Stroke and its after-effects and role of speech therapy
Stroke and its after-effects and role of speech therapy

The period after a stroke is very critical, not only for the patient but also for his/her caregivers. A stroke patient has to go through a lot of challenges, including speech problems. Complete recovery from a stroke attack takes time, and one has to keep patience. It is normal for a person to get depressed in such a situation and everybody has to stay strong and optimistic about good outcomes and quick recovery.

Impact of Stroke

Stroke is an injury caused to the brain, which controls everything, including speech and language. It also controls our ability to interpret and understand the meaning of something that somebody says. So if there is a damage caused to the part of the brain responsible for processing speech and language, a person’s communication skills get affected, along with his/her ability to understand.

The effects of stroke might be different for different individuals, depending upon the type, severity, number of strokes and location. Our brain is a complex organ, and each of its various areas is responsible for processing specific abilities and body functions. If our brain gets affected due to stroke, it might hamper these functionalities, and hence, has a significant impact on one’s basic abilities like speech, language, understanding and interpretation.

Effects of a Stroke in the Cerebrum

The cerebrum of your brain controls speech, reasoning, thinking, vision, memory, emotions, movement and sensation. Our cerebrum is divided into two hemispheres – the right and the left, each one responsible for carrying out particular abilities or functions. Depending upon which side or area of the cerebrum gets affected by stroke, one or more of the following functions might get impaired –

  • Movement and sensation
  • Speech and language
  • Cognitive ability, including reasoning, thinking, judgement, and memory
  • Vision
  • Eating and swallowing
  • Self-care ability
  • Sense of perception and surrounding orientations
  • Emotional control
  • Bowel and bladder control
  • Sexual ability

Apart from these, more specific impairments or disorders might occur in case of a damage caused to a particular area of the cerebrum,like Lt MCA territory infaracts mostly lead to Motor aphasia and apraxia of speech.

Effects of a Stroke in the Cerebellum

The cerebellum is located behind the cerebrum at the back of the skull. Upon receiving sensory information from our body via the spinal cord, the cerebellum helps to coordinate muscle actions with movement, control, coordination and balance. The impacts that a cerebellar stroke can have on the patient include –

  • Inability to walk, accompanied by the loss of balance and coordination (ataxia)
  • Dizziness or vertigo
  • Nausea and vomiting
  • Headache

In this article, we will discuss the impact of a cerebrum stroke and how a speech therapist would help him improve the patient’s speech and language, as well as treat swallowing disorders.

Impact of Stroke on Communication

Stroke survivors suffer from various speech and language issues like aphasia, dysarthria and dysphagia (swallowing disorders). While they, along with their family members/caregivers, are struggling with these issues in their day-to-day lives, the assistance of a professional speech therapist might help to improve outcomes. As per the studies, about one-third of the total stroke survivors develop speech and other communication impairments, along with issues with reading, writing and comprehending what others are trying to convey.

The left side of our brain controls speech and language processing abilities. However, communication disorders can also occur if the facial muscles, tongue or throat are affected due to stroke. The nature and extent of communication problems that a stroke survivor might have, depend upon the area or part of the brain that was injured.

Moreover, stroke can also cause a change in the emotional content of a speech. For example, you might have difficulty understanding feelings like humour or even fail to realise when to take turns while participating in active communication. Further, the fact that your speech and language has been affected by stroke might itself be a depression-causing factor. This causes a change in the stroke survivor’s mood or personality, and might even make the person lose his/her self-confidence.

Can Speech be Improved After Stroke?

Any individual having speech and language difficulties after a stroke can be best treated through speech therapy. The person must consult a professional speech-language pathologist (SLP) to receive a full assessment, diagnosis and treatment of their speech impairments. A qualified SLP having specialisation in stroke and rehabilitation would know how to deal with stroke survivors. The speech therapist would get to the root of the problem and assess the strength of the patient’s speech and language abilities. An SLP would perform various tests to identify and determine the exact nature and extent of the communication problems the patient is facing.

A stroke survivor can have either aphasia, dysarthria or dyspraxia, or even a combination of all these conditions in serious cases. Based on the nature of the problem, a speech and language therapist would analyse and decide upon the best method to improve the affected communication skills of the patient. The therapist would also discuss with the caregivers or family members of the affected person, as well as other professionals in the medical team to ensure the best outcomes for the person.

