Speech impairment can arise from a variety of reasons, depending on the patient’s specific illness, trauma, or injury. Common causes of speech loss include:

1. Assisted ventilation – patients on a ventilator cannot speak because the cannula inserted into the trachea is located below the vocal cords. The air exits and enters under the vocal cords and does not pass through them, thus the patient cannot utter any sound. Consult with the hospital’s speech therapist about inserting a speech valve that could help patients with a cannula to utter sounds.
2. Weakness, blurring and pain – Patients suffering from extreme weakness, blurred consciousness due to injury or medication, as well as patients suffering from pain, may have trouble speaking.
3. Brain injury/stroke – A brain injury or a stroke may damage different areas of the brain responsible for speech. The injury can be in areas responsible for the function of the oral muscles or areas responsible for comprehension or for expressing language. The injury can be permanent or temporary (as in the case of edema).
4. Jaw and mouth injury – An injury to the oral area can impair the ability to speak.
5. Muscle disease – Disease can damage the oral muscles and cause a gradual deterioration in speech.

Speech impairment can be temporary or permanent. Sometimes the speech impairment is permanent, but its intensity changes and it gradually improves or worsens.

• If the reason for the loss of speech is assisted ventilation, weaning from mechanical ventilation or inserting a speech plug can enable speech. Staff should be consulted.
• If the cause is blurry consciousness, fatigue, or edema – the improvement in speech will generally occur with the recovery and improvement in the patient’s condition.
• Loss of speech because of a brain injury or stroke depends greatly on the location and nature of the injury. Restoration of speech in such cases can take place over days, months, or years. The degree of improvement also depends on the type and nature of the injury.
• Degenerative muscle disease results in the deterioration of speech. Speech functions are expected to worsen. Various treatments can slow the rate of deterioration or improve functionality under existing conditions, but they do not improve muscle functions. Here too, a speech therapist should be consulted regarding the available solutions.

When a person is unable to express himself, he suffers from severe distress and the loss of his basic ability to control  his environment and  his identity. The loss of the ability to communicate may lead to depression, despair, and might worsen  the health condition. This situation may harm the patient’s ability to recover in general, and specifically to recover  his speech. The clinical and research reality demonstrates that the use of communication methods other than speech promote the rehabilitation of speech. Patients aspire to resume speaking and – if they can speak at all – will not be satisfied with an alternative method of communication.

Patients may suffer from episodes of fatigue, blurred consciousness and sometimes even confusion. These situations can arise from the disease or the injury itself or from the treatment (such as medications). Therefore, at times a patient can demonstrate a clear head and accurate understanding while at other times he can have  difficulty comprehending what is being said to him . In addition, the way the message is conveyed to the patient can impact  his ability to understand. If you speak to the patient clearly, with appropriate intensity, at an appropriate pace and accompanied by text or pictures, he may have a better chance of understanding than in situations where communication was not facilitated in a modified way.

Patients want to talk about their basic needs, but not only. Often, the patient needs to express a variety of messages to maintain his basic right to identity. The topics can be divided into 3 types:

1. Basic needs (I’m thirsty, I’m tired, I’m in pain)
2. Need for information or providing information (I feel pain on my right side; Why am I going to have an X-ray? When will I be discharged?)
3. Social closeness (thank you, I love you, how are you)

When we provide the patient with a tool for alternative communication, it is important that the vocabulary includes a collection of words that truly represent the full spectrum of what the patient would like to express.

The patient’s position may significantly have an  impact on his ability to stay alert and make effective and long-term use of alternative means of communication. In many cases, this ability can be facilitated by adapting a position for that patient and for identifying the best way for him to access and activate the means of communication, as well as to maintain alertness and endurance over time. Contact a speech therapist to recommend different options such as: a table for the bed, pillows to support the arms or adjustable arms on which communication boards can be placed.

