The University of Dhaka

Course code: PMSLP 5201

Subject: Technology and Methods of Investigation Pathological Language Data

Topic: The necessity of using neurophysiological methods for

diagnosing communication disorders.

Submitted to
TAWHIDA JAHAN
(Assistant Professor & Chairperson)
Department of Communication Disorders
Faculty of social science
The University of Dhaka

Submitted by
Md. Akhsaful Imam
Roll No 51
PMSLP 5th batch
Department of Communication Disorders
Faculty of social science
The University of Dhaka

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The necessity of using neurophysiological methods for diagnosing
communication disorders.

Introduction:

A communication disorder is a problem for the whole world. The percentage of communication
disorders is not few at all. But in an undeveloped country, communication disorder isn’t
considered a disease. Special education concept is spreading all over the world; communication
disorder is considered a disability nowadays. About 40 million people in the USA have
communication disorders. According to the research of IDEA found 24.1% of communication-
disabled children at the age of 3 to 5 years. Among affected children, 1.4% receive special
education.

A communication disorder is a critical problem for every country. A developed country is

working to prevent and intervene. However, in a country like Bangladesh, it is an unfamiliar
topic till now, and we do not find noteworthy research on communication disorders Prevalence
of speech difficulties among children under 15 years of age (around 22%) than people over 60
years (4.81%), [Shams Al Galib. 2020] [https://bdeduarticle.com/communication-
disorder/]

Bangladesh Person with Disability Act 2013 categorized those types of disabilities that are
easily visible (For example, visual impairment, Intellectual disabilities, Physical disabilities,
etc.). Though the Persons with Disabilities Rights and Protection Act 2013 categorized speech
impairment individually, communication disorder is considered a disability now we do not
have any statistics about communication-disabled person and their future because
communication disorders are not speech impairment alone.

Nevertheless, the diagnosis of communication disorders is the most important task to identify
communication-disabled persons, distinguished speech disorders, language disorders, and
hearing and auditory processing disorders separately. Communication disorder becomes
visible when a person speaks or follows any instructions. In this perspective, communication
disorder doesn’t any specific further assessment. If it seems that a person has defective
communication skills, he should meet a speech and language specialist. Sometimes child
psychologists or child specialists can identify defective communication skills. They diagnose
communication disorders by considering the developmental milestone of a child.

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To identify communication disorders, in general, specific healthcare professionals use some
activities as follows:

1. Psychological testing of thinking abilities.

2. Psychometric test to identify Child’s reasoning skills and reactions to different situations.
3. Developmental test of a child according to the milestone and
4. Measure defective pronunciation and duration of defective speech while speaking.

Nowadays, Speech and Language Pathologists (SLT) use above mention techniques along with
modern technologies such as neurophysiological methods to diagnose communication
disorders in depth to assess the etiology, the extent of brain damage, and the actual defect in
the area of speech-producing parts. There are several neurophysiological methods used to
diagnose and plan specific treatment strategies as follows: Computerized tomographic scanner
(CT scan), magnetic resonance imaging (MRI)) or functional (e.g. positron emission
tomography (PET), functional MRI (fMRI)). Techniques that measure the electromagnetic
activity of the brain, e.g. electroencephalography (EEG) and magnetoencephalography (MEG),
are referred to as electrophysiological techniques.

Before elaborating on “the necessity of using neurophysiological methods for diagnosing

communication disorders” I would like to explain briefly the background of communication
disorders because without knowing, oral-motor mechanisms, the pathomechanism of
communication disorders, the area of involvement we cannot use and interpret modern
technology (neurophysiological methods). Therefore, discussed the background of
communication disorders is as follows:

Background of Communication Disorder:

A communication disorder is an impairment in the ability to receive, send, process, and
comprehend concepts or verbal, nonverbal, and graphic symbol systems. A communication
disorder may be evident in hearing, language, and/or speech processes. A communication
disorder may range in severity from mild to profound.
- By American Speech-Language-Hearing Association (ASHA)

A communication disorder is a developmental or acquired impairment to an individual’s

speech, language, or hearing and some individuals face deficits in more than one area.
Communication disorders can make it mildly or profoundly difficult for someone to receive,
send, or understand various forms of communication.
- By Tim Stobierski 2021.

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There are several types of communication disorders. They are:

 Mixed receptive-expressive language disorder:

A child has developmental delays and problems understanding spoken language and
speaking.
 Expressive language disorder:
A child has developmental delays and problems speaking.
 Speech-sound disorders:
A child has a hard time expressing words clearly past a certain age.
 Childhood-onset fluency disorder:
This is also known as stuttering. It starts in childhood and can last throughout life.
 Social communication disorder:
A child has trouble with verbal and nonverbal communication that is not caused by
thinking problems.

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The Ad Hoc Committee developed a guideline called “Communication Disorders and
Variations,” [Asha, November 1982, pages 949–95O].