Role of  Speech Therapy in After Stroke Program

An ideal after stroke speech therapy session would involve the speech-language pathologist to teach some effective and practical exercises to enhance the person’s communication skills. The goal of a speech therapist is to restore as much speech and language skills as possible to help the patient live a better quality of life. The therapist would also work on compensating for the lost language skills by teaching and assisting the stroke survivor in learning other ways to communicate.

A professional SLP uses a combination of techniques and resources to improve outcomes. After undergoing the initial evaluation conducted by an SLP, the patient may start rehabilitation in which he/she may need to join one-on-one therapy sessions with the SLP. In other cases, the affected person might also be asked to participate in group sessions with other individuals having similar speech and language problems.

This group setting might be very impactful as it provides a low-stress environment, probably because people having the same issues feel more confident in being with a single community having one motto. In group sessions, one can practice communication and understanding skills, such as by starting a conversation, or taking turns in the discussion, clarifying doubts, misunderstandings and ideas. This makes way for a productive communication environment, thus helping to improve one’s speech and language.

To brief up, speech therapy can be beneficial for the stroke survivor in the following ways –

  • Speech therapists would suggest specific exercises based on the nature, type and severity of your speech disorder. The common speech therapy exercises for stroke patients include –
    • Breathing exercises
    • Practising speech sounds through effective communication
    • Tongue strengthening exercises
    • Sentence practice
    • Naming pictures or labelling charts
  • Speech-language pathologists assess, analyse, diagnose, and treat problems related to speech, language, cognitive-communication and even voice. They work on improving the overall communication function of a stroke survivor.
  • Speech therapists help to boost one’s confidence and social interaction skills by providing advice, education, exercises, and strategies.
  • The SLP may also incorporate the usage of effective computer programs or mobile apps, or other technological resources that aid the patient in relearning sounds, words, and language.
  • A speech therapy session might involve the stroke survivor to try to make effective communication and understand what the other person is trying to say.
  • The speech therapist can use communication aids and props like pictures, charts, notecards having common phrases, or a paper pad and paper, as a part of rehabilitation for speech and language. This encourages the person to work on conveying his/her thoughts and feelings more meaningfully and clearly.
  • A speech therapy program might involve counselling sessions for the family members or caregivers in which they are told about the strategies and techniques to improve the person’s communication. This might include the way of speaking with them, monitoring the environment the patient is speaking in, or whether they are doing the suggested exercises properly. For example, being a caregiver, you might often be asked not to complete or correct the sentences of the patient. Also, it is advised to keep all sorts of distractions away, like turning off the TV or other electronic devices when you are talking with the patient, so that he/she can focus only on what he/she is saying. In every way, the person should feel relaxed and must have your support completely.
  • In advanced speech therapy sessions, the SLP may also role-play with the patient, such as by practising to talk over the phone, interacting with the vegetable man or a salesperson at the grocery store.
  • A speech therapist can also work with an occupational therapist to help improve the patient’s movement and sensation, as well as cognitive abilities, so that he/she can go back to work or school. In such a situation, the SLP might even discuss with the employer or educational specialist to modify their work environment or learning strategies to meet the new needs of the stroke survivor.
  • A Speech-language pathologist may also teach the patient how to keep track of the occurrences in his/her day-to-day lives using a memory log. The professional might also advise the person to use an organiser for planning his/her daily tasks.
  • Online speech therapy after stroke might be quite effective in boosting the motivation of the patient and thus, help to improve outcomes. The after stroke online therapy sessions work the same way as a traditional therapy program, only with more efficiency and better results. Moreover, one can participate in these online sessions at the comfort of one’s home, thus making the patient feel more relaxed and comfortable, which is the key to a successful speech therapy program for stroke survivors.

In a nutshell, you must know that the recovery of the speech and language skills of a stroke survivor might take time and needs some patience and persistence on your part. However, never delay rehabilitation because it may lead to further complications and hence, might reduce the chances of improvement. This may lead to misunderstandings, relationship problems, embarrassment, frustration, anxiety disorders and even in some severe cases, depression.

So being a caregiver, it is your responsibility to encourage and motivate the stroke survivor to make the appointment with a professional speech therapist, and make the person realise its importance and what might be the expected outcomes.

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