“What’s Next?” How to Keep Challenging Your Brain to Maximize Recovery KERRI SUTLEY M.S., CCC-SLP LEAD SPEECH PATHOLOGIST ENCOMPASS HEALTH REHABILITATION [email protected] 1. Provide a brief overview of common cognitive, communication, and swallowing difficulties that stroke survivors and caregiver's can Learning encounter. Objectives 2. Offer tips, techniques, and technology based resources to help facilitate continued recovery What is a Speech- Language Pathologist and how can we help? What is a Speech-Language Pathologist and how can we help? A Speech-Language Pathologist is an individual trained in the assessment and management of difficulties with communication, cognition (thinking skills), voice, and swallowing. A Speech-Language Pathologist is trained to treat children and adults, however my specialty is adult rehabilitation therefore that will be the area of focus during this presentation. Common diagnosis that I see are those with Stroke, brain injury, Parkinson's and other neurologic conditions. Communication skills include: listening, The most common types speaking, reading, of communication writing, conversation, disorders are Aphasia, and non-verbal Apraxia, and Dysarthria. communication skills Communication Aphasia Aphasia is a disorder that results from damage to portions of the brain responsible for language. Aphasia can develop suddenly as the result of a stroke or head injury, or gradually as the result of a brain tumor or infection. It can also be a symptom of a degenerative dementing illness such as Alzheimer's. It is estimated that 18-38% of stroke survivors have aphasia. According to the America Heart Association in 2017 Aphasia Approximately 795,000 strokes occurred in the U.S. each year and about 1/3 of those result in aphasia. There are many types of aphasias. We will discuss three of the most common: Wernicke’s Broca’s Global. Wernicke’s FLUENT/RECEPTIVE APHASIA Wernicke’s area in the brain Fluent/Receptive Wernicke's aphasia occurs when there is damage in the posterior region of the temporal lobe in an individual’s dominant hemisphere of the brain. In fluent aphasia, an individual may be able to speak with normal rate and intonation but speech may have little or no real meaning because the individual’s sentences are lacking content words or may contain "made up" words (paraphasias). Paraphasia Types: Semantic Phonemic Neologisms The person may The person may The person may have substitute one word for substitute one sound or speech characterized another. For example, syllable for another. For as “jargon.” For example an individual may say example, an individual an individual may use “watch” for “clock” may say “dock” for words that are “made “clock” up.” For example saying “smire” for “clock.” Individuals with fluent aphasia are often unaware of their mistakes and can have some degree of difficulty with comprehension. They tend to lose focus when background noise is present or Fluent/Receptive when more than one person is speaking. Reading can also be impacted. The individual may be able to read a headline but not comprehend the text in the body of an article. Broca’s NON-FLUENT/EXPRESSIVE APHASIA Broca’s area in the brain Non-Fluent/Expressive Aphasia Broca's aphasia is the most common type of non-fluent aphasia. In this type of aphasia, damage is primarily in the dominant inferior frontal lobe of the left hemisphere (Broca’s Area). When there is a lesion in Broca’s Area, there can be a breakdown between one’s thoughts and one’s language abilities. Thus individuals will report they know what they want to say but are unable to produce the words. Speech is often produced in short phrases and with great effort. The individual may have difficulty Non- producing the right sounds or finding Fluent/Expressive the right words to communicate. Aphasia Sentence structures are typically simplified and often missing linking words or conjunctions: "drink water" for "I want a drink of water.” Non-Fluent/Expressive Aphasia Those with Broca’s aphasia generally comprehend fairly well, however understanding may break down with more complicated sentence structures. For example: "Joe gave Cindy a flower" may be easy for the individual to interpret, however "The flower was given to Cindy by John" may result in a breakdown in comprehension. Those with Broca's aphasia may be able to read but have limited writing ability. Global RECEPTIVE/EXPRESSIVE APHASIA Global Aphasia Global aphasia is the most severe form of aphasia. It results from damage to multiple language-processing areas of the brain. In global aphasia, individuals can typically produce little to no spoken language or the language they can produce may be incomprehensible. Comprehension skills are impaired even with very simplified sentence structures. These individuals are also often not able to read or write. While we have only covered three of the more common types of aphasia, Other Types more types do exist. Other types of aphasia include: mixed transcortical, of Aphasia transcortical motor, transcortical sensory, conduction, and