The Speech Pathologist’s Role
Speech pathologists are well placed to provide services to people with Agenesis of the Corpus Callosum (AAC) having academic training and professional experience in understanding the neurological function of brain structures in relation speech, communication and swallowing (Love and Webb, 1992). Research has suggested that when the two hemispheres of the brain are not effectively linked, as with AAC; shortfalls in processing speed, executive functions, paralinguistics, pragmatics, working memory, and phonological awareness may be present (Kellmeyer et al., 2019 and Marco et al., 2012).
When the neural pathways in the brain are interrupted the above skills may be impacted and then, in turn, impact further skills. An example of this would be; when experiencing a reduced overall processing speed, executive functioning skills such as interpreting social cues or planning and formulating phrases will also be effected (Melogno et al., 2021).
Speech Pathology in Practice
I began working with Jasmine* in early 2020. Jasmine presented as reserved, but welcoming, and showed complex and descriptive expressive language skills when given extended time to respond. Jasmine reported communication breakdowns with those close to her and with allied health professionals in terms of word finding, constructing her sentences, interpreting others’ communications, and social communication for friendships. Alongside these difficulties Jasmine also reported difficulty in advocating for her ideas and opinions. Jasmine was in her late 20’s, presented with partial ACC, ASD, anxiety and depression and had not accessed Speech Pathology services previously.
We quickly established session ground rules:
• Jasmine would let me know (either verbally or with facial cues) to rephrase if I had not made tasks clear and would attempt a little bit of homework once in a while.
• I would regularly check in to gauge understanding and be supportively persistent and curious when Jasmine used her habitual phrase ‘I don’t know’ as a response.
• Most importantly we agreed to go at Jasmine’s pace, allowing ample processing and formulating time in sessions.
Borrowing from and adapting social communication and neurological rehabilitation interventions, strategies used throughout the year to assist communication were:
• Scripting – Writing down thoughts, feelings, and questions to take into health appointments. This reduces the cognitive load of formulating and planning ‘on the spot’ or when in stressful situations.
• Semantic feature analysis and paraphrasing- To assist with word finding and understanding others ideas by putting into your own words.
• Emotional recognition and inferencing – Inferring an emotional state and its potential trigger from a photo stimulus.
• Motivation interpretation – Inferring motivations by dissecting non-literal written statements.
• Assertive Language –To increase self-advocacy skills.
The pace of therapy changed depending on Jasmine’s affect, however, we found that even on the quieter days we could weave learning opportunities into our sessions. Jasmine’s confidence in her communicative abilities grew each session and her verbal responses became faster and more succinct each week. Jasmine is beginning to use assertive language strategies to ask for clarification and to dispute in session. After repetitive practise Jasmine is beginning use the strategies above independently and outside the therapy space. Jasmine will often report back on how she has been applying these strategies to her everyday life which shows fantastic progress.
At Jasmine’s pace, we will continue to work on the above strategies this year to promote an increase in her health care participation, decision making and social connection. I am very excited to see Jasmine’s skill and confidence levels continue to grow steadily and to where these new skills will lead her.
If you would like to know more about the services a Speech Pathologist could provide you, please explore our peak body website https://www.speechpathologyaustralia.org.au/ for further information.
M.Sp.Path, B.Hlth.Sci, CPSP
GRP Speech Pathology (Victoria) www.grpspeechpathology.com.au Click here to make a referral.
Brigitte Amos Speech Pathology (Sunshine Coast) www.brigitteamosspeech.com.au
Kellmeyer, P., Vry, MS., and Ball, T. (2019). A transcallosal fibre system between homotopic inferior frontal regions supports complex linguistic processing. European Journal of Neuroscience. (50): 3544-3556. https://doi.org/10.1111/enj.14486
Love, R.J, and Webb, W.G. (1992). Neurology for the speech-language pathologist. Butterworth-Heinermann.
Marco, E.J, Harrel, K.M., Brown, W.S., Hill, S.S., Jeremy, R.J., Kramer, J.H., Sherr, E.H., and Paul, L.K. (2012). Processing speed delays contribute to executive function deficits in individuals with agenesis of the Corpus Callosum. Journal of the International Neuropsychological Society, 18(3): 521-529. https://doi.10.1017/S1355617712000045
Melogno, S., Printo, MA., Scalisi, T.G., Badolato, F., and Parisi, P. (2021). Case Report: Theory of mind and figurative language in a child with agenesis of the corpus callosum. Frontiers in Psychology, (11): 1-9. https://doi.10.3389/fpsyg.2020.596804