Speech Therapy After a Stroke

The Role of a Speech-Language Pathologist

Speech-language pathologists (SLP’s), also known as speech therapists, are a very important piece of a stroke person's recovery team. SLP’s are responsible for evaluating, diagnosing and treating disorders related to speech, language, cognitive-communication, voice, swallowing ability, and other related issues. Let's explore some of the most common areas of treatment for stroke rehabilitation.

Language Impairments

Depending on the area of the brain the stroke occurred (typically on the left side), a person may experience language deficits that affect both the understanding of language and the expression of language. This means that not only do they have trouble speaking or remembering the words for things, they may also be unable to understand the words that others are saying. This can make recovery challenging since the words that you speak to them may as well be a foreign language. In most cases, speech therapists evaluate the patient to determine which abilities are spared in order to build onto the foundation of new learned words and skills. Stroke therapy is often very intense and many of the patients may find speech therapy to be just as exhausting as their physical or occupational therapy, as it requires an incredible amount of focus and determination to retrain the brain on how to process language. It is common for stroke patients to experience behavioral changes also. What was once an automatic function, now requires you to shift into gear and tell the brain where to send the information to make it meaningful. The SLP may train a patient who has a deficit with language by using specific strategies to retrain word retrieval, such as using pictures or making associations with the word (e.g., color, category, use, etc). The SLP may also recommend participation in group therapy to improve conversational skills, such as taking turns and clarifying ideas. Both group and individual therapy approaches may target elements of role-play with the patient to practice talking on the phone, interacting with a sales clerk or even having a simple conversation with a loved one. In addition, SLP’s interface with other therapists in the recovery process, working together to ensure the patient gets the most comprehensive therapy possible to ensure the greatest recovery. As an example, the SLP may work with a vocational specialist in an effort to prepare the patient for a return to school or work or they may contact an educational specialist or employer to modify the learning or work environment to meet the patient’s new needs. This can also include the SLP completing an evaluation for an AAC device (Augmentative and Alternative Communication) that will supplement or replace speech or writing for those who are unable. Ensuring that the patient has every opportunity to improve their language and offer the person the ability to express themselves is of the utmost concern for a speech pathologist.

Speech Impairments

While there are many challenges faced by a stroke survivor, difficulty articulating words is one of the most significant. The inability to clearly communicate can lead to feelings of isolation and increase the incidence of depression among patients. The guidance of an SLP can assist patients who suffer from apraxia (the inability to control the muscles used to form words) to learn exercises that will increase coordination, strength and range of motion for the oral muscles, including the lips, tongue and cheeks, that work to form sounds. Patients may struggle with speech that is slow, or get "stuck", or make multiple attempts to articulate a word. Often their errors are inconsistent and they may be successful saying it once, but then unable to do it again. Another speech impairment suffered by stroke patients is dysarthria (a lack of coordination of weakness in the muscles that form words), which often results in slow, slurred speech. These patients are often thought to be 'drunk' or 'dumb' as a result of their speech, which can significantly affect a patient's self esteem. Therefore, it is critical to seek SLP intervention to train speech exercises that will strengthen the muscles and improve the coordination of the mouth in order to improve their speech function and allow them greater opportunity to speak clearly.

Cognitive-Communication Impairments

Person who suffer a stroke can be left with multiple impairments related to their ability to process and react to information and stimuli that is gong on around them. As a result, those persons can experience increased behaviors, frustration and depression related to the loss of function and often the loss of their independence. Approximately 30% of patients are left with a cognitive impairment 3 months post stroke. The most frequently experienced cognitive impairments include reduced memory, reduced judgement and at the loss of the ability to self-monitor their own actions and communications. If a patient’s cognitive skills are affected, the SLP may teach the patient to use a memory log to keep track of daily occurrences or suggest an organizer to plan daily tasks. The SLP will often educated patients and family member of strategies on how to help the stroke patient with completing a task by providing cues to retrain the brain and help the person gain back their autonomy. It is important that the SLP work with other members of the care team as well as the patients family to achieve the greatest carryover and ensure optimal results for recovery. Family members are often instructed to remind patients when they have made an error and explain what the correct response would be (much like you would with a child) in order to help the patient develop new brain pathways to process the information they are experiencing. Cognitive therapy is often treated in combination with the language impairments making the SLP an excellent resource for assisting the stroke victim in regaining their independence.

Swallow Impairments

The SLP also addresses issues such as the a decreased ability to swallow, which greatly impacts the patient’s ability to receive optimal nutrition or puts the patient at risk for developing an infection as a result of aspiration (food or liquid going into the airway or lungs). One of the most important skills for a stroke survivor is the ability to swallow. In the more severe cases of a stroke, a patient may lose the complete ability to swallow safely and a tube must be inserted into the nose or stomach in order to provide the patient with nutrition until the swallow function has improved. Upon referral, the SLP will evaluate the patient’s ability to swallow and make recommendations regarding proper positioning, feeding techniques, and possible changes in the consistency of food and drink. This may require the patient to perform such actions as tucking their chin down or turning their head to the affected side may help to move the food and liquid through the oral cavity safely and keep it from falling down into the lungs, which could result in aspiration pneumonia. The SLP may also provide guidance as to whether or not a person would benefit from thickened liquids of a nectar or honey consistency, as well as modifying food textures to have ground up meat or blended (baby food) consistency in order to allow the patient to remain on food and eliminate the need for the stomach tube. In addition, the SLP is responsible for educating the patient, family and other caregivers on how to keep the patients safe during meals in order to ensure the patients is not at risk for dehydration or nutritional compromise.

Finding the Right Speech Language Pathologist

Thus, enlisting the help and expertise of a speech-language pathologist is one of the greatest benefits available to a stroke patient, and it is important to be aware of the benefits of recommending one when necessary. The SLP can be the catalyst to coordinating all other care providers (physical therapist, occupational therapist, vocational therapist, doctor and family members) to ensure the patient receives a wholistic approach to a challenging condition. Be an advocate for your loved one and get help as soon as possible. It's never too late to seek assistance.

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