I. Communication disorder:
It may be developmental or acquired. Individuals may demonstrate one or any
combination of communication disorders. A communication disorder may result in a
primary disability or it may be secondary to other disabilities.
A. A speech disorder is an impairment of speech sounds, fluency, and/or voice articulation.
1. An articulation disorder is the atypical production of speech sounds characterized by
substitutions, omissions, additions, or distortions that may interfere with intelligibility.
2. A fluency disorder is an interruption in the flow of speaking characterized by atypical
rate, rhythm, and repetitions in sounds, syllables, words, and phrases. This may be
accompanied by excessive tension, struggle behavior, and secondary mannerisms.
3. A voice disorder is characterized by the abnormal production and/or absence of vocal
quality, pitch, loudness, resonance, and/or duration, which is inappropriate for an
individual's age and/or sex.

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B. A language disorder is impaired comprehension and/or use of spoken, written, and/or
other symbol systems. The disorder may involve (1) the form of language (phonology,
morphology, syntax), (2) the content of language (semantics), and/or (3) the function of
language in communication (pragmatics) in any combination.
1. Form of Language
a) Phonology is the sound system of a language and the rules that govern sound
combinations.
b) Morphology is the system that governs the structure of words and the
construction of word forms.
c) Syntax is the system governing the order and combination of words to form
sentences and the relationships among the elements within a sentence.
2. Content of Language
a) Semantics is the system that governs the meanings of words and sentences.
3. Function of Language
b) Pragmatics is the system that combines the above language components in
functional and socially appropriate communication.
C. A hearing disorder is the result of impaired auditory sensitivity of the physiological
auditory system. A hearing disorder may limit the development, comprehension,
production, and/or maintenance of speech and/or language. Hearing disorders are
classified according to difficulties in the detection, recognition, discrimination,
comprehension, and perception of auditory information. Individuals with hearing
impairment may be described as deaf or hard of hearing.
1. Deaf is defined as a hearing disorder that limits an individual's aural/oral
communication performance to the extent that the primary sensory input for
communication may be other than the auditory channel.
2. Hard of hearing is defined as a hearing disorder, whether fluctuating or permanent,
which adversely affects an individual's ability to communicate. The hard-of-hearing
individual relies on the auditory channel as the primary sensory input for
communication.
D. Central auditory processing disorders are deficits in the information processing of
audible signals not attributed to impaired peripheral hearing sensitivity or intellectual
impairment. This information processing involves perceptual, cognitive, and linguistic
functions that, with appropriate interaction, result in effective receptive communication of
auditorily presented stimuli. Specifically, CAPD refers to limitations in the ongoing
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 transmission, analysis,
organization, transformation,
elaboration, storage, retrieval,
and use of the information
contained in audible signals.
CAPD may involve the
listener's active and passive
(e.g., conscious and
unconscious, mediated and
unmediated, controlled and
automatic) ability to do the
following:
1. Attend, discriminate, and
identify acoustic signals.
2. Transform and continuously transmit information through both the peripheral and
central nervous systems.
3. Filter, sort, and combine information at appropriate perceptual and conceptual levels.
4. Store and retrieve information efficiently; restore, organize, and use retrieved
information.
5. Segment and decode acoustic stimuli using phonological, semantic, syntactic, and
pragmatic knowledge.
6. Attach meaning to a stream of acoustic signals through the use of linguistic and
nonlinguistic contexts.

II. Communication Variations:

A. Communication difference/dialect is a variation of a symbol system used by a group
of individuals that reflects and is determined by shared regional, social, or
cultural/ethnic factors. A regional, social, or cultural/ethnic variation of a symbol
system should not be considered a disorder of speech or language.
B. Augmentative/alternative communication systems attempt to compensate and
facilitate, temporarily or permanently, for the impairment and disability patterns of
individuals with severe expressive and/ or language comprehension disorders.
Augmentative/alternative communication may be required for individuals
demonstrating impairments in gestural, spoken, and/or written modalities.
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The general importance of using neurophysiological methods for diagnosing
communication disorders:

1. In the early 1800s people used phrenology to measure scalps to learn about underlying
mental dispositions. But by then scientists had developed several neurophysiological
testing methods so that speech pathologists could see live images of the brain and
accurately identify the defect.
2. Using modern neurophysiological testing methods, we can see blood flow in the brain
where it was impossible a few decades ago.
3. Modern neurophysiological testing methods help us to analyze and see the progression
of the disease.
4. Modern neurophysiological testing methods started a new era in diagnosis and most
studies.
5. We can see blood flow associated with neural activity using modern neurophysiological
testing methods. These arrangements are a boon to mankind.
6. Using modern neurophysiological testing methods, we can take several functional brain
images at a time which is revolutionary for the speech and language pathology sector
as well as medical science.
7. Using modern neurophysiological testing methods, we can see moving brain images so
we can understand defects more specifically.
8. With modern neurophysiological testing methods, we can look at the vocal sound signal
strength or "loudness" of a signal over time at different frequencies present in a
particular waveform.
9. These modern neurophysiological testing methods help not only in diagnosis but also
in planning and implementing specific treatment methods.
10. Although few of these modern neurophysiological testing methods have radioactive
hassles and are costly too, however, for the betterment of finding the specific problem
and appropriate measures, we can use those modern technologies.
11. I believe for the emotional satisfaction of health care professionals, speech and
language pathologists, patients, and their attendants, using modern neurophysiological
testing methods is a perfect decision in the context of evaluating and providing
treatment.

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The specific necessity of using neurophysiological methods for diagnosing
communication disorders:

There are various neurophysiological testing methods used in the evaluation, diagnosis, and
treatment of specific speech and language disorders as well as communication disorders
which are as follows:

Positron emission tomography (PET)

A positron emission tomography scan is an imaging test that helps to identify a patient’s
tissues and organs. PET scan uses a radioactive drug (tracer) to show this activity. This
technique measures physiological function by looking at blood flow, metabolism,
neurotransmitters, and radiolabeled drugs. PET offers quantitative analyses, allowing relative
changes over time to be monitored as a disease process evolves or in response to a specific
stimulus. This technique has more accuracy to diagnose a case like communication disorder and
nowadays this is becoming popular too.

Electroencephalography (EEG)

A noninvasive method of measuring brain activity. It records the signals as wavy lines onto
a computer screen or paper in order of microvolt. This is a useful technique for identifying
correct communication disorders. With this technique, we can visualize the normal and
abnormal wave signals occurring within speech and language processing areas during vocal
activity. For that reason, this technique is essential for diagnosing communication
disorders.

Magnetic Resonance Image (MIR)

It is a medical imaging technique used to identify damaged areas of speech and language
processing centers in the context of communication disorders. This helps us see other
anomalies of the vocal tract. MRI measures blood flow and nerve activity in the brain.
Therefore, it should be used in the diagnosis of communication disorders.

Functional Magnetic Resonance Image (fMRI)

This is an indirect method of measuring brain activity where a series of moving images are
taken to watch clips of brain activity. With this technique, we can more precisely identify
the damaged area of the speech and language processing center. Therefore, it is necessary
to use this neurophysiological technique to diagnose communication disorders.

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 Event Related Potential (ERP)

This is a more sophisticated method of extracting more specific sensory, cognitive, and
motor events using simple averaging techniques where we can measure real-time brain
activity. ERPs are measured by electroencephalography (EEG). The
magnetoencephalography (MEG) equivalent of ERP is the ERF or event-related field.
Evoked potentials and evoked potentials are subtypes of ERPs. Therefore, it is very
important to use the most reliable neurophysiological methods of this kind to diagnose
communication disorders.

Reference:

1. Principles_of_Neuropsychology by Eric A. Zillmer et al. 2nd edition 2008 Thomson

Wadsworth. Belmont, USA.
2. Tawhida Jahan et al. P3b amplitudes differences in ultra-rapid visual categorization task
of food and non-food items. South Florida Journal of Development, Miami, v.2, n.1, p.
440-457, Jan./Mar. 2021. ISSN 2675-5459.
3. American Speech-Language-Hearing Association. (1993). Definitions of
communication disorders and variations [Relevant Paper]. Available from
www.asha.org/policy. doi:10.1044/policy.RP1993-00208.
4. Shams Al Galib et al. Communication Disorder: Incapacitates the Ability, Bangladesh
Education Article, 2020.
5. https://www.stlouischildrens.org/conditions-treatments/communication-disorders.
6. National Strategy on Prevention of Deafness and Hearing Impairment in Bangladesh:
2011-2016.
7. Guillaume Thierry et al. Neurophysiological examination methods: electrophysiology
and neuroimaging. Oxford Academic 3; 19–38, 2008.
doi.org/10.1093/acprof:oso/9780198569275.003.0003.
8. David Friedman, Ray Johnson Jr. et al. Event-related potential (ERP) studies of
memory encoding and retrieval: A selective review September 2000 DOI:
10.1002/1097-0029(20001001)51:1<6::AID-JEMT2>3.0.CO;2-R.
9. Brouwer AM, Zander TO, van Erp JB, Korteling JE, Bronkhorst AW. Using
neurophysiological signals that reflect cognitive or affective state: six
recommendations to avoid common pitfalls. Front Neurosci. 2015 Apr 30;9:136. doi:
10.3389/fnins.2015.00136. PMID: 25983676; PMCID: PMC4415417.

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 10. Brown CM, Hagoort P (1999). "The cognitive neuroscience of language". In Brown
CM, Hagoort P (eds.). The Neurocognition of Language. New York: Oxford University
Press. p. 6.
11. Persons with Disabilities Rights and the Protection Act 2013.
12. The United Nations Convention on the Rights of Persons with Disabilities (CRPD).
13. Luck SJ (2005). An Introduction to the Event-Related Potential Technique. The MIT
Press. ISBN 978-0-262-12277-1.

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