Aphasia and Dysarthria are the main two communication problems. In this article, we will mainly discuss language and communication problems in stroke and their treatment or intervention. A stroke may produce a wide variety of language and communication disorders ranging from mild to severe.
These speech and language problem occurs most frequently with a stroke resulting from damage to the left hemisphere of the brain (left side of the brain plays a very important role in a speech and language speech). Speech and language problems may also occur with right hemisphere brain damage but these are very less common.
To identify the speech and language disorder patients with stroke should be examined by a speech-language pathologist.
Speech-language pathologists carefully evaluate the patients for speech and language disorders and they can provide valuable information to the members of the rehabilitation team.
This will further help the therapist in planning an intervention and also helps family members regarding the best technique for communication with the particular client.
The occupational therapist should continue the work of the speech therapist in the treatment of the person with speech and language impairment as appropriate.
The occupational therapist may reinforce communication techniques that the client is learning and in presenting instructions to the client that he/she is able to understand and integrate.
Types of Speech and language dysfunctions
These are the speech and language dysfunctions which can occur from mild to severe in stroke patients:
Aphasia is a complex acquired language and communication disorder caused by damage to the language center of the brain and characterized by impairment of language modalities (such as speaking, listening, reading, and writing).
Damage to the brain may be caused by:
- A stroke or cerebrovascular accident CVA
- Head injury
- Tumor in the brain
- Other neurological illness
Aphasia is not only caused by a stroke but stroke is one of the leading causes of aphasia.
Aphasia is a communication disorder and it does not affect your intelligence or IQ. A person with aphasia can still think, but unable to express their thoughts easily.
Aphasia vs. Dysplasia
Aphasia is a medical term used for complete loss of language whereas dysphagia is referred to as partial loss of language.
Nowadays aphasia is used to describe both conditions aphasia and dysphagia.
People with aphasia may face the following difficulties:
- The problem in speaking (known as expressive aphasia)
- Problems in understanding speech (known as receptive aphasia)
- Reading difficulties
- Writing difficulties
- Problem with using numbers
- Unable to remember the time
Types of aphasia:
- Global aphasia
- Broca’s aphasia
- Wernick’s aphasia
- Anomic aphasia
It is the most severe form of aphasia characterized by impairment of all language skills. Patients with global aphasia may produce few recognizable words and understand little or no spoken language. Persons with global aphasia are unable to read and write.
All intellectual and cognitive capabilities (unrelated to language and speech) are preserved, same as other aphasia. Global aphasia usually caused by damage to the middle cerebral artery (MCA) of the dominant cerebral hemisphere. Global aphasia is an immediate result of a stroke or brain injury symptoms may rapidly improve in the first few months.
Broca’s Aphasia is also known as expressive or non-fluent aphasia. It is characterized by poor speech production and agrammatism.
Persons with Broca’s aphasia have difficulty producing grammatical sentences and their speech consist of only short words. They have a problem finding the right words. All intellectual and cognitive capabilities (unrelated to language and speech) are preserved same as in other aphasia.
Persons with Broca’s Aphasia may understand the simple grammatical language but they are having problems in understanding complex grammatical language.
Persons with Broca’s Aphasia usually have deficits in monetary concepts and the ability to perform calculations. Individuals with Broca’s Aphasia may be able to read but very difficult and limited in writing.
Broca’s Aphasia is the result of damage to speech and language brain areas due to stroke or injury to the head.
Wernicke’s aphasia is characterized by impairment to understand the meaning of spoken words and sentences.
Persons with Wernicke’s aphasia have not much difficulty in connecting speech. Therefore it is also known as fluent or receptive aphasia. There is completely preserved intellectual and cognitive capability (unrelated to speech and language).
Wernicke’s aphasia may be caused due to the damage to the Wernicke’s area of the brain as a result of stroke or brain injury. This area is very important for processing the meaning of words and spoken language. Persons with Wernicke’s aphasia are severely impaired in reading and writing.
Anomic aphasia is a milder form of aphasia. Persons with anomic aphasia have left with a persistent inability to supply the words. The speech is fluent and grammatically correct.
People with anomic aphasia have a good understanding of a speech and they can repeat the words and sentences. This problem can result in hesitant or slower speech.
Primary progressive aphasia (PPA)
There is one more type of aphasia known as primary progressive aphasia. It is a neurological syndrome and characterized by slowly and progressive impaired language capabilities. Unlike other aphasia which is caused by stroke or brain damage, primary progressive aphasia is caused by neurodegenerative diseases such as Alzheimer’s disease. As here we are mainly discussing stroke. So, we will talk about PPA in another article.
Communication with clients who have Aphasia
Speech-language pathologists are mainly responsible for the treatment of speech and language impairment. The occupational therapist facilitates communication and meaningful interaction.
Occupational therapists use the following strategies with the aphasic client and their caregivers:
- The use of gestures for communication should be encouraged.
- OT may use daily activities (ADL) as an opportunity to encourage speech.
- Teach the client, speech impairment is a part of the disability and not a mental disorder.
- Give the client sufficient time to respond.
- Use simple form of questions.
- During conversation use visual cues or gestures to help the client understand.
- Never force the client for a response.
- Take sufficient time for communication Rush may increase frustration and decrease the effectiveness of communication.
Dysarthria is a speech disorder that mainly causes articulation disorder. It can affect pronunciation, the rate of the voice, the loudness of the voice, and the normal intonation of voice.
Dysarthria is cussed due to dysfunction of the CNS mechanism that controls speech muscles. Depending on the severity and location of the stroke every individual with dysarthria experiences different symptoms.
Dysarthria results in paralysis and incoordination of speech organs which causes the speech to sound thick, slurred, and sluggish.
Communication with clients who have Dysarthria
These are some simple strategies that can be used to improve communication in patients with dysarthria:-
- A noisy environment should be avoided during talks.
- If possible eliminate the noisy source or move away from the source before starting a conversation.
- Always communicate face to face whenever possible.
- Avoid visual distraction during communication.
- Prepare the listener what you are going to talk about? Before starting the main conversation.
- Try writing the first letter of each word on a notebook or paper during the conversation. This is a very effective technique in dysarthria.
- Be patient and ask people to be patient.