PresentationPDF Available

Electrical Injuries: Communication and Speech disorders and AAC-- What's the next step?

Authors:
  • Psychiatric Rehabilitation and Recovery

Abstract

Original research discussing acquired communication disorders caused by electrical trauma which pose unique communication barriers due to their evolving symptom manifestation. As the person ages away from the initial injury, communication barriers can become more pronounced with age. This presentation provides details explaining how electrical trauma, repeated electrical trauma and lengthy exposure to other forms of non-ionizing radiation can impact speech and communication. Following both UK's National Radiological Protection Board and United States Gulf War Hearing recommendations to study electroconvulsive therapy recipients to better understand the heterogeneity of amyotrophic lateral sclerosis (ALS) and other neurodegenerative diseases. I present four different case studies: Functional NeuroCognitive Imaging results and videos of ECT recipients now living with the neurological sequela of electrical injury which impacts speech and communication. It provides insights into the potential interventions which successfully work for the presenter who lives with speech and communication disorders as a result of chronic electroconvulsive therapy. It identifies strategies to make alternative augmentative communication (AAC) less fatiguing for people who live with a history of chronic exposure to non-ionizing radiation. The presentation concludes with ideas for future research. -Non-ionizing radiation exposures and subsequent neurodegenerative diseases (Progressive supranuclear palsy and Myoneural Disorders: Amyotrophic Lateral Sclerosis, Motor Neuron Disease and Muscular Sclerosis). -Immediate and delayed consequences of Electrical Injury/Electromagnetic injury -Repetitive mild to moderate Traumatic Brain Injuries -Cognitive communication disorder -Anoxia/Hypoxia -Trigeminal, vagal and other cranial nerve dysfunction. -Electroporation -Motor Neuron Dysfunction/Motor Neuron Loss -Demyelination -Episodic Paroxysmal Neuromuscular Disorders -Acquired Channelopathies -Thiols -Aphasia -Verbal Apraxia -Dysarthria, Anarthria -Preserving residual voice -Barriers to accessing AAC -Voice Banking -AAC Recommendations The presentation is available with 1.0 CEU through "AAC in the Cloud" website (https://presenters.aacconference.com/videos/UXpVd1FUSXk=)
ELECTRICAL
INJURIES: SPEECH,
COMMUNICATION
DISORDERS & AAC --
WHAT'S THE NEXT
STEP?
ICD DIAGNOSTIC CODES FOR ELECTRICAL INJURY’S SEQUELA
W86.8XXS: Exposure to other
electric current-sequela
Y84.3- Complication (delayed)
of electroshock therapy
2
3
4
WHAT AM I UP TO
NOW?
International Advocacy work to
Audit ECT use & rehabilitation for
life after ECT
UK ECT Improving Standards
Campaign Group
PAIMI
Contributor for the Life After ECT
website
Researching assessments and
rehabilitative interventions for
people with a history of Electrical
Injury
This Photo by Unknown Author is licensed under CC BY-SA
This Photo by Unknown Author is licensed under CC BY-SA-NC
This Photo by Unknown Author is licensed under CC BY-SA
5
MY AAC
TECHNOLOGY
6
wired
PRESENTATION OUTLINE
1. What is repetitive electrical trauma?
2. How does electrical injury cause a repetitive mild to moderate traumatic brain
injury?
3. How chronic non-ionizing radiation exposure compounds repetitive traumatic
brain injury
4. What are speech and communication disorders associated with electrical injury.
5. How can AAC improve quality of life?
6. Assessing AAC needs
7
WHO CAN USE THIS
PRESENTATION?
8
NOTHING
PRESENTED IN THIS
PRESENTATION IS
MEDICAL ADVICE,
IT IS PRESENTED
FOR
INFORMATIONAL
PURPOSES ONLY
9
This Photo by Unknown
Author is licensed under
10
11
“IF THESE SOLDIERS WERE
DYING IN THE FIELD RATHER
THAN QUIETLY AT HOME AS A
CONSEQUENCE OF THEIR
SERVICE, WE WOULD LEAVE NO
STONE UNTURNED. WE WOULD
USE THE BEST EXISTING
RESOURCES AND PROGRAMS TO
MAKE SURE THEY HAD
WHATEVER THEY NEEDED TO
SURVIVE”
-GENERAL THOMAS MIKOLAJCIK
(DECEASED)
12
WHO SHOULD
WE STUDY TO
UNDERSTAND
NON-IONIZING
RADIATION?
