A brain tumor, known as an intracranial tumor, is an abnormal mass of tissue in which cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells.
Primary brain tumors include tumors that originate from the tissues of the brain or the brain’s immediate surroundings. Primary tumors are categorized as glial (composed of glial cells) or non-glial (developed on or in the structures of the brain, including nerves, blood vessels and glands) and benign or malignant.
Classification of tumors
Tumors are classified as benign and malignant. Benign tumors are noncancerous growths in the body such as Schwannomas, Meningiomas etc. Malignant means that the tumor is made of cancer cells and it can invade nearby tissues.
Gliomas are the most prevalent type of adult brain tumor, accounting for 78 percent of malignant brain tumors. They arise from the supporting cells of the brain, called the glia. These cells are subdivided into astrocytes, ependymal cells and oligodendroglial cells (or oligos). Astrocytomas are the most common glioma, accounting for about half of all primary brain and spinal cord tumors. Astrocytomas develop from star-shaped glial cells called astrocytes, part of the supportive tissue of the brain.
Brain tumors are thought to arise when certain genes on the chromosomes of a cell are damaged and no longer function properly. Once a cell is dividing rapidly and internal mechanisms to check its growth are damaged, the cell can eventually grow into a tumor.
Symptoms vary depending on the location of the brain tumor, but the following may accompany different types of brain tumors:
- Headaches that may be more severe in the morning or awaken the patient at night
- Seizures or convulsions
- Difficulty thinking, speaking or articulating
- Personality changes
- Weakness or paralysis in one part or one side of the body
- Loss of balance or dizziness
- Vision changes
- Hearing changes
- Facial numbness or tingling
- Nausea or vomiting, swallowing difficulties
- Confusion and disorientation
A 45 years old, known case of brain tumor has come with the complaint of frequent falls (balance issues), difficulty in speaking fluently, difficulty in naming, difficulty in holding objects and difficulty performing everyday activities.
In 2006 the client had problem in speaking, then slowly in walking and writing. The radiological test MRI report reveals Left posterior frontal grade II Astrocytoma. Thereafter, the client was under medication and was operated for the same. After the surgery he had undergone chemotherapy and radiotherapy. He attended Physiotherapy classes regularly and Speech therapy once in a while.
Speech and language characteristics
- Difficulty in naming (Anomia)
- Slow rate of speech
- Impaired Prosody
- Omission of first sound in a word
- Phonemic paraphasias
- Difficulty in reading aloud
- One word utterances to phrases
- Hyperextension knee
- Circumductory gait
- Built- mesomorphic
- Right hand flexion pattern
Speech and language assessment
Oro motor assessment
The client’s oral parts observed to be normal structurally and functionally. Vegetative skills like sucking and blowing were poor.
He was examined for speech and language skills by formal assessment tool Western Aphasia Battery WAB. The four sub components of the test are
- Spontaneous speech
- Auditory verbal comprehension
Spontaneous speech and fluency were poor, the client performed poor in Confrontation naming and Fluency naming compared to responsive naming.
Also reading and writing were assessed. The client showed difficulty in reading words and sentences. He did not attempt to write with his right hand.
Speech language therapy
The clinician built the rapport with the client and set the goals for speech therapy. The initial goals were to build up the vegetative functions like blowing and sucking, for this the clinician made the client to blow the balloon, blow a whistle, purse lips and pucker lips, suck water and juice through straw.
The second goal clinician worked on was to reduce naming difficulties. At first clinician choose to improve confrontation naming, by helping with phonemic cues in the beginning sessions and faded the cues later.
The clinician then worked to improve the fluency naming by choosing a lexical category and naming them in sequence in any given time.
To improve the rate of speech the client was asked to read newspaper aloud everyday for 15 to 20 minutes. He was encouraged to use spontaneous speech more.
The clinician used “WH” questions to make the client answer fluently in response to the question. Eg. Clinician: Where do you see the book? Client: On the table.
Then clinician changed the therapy context by activities like role play and some interactive sessions.
Naming: Confrontation naming is improved, phonemic cues completely faded. But duration to name objects is for about 30 seconds.
Fluency: The client is able to speak 3 to 4 words in one utterance, however his rate of speech is still low and the clinician is working on it.
- Speech and language therapy
- Physical therapy
- Occupational therapy
- Follow up
Clinician planned to increase rate of speech and improve overall speech intelligibility. In every session clinician arranged one stranger to talk to the client and scored speech intelligibility.
Speech and language, cognitive, and swallowing problems are common brain tumor sequelae. Clients diagnosed with brain tumors can and do benefit from rehabilitative services addressing these deficits. SLPs help to facilitate and maximize rehabilitation-related diagnostic and treatment procedures.