Aphasia: when stroke robs you of your speech

Most people take for granted the ability to communicate through speech and gesture. From birth, much of our life is dedicated to first acquiring the ability to speak, and then improving it through continual use. The “Matthews Effect” explains how the more you read the better your reading skills become. Repetition is the guiding light to learning to speak, as we learned as infants and has been reinforced throughout our lives.

For a stroke victim, at a time when he or she is already disoriented and afraid, the loss or impairment of language is a ruthless blow. When brain tissue is damaged by a stroke, aphasia is the result in about 20 percent of stroke victims. But how many people have heard of this disease that causes a unique set of speech and language problems?

What exactly is aphasia?

Aphasia is the inability to speak, along with language problems caused by damage to the brain from a stroke. People with aphasia may have problems speaking, understanding speech, reading and writing (just one or all of these areas may be affected), ranging from mild to severe in nature. Aphasia does not generally affect the ability to think, reason and understand. Most aphasics know what they want to say – they just have trouble putting their thoughts into words. The inability to understand non-verbal forms of communication such as gestures and facial expressions may also exist.

The speech/language pathologist assists the stroke patient in relearning the communication skills necessary to rejoin his or her family, friends and colleagues. Intensive (four or five times weekly) speech therapy in the hospital setting usually begins soon after the patient is well enough to begin treatment. Usually six months after the stroke recovery begins improvement can be seen. However, the patient may also plateau after this time period. Depending on the patient’s health, age, motivation and the severity of the stroke, improvement can continue indefinitely.

First steps in recovery

First, understand that the aphasic person (and stroke survivors in general) may not seem like the person you used to know. And aphasia does not get worse over time unless there is another stroke or brain injury.

• Consult with the speech pathologist and ask what you can do. Never assume that the aphasic person can’t understand what’s being said – this will cause frustration, irritability and depression.

• Set up a daily routine for the aphasic person, being sure to provide rest periods, as stroke survivors tire easily.

• Encourage both favorite and independent activities.

• Display clearly labeled photos of family and friends to help orient the patient.

• Speak slowly and clearly rather than loudly.

• Speak in clear, simple language. Face the person to allow them to see your mouth and facial expression, it will help them understand what you are saying.

• Encourage the aphasic individual to speak by engaging in conversation on a level they can handle. Help with word finding if they get stuck, but first allow them to try for themselves. Let them slowly explain the word; this may allow their mind to think of the word.

• Listen carefully and patiently, even if the person’s speech is hard to understand. Compliment them on their progress, no matter how small.

• One-on-one conversation is easiest for an aphasic person – two or more people speaking at the same time can be confusing and make comprehension impossible.

• Encourage stroke survivors to try to write and draw. If the dominant arm is impaired, stroke survivors should practice writing with their other hand. Teach them to draw a line for each syllable of a word as they speak. When mastery is accomplished ask them to use the hand to pronounce each word.

• If difficulties are experienced in reading, books with plenty of pictures or large print books may aid comprehension. Help them write the main characters, plot and what happened (as a referral when they return to their reading).

Aphasia is a family illness – support for the caregiver is as important as help for the patient. Caregivers are special people who innately realize knowledge is power and can help heal or comfort with this power. It is a change for you but always remember it is also a life-changing event for your parent(s) or family member. They are your focus and you are their guardian.

Sometimes a hug, a kiss on the cheek, or quietly holding hands without talking can be the most comforting medicine for an aphasic person.

Carol Maloney is author of “Finding My Voice with Aphasia.”

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