Communication Disorders: An Introduction for Community-Based Rehabilitation Workers

4. Principles of Prevention

4 Principles of Prevention Prevention has long been recognized as an essential concept in the fields of medicine and public health. The importance of prevention in communication disorders has been recognized more slowly but is now also recognized as essential in the effective management of communication disorders. The American Speech-Language-Hearing Association Committee on the Prevention of Speech, Language and Hearing Problems defined the issue: 'In a general sense, prevention of communication disorders is the elimination of those causes which interfere with the normal acquisition and development of communication skills.' (ASHA, 1982:425) The committee differentiated between primary, secondary, and tertiary phases of prevention as follows: 1. Primary prevention is the elimination or inhibition ofthe onset and development of a communicative disorder by altering susceptibility or reducing exposure for susceptible individuals. For example, cigarette smoking is eliminated to prevent future laryngeal and breathing anomalies. 2. Secondary prevention is the early detection and treatment of communicative disorders. Early detection may lead to the elimination of the disorder or the retardation of the disorder's progress, thereby preventing further complications. One of the major practices of secondary prevention is mass screening of persons without symptoms. For example, the institution of a school auditory screening programme which systematically tests the hearing of all children on a periodic basis and after certain illnesses, such as infectious diseases of the ear. 3. Tertiary prevention is the reduction ofa disability by attempting to restore effective functioning. The major approach is 24 Communication Disorders rehabilitation of the disabled individual who has realized some residual problems as a result of the disorder. For example, the institution ofa program ofrehabilitation for a dysphasic patient as soon as possible after the onset of the neuropathology in order to prevent more serious communicative and behavioural problems. (ASHA, 1982: 425, 431) As can be seen, many of the steps taken to prevent communication disorders are synonymous with those to reduce other medical problems. Marge (1981) presented 13 strategies for prevention intervention with many disabilities, including communicative disorders: 1. immunization against infectious diseases such as diphtheria, tetanus, pertussis, rubella, polio, measles, and mumps, some of which are directly linked to speech, language, and hearing disorders 2. genetic counselling to decrease the number of cases of communication problems linked with certain genetic diseases 3. prenatal care to maintain the proper intra-uterine environment for the delivery of a neurologically intact infant 4. mass screening and early detection to identify individuals with subtle signs of a disease or disability 5. early intervention programmes to suppress the effects ofa known or suspected disorder 6. family planning to reduce the numbers of unplanned pregnancies 7. proper medical care ofthe population at large to monitor health status and again for the purpose of early identification of problems 8. public education to inform the community about prevention strategies and promote their use 9. education programmes for children and youth to equip youngsters with information about health care, specifically as it relates to communication disorders 10. environmental quality control to protect the population from the hazards that result from the abuse or misuse of our natural resources 11. quality-of-life programmes to offer support and assistance to individuals entering into or involved in stressful situations or experiences . 12. governmental action to oversee the implementation of prevention programmes 13. reduction ofpoverty to alleviate the health problems associated with indigence. (Marge, 1981) According to Cornett and Chabon (1988: 61), 'Examples of prevention activities specific to speech-language pathology and audiology include early identification of and intervention with speech-language problems, participation in anti-smoking campaigns and noise-pollution programmes, the implementation of a vocal abuse reduction program, the development of industrial hearing conservation programs, and the use of support groups with families of individuals who have communication problems.' Principles of Prevention 25 It should be recognized that some communication disorders can lead to additional problems in a child or adult's life. For example, a language disorder in a child may lead to later problems in cognitive development, academic achievement, or social-emotional development. Therefore, prevention, early detection and early intervention of communication problems are important for the prevention of other related problems. SUMMARY We are firmly committed to the concept of prevention in the management of communication disorders. Prevention is an efficient, important and cost-effective management approach. Many strategies for the prevention of communication disorders are synonymous with those for the prevention of other disabilities or...