Submissions from Readers

Determining the Type of Aphasia

Question Hello, my dear friend had a stroke a year ago last December. Unfortunately her husband and she had fallen upon severe financial distress before the stroke, so her medical resources were very limited at the time and only now do they have state assistance which does not cover any type of therapy.


Her husband and I would like to start some form of home speech therapy, but after reading about the different types of aphasia there are, we are now more confused about where to start.

How does an untrained professional evaluate where to start with home speech therapy? Can it even be done?

My dear friend seems to understand what you are saying but only utters one word over and over again in response - Lola. Her left side is inactive, she is in a wheel chair but does tend to her own personal hygiene to a certain extent.

With no medical assistance, we are striving to do something to help her regain some of her speech or at least improve her communication skills and some form of independance.

Is there such a thing as cost free speech therapy?

Thank you
Cary Asuncion

Answer: I don't know where you can get free speech therapy, but your friend's husband could search to see if there are any speech clinical trials in the area in which she could participate. See www.stroke-rehab.com/stroke-clinical-trials.html for more information on clinical trials. I would also see if there are any schools in the area that offer speech language pathology degrees. You could contact the school and see if they ever use patients for training or know of someone such as a continuing education provider that does. All therapists must complete continuing education credits to keep their license and some continuing education providers use actual patients during their courses to provide training.

You could also contact the American Speech-Language-Hearing Association (if you are not in the US, then contact your country's association), and ask for any information or resources that they may have. Lastly, there are many websites and books that offer information about speech therapy. You could go to your local library and look for books about aphasia and treatment of aphasia or order books off of amazon.com. You can also search for websites that offer information on aphasia exercises. One such website mentioned in the above questions.

It sounds as if your friend has problems with expressive language since she cannot verbalize what she wants to say. If she cannot follow directions, she may have trouble with receptive language as well. Some stroke victims have difficulty with both. You would want to look up exercises for expressive aphasia based on what you've told me, but if your friend has problems with understanding and following directions then you would want to do exercises for receptive aphasia as well. It will not hurt to do both, but you want to focus on her weaknesses.

I know you stated that their financial resources are limited, but if they can afford it, it would be beneficial to go for one speech therapy evaluation and determine the weaknesses as well as have the therapist issue some home exercises. If your friend is able to do one visit, make sure her husband explains their situation ahead of time so the therapist can gather exercises and be prepared to issue a home exercise program. Hopefully, I've given you some ideas and resources to help!

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Cognitive Impairment After a Stroke.

by Sandra
(PA)

Question:My 60 year old brother had a stroke that has affected his right side. He is experiencing an inability to recognize the written word but can speak and communicate fine. He can watch a half hour sit-com and follow the story but show him a written sentence and he cannot process the words. Will this improve with therapy - and what kind of therapy will help?

Answer: This problem is identified as alexia, and he needs to see a speech therapist. I have seen this happen after stroke. It should improve with therapy, but I don't know to what extent. I have seen some people improve greatly and others continue to have problems. Here is an article that you may find helpful:

http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/CommunicationChallenges/Reading-Rehabilitation-After-Stroke_UCM_310087_Article.jsp.

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Speech Problems, Mild Lazy Tongue

Question: Can a caregiver contribute to speech exercises? I am a music therapist and have voice exercises which might help like tongue twisters and tonal/speech sequences to loosen tongue/jaw to help with articulation etc...

Mostly the guttural consonants are affected and the sibilants:
e.g. saying "glue" is difficult
Sphinx - combining tip of tongue and x -k- g -guttural
and P/B -T/S/Z -L -R - BRBRBR
and pursing of lips - maybe slight inability to 'drink' - with pursed lips from a paper mug with lid and small opening!

HE loves the nonsense - rhymes and spike milligan poems ect.

Any other suggestions?

