As part of my clinical experience during graduate school I helped run a stroke communication recovery group at the University of Utah Wellness Center. Our clients all suffered from varying communication disorders due to stroke. These people were severely limited in their abilities to "talk" but were able to communicate in so many ways that I never even thought of. It is amazing to interact with these people and learn about their lives. Meeting together with other people who have the same difficulties was such a great support for them and every communication effort was celebrated. It was truly an amazing experience.
The Wellness Center is a physical therapy clinic run by the University of Utah Physical Therapy students. The stroke cummincation group held at the wellness center was run by the speech language pathology students but was a learning experience in colloborative treatment with physical therapists and speech language pathologists. As part of our collaboration we held an inservice during which the SLPs discussed the communication needs of the clients and the PTs discussed the the physical needs of the clients. Here is a copy of the Inservice Handout on Aphasia that we made for the meeting. You can use it as a resource if you ever need to describe possible communication impairments associated with a stroke. (click on link below)
Stroke Communication Group Inservice
Aphasia: “A disorder that results from damage to portions of the brain that are responsible for language. For most people, these are areas on the left side (hemisphere) of the brain. Aphasia usually occurs suddenly, often as the result of a stroke or head injury, but it may also develop slowly, as in the case of a brain tumor, an infection, or dementia. The disorder impairs the expression and understanding of language as well as reading and writing. Aphasia may co-occur with speech disorders such as dysarthria or apraxia of speech, which also result from brain damage.” (National Institute on Deafness and Other Communication Disorders, http://www.nidcd.nih.gov/health/voice/aphasia.asp)
- Anomia (word finding difficulty) is the clinical marker for aphasia (not a memory problem, an access problem)
- Fluency, Comprehension, Repetition can be affected
Apraxia of Speech (AOS): a motor speech disorder that results in difficulty sequencing sounds in syllables and words. “People with AOS know what they want to say but their brains have difficulty coordinating the muscle movements necessary to say those words.” (American Speech-Language-Hearing Association, www.asha.org)
- treatment requires extensive repetition and practice of motor movements
- apraxic patients often exhibit groping and vowel distortions
- errors increase with increased length and complexity of words
Dysarthria: “a motor speech disorder in which the muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all after a stroke or other brain injury. The type and severity of dysarthria depend on which area of the nervous system is affected.” (www.asha.org)
- Symptoms vary according to site of lesion and type of dysarthria
- Possible symptoms include: “slurred” speech, soft speech, slow rate, mumbling, limited tongue, lip and jaw movement, abnormal rhythm when speaking, hyper/hyponasality, hoarseness, breathiness, drooling, chewing and swallowing difficulty
Neurogenic Stuttering: an acquired fluency disorder that can be brought on by CVA or degenerative diseases sometimes associated with Parkinson’s Disease
General Guidelines for Speech Facilitation
- Give patients time to say what they want to say
- If you don’t understand what they are trying to say, tell them that you didn’t understand and offer other modes of communication (paper and pen, gesture, ask yes/no information)
- Anomia-If you know what word they are trying to say, give them a cue (first letter of the word, first sound in the word)
- If they are having word finding difficulties (anomia) and you don’t know what they are saying, be patient. If they are frustrated ask them to describe it
- Encourage conversation! They want to talk.
- Treat them as equals. Do not talk down to them. Most of them are cognitively intact.
www.stroke.org (order: Stroke Smart magazine)
www.strokeassociation.org (order: Stroke Connection magazine)