13
14
WHO CAN THIS
INFORMATION HELP?
Electricians
Welders
Modern combat veterans
TMS recipients
ECT recipients
This Photo by Unknown Author is licensed under CC BY
This Photo by Unknown Author is licensed under CC BY
This Photo by Unknown Author is licensed under CC BY-ND
15
This Photo by Aaron D. Franklin, SpiritualPhysicsofLight.com
16
17
18
19
20
WHO GETS ECT?
This Photo by Unknown Author is licensed under CC BY-SA
21
22
23
ECT’S UNREGULATED DOSING VARIABLES:
Current
Pulse width/Pulse type
(Sine, brief, or ultra-brief)
Frequency (10 to 140 Hertz)
Charge
Voltage
Percentage of device output
power or Joules
Medications in patient’s
system when they had ECT PAGE 24
This Photo by Unknown Author is licensed under CC BY-NC-ND
MORE UNREGULATED DOSING VARIABLES:
Electrode placement
PAGE 25
This Photo by Unknown Author is licensed under CC BY-NC-ND
This Photo by Unknown Author is licensed under CC BY
MORE UNREGULATED DOSING VARIABLES:
How high above seizure
threshold?
2.5-6x
Or
10-20x
PAGE 26
This Photo by Unknown Author is licensed under CC BY-NC-ND
MORE UNREGULATED DOSING VARIABLES:
Number of treatments
Length of time between
treatments
PAGE 27
This Photo by Unknown Author is licensed under CC BY-NC-ND
MORE UNREGULATED DOSING VARIABLES:
How long the stimulus
lasted?
Seizure’s Length of Time
Absence of brain activity
after seizure
PAGE 28
This Photo by Unknown Author is licensed under CC BY-NC-ND
HOW MANY SHOCKS?
This Photo by Unknown Author is licensed under CC BY
29
30
This Photo by Unknown Author is licensed under CC BY-SA-NC
31
MORE UNREGULATED DOSING VARIABLES:
What is the person’s head
and neck size?
PAGE 32
This Photo by Unknown Author is licensed under CC BY-NC-ND
PAGE 33
WHAT CAUSES
NONIONIZING
RADIATION INJURY?
This Photo by Unknown Author is licensed under CC BY-NC-ND
34
35
SPEECH AND
COMMUNICATION
DISORDER SUPPORT?
Women and Men with a history
of ECT and electrical injury have
difficulties obtaining access to
referrals speech
communication disorders and
AAC.
36
WHERE TO GET HELP FOR ELECTRICAL INJURY?
37
38
NEURONS COMMUNICATE BY PASSING APPROXIMATELY
2-4 MILLIAMPERES ELECTRIC CURRENT BACK AND FORTH
39
WHAT CAUSES
ELECTRICAL INJURY?
EITHER
A FLASH (MILLISECOND)
OF A HIGH FIELD OF
ELECTRIC STRENGTH
OR
PROLONGED EXPOSURE
TO A MEDIUM FIELD OF
ELECTRIC STRENGTH
By Biswarup Ganguly, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=57159456
40
ELECTRICAL
INJURY ALTERS
HOW CELLS USE
ELECTROLYTES
41
WHAT ARE “ACQUIRED
CHANNELOPATHIES?”14
PAGE 42
PAGE 43
https://twitter.com/Jaco_H_Nel/header_photo
WHAT CAUSES ELECTROLYTE AND OTHER ION SHIFTS?
HYDRATION FOODS LIQUIDS HORMONES ENVIRONMENT
44
SHIFTS IN
ELECTROLYTES
ALTER NERVE
IMPULSES,
IMPACTING:
MUSCLE TONE,
STRENGTH
COORDINATION
45
PAGE 46
What is electroporation?15, 17
HOW ARE
ELECTRICAL
INJURIES
CLASSIFIED AS
BRAIN
INJURIES?
