Communication difficulties

People who have suffered a stroke may experience a number of speech and language difficulties – some may have one main problem, but many experience a combination of problems – especially immediately after their stroke. These may include:

  • Struggling  to understand all that is said to them – especially complicateideas and things outside their immediate environment (Dysphasia)
  • Struggling to read and understand either single words and/or phrases and sentences (Dysphasia)
  • Struggling to find the right words for what they want to say – their speech is very disjointed, or is just single words strung together, or sentences are started and left incomplete (Dysphasia)
  • Struggling to form longer sentences (Dysphasia)
  • Struggling  to remember or produce letters to form words, i.e. spell (Dysphasia)
  • Struggling to speak clearly – their speech sounds slurred or very jumbled (Dysarthria)
  • Struggling to programme speech sounds, put their lips, tongue and mouth in the right positions for sounds and words – a breakdown in the part of the brain which governs the automatic sequencing processes of speech (Dyspraxia)

DYSPHASIA

Definition: A language problem as a result of damage to the Left Cerebral Hemisphere of the brain.

It can result in difficulties with listening, understanding, reading, speaking and writing.

Dysarthria and/or Dyspraxia can co-exist with the dysphasia but they result in different symptoms and require different therapy techniques from those clients with pure dysphasia.

LANGUAGE

RECEPTIVE LANGUAGE

Auditory Comprehension

The patient may not be able to understand what is being said to them.

This lack if understanding can range from having difficulty understanding simple yes/no questions and being unable to point to an object, to understanding and following more complex commands and questions.

Reading

The problem may range from being unable to match a written word to an object, to being able to read a long and complex paragraph

EXPRESSIVE LANGUAGE

Verbal Expression

Disability may range from being unable to name an object or using an associate word instead of the current one, e.g. chair for table, to being unable to form complete sentences.

Writing

Problems can range from being unable to write his/her name and address to labeling everyday object to putting words together to form a sentence.

He/she may be able to spell simple words such as hat or pen but unable to spell yacht.

Dysphasia can involve all four areas or can be quite specific and only affect one area.

DYSARTHRIA

Definition: A group of Motor Speech Disorders.

It results from impairment of the Upper or Lower Motor Neurone System or the Cerebellum or the Extrapyramidal System or a combination of all of these.

It can affect:

  • respiration
  • phonation
  • resonance
  • articulation
  • prosody

It requires 140,000 muscle events per second to produce normal conversation.

These movements must be fastaccurate and well coordinated.

Dysarthria reduces the ability of speech muscles to perform properly.

The patient will, if no dysphasia is present, be able to understand what is said to him and knows what he/she wants to say but muscle weakness inhibits them.

Speech may be slurred; may sound nasal; may become unintelligible after the first few words.

DYSPRAXIA

Definition: A sensori-motor speech disorder resulting from a Unilateral Left Hemisphere Lesion. It may co-exist with Dysphasia and Dyspraxia but language deficits and deficits in muscle strength do not account for Dyspraxia errors.

It is a disorder that affects the sequencing or ordering of movements, like the movements that we usually make automatically to produce speech sounds. It is caused by damage to the area of the brain that controls those movements that are made in speech. The damage means that the person does not ‘know’ how and where to position the tongue, lips and mouth to make sounds, or how to put sounds together.

The severity of the problem varies from person to person, depending on the amount of damage to the brain. Some actions are not affected by the damage, e.g. very automatic movements such as licking the lips whilst eating, or smiling in greeting.

There may even be some words and phrases that are not affected. Again, these would be very automatic, for example ‘oh dear’ or ‘well well’. Swearing is often not affected either, but these automatic movements and words are produced by an entirely different process from the one used for making sounds and words by conscious effort.

There is no muscle weakness with Dyspraxia unless it co-exists with Dysarthria.

If Dysphasia is also present, the prognosis for the return of speech is poor.

If the patient is not Dysphasic he/she can use writing/gestures/ pointing to aid communication while therapy is carried out, if these abilities were present pre-morbidly.

Ways to help

Communication is easier if:

  • dentures fit and are worn
  • hearing aids work and used properly
  • glasses worn if necessary
  • touch the patient to attract his/her attention
  • say his/her name
  • make eye contact before speaking
  • keep speech slow, clear and reduce complexity of language
  • give patient time to respond

How to help if they are having difficulty understanding:

  • Take your time, speak slowly and clearly. Do not shout unless you know your relative has a hearing problem
  • Make sure your relative can see your face as you speak
  • Break requests into stages, allowing a pause between phrases to give an individual time to try and understand what you are saying
  • Use mime, gestures and facial expression to back up what you are saying if necessary
  • Ask questions one at a time
  • When talking, try to reduce background noise and activity. The stroke client can be confused by too much noise and visual stimulus. Too many people speaking at one time may cause confusion
  • Vision may be affected by a stroke—especially being unable to see things on the stroke side. Place all materials on the ‘good’ side or directly in front of them
  • Talk about specific subjects using gestures / photographs / mime to help comprehension
  • Be patient and listen.
  • Use as much gesture and pointing as possibly to aid his/her understanding
  • Use facial expression

How to help if they are having difficulty speaking:

  • Do not rush them – we all speak better if we are relaxed
  • Ask them to gesture or point to what they want if you do not understand them
  • Encourage them to speak slower, saying each sound/syllable clearly
  • Say one word at a time
  • Notepads/alphabet and/or picture boards maybe useful
  • Ask questions requiring either yes/no answer. He/she may be able to nod/shake their head or use thumbs up/down to respond. Answers may not be reliable if Dysphasia is present
  • Repeat what you hear if you are having difficulty understanding to check whether you heard them correctly.

FEEDING AND SWALLOWING DIFFICULTIES

Approximately 50% of patients who have had a stroke have Feeding and Swallowing difficulties for a variety of reasons.

70% make a spontaneous recovery, but it can take up to 6 weeks.

Patients with Feeding and Swallowing difficulties are referred to he Speech and Language Therapy Department by the Medical Team.

Following assessment, specific recommendations are made about drinks and food—the amount and type that the patient can have.

If these recommendations are not followed, the patient may be at risk of drinks and/or food entering the lungs instead of the stomach. This could cause chest problems, which can have serious consequences.

The patient is seen regularly while difficulties continue, and where necessary will be seen after discharge from the hospital.