"We usually take it for granted that we can eat and drink, that we can speak, that we understand, that we can read, write, that we recognize, or that we remember. But that is not at all self-evident. It is an unpleasant truth that we can lose all these abilities in an instant," says David Konopáč, a clinical speech therapist at the adult hospital in Janské Lázně. For the thirteenth year now, he has been helping people with speech and swallowing disorders, for example after strokes or other brain damage. He also acts as a professional supervisor and guarantor of speech therapy care at the Vesna children's hospital there. He enjoys his job: "I am pleased that I can be useful to people in need."
Who is a clinical speech therapist and where can we meet him?
A clinical speech therapist is a certified speech therapist, i.e. one who has passed a qualification exam, who works either in an outpatient clinic, in a hospital, or in a treatment center, such as me in Janské Lázně. Depending on where he is employed, his clients also change. Speech therapists in outpatient clinics most often work with children with incorrect pronunciation, stuttering, or some kind of impaired speech development. Speech therapists in hospitals mostly deal with adult patients immediately after cerebrovascular accidents (strokes) and other sudden brain damage. Speech therapists in adult treatment centers usually help patients in the period when they have already been discharged from the hospital, but the speech or swallowing disorder persists.
Which patients do you treat in Janské Lázně?
In the adult treatment center in Janské Lázně, I also work with a colleague, a speech therapist, and we mainly treat patients who have suffered brain damage. Most often, these are strokes, head injuries, conditions after brain surgery, after brain inflammation, dementia, sclerosis, and other progressive diseases.
Brain damage can cause a number of speech disorders: speech motor disorders (dysarthria), speech and comprehension disorders (aphasia), cognitive disorders (agnosia), impaired awareness of half of the space including half of one's body (neglect syndrome), and others. In addition, we address voice disorders, swallowing disorders, and many others.
Can you tell us about the difficulties faced by patients with some of these disorders?
I will try to describe a few types from the two most common groups of disorders.
The first of these are aphasias, which arise when the cortex of the left cerebral hemisphere is damaged. For example, if you have sensory aphasia, you hear sounds but do not recognize them, you cannot determine what is the crowing of a rooster and what is the gurgling of a stream. If the impairment is milder, you will only have problems distinguishing speech sounds – vowels. You will stop understanding – as if everyone were speaking an unknown foreign language. In reality, however, it will be you who will speak in a curiously garbled manner, but you will not recognize it due to your impaired hearing.
If you have afferent motor aphasia, your brain loses control over how you make movements. You want to stick out your tongue, but instead you bar your teeth. You want to say A, but all you hear is that your lips have gone "smack" or something else. Your speech is bizarrely distorted, making different sounds than you intended, which you can hear well, but there's nothing you can do to improve it.
And the other group?
These are dysarthrias. They arise when the inner regions of the brain are damaged. I'll give you an example of one of them.
If a patient suffers from flaccid dysarthria, the muscles of his or her speech will be weak, his or her speech will be quiet, slurred, and mumbled. Food and drink will leak out through his or her lips, he or she will have difficulty chewing and swallowing, he or she will gag when taking a bite, and he or she will gag when drinking, which is very dangerous because repeated food entering the airways not only poses a risk of choking, but also leads to pneumonia.
However, the severity of all these disorders can vary: from transient deficiencies to the practical impossibility of communication. The duration of their persistence also varies: sometimes the disorder is corrected soon, sometimes unfortunately not. In any case, every patient can be helped in some way.
Could you give a practical example?
It depends on the nature of the disorder and indeed the nature of the patient. However, the key is to discover the central mechanism of the disorder, find out what is damaged in the system, and then help the patient strengthen that area, or find other options to replace the damaged or eliminated area.
For a patient who, for example, is completely unable to control his or her speech or hands due to severe dysarthria (i.e. cannot speak or write), I will provide an alternative method of communication, such as a letter chart.
In some disorders, such as optical alexia, it is possible to find some kind of “detours” in brain activity. Optical alexia is an acquired reading disorder, a disorder of visual letter recognition. For example, you see a Czech newspaper full of text, but it seems to you that it is written in meaningless Cyrillic. But you write normally (you just can’t read it after yourself), and this is exactly what we can use: if you trace an unrecognized letter, the undamaged sensation from your hand in the brain recognizes what letter it is. So, in fact, you end up reading by moving your hand.
How do you relax after such a demanding job?
I really like music. And I like being creative, so for example I draw (I illustrated two books by the writer Václav Uhr), I write lyrics for the wonderful band Jarabáci (with whom I sometimes perform), for the famous bluegrass group Poutníci, for the singer-songwriter Lásku and others. For over ten years, together with my wife and a friend who died prematurely, I also led a theater group of physically disabled volunteers and wrote plays for it. In addition, I have a family, two wonderful daughters, an old house that needs endless renovation and a naughty dog. I am never bored at all.
