The word stroke applies to both ischemic and hemorrhagic cell injury. Ischemia is caused by decreased blood flow leading to infarction of tissue and cell injury and death. Hemorrhagic stroke is secondary to extravasation of blood into brain tissue resulting to cerebrovascular disease. Stroke can damage one or more vital centers for the production of intelligible speech. Dysarthria is a common finding after a stroke. It is characterized by weak, imprecise and poorly coordinated speech production with decreased articulation without problems in word comprehension and word retrieval. In aphasia, there is impairment in comprehension of written and spoken word, and word retrieval.
Right after a stroke, establish a reliable means for basic yes/no communication. The hospitalized person may nod or shake his head lightly in answer to a question. Fluttering the eyelash is another basic yes and no communication. Other functional means of early communication are writing and communication boards and eye-gaze system. This promotes rapid and efficient one-to-one communication between the affected person and his family. Use simple words and gestural communication. Avoid simple childish phrases as he may perceive them as infantile and may withdraw. Be observant for his guttural responses and communication because he may not understand the verbal and written language. Try to understand what he is trying to communicate.
Speech therapy starts two weeks from start of speech impairment. Speech and language therapists assess people with communication difficulties and plan techniques according to the severity of the symptoms. The aim of therapy is to help the affected person recover his speech as much as possible and find alternative ways of communication. Two to eight hours per week for six months makes a significant recovery.
Treatment of dysarthria ia generally beneficial and satisfying. The basic principles are to increase muscle strength, endurance, coordination and efficiency. Exercises are steady controlled exhalation, articulation and voice exercises, palatial exercises and respiratory retraining. Draw attention to own mouth with slight exaggeration. Slowly form the start of the word with lips and prompt him the correct word. Pause between sentences to take a breath. Repeat words and sentences to improve his comprehension. Involve him in conversations. Guide his lips and tongue in forming words. For some people electronic communication may be beneficial. There are a variety of devices on the market from hand held keyboard print outs to computerized panels which offer a selection of phrases.
How well the afflicted person understands what is said to him? How difficult is it to express himself? He will be asked to describe his surroundings as a test of spontaneous speech. He is asked to repeat simple phrases or sounds. The techniques the speech therapist use will depend on the particular problem he has. If he has difficulty understanding the meaning of words (receptive aphasia) he may be asked to match words to pictures, sort words according to their meaning and judge whether the word have the same meaning. These activities aim to strengthen his ability to remember word meanings and link them to the spoken and written words.
If he has difficulty finding the words he wants to say (expressive aphasia), the therapy might include practicing naming pictures and repeating words the therapist will say. The therapist may provide prompts, making the first sound of a word or writing the first letter. They may also show him objects that he can touch and see while speaking their names. If he has weak muscles in the mouth, he may do exercises to help improve muscle strength. The therapist will tell him where his tongue, lips and jaw should go when producing particular sounds. Difficulty controlling his breathing muscles can force him to take a breath in the middle of a sentence. Breathe and pause within sentences.
One approach to helping dyspraxia is to use natural melodic patterns for everyday phrases. “Good morning,” when said very cheerfully has musical melody. Use this in an exaggerated way to coordinate speech. If he has difficulty making the rights sounds in the right order to form words, repeat words of increasing length. Do single words then follow with making simple sentences.
Alternative or additional communications are gestures, writing, communication charts, letter board and drawing. Combine verbal communication training with language games that build simple and complex language skills. Encourage the affected person to speak than using gestures. In severe cases a communication device may be considered. Electronic communication may enable even the most severely disabled non speaking individual to produce written and spoken output.
When therapy starts, the therapist will give written instructions so that the affected person and his family can practice specific exercises. It may be helpful if a family member can attend some therapy sessions and help him to practice them at home. The family should not do all the talking for him. Speech may be slow at first. Wait for half a minute for him to answer. Ask questions with yes and no answer and gradually increase the complexity just like learning a foreign language. Repetition and hard work are important. Communication can be very tiring. Sometimes just enjoy each other’s company like listening to music together or looking through photo albums. Affected people who received additional language training reinforced by friends and family showed further improvements. The therapist acts as an advisor and will follow up and review within six months from end of therapy.
Study says short intense speech therapy is best. At first, frequent short sessions then later on longer sessions when the person has better understanding. Most improvement in impaired speech occurs in the first six months after a stroke. Speech therapy improves functional communication and spontaneous neurologic recovery.
Article by Trifonia Sumicad
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