Communication Problems After Stroke
When we communicate or speak, it is controlled by our brain. Research indicates that approximately 40% of stroke patients have experienced varying degrees of communication difficulties. There are several types of communication disorders. The first is aphasia, where language abilities are impaired, potentially affecting patients’ comprehension or expression. They may not fully understand what other family members say or may struggle to speak fluently, sometimes forgetting certain phrases or words. The second is motor speech disorders, where patients have unclear articulation or pronunciation, commonly known as “slurred speech.” Some patients may even have impaired voice quality. Another type is cognitive-communication disorder, which involves impaired cognitive functions such as deterioration in memory, attention, even logical reasoning. These patients may speak relatively fluently, but their speech may be disorganised, incoherent or irrelevant to the conversation.
Q2. Do communication disorders only affect a patient’s ability to speak?
Communication impairment certainly affects a patient’s ability to interact and speak with others. While communication abilities are impaired, it also affects various aspects, most immediately is one’s emotional well-being. Due to reduced social interaction, many patients might fail to speak out their mind or feel sad, or even experience depression and anxiety. Some may develop low self-esteem as they cannot communicate effectively. Also they may feel isolated, in the belief that no one can understand their situation.
Communication disorders also impact social and interpersonal aspects. When patients are unable to communicate as usual, they are less likely to interact with others. It may end up in differences in social engagement or family roles. Communication difficulties can also affect participation in rehabilitation, as one may find it difficult to understand the instructions from therapists, doctors, and nurses, thereby hindering recovery. For some patients who need to work, severe communication disorders may prevent them from returning to their job duties.
Q3. Is aphasia merely "a difficulty with speaking"?
Aphasia presents with a variety of symptoms, which can differ from person to person. It may affect a patient's comprehension, expression, and even reading and writing abilities. Aphasia can be broadly divided into expressive and receptive aphasia.
Patients with expressive aphasia want to speak but cannot articulate their thoughts. They may struggle to recall certain words while speaking, possibly forgetting them, confusing them with other words, mispronouncing them, or even talking nonsensically that no one can understand. Some patients have difficulty speaking in coherent sentences or reading long passages fluently. Others may have writing difficulties. These are all symptoms of expressive aphasia.
Receptive aphasia refers to an inability to fully comprehend what others say. Patients may miss or mishear questions, or fail to follow instructions. While speaking fluently, they may give irrelevant answers to or misunderstand what is being asked, causing difficulties in conversation. Some patients may have both expressive and receptive aphasia at the same time.
In addition to differences in classification, the severity also varies significantly. More severe patients may show no response to sounds or have little reaction to others’ speech, often remaining non-verbal most of the time. While patients with milder aphasia may speak fluently but occasionally struggle to recall specific words.
Q4. What is motor speech disorder?
To speak clearly and pronounce words accurately in daily conversation, the brain controls nerves that direct the speech muscles responsible for articulation. When those nerves and muscles in the mouth, tongue, or throat are affected by stroke, their movements may slow down, weaken, or lose coordination, impairing one’s pronunciation and articulation. This is known as motor speech disorder.
What are the common symptoms of motor speech disorder? One of them is unclear articulation and pronunciation, commonly known as "slurred speech". Voice may become hoarse or tight in some patients, while in others the brain’s “programming” for pronunciation may be disrupted and cause sound misarticulation. For example, even when they want to say "A", it may come out as "Ar", "Er" or "Da". These are all classified as motor speech disorders. While patients do know what they want to say, unclear articulation or pronunciation can make it difficult for others to understand.
Q5. How does speech therapy assess and improve patient conditions?
Upon receiving a doctor’s referral, speech therapists will meet the patients and their family members and conduct a clinical evaluation. Standardised assessment tools or a series of tests are used to evaluate the language and speech abilities. To gain a comprehensive understanding of the patients’ current communicative abilities for accurate evaluation and diagnosis, we also observe their interactions with family members to assess their conversational performance. Based on one’s specific difficulties and needs, we develop individualised treatment goals and plans in such areas as oral motor skills, articulation, language comprehension and expression, as well as reading and writing. These measures are tailored to individual’s diagnosis and requirements. Additionally, we will also learn about one’s interests and daily communication needs to ensure that the treatment aligns with one’s needs and preferences. This approach helps patients apply what they learn in therapy to their daily communication more effectively.
Q6. How can family members support the therapy process?
Family members play a crucial role in the therapeutic process. Their presence during therapy sessions provides emotional support to the patient, often enhancing the effectiveness of the therapy on the road to recovery. Family members can also gain valuable insights during therapy sessions. They can learn to understand the patient’s communication needs, adjust their own communication methods accordingly, and adapt their own speaking style to facilitate better interactions. They can also learn effective prompting techniques to encourage and improve the patient’s communication, and also contribute to recovery by engaging in home-based exercises with patients.
Q7. How to communicate with patients with communication disorders?
Effective communication with patients requires appropriate environmental conditions and timing, ideally when they are alert and in a quiet setting with minimal distractions. Adequate lighting is also essential to ensure the patient can see you clearly. When the patient is seated or lying in bed, it is better for family members to position themselves at an angle that allows face-to-face interaction. This fosters a sense of respect and aids their comprehension by allowing patients to observe your face and lip movements clearly.
Family members should also allow extra time for the patient to respond, especially to process and formulate their thoughts. Do not interrupt while they are talking, speech, as this may deter them from speaking and communication. Be patient and wait for their response. Try to speak slowly and give them sufficient time to process. Repeat key words or phrases several times for emphasis. If you are familiar with the patient’s specific difficulties, you can provide supportive prompts. For example, if the patient struggles to express a thought and fail to do so, you might model lip movements, offer multiple-choice or yes/no questions, or provide a single-word cue to help them articulate their response.
Q8. Is there a critical period for speech therapy? Should treatment still be sought if it is missed?
Generally speaking, the critical period refers to the first three to six months after stroke, during which the recovery is most rapid. However, more and more recent studies have shown that progress can still be achieved six months or even one to two years post-stroke, though at a slower rate than in the initial six months. In addition to the time elapsed after the stroke, several factors influence a patient’s recovery potential, such as one’s willingness to engage in therapy, frequency of practice, family support, emotional wellbeing, and overall functional abilities. Some patients with limited verbal capabilities, or those who have had a stroke for some time, can still achieve improvements through speech therapy and maintain existing abilities to prevent further deterioration. Augmentative and alternative communication tools, such as a communication book, are often designed for patients with restricted verbal capabilities. With non-verbal means, such as convey instructions with pictures and texts, these methods can help patients express themselves and make it easier for others to understand their thoughts. Therefore, regardless of how long it has been since the stroke, patients can still achieve improvement by consulting a speech therapist for assessment and follow-up.
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