anomic aphasia. Additional types of Aphasia Apps for Aphasia Apraxia MOTOR SPEECH DISORDER Apraxia Apraxia is a motor speech disorder that affects the brain pathways involved in planning the sequence of movements for producing speech. Just as in aphasia, apraxia can be mild to severe. Apraxia however, can happen in conjunction with other Apraxia speech and language problems (such as aphasia or dysarthria). In apraxia errors are often inconsistent and speech may be slow and halting or the individual may “grope” for sounds. An individual may be able to say everyday phrases and greetings with little effort especially when relaxed, Apraxia however longer and more complex sentences are difficult. An individual may also struggle more when asked to repeat a word or phrase vs. spontaneous production. Apps for Apraxia Tips for Improving Communication Interactions Have the individual keep a card they can show Improving or someone in case of emergency explaining that Compensating they have aphasia and/or apraxia and how that impacts their communication and for Aphasia understanding. Keep pertinent emergency contact and Apraxia information accessible or with the individual at all times. Improving or Compensating for Aphasia and Apraxia Do not “talk around” the person with aphasia/apraxia. Include them in the conversation. Many people with aphasia/apraxia feel that family, friends, doctors, etc., bypass them and communicate directly with the caregiver. While this may be necessary to a point to ensure that important information gets conveyed accurately, it is also important for the individual to feel included in these interactions. Improving or Compensating for Aphasia and Apraxia Do not talk FOR the person with aphasia/apraxia. Although word finding may be difficult for an individual, it's important for you to be patient when they are attempting to speak or communicate. Ask permission before you help or speak for them. Sometimes interrupting an individuals train of thought can actually make it harder and more frustrating for them to communicate. Improving or Compensating for Aphasia and Apraxia Minimize distractions and noise level. Turn off the TV or radio or other background noise and move to a quieter location if you can. This can help the person focus on the conversation at hand. Improving or Slow down YOUR rate of speech and make eye contact when Compensating speaking whenever possible. This for Aphasia can help the person with aphasia/apraxia better understand and Apraxia what you are saying. Improving or Compensating for Aphasia and Apraxia When you ask the individual questions use simple yes/no for basic needs and preferences. Try to limit open-ended questions: "What would you like for dinner?" Instead ask the question and provide simple/clear choices: "Would you like steak or chicken for dinner?" Improving or Compensating for Aphasia and Apraxia When giving instructions, break them down into simple steps and gesture if necessary. Allow plenty of time for the individual to process and respond. Improving or Compensating for Aphasia and Apraxia If the individual is struggling, try to encourage them to say their message another way or rephrase it. Also break down longer, more complex words into shorter segments. Try singing. Using melody can often make it easier to articulate words. Try tapping out the syllables in a word or tap your finger for each word in a sentence. Improving or Compensating for Aphasia and Apraxia BEST APPROACH: Use multimodal communication strategies. An individual will have much greater success when communicating by using a combination of speaking, gesturing, writing, sketching and/or the use of either low or high tech augmentative communication systems. Augmentative Communication Low Tech High Tech Does NOT require electronics of DOES use electronics to any kind and can include supplement communication. things such as picture boards , These can include the use of letter boards, word boards and computer programs, tablet any combination of the three. computers with APPS, and specially designed augmentative devices that can not only assist with communication but can be accessed multiple ways (pointing, vocalizing, eye gaze) Improving or compensating for aphasia and apraxia SOCIALIZE!!! This is often a scary one for those struggling with aphasia/apraxia but it is likely one of the most important things for brain recovery. Individuals with aphasia can feel very isolated and this can limit their desire to attempt to communicate. Try to get involved regularly with friends or family. Get involved in your church or other organization. Join a stoke survivors support group. How can you expect language and communication skills to recover if you don't USE them? Dysarthria MOTOR SPEECH DISORDER Dysarthria is weakness in the muscles used for speech including those of the lips, tongue, throat, and muscles for breathing. Dysarthria differs from aphasia. The individual with aphasia may have difficulty understanding speech Dysarthria (comprehension), using the right words or poor sentence structure.