Treatment of Communication Disorders Unit

Prof. Aviah Gvion- Director, Communication Disorders Unit

The treatment of Communication Disorders Unit at Reuth TLV Rehabilitation Hospital diagnoses and treats patients with language, speech, voice, and swallowing difficulties resulting from various brain injuries. The unit’s goal is to enable those who require these services to return to full activity, as much as possible, in their ability to communicate with their environment and to regain functional swallowing ability.

Patients

The Unit treats individuals suffering from defects in communication abilities that could be derived due to various causes, including CVA, brain traumas as a result of an accident, brain tumours, and degenerative diseases.

The disorders are divided into four types:

Language disorder (aphasia): brain damage, for the most part in the left hemisphere of the brain that could be expressed by various degrees of severity of disorders in speech, comprehension, reading and/or writing.
Speech disorder (dysarthria): injury to areas of the brain controlling the facial muscles, the tongue and other areas required for speech. The difficulty could be expressed by pronunciation, by the speed of speech and the vocal quality.
Harm to the quality of the voice (dysphonia): brain damage or direct damage to the vocal cords which could cause a decrease in the vocal quality going so far as inability to produce sounds.
Difficulties with swallowing (dysphagia): brain damage that could harm the swallowing system. This is a complex system which obligates coordinated activity of various muscle systems. Difficulty in swallowing could harm the patient’s nutrition and sometimes even endanger his life.

Treatments

A range of treatments are provided in the Treatment of Communication Disorders Unit:

Treatment for language disorders: the treatment has two main objectives: reduction of the linguistic difficulty thus the patient is able to return to communicate as closely as possible to his previous ability, and simultaneously to focus on provision of strategies and additional non-verbal means that will enable the patient to communicate with his environment notwithstanding his linguistic restriction.
Treatment for Speech and Voice Disorders: The treatment includes a variety of exercises aimed at improving movement and sensation of the speech organs to improve articulation and vocal quality. The staff also specializes in unique methods for voice disorders such as LSVT and Speak-out, which are also unique for treating voice and speech disorders characteristic of patients with degenerative disorders such as Parkinson’s.
Treatment of swallowing disorders: the treatment includes exercises for strengthening and improvement of the swallowing mechanism, alongside learning safe swallowing techniques. Furthermore, each patient receives customized nutritional textures which he can swallow without risk. If necessary it is also possible to receive nutritional advice from the hospital’s dietary unit.

The treatments in the unit are provided in a full inpatient setting, in a day hospitalization framework, and also through three specialized clinics: speech and language therapy, voice, and swallowing.

Technologies Used in the Unit

Eye-Gaze System

An eye-gaze system is an assistive technology that enables individuals with severe motor impairments (such as ALS or following a stroke) to control a computer using eye movements alone.
Control is achieved by detecting eye movements (using an advanced camera that tracks the eyes) and operating a mouse cursor and a virtual keyboard (depending on the patient’s abilities). This enables communication and access to communication applications (AAC – Augmentative and Alternative Communication software, which allows the transmission of recorded or typed messages) and to the internet.

EyeCon

A system developed by Dr. Goded Shachaf at Rambam Medical Center, in collaboration with Reuth Hospital. The system, which is used with patients with disorders of consciousness, provides real-time feedback for monitoring and improving responsiveness and interaction abilities.
The system delivers the necessary real-time feedback regarding the patient’s attentional engagement in response to an intervention, using an EEG headset. The first protocol of the EyeCon system is designed to teach the patient to indicate a positive response through blinking, which constitutes a first step toward communication.
Through the system, an audio segment is played (for example, music the patient enjoys or a recording of a family member) in order to elicit attention. The segment stops automatically after 30 seconds, and the patient is asked to blink in order to continue the playback.

Cognishine

A digital platform developed to provide therapeutic materials for cognitive and/or communication rehabilitation.
The platform includes a repository of structured exercises across a variety of domains and is used (among others) by speech-language pathologists as part of treatment for language, speech, and communication difficulties. The clinician can adjust the level of difficulty of the exercises on the platform according to the needs and abilities of each patient.
We use this platform both for guided therapeutic work during treatment sessions and for supervised practice between sessions, enabling independent practice by the patient.

iPad

The iPad is used as an AAC (Augmentative and Alternative Communication) tool for patients with speech, language, and/or communication difficulties, through dedicated applications such as Grid and TouchChat. These systems enable the creation of personalized communication boards that include symbols, images, text, and synthesized speech, tailored to the patient’s motor, cognitive, and linguistic abilities.
We use the iPad both for assessment purposes and as part of an ongoing therapeutic process, with the aim of enabling the patient to express needs, wishes, emotions, and complex content, and to support optimal communicative participation in daily life, at home and in various settings.

Research and academic activity

Student Training: The unit is recognized as a training center for students from various institutions of higher education, who are at different stages of their studies, and is also involved in supervising advanced degree students in MA and PhD theses.
Research and Academic Publications: The unit conducts extensive research activities and carries out studies in collaboration with researchers from Tel Aviv University, Haifa University, Ariel University, and Ono Academic College, and from Rambam Hospital and Beit Loewenstein Hospital.

The team

The unit’s team includes 13 speech therapists with extensive experience in rehabilitation, dyslexia and dysgraphia, and specialization in unique treatment methods for voice therapy, as well as an ENT physician specializing in performing FEES examinations. The team works in full collaboration with the various relevant departments in the hospital.