Avera Medical Minute: Aphasia and Speech Therapy

By Nancy Naeve

Story Created: Jun 4, 2008 at 3:05 PM CDT

Story Updated: Jun 15, 2008 at 1:11 AM CDT

Aphasia affects 1 in 250 people in this country. More than 100,000 of you will acquire it this year, and yet most of us have never heard of it. It's a disorder that impairs a person's ability to process language and most of the time it happens after a stroke or after a head injury.

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One man in Sioux Falls is fighting tooth and nail to get his speech back with the help of outpatient therapy at Avera Physical Medicine and Rehabilitation.

46 year old Dave Gluyas is hammering away re-learning words to everyday objects that would come out without second thought. He has aphasia. A common communication disorder resulting from a stroke or head injury. Dave had a stroke in April 2008.

Dave says, "I know what I want to say... (he stops)
His longtime girlfriend Linda Tenneson helps finish his sentence and says, "It's in his head but it won't come out his mouth. It's very frustrating for him."

Three times a week for 45 minute sessions, Dave works with Tina Jacobson, a speech and language pathologist with Avera.

Dave says, "Tina she's great." He looks at Linda and says, "Tina, right?" Linda smiled and said, "That's right, Tina. She's been a great help."

Tina says, "Initially he used single words and a lot of gesturing. Everything was all jumbled up. But he has the best attitude. He's so happy and laid back and is very motivated to improve so he works hard when he's not with me by doing home projects."

Tina says some people are so impaired when she first sees them that she has to use a communication board to figure out what they need. It has pictures with words on it so the patient can point to what they want or what they are trying to say.

Tina says, "He still has trouble with word retrieval, coming up with words. So what we do is work on repetitive exercises and positive feedback."

Linda says, "He's come a long way from not knowing what the ER doctors meant in the when they asked him to raise his arms. He didn't know his birthday. He didn't know my name. And now he does. He knows all those things so I don't feel as bad leaving him alone so I can go to work. "

He now puts 2 to 3 word sentences together, but Linda says Aphasia is still hard on both of them. Dave was lucky in a sense because he recovered very quickly from his stroke physically. Other than aphasia, he has no impairment, but his speech pathologist credits his hard work and starting therapy immediately.

Linda says, "It is hard. In a sense, I've lost my best friend because it's so hard to communicate with him. It's frustrating for him too. To tell me what he wants to eat it becomes a game of charades and sometimes I don't get the charade. But with Tina's help we'll keep working on it. We are working through it."

And the hope is, his communication will once again be as sharp as the pencil he is learning to identify all over again.

HEALTH MATTERS: Recovery and rehab following a stroke

According to the National Stroke Association, 10 per cent of stroke survivors re cover almost completely, and 25 percent recover with minor impairments.

Tuesday, May 20, 2008 1:15 PM EDT

By Carol Sonatore, M.D. Princeton HealthCare System

This column is the second of a two- part series in recognition of National Stroke Awareness Month. Last week’s Health Matters focused on stroke symptoms and prevention.



More than 5 million people in America today have survived a stroke. Many are back to leading regular lives and through rehabilitation have learned to adapt to the changes that may have occurred because of damage to the brain.

This month is National Stroke Awareness Month and provides us an opportunity not only to educate people about the signs and symptoms of stroke and how to prevent it, but to teach people that there is life after stroke.

According to the National Stroke Association, 10 percent of stroke survivors recover almost completely, and 25 percent recover with minor impairments. The majority of stroke survivors — 40 percent — experience moderate to severe impairments that require special care.

No two strokes are alike, and the physical and emotional impacts, along with the rehabilitation and recovery process, vary from person to person. Much depends on the area of the brain that is affected, the severity of the stroke and the patient’s overall health.

Patients who experience a stroke in the right hemisphere of the brain, which controls movement on the left side and controls analytical and perceptual tasks, may experience the following effects:

• Weakness or paralysis on the left side of the body.

• Trouble with spatial and perceptual abilities that may cause problems judging distance or may create challenges in guiding their hands to pick up objects or button their shirt or tie their shoes.

• Impulsive behavior and impaired judgment that often causes some stroke survivors