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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Mar 12, 2012
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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