Speech therapist at the SLA Reference Center and the Neurological Hospital

10-14 October 2016

STUDENTS IN SPEECH THERAPY AT THE STATE UNIVERSITY OF YEREVAN

Astrig Topouzkhanian, orthophoniste, Hopital Neurologique et Hopital Dugoujon 

Laurianne Blanchet, Orthophoniste, Centre reference SLA, Hopital Neurologique

UMAF - Lyon

I) Description of the Plan

This mission follows the training plan performed in 2013 for the speech therapists of the Lady Cox Rehabilitation Centre at Stepanakert (Artsakh), together with three Associations :

Physiotherapists of the World, Speech Therapists of the World, and Hope for Armenia.

A contact of 2 years by Skype with Zhanna Paylozyan (Head of the studies in Speech Therapy in Yerevan), and a visit to Yerevan in 2015 in order to suggest 2 lectures (one for speech therapists working in neurology, another to students) have allowed a contact with the Pedagogical State University Khatchadour Abovyan, where is situated the Department of Speech Therapy. The Dean of the Department of Specialized Education, Armenuhi Avagyan, invited us officially to come and teach neuro-degenerating pathologies, which are not developed during the initial training, and therefore not rehabilitated by the speech therapists.

II) Speech Therapeutical Plan

It consisted in contributing to the initial training of the students in Speech Therapy in Armenia, Master 1 level, during 27 hours allotted to lectures.  The teaching of Speech Therapy in Armenia is recent because it began in the 80-ies, and the interest of speech therapists for the pathologies of the adult are relatively limited, even in the centres of functional rehabilitation. The positions in hospitals or private clinics are rare (there is only one position in neuro-vascular unit in the entire country; therefore early taking into care is nearly inexistent), and the liberal speech therapists meet difficulties due to the absence of taking care of the health of the population.

On the other hand, the taking into care of vascular (aphasia) and neuro-degenerating (dysarthria, dysphagia) pathologies are very scarcely ensured, for salaried employees or liberal professionals, due to lack of knowledge and praxis of the professionals.

So we were 2 speech therapists, specialized in neurology, with the aim of providing 5 days of teaching about the following themes:

1- Cognitive approaches in aphasiology

2- Swallowing disorders in neurology

3- ALS (Amyotrophic Lateral Sclerosis)

4- Multiple sclerosis

5- Parkinson’s disease

III) Prospects

- The absence of calibrated and standardized tests in the Armenian language raises a major problem for the transfer of checkups: is it relevant to translate into Armenian tests in French, English or Russian (the majority of the inhabitants in Armenia speak the latter)?

Who will develop the tools and the specific equipment suited to the country? 

The development of Speech Therapy in Armenia will imply necessarily this work of calibration, which may be the subject for one or more theses.

- When discussing with some teachers and speech therapists, it seemed that the neurologists have very little information about the role of speech therapists in the therapy of all the neuro-degenerating and neuro-inflammatory pathologies, together with a limited vision of its importance in the vascular attacks (aphasias and dysphagias).

Under these circumstances the patients are not sent to speech therapists, which, added to the ignorance of the general public, leads to situations where the majority of patients leaving the hospital (1 or 2 weeks after a cerebrovascular insult) have no rehabilitation (by lack of means and/or therapists).

This situation is not different from that of the Speech Therapy in France some 30 years ago..

It seems essential for us to carry on with this collaboration with the Institute of training, in order to share and transmit our French know-how of diagnosis, taking into care and rehabilitation of patients suffering from neurological pathologies (vascular, neuro-degenerating and also dementia).

We consider to propose a collaboration with the Union of Armenian Physicians in France (UMAF), which may lead to a partnership with the neurologists of Armenia, and why not to the organsation of a symposium open to physicians and speech therapists, for the purpose of developing the main lines of cooperation, training and prevention.

IV) SPEECH THERAPY IN NEUROLOGY

It is no more necessary to prove in the Neurovascular Units the importance of Speech Therapy in the case of strokes at a very early stage. It consists in estimating the troubles of language (aphasia, dysarthria), the abilities of swallowing , and in informing the families. This initial checkup allows to make out a speech therapeutical diagnosis (type of aphasia, linked disorders, course of action to be taken), which will direct towards the objectives and the program of care. 

In the department of functional rehabilitation, Speech Therapy is essential, together with physiotherapy and ergotherapy, and optimal during the first 6 months of the recovery. It concerns the language as well as the swallowing.

With regard to taking into care the neuro-degenerating pathologies (Parkinson, ALS, Multiple sclerosis, Dementia…), the speech therapist plays a central role at different levels of intervention: from the prevention to the estimation, from the rehabilitation to the maintenance of the communication, from the information to the therapeutic education, with a dynamics of accompaniment and advices to the family circle. Specific rehabilitation techniques exist, according to the pathologies (work through force in the case of Parkinson, rather gently in ALS, alternate communication tools, adaptation of food textures to avoid wrong ways…). In this case, the principal objective of the intervention of the speech therapist is to maintain and adapt the communication functions of the patient, and help the family and the therapists to adapt their behaviour to the difficulties of the patient.