This Photo by Unknown Author is licensed under CC BY-NC-ND
47
Course
Outline
ECT’s repetitive mild to moderate
traumatic brain injury (rmTBI)
PAGE 48
Repetitive = number of high electrical field
strength exposures.
External force caused brain activity “Silence”
and coma.8
Mild vs moderate acquired brain injury from
cerebral hypoxia and anoxic effects.10, 12, 21
Photo credit 25
PAGE 49
This Photo by Unknown Author is licensed under CC BY
50
CASE STUDY
Female
8 ECT treatments
age 21
Age 46:
Functional MRI
(FNCI) for
lingering ECT
effects
51
52
HOW CAN
ELECTRICAL INJURY
IMPACT SPEECH
AND
COMMUNICATION:
IMMEDIATE VS
LONG-TERM
This Photo by Unknown Author is licensed under CC BY
53
ECT DIRECTLY OVER-STIMULATES
TRIGEMINAL, VAGUS AND OTHER CRANIAL NERVES
NERVES
54
Espinoza RT. An Overview of Electroconvulsive Therapy. https://slideplayer.com/slide/14273442/
55
Kibret B, Premaratne M, Sullivan C, Thomson RH, Fitzgerald PB. Electroco nvulsive therapy (ECT) during pregnancy: quantifying and assessing the electri c field strength inside the foetal brain. Sci Rep. 2018;8(1):4128. doi :10.1038/s41598-018-
22528-x
DO ALL PEOPLE
WITH ELECTRICAL
INJURY DEVELOP
COMMUNICATION
DISORDERS?
This Photo by Unknown Author is licensed under CC BY-NC
56
57
Kibret B, Premaratne M, Sullivan C, Thomson RH, Fitzgerald PB. Electroco nvulsive therapy (ECT) during pregnancy: quantifying and assessing the electri c field strength inside the foetal brain. Sci Rep. 2018;8(1):4128. doi :10.1038/s41598-018-
22528-x
SPEECH AND
COMMUNICATION
CONSIDERATIONS
What is the immediate
need?
How will these needs
evolve over time?
How many hours in a
month with profound
dysarthria and verbal
apraxia does it take to
qualify for considering AAC?
This Photo by Unknown Author is licensed under CC BY-NC-ND
58
ELECTRICAL INJURY’S IMMEDIATE IMPACT ON SPEECH &
COMMUNICATION
Aphasia (conductive aphasia most frequently reported by peers,
Lisp or slurred speech (only when tired or overstimulated)
Language and communication regression in people with communication disorders
prior to shock
Worsening Dysarthria (in people with a history)
Mutism
Echolalia
59
DELAYED ELECTRICAL INJURY’S IMPACT ON SPEECH AND
COMMUNICATION
Progressive episodic paroxysmal neuromuscular problems
Slurred speech when tired or overstimulated
Dysarthria
Laryngospasms
Motor Dysfunction
Hoarseness
Apraxia
Fasciculations in tongue, mouth, or neck/throat
Complete loss of functional voice
60
TRIGGERS
Sensory flooding
Rapid weather/ temperature
changes
Foods with high thiol content
neuro cognitive fatigue
Multiple chemical sensitivities
Hyperelectrosensitivity
Alcohol
Caffeine, Green tea, coffee
Stress
Amino Amines and other
medications which block or reduce
ion channel function
61
62
63
64
65
66
67
AAC
CONSIDERATIONS
Visual processing disorder
Colors used on the device
working memory impact
changes in neuromuscular tone
affect accessibility
Non-ionizing radiation emitted
by the device
Corded keyboards and switches
over infrared eye-tracking
68
CALL TO ACTION!
Automatic referrals for comprehensive speech
assessment
Routine life-time follow-up to identify delayed
symptom onset of lengthy exposures to chronic,
nonionizing radiation.
Listen to your clients. Presume Competence
Fund studies of speech & communication in
people with nonionizing radiation injuries.
Create resources for Adults living with acquired
speech disorders and their family
members/caregivers.
Early access to AAC
Remove barriers to voice banking
69
For more information
www.LifeAfterECT.com
WWW.Change.org/PatientSaf
etyECT
70
This Photo by Unknown Author is licensed under CC BY-SA-NC
71
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72
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