“We know that there’s some recovery in the brain immediately after an injury, and if you can add therapy in that time immediately after, that’s when you will see the majority of the gains,” Fritz says. In this acute-care setting, speech pathologists can evaluate a stroke patient’s ability to put together words and express themselves. They may gauge how well an individual answers questions, identifies objects, has a conversation, and carries out commands. About one-third of all strokes result in aphasia, yet the National Aphasia Association (NAA) estimates that about 8 out of 10 people have never heard of this disability. Although the condition affects everyone differently, in general, aphasia inhibits a person’s ability to speak. It can also impair speech comprehension, reading, writing, gesturing, and use of numbers. People with aphasia do maintain their intelligence. “One of the problems they often face is that everyone looks at them as if they are mentally challenged, because when they speak only three words may come out, says Carol Persad, PhD, the director of the University of Michigan Aphasia Program (UMAP) in Ann Arbor. That is devastating to people.” People with aphasia are the same as they were before their strokes, trying to express themselves in spite of disability. Although aphasia has no cure, individuals can improve over time, especially through speech therapy.
The Different Types of Aphasia
Aphasia can appear in different ways, notes the NAA. With Broca’s aphasia, damage to frontal regions of the brain make it difficult to form full sentences, and patients may leave out words. For example, the National Institute of Deafness and Other Communication Disorders (NIDCD) notes that a person with Broca’s may say “walk dog” when he or she means “I’ll take the dog for a walk.” Another type of aphasia, known as Wernicke’s aphasia, causes people to utter long sentences that may include nonsense words. Someone with Wernicke’s area damage may refer to a fork as a “gleebie,” according to the American Stroke Association. Global aphasia can be even more extreme, causing communication impairment in both speaking and understanding.
Starting the Recovery Process
After determining initial deficits, speech therapists begin coaching patients in pronouncing basic word sounds and teaching them ways to communicate nonverbally — pointing to pictures or words, for example. Although good progress can be made in the months after a stroke, Dr. Persad stresses that it is possible for people to make advances even years after their episode. Typically, regaining communication ability requires significant one-on-one repetitive therapy. “Scientific data show that the more you can do something repetitively and intensively, [the more] you will see changes from a language standpoint,” says Persad. Therapists also work with patients on exercises to make basic sounds again. They often present images to patients and ask them to verbalize what they see. “There is a lot of repetition to try to make associations between words and pictures,” says Persad. Patients may have an easier time finding the word that matches a simple object like a chair, while words like “on,” “in,” and “between” can be more difficult to process because these words don’t trigger a concrete image. In many ways, the process can be similar to learning a foreign language. In his book Relentless: How a Massive Stroke Changed My Life for the Better, Ted W. Baxter, a now-retired global financial executive who suffered a stroke in 2015, wrote about how taking English as a second language (ESL) courses helped him. Through a variety of therapies, Baxter regained speech and now provides his expertise as a stroke survivor in hospitals, universities, and health institutions in Orange County, California. Speech therapists rely on an assortment of techniques to revive speaking skills. Music, for example, has proved to be an effective means for people to remember words. Some aphasia patients can barely speak but they can sing entire songs.
The Benefits of a Group Experience
Because language is all about communication with others, therapy often includes group sessions with other stroke patients. These individuals face similar challenges, and group sessions give them the opportunity to support each other. “If one patient has a strong skill in one area and another has a strong skill in a different area, they can help each other,” says Fritz. Aphasia patients want to regain as much normalcy in their lives as possible and go about their typical day-to-day activities. With her aphasia groups, Persad and her colleagues practice reading a menu and ordering. Patients work toward the goal of going out together for dinner and ordering their food. “It sounds like a little thing, but it’s a big thing,” she says. “Everyone’s in the same boat. We have fun. It helps people realize that they can be functional again and have a life and not have to sit inside on the couch all day.” If group sessions are not available in your area, people who have had a stroke may seek out support clubs online or form their own. They may also consider joining in other types of activities, such as book clubs or art classes, attending sporting events, or taking trips to the farmer’s market. These experiences can boost confidence and self-esteem.
Getting Family and Friends Involved
While professional speech therapy is a vital part of rehabilitation, friends, and family can play a supportive, healing role. Speech therapists often encourage them to attend sessions to learn how they can better serve as caregivers and improve communication. But it’s also important to remember to take time to relax and recharge in between sessions. “I have watched people be so motivated for their family member who had a stroke that they just want them to work on it nonstop,” she says. “Sometimes that’s when I see frustration on the patient’s end. You need balance.” Finding a way to communicate this frustration or any other difficulties is key for recuperation, adds Fritz. Patients may use a card or signal to alert a therapist, family member, or friend that they are tired, frustrated, or having difficulty.
Turning to Tech Tools and Other Advances to Aid Recovery
Smartphones, tablets, and other electronic gadgets can equip aphasia patients with the means to both communicate better and practice their speaking skills. Many mobile devices come with voice-generating technology that allows users to express themselves with an electronic voice. With the Proloquo2Go app, individuals press symbols and images to produce spoken words. Other apps can help people with aphasia type out their questions, replies, and statements on their gadgets. Some of these apps include:
Constant TherapyTactus TherapyLingraphica
“These apps let patients do therapy even when the therapist isn’t with them,” says Fritz. In some healthcare facilities, including the University of Michigan, healthcare professionals are turning to telemedicine to carry out one-on-one sessions via their computer screens. “Patients can go home and we can continue therapy several times a week,” says Persad. In previous research, scientists have explored noninvasive brain stimulation as a means to boost language abilities. According to Johns Hopkins Medicine, transcranial direct current stimulation is considered experimental, but this noninvasive technique has shown promise helping stroke patients with their motor functions. “Stimulating parts of the brain in this way can potentially improve recovery,” says Persad. “The idea is to give the neurons an extra nudge.” For many aphasia patients, the road to recovery can be discouraging at times, but the odds of getting better are strong. “I certainly see more patients improving than not improving,” says Fritz. “It may take hard work on your part, but it can get better; it can get easier." Additional reporting by Ashley Welch.
