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Communication in Stroke


Many people have communication problems after a stroke.


One-third of stroke survivors have some difficulty with speaking and understanding what others have to say.

They will have trouble

  • recalling certain words or

  • understanding certain commands,

  • not being able to form sentences well or

  • even repeating syllables and words.


These issues usually occur because the centres of the brain that are responsible for Speech and Language, have been impacted by the stroke.


Another fact to note is that one side of the brain is responsible for the opposite side of the body, therefore if the left side of the brain is damaged, the right side of the body may have weakness and/or paralysis.


In this blog, we will talk about how we can aid communication in people with stroke.

Communication challenges may vary depending on the area of damage and the duration of stroke.


The main conditions that can happen post-stroke are usually divided into Language Disorders and Speech Disorders.


Language Disorder





Aphasia


The left part of the brain is responsible for language, therefore, any damage there may result in a language disorder such as Aphasia. It mostly occurs all of a sudden, as a result of a stroke or any kind of head injury. This may impair cognition, reception and expression of language.


Reception is the understanding of language and expression of language are the various ways through which we can respond or express our needs or opinions. Formulating verbal and non-verbal responses can be challenging with language disorder such as Aphasia.


Types of Aphasia

There are 5 main types of Aphasias, and each of them is characterized by speech and language errors they depict and the area where the damage is.

These are:

  • Broca's Aphasia

  • Wernicke’s Aphasia

  • Global Aphasia

  • Anomic Aphasia

  • Conduction Aphasia


Can Aphasia be treated?


It is possible for individuals to completely recover from aphasia without any kind of treatment. This type of recovery is often called spontaneous recovery. However, language recovery is usually not as quick. Speech and language therapy is often helpful while recovery usually continues over a 2-year period. Most people believe that the most effective treatment begins early in the recovery process. Some of the factors that influence improvement post-stroke include the cause of the brain damage, the area of the brain that was damaged, the extent of the brain injury, and the age and health of the individual. Additional factors include motivation, handedness, and educational level. Treatment may be offered in individual or group settings. Individual therapy focuses on the specific needs of the person. Group therapy offers the opportunity to use new communication skills in a comfortable setting.


Aphasia therapy strives to improve:


  1. The individual’s ability to communicate by helping the person to use remaining abilities

  2. To restore language abilities as much as possible

  3. To compensate for language problems

  4. To learn other methods of communicating.



Speech Disorders



Apraxia of Speech



Apraxia of speech is a motor speech disorder that results in the inability to control the muscles used to form words. When the messages from the brain to the mouth are disrupted, the person cannot move his or her lips or tongue in the correct manner to make letter sounds. The muscles are often perfectly fine, but the person has trouble controlling them. Thus, there is difficulty initiating and executing voluntary movement patterns necessary to produce speech when there is no paralysis or weakness of speech muscles. It also involves difficulty in voluntarily moving the muscles of the lips, throat, soft palate and tongue for purposes other than speech, such as smiling or whistling.


It may cause difficulty with:


  • Producing the desired speech sound

  • Trouble moving the tongue, lips, and/or jaw.

  • You may see groping movements in the mouth as the person tries to speak.

  • Using the correct rhythm and rate of speaking.

  • Errors are inconsistent. The person may be able to say something once, then not be able to say it again, or it might come out differently the next time.

  • It’s usually easier when the person isn’t trying too hard. Everyday phrases seem to pop out more easily, especially when the person is relaxed. Even then, long or complex words and phrases can be more difficult to produce.

Can Apraxia be treated?

Yes, regular one-to-one sessions with a speech therapist can help people improve the symptoms of apraxia of speech. Techniques can include learning how to move the mouth muscles to make certain sounds, learning sign language, for those who have severe difficulty with speech and using all of the senses to help with speech, for example, listening to recorded sounds and using a mirror to see how the mouth is making sounds



Dysarthria


Dysarthria is a speech impairment that sometimes occurs after a stroke. It can affect pronunciation, the loudness of the voice and the ability to speak at a normal rate with normal intonation. The exact speech problems will differ from person to person, depending on the location and severity of the stroke.

If you have dysarthria you may:

  • Have "slurred" or "mumbled" speech that can be hard to understand.

  • Speak slowly or talk too fast.

  • Not be able to move your tongue, lips, and jaw very well.

  • Sound robotic or choppy.

  • Have changes in your voice. You may sound hoarse or breathy. Or, you may sound like you have a stuffy nose or are talking out of your nose.

Can Dysarthria be treated?


Although the treatment depends on the severity of the brain damage, with the help of a Speech-Language Pathologist, and intensive therapy, the symptoms can be managed and improve speech over time. The SLP will work alongside caregivers and the family of the patient and may use techniques such as slowing down your speech, using more breath to speak louder, using exercises to make your mouth muscles stronger, producing clear sounds in words and sentences or using other ways to communicate, like gestures, writing, or using computers. This is augmentative and alternative communication or AAC.

 

AAC in recovery post Stroke


AAC is Alternative and Augmentative communication. It is used as a means of communication for those who are not able to communicate verbally. AAC includes a variety of devices ranging from High-technology to Low-technology. AAC encompasses a wide range of nonverbal communication methods, from sign language and picture boards to mobile device apps and sophisticated, dedicated speech-generating devices.

For those physically unable to use the touchscreen, SGDs offer flexible access options including:

  • Eye-gaze

  • Head tracking

  • Joystick and alternative mouse control

  • Single and multiple switch control



 

Family & Community Involvement






Stroke clubs, which are regional support groups formed by individuals who have had a stroke, are available in most major cities. These clubs also offer the opportunity for individuals with aphasia to try new communication skills. In addition, stroke clubs can help the individual and his or her family adjust to the life changes that accompany stroke and aphasia. Family involvement is often a crucial component of aphasia treatment so that family members can learn the best way to communicate with their loved one.


Family members are encouraged to:

  • Simplify language by using short, uncomplicated sentences.

  • Repeat the content words or write down keywords to clarify meaning as needed.

  • Maintain a natural conversational manner appropriate for an adult.

  • Minimize distractions, such as a blaring radio, whenever possible.

  • Include the person with aphasia in conversations.

  • Ask for and value the opinion of the person, especially regarding family matters.

  • Encourage any type of communication, whether it is speech, gesture, pointing, or drawing.

  • Avoid correcting the individual’s speech.

  • Allow the individual plenty of time to talk.

  • Help the individual become involved outside the home. Seek out support groups such as stroke clubs.

  • Talk to them in a quiet area with good lighting and pay attention to them when they talk.

  • Watching them talk may help you understand them better.

  • Let them know when you have trouble understanding them. Don't pretend to understand them.

  • Repeat the part of what they said that you understood. Then they will not have to start all over again.

  • If you still don't understand them, ask them yes or no questions. Or, ask them to point or write down what they’re saying.





 


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