context (the school, the teacher of the sport they attend). And this, as often stated in my articles, must be done in a collaborative and multidisciplinary way.

While I try to find the right words to express many other concepts I have in my mind and on my skin as a result of a daily living of work, study, insights and questions, I still wonder: Why is it so important to point out that there are differences?

I think the truest and most appropriate answer lies in the title I chose for this article, that is, “Words are important”, we must know how to give a name to things when we are facing people who come to us looking for answers. We must be able to tell them honestly what has happened and how we can help them to solve their difficulties. And we need to do that by modulating ourselves according to who’s in front of us.

I always repeat myself and I always repeat it to the students of the Degree Course in Speech Therapy “Never consider only the problem you face, try to catch a glimpse of who, sometimes, hides behind that problem, what their world is. Always look at the human being in front of you first, then everything else”. Whenever you meet a patient you must consider them before their condition that emerged as a result of a brain injury.

And this is even more true of those who have not suffered any brain damage. In the absence of that lesion, one must deepen better on the causes that have brought out some problematic.

My job is relationship work, connection… And if there’s one thing I’ve understood right is that as often as some truths, realities are uncomfortable and thorny, you can always find a way to “enter” on tiptoe and try to change things.

It’s no doubt difficult to get people to accept what happens to them (in cases where a disease affects them), especially if it turns their lives completely upside down and forces them to learn again to do something that before was perfectly in their abilities.

As difficult as saying to a child: “You will succeed, we just have to find a way, there is nothing wrong with you”.

Sometimes I found myself in front of very high walls, built with bricks of fear, prejudices, preconceptions and perhaps, sometimes, I sit there with my shoulders against them and my head in my hands trying to figure out how to break down certain barriers and find a kind way to deal with certain issues by questioning some things. I’m trying.

That’s it. Yes. Words are really important, especially when they need to be followed by actions.

Valeria Verna

Thanks to Chiara Fanasca for the translation of this article


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Credits by: Mohamed Abdelghaffar