Aphasia, Comunication and Stroke

Stroke and Language

The ability to communicate through speech and gesture is something most people take for granted. From an early age, much of our life is dedicated to first acquiring, then exercising the natural skill of language as we conduct our family and business affairs.

Imagine suddenly losing the ability to order a restaurant meal, read the paper, understand a radio broadcast, or respond when spoken to.

For a stroke victim, at a time when he or she is already disoriented and afraid, the loss or impairment of language is a cruel blow. When brain tissue is damaged by a stroke, aphasia is the result in about 20 percent of stroke victims. Each aphasic person has a unique set of speech and language problems, accompanied by other symptoms caused by the same stroke.

Aphasia

Aphasia is marked by speech and language problems caused by damage to the brain. People with aphasia may have problems speaking, understanding speech, reading and writing (just one or all these areas may be affected), ranging from mild to severe in nature. Aphasia does not generally affect the ability to think, reason and understand. Most aphasics know what they want to say - they just have trouble putting their thoughts into words. A similar inability to understand non-verbal forms of communication such as gestures and facial expressions may also exist.

Aphasia can take many forms. Some aphasics have word finding difficulties (anomia). Some can only respond to a question by repeating it back, parrot-like (echolalia). Others use invented words (neologisms), or get "stuck" on a certain word, repeating it over and over (perseveration). Paraphasic errors, in which "dye" may be substituted for "tie" and / or "wife" for "husband" are also common.

Those with aphasia may have a grammar which is rational and orderly even though the words make no sense (fluent aphasia), or may use a word or two appropriately, but not produce meaningful sentences (nonfluent aphasia).

Dysarthria is a weakness or paralysis of the muscles of the face, mouth, neck and/or throat caused by brain injury, that may cause difficulties in talking, eating, swallowing and/or breathing, and cause speech to be slurred and sometimes unintelligible. It may occur with or without aphasia.

Speech Therapy

The speech / language pathologist assists the stroke patient in relearning the communication skills necessary to rejoin his or her family, friends, and colleagues. Intensive (four or five times weekly) speech therapy in the hospital setting usually begins soon after the patient is well enough to begin treatment. Generally, recovery is most likely to occur from three to six months after the stroke, plateauing after this period. However, improvement may continue for an indefinite period, depending on the patient's health, age, motivation, and the severity of the stroke.

Aiding Recovery While in the hospital

To maximize the patient's comfort and support his or her abilities, bring glasses, hearing aid and batteries, dentures and dental adhesives if needed.

Display clearly labelled photos of family and friends to help orient the patient.
Consult with the speech pathologist (or neurologist, case doctor and nurses in smaller hospitals) and ask what you can do. Comforting and communicating will be most successful if you understand your loved one's aphasia.
Don't assume that the aphasic person can't understand what's being said. Never say anything you wouldn't want the aphasic person to completely understand.

It is best to remember that

The frustration of aphasia may cause irritability.
It is normal to expect depression due to illness and stress in an aphasic stroke survivor, and chemical changes caused by stroke may result in deeper depression and apathy.
The aphasic person (and stroke survivors in general) may not seem like the person you used to know.
Aphasia does not get worse over time. Unless new brain damage occurs, almost all aphasic patients improve their use of language over time.

On Returning Home

Set up a daily routine for the aphasic person, being sure to provide rest periods - stroke survivors tire easily.
Encourage both favorite and independent activities.
Aphasia is a family illness - support for the caregiver is as important as help for the aphasic person. Join a stroke support group. After Stroke provides peer support, fellowship, and helpful information to stroke survivors and their families.

To aid speech and comprehension

Speak slowly and clearly rather than loudly.
Speak in clear, simple language. Face the person to allow them to see your mouth and facial expression - it will help them understand what you are saying.
Encourage the aphasic individual to speak by engaging in conversation on a level they can handle. Look at pictures and photographs and discuss them. Help with word finding if they get stuck, but first allow them to try for themselves.
Listen carefully and patiently, even if the person's speech is hard to understand. Complement them on their progress, no matter how small.
Don't be condescending. Treat the aphasic person like the mature adult they are.
One on one conversation is easiest for an aphasic person - two or more people speaking at the same time can be confusing and make comprehension impossible.
Encourage stroke survivors to try to write and draw. If the dominant arm is impaired, stroke survivors should practice writing with their other hand. It may be easier to print before writing, and using large letters may help. The key to progress is practice.
If difficulties are experienced in reading, books with plenty of pictures or large print books may aid comprehension. Try reading your newspaper's weekend comics (the pictures help), then go on from there.
In some cases, where writing and natural speech are not functional, alternative forms of communication must be explored, using adaptations and other strategies such as a communication board.