If you know that you are going to undergo a medical procedure after which you will not be able to speak for a few hours, days or more, get as much information as possible about the duration of the recovery and how restricted you will be (How long will you have to be bed bound? Will there be restrictions on arm or eye movement? etc.). According to the expected degree of restriction, choose a suitable way of writing for you: a marker on a whiteboard, typing on a tablet or smartphone keyboard, or pointing to a letterboard. You should also have a board with common words and messages that you would like to use. It is very important to instruct those who are going to accompany you to the hospital about the means of communication you are going to use, ask them to bring the supplies with them and give them to you in a way that is convenient for you to use. You can agree in advance on “yes” and “no” signals and additional hand signals as needed.

There is a wide variety of hi-tech tools for communication: laptop computers and various tablet devices (for example, iPad). There are many software and apps for facilitating communication as well as spelling boards, and tablet or smartphone cameras, that can serve to create communication by photographing objects or topics that the patient wants to talk about.

It is important to note that the use of such hi-tech tools may be a significant challenge for patients in hospitals. There are many reasons for this:

1. Patients who were unfamiliar with the device may find it difficult to learn how to operate it. In situations of illness or injury, it is difficult to learn something that requires concentration, memory skills and perseverance.
2. Operating the device, usually via a touch screen, requires precision and a stable finger which is not possible for many patients, especially in lying positions.
3. Operating the device requires focusing gaze and scanning the screen, which may be a challenge for many patients.
4. Hi-tech devices may be exposed to various malfunctions (battery drain, etc.) which can be frustrating for patients who rely on the device for communication purposes.
5. In hospitals, electronic devices cannot be left unattended, so visitors are compelled to take the device with them, which may render them unavailable to the patient when they want to communicate.

Hi-tech tools are more suited for patients suffering from a lingering medical condition, staying in a rehabilitation facility or outside the hospital. Whatever the case, it is worthwhile consulting with a speech therapist specializing in Augmentative and Alternative Communication (AAC) to check patient-specific adaptation options. For trial purposes, hi-tech communication aids can be borrowed at the Ezer Mizion national lending center for Augmentative and Alternative Communication (AAC). Click for details >> (insert a link to the center’s  main page for voice output)

Patients with unintelligible speech often use signals that are unique to them, even if they or those around them are not aware of it. Relatives who are with the patient regularly and intensively learn to recognize these signals and respond to them. The patient relies on the ‘private language’ between him and the loved one who manages to ‘translate’ them. For other visitors to understand the patient too, it is important to create a ‘signals dictionary’ and teach the other visitors the agreed signs. It is also important to provide patients with clearer ways of communication (such as writing or pointing to letters, pictures, or objects), for those visitors who do not understand them properly.

Patients whose speech impairment is prolonged (over two months) can often use permanent and adapted communication tools. The recommendations in this guide are intended for hospitalized patients in inpatient departments. Some of the tools will also be suitable for patients in rehab facilities and outside the hospital, but many tools that may be suitable for patients coping with prolonged communication challengesare not mentioned here. Therefore, a patient who has difficulty speaking for a long period of time needs a speech therapist and an occupational therapist, who are experts in Augmentative and Alternative Communication (AAC) and can provide him with an appropriate solution.

You can contact the doctor in the department and ask to be referred to a speech therapist. If such services are not available and this guide did not lead to sufficient communication for you, or if you encountered difficulties in operating the various aids, you can contact the Ezer Mizion ‘Omer’ center for Augmentative and Alternative Communication (AAC) to conduct an assessment and accessibility meeting. Click here for Ezer Mizion Omer Center >> (insert link to Omer Center’s webpage צריך לדאוג שיהיה בקישור מידע באנגלית!!! )

Contact the patient’s family doctor and ask for a referral to a speech therapist from the health insurance or to clinics specializing in communication.

ISAAC Israel https://isaac.org.il/

ISAAC International https://isaac-online.org/english/home/

There are many articles online on speech impairments and alternative communication. Recommended search words:

Augmentative and Alternative Communication (AAC)

Acquired speech injury

Temporary or permanent communication loss in adults

Intensive Care Unit (ICU)

Neurological damage

Aphasia

Traumatic Brain Injury (TBI)