Last year's movie, The King's Speech, brought to light the difficulty an individual may experience in personal and social relationships when faced with a speech impairment. In fact, during the period of time the movie was showing, nearly all of my patients commented on being able to "relate" to the central character, and his daily struggle to communicate. Whether the communication difficulty is the result of a stroke, Parkinson's disease, head and neck cancer, or any other medical or neurogenic problem, it is tempting for many persons to choose to withdraw from social situations.
This tendency, in fact was reported in an excellent article published last year: A Qualitative Study of Interference With Communicative Participation Across Communication Disorders in Adults (Carolyn Baylor, Michael Burns, Tanya Eadie,Deanna Britton, and Kathryn Yorkstona.Am J Speech Lang Pathol 2011). The researchers sought to identify the ways that a communication impairment interferes with participation in life activities. Analysis of interviews with 44 individuals with communication impairments associated with a variety of medical diagnosis, revealed several prominent themes. One common theme that emerged from the study was that: Interference in communicative participation in life activities is both “functional” and “emotional.” Functional, refers to not being able to do a particular task, for example successfully make a phone call due to a speech impairment. Emotional interference had more to do with how the individual felt, with comments such as: "I felt like a bystander," "I lean on my family and friends to communicate for me." Several participants reported that over time they adopted strategies such as: "keeping a low profile,"do the bare amount of talking," "retreat into the background,"and "avoid unnecessary conversation."
The coping "strategies" noted above are commonly reported by many of my own patients, along with their reports of frustration due to the unpredictable nature of their speech or voice problem. Speech can fluctuate from day to day as well as in different settings. Situations that impose communication "pressure" for most speakers ( eg: being at the doctor's office, standing in line at the store,talking with the background noise of a restaurant) can elicit anxiety for individuals with a speech problem, and an anticipatory response that can momentarily worsen the problem.
As a society, we have finally taken some measures to accommodate persons with physical disabilities, by way of ramps, parking spaces, and bathroom stalls. Communication impairments, on the other hand, are less visible, and consequently not often acknowledged by health care professionals much less the general population, leaving individuals struggling or suffering in isolation.
If you have a communication problem, then improving or maintaining communicative participation in life activities needs to be a goal of not only your therapy programs, but also part of discussions with your neurologist or treating physicians as well as family members. In a future blog post, I will try to offer some suggestions for staying communicatively independent and engaged in life.
My Mission: To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower.