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Speech Therapy for Stroke Patients

Caroleen Joy Ileto

By: Caroleen Joy Ileto | Squeeze Opinion | Published September 3, 2017 | Updated September 3, 2017

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Depending on the damage of stroke in the brain, patients may have a communication or language disorder called “aphasia.” There are classifications or types of aphasia. Amongst the types include Global aphasia, Broca’s aphasia, Wernicke’s aphasia, and Anomic aphasia.

GLOBAL APHASIA. Considered as the most severe form of aphasia, Global aphasia is characterized by “producing only few recognizable words and understanding of little or no spoken language. Persons with Global Aphasia can neither read nor write.” According to research, global aphasia may often be seen immediately after the patient has suffered a stroke and it may rapidly improve if the damage has not been too extensive.

BROCA’S APHASIA. Damage to the left hemisphere of the brain, where Broca’s area is located, would most likely result to Broca’s aphasia. This is characterized by difficulty in producing grammatical sentences and by speech that is limited mainly to short utterances of less than four words. Patients with Broca’s aphasia likewise find it laborious or effortful to produce the right sounds or find the right words. In some cases, patients with Broca’s aphasia have more difficulty using verbs than using nouns.

WERNICKE’S APHASIA. Damage to the left hemisphere of the brain, where Wernicke’s area lies, would most likely result to Wernicke’s aphasia. Patients with this type of aphasia talk a lot but their speech may be empty. Patients may be unable to maintain topic, may go around in circles, and / or may substitute words with different words. Reading and writing are often severely impaired.

ANOMIC APHASIA. “Tip of the tongue” phenomenon describes anomic aphasia. Most of the time, patients have difficulty accessing the exact words in naming objects, people, events, places, etc., which result to more semantic substitutions. For instance, a person would like to say “pencil” but would say “paper” or “ball pen.” The difficulty in finding words is evident in writing as well.

 

WHO ASSESSES APHASIA?

The speech language pathologist (SLP) evaluates the individual with a variety of tools to determine the type and severity of aphasia. They work in hospitals (rehabilitation units along with physical therapists and occupational therapists), private clinics, and on freelance. They may use formal or informal screening to help them understand the strengths of patients and the areas where compensatory strategies would be helpful. After an assessment and depending on the results, therapy sessions may most likely follow. A speech therapy session may transpire from 45 minutes to an hour on a weekly basis. Usually, a neurologist or a primary physician attending the patient’s case makes the recommendation to see an SLP.

 

WHY SPEECH THERAPY IS IMPORTANT

Speech therapy becomes effective especially when it makes more sense to the people concerned. Yes, definitely not just the patients themselves but also the families that support them. Family support could mean ensuring somebody takes the patient to therapy sessions, prepares and provides the medicines on time, serves nutritious food, and ensures that strict diet is observed. Emotional and social support must likewise be felt – communication and inclusion in the family and community are essential to this.

 

HOW CAN YOU HELP?

What are the common speech therapy goals and what do we mean by these?

If you have a family member who is currently undergoing a speech therapy as part of post-stroke rehabilitation treatment, perhaps one or combination of any of the following would be the goals he or she is working on with the speech pathologist. As a family member, it is wise that you ask about the treatment goals being done to your family member. This ensures that you and the whole family, or the primary caregivers, can participate and use these strategies at home. The transfer or carry over of the goals at home and in other situations, or communication partners, would contribute to the positive outcomes of the speech therapy.

Below are some of the common goals to start with as part of engaging in your family member’s therapeutic goals:

VERBAL EXPRESSION. This may target production of functional everyday expressions such as “Good morning!”, “Thank you!”, “I want to sleep,” “Please stop!”, or “One black coffee, please.” Activities for this goal may include describing a photo or providing problem-solution to a situation. Basically, the speech language therapist helps the patient produce meaningful spoken language.

WORD FINDING. This means accessing the right words for names of objects, location or places, people, and occupation. Verbs using pictures or actual objects or spoken descriptions would be very useful in this word-finding category. To serve this goal, the speech language pathologist may use various creative games or drills. For instance, the speech therapist would show an actual toothbrush and ask the patient what it is.

SEMANTIC FEATURES. Using semantic features means utilizing other clues to help the patient access the right word. For instance, in accessing the word “ballpen,” one may consider the descriptors “long,” “black,” “with ink,” “at school,” “for writing,” or “pen.” Semantic features may also include giving the first letter of the word or first syllable of the word, or a word that sounds like the target word and the like. It may also be given through gestures or acting out.

AUDITORY COMPREHENSION. “Auditory” means the language we hear while “comprehension” means understanding what we hear or what we are told. Examples of activities that target this goal include giving direction and extracting details heard (who, what, when, where, why and how), among others.

READING COMPREHENSION. This may be achieved through functional reading using short news passages, recipes, menus, medication instructions, and the like.

WRITING. Functional writing may be done via different activities: grocery listing, writing checks, and answering forms, among others.

GESTURE. The use of body movements to indicate needs such as to drink, to eat, or to pointing to an object. Gestures are part of total communication, or the use of different communication modes that help patients communicate their needs.

SELF-ADVOCACY. Patients need to be able to direct their own care. This goal reminds patients that they have the power to initiate communication whenever they need to. When a patient communicates verbally or non-verbally a request, this should be followed up with a response from the caregiver.

These are just snippets of explanations on what to expect for each goal. The level of difficulty and support (giving cues) vary from one patient to another. Knowing what to expect from speech therapy sessions may engage families well to support their patients in a more productive and functional way. 

Reference: https://www.aphasia.org

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