Answer I have less knowledge of oral motor exercises, but I do know that caregivers can absolutely help stroke patients with their speech recovery. You could check with a speech therapist to make sure, but I think your voice exercises would be great. For a list of oral motor exercises to try, you can visit www.speech-therapy-on-video.com/oralmotor.html.

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Speech Therapy After Stroke


byDavid
(Alabama)

Question: Is it normal for speech to be good at one point during the day and then be bad later?

Answer: It is not unusual for speech to deteriorate in a stroke victim during the evening or after they have been up for a while. Just as arm and leg muscles become fatigued so does mouth musculature which can cause speech to become more distorted and difficult to understand later in the day. There can also be mental fatigue which can result in increased speech difficulty. One other factor to look at is medication. Medication could be affecting speech patterns so it is important to recognize if symptoms appear after taking medicine.



Exercises to Improve Speech
by Sultan
(UK)

Question: How do you improve patient's tongue control and speech after stroke? Please tell me some exercises for my mother. Thanks.

Answer: I'm going to refer you to another website for this answer. Please visit speech-therapy-on-video.com for exercises to help with aphasia or http://www.speech-therapy-on-video.com/oralmotor.html for exercises dealing with dysarthria.

In case you don't know what the terms mean, aphasia is a problem with expressing or understanding language and dysarthria is difficulty with controlling mouth and facial movements.



Speech Therapy
by Anita
(Lake, WV)

Question:My mother had a hemorrhagic stroke 1 year ago. She lost her speech and is also paralyzed on her right side. We no longer have therapists to aid us in her recovery. What can I do to help her regain her speech. She occasionally says simple words like, no, yeah, oh lord, or oh god. She has learned to make her needs known in other ways but there are still times when we don't have a clue of what she wants or needs. It is very frustrating for us and her.

Answer: I recommend making or purchasing a communication board with pictures. The pictures would entail her most frequent requests (food, drink, bathroom, pain, etc.) I would search for the phrase "communication board for stroke patient" on one of the search engines for ideas or to find a communication board you can purchase. There are ones out there that are very detailed if your mother is able to point to the pictures. If she is not, then you might work on learning to use a communication board with her.

I also recommend visiting the speech-therapy-on-video.com website mentioned above in Sultan's question. The website has a selection of videos with speech therapy exercises you can practice at home with your mother.

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Speech Problems

by Gene Pester
(Woodland Hills, CA USA)

Question: I had a stroke 4 years ago. I have had problems while talking to anyone. It seems that my thoughts don't always get transmitted to my mouth. I kind of stutter before I can get it out. This problem is not continuous and may be associated with subjects. I find it most difficult when talking about something and I need to remember something about the subject. Once I get passed the event, I can talk normally.

It is not debilitating, but it is frustrating and seems to be getting worse.

Also, immediately after my stroke, my eye sight changed. I wear glasses for near sightedness. After my stroke I could see better without my glasses. I changed my prescription to accommodate my new eyes, but the condition changes over time. It almost seems eyes change hour to hour. If I squint, I can see better, but it hurts when I do that. I work on the PC a lot and it is difficult to work since my eyes go in and out of focus.

Any ideas?

Gene Pester

Answer: I know some exercises that can be done to help with word finding, however, it sounds like your word finding difficulty is on a much milder level, and I feel that the resources I could refer you to would be too remedial. I would go for a speech therapy evaluation/consult and get some exercise recommendations to improve your memory/word finding. You could try some online games that help with memory and word finding. One such site is www.kerobics.com.

As far as your vision issues, I would visit a neuropthamologist that deals with vision problems after stroke. Since your focusing goes in and out, I wonder if you might be having problems with the eyes tracking simultaneously. You might be able to test this by covering one eye and reading then trying it with the other eye. If you don't notice the same problem as when both eyes are open then you may have a problem of the eyes not working together. A neuro-opthamologist could help identify exactly what problem you are having and could refer you to a vision rehabilitation specialist.

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Thanks for your advice
by: Gene Pester

Thanks for your advice!!

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Speech

by Dennis Haut
(Bettendorf, IA)

Question: I had Posterior Occipital Stroke December 23, 2013. I am home from hospital now. Sometimes I can't find words. Here is my important question: My speech is halting and slow most times but some times is close to normal. Is this normal for it to come and go?

Answer: Hi Dennis. This is a very common complaint I hear from stroke patients. Often speech and/or the ability to find words will fluctuate post stroke. Some of the obvious factors that will affect speech are fatigue (physical and mental), frustration, being tired or sleepy, new situations, and medications to name a few. The good news is that you are very early in the recovery process, and this is the time when the most rapid gains in recovery are made. Hopefully this fluctuation in speech will be less noticeable to you or be resolved altogether as you continue to heal from your stroke.

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Aphasia

by Ramon Guardado
(Rogers, AR U.S.A.)

:Question: I had a stroke 7 years ago and I'm having problems in communicating. My speech is terrible and I'm looking for some exercising to do online to improve my speech.

Answer: You can review these resources:

http://www.stroke-rehab.com/aphasia.html

http://www.aphasia.org/category/i-have-aphasia/

http://csuspeechandhearingclinic.weebly.com

You also might look into local universities to see if they offer free speech therapy provided by their students who are training to be speech language pathologists. Here is a link describing the speech and language clinic at the University of Arkansas in Fayetteville:

http://http://cdis.uark.edu/speech-hearing-clinic/



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Speech Therapy in Mother Tongue

by Erazuna
(Bdnoni South Africa)

Question: My brother is afrikaans speaking; yet most of his speech therapy is in English. Does that not effect the recovery of speech negatively?

Answer: In my opinion, his speech therapy should be done in his first language rather than English unless he is quite proficient in English. Sometimes when people have strokes, they will revert to speaking in their first language especially if it is more comfortable for them.

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Speech Therapy

by catherine gutterson
(bordentown nj)

Question:My father had a stroke 2 weeks ago. He is currently in a rehab center and is making progress, but he is hating the place with a passion because of the speech therapy portion that is making him frustrated and feel humiliated. He is feeling hopeless and depressed which he shouldn't because he is doing well with the other 2 therapies, physical and occupational, thank our lucky stars. He's not interested in eating and no longer smiles when you enter the room. He just wants to come home, and he is mixing his days up and saying things that just didn't happen as if he's hallucinating. Can speech therapy be given at home? I believe the stoke hurt him cognitively. Is that something that can be overcome at home with time. I want to blame the environment and not being home because he has always been independent at 83 and up and on the go, and this is keeping him bored and restless especially at night, He's a bad boy for the nurses. Your insight and help is greatly appreciated.

Answer: Speech therapy as well as the other two therapies can be given at home. Your dad may do better at home in familiar and comfortable surroundings, but taking him home does not necessarily mean his cognition will improve. Only time will tell. Cognitive changes may be a result of the stroke, but these changes can also occur because of medicines or lack of sleep. Sometimes, elderly patients that have dementia, even if just a slight dementia, will become more confused when removed from their home and put in a new situation. I can't tell you whether your father will do better at home or not, but you definitely can have home health therapists come to see him. The only disadvantage to home health this early in his stroke recovery is that they only come out 2 or 3 times a week usually for 30-45 minutes. In an inpatient rehabilitation facility, patients will be seen several hours per day at least 5 days a week. Inpatient rehabilitation usually only lasts a few weeks for stroke patients so I would try to take advantage of the more frequent/intense therapy as long as possible.

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Stroke Aphasia

by Denise Lehman
(Pleasant Valley, MO)

Question: If you had a mid-cerebral artery stroke, does aphasia get worse and also what is the most amount of time you have seen the "light" come back on after someone has suffered this type of stroke? Thanks.

Answer: The mid-cerebral artery can be affected in different areas as well as the left versus the right MCA. The severity of damage as well as the effects and long term outcomes vary among stroke victims so it would be difficult to predict what happens. The MD working with the patient may be able to give you some idea of prognosis based on severity and area of the MCA involved. Generally, the longer someone continues with adverse effects (especially more severe effects), the more difficult it will be for recovery. In my practice, I find that the most rapid recovery occurs in the first six months after stroke and slows down after this time period. Many gains can still be made after this initial period, but in my experience they are slower to occur and not usually as significant as the initial gains made.

A quick review of research on my part appears to back up my sentiment regarding aphasia. I would recommend doing a search on "aphasia outcomes after stroke" which will give you a lot more information.

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Aphasia but Intelligent

by JB
(Texas)

Question:My mom, 73, had a both kinds of stroke almost 2 years ago resulting in right side paralysis, some apraxia and aphasia. She went from working full time as a secretary to a hospital bed. After suffering gall bladder attacks and surgery for 3 months after stroke and then needing a PEG tube for eating for months after, then CDiff and a broken hip after a fall, she has finally come around to being fairly healthy but living in a nursing home close to me. Throughout all of this her communication has not improved. She has about 10 words she repeats for everything. We've told her she doesn't make sense and she now has a communication tablet to use but she never uses it. Yet, she continually tries to talk to us and expects us to understand her. There are times through the long minutes of charades, we can get what she's talking about to a point but many times, after LONG periods of trying, we just give up. I feel we have failed her by humoring her at times pretending to understand or going through the charades or not insisting that she try to use the device. She can write and sometimes get the letter or part of word but it is taxing and a chore. Aside from all of that, she still has a very intelligent mind but because of right side paralysis and the communication issue, she has no way of expressing her thoughts or of doing anything really productive. So she sits in a nursing home in a wheelchair. Her aides and nurses have mostly learned her needs and gestures but this is not communicating and does not help when she wants to have these lengthy, abstract conversations with me or her roommates or others in the home. She also calls and rattles on for an hour and I have almost no idea of what she's talking about. How can I help her realize she doesn't make sense? How can I help her use her device or be more clear? Do I continue to humor her? We are all tired of living in frustration but I do not know what else to do. Any advice would be helpful.
Thanks,
JB in Texas

Answer: Rehabilitation for speech often requires a long term strategy, and I highly recommend that you get more speech therapy for your mom. If they do not offer speech therapy at the nursing home or you are not impressed with their speech therapy services, you can hire an outside therapist to come in on a private pay basis. I would check to see what services the nursing home has regarding speech therapy and support groups. If there is limited help, and you cannot afford to pay for ongoing private services, you pay to have a speech therapist come out for just a few visits and then meet with your family and the hospital staff to discuss strategies to help your mom.

I'm not sure if your mom is able to leave and be transported to outside services, but you could also search for outside services that could benefit her. I don't know what area of Texas you live in, but for example, in the Dallas area, there are several free programs for patients with aphasia. A speech therapist in your area would most likely be able to tell you what services are available.

If none of the above is an option, you could read online about treatment for Wernicke's aphasia and speech apraxia for suggestions. I highly recommend using the services of a speech therapist though over trying to figure it out yourself.

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Deterioration in speech 10 months post stroke

Question: My husband had a major hemorrhagic stroke 10 months ago. His right side was paralyzed and he lost speech and swallowing ability. He made good recovery in the first 3 months and was able to start swallowing and some speech returned and he started walking with help. Now 10 months later I feel his speech is starting to deteriorate. He could converse with others in broken speech, and others could understand what he was trying to say. Now he has severe difficulty in recalling words and is unable to carry on a conversation. Even I can no longer understand what he is trying to say. Can you please offer some advice about what I should do to help him? Thank you.

Answer: I would recommend evaluation by a MD to see if there have been changes in the brain or a subsequent stroke. If not, I would recommend returning to speech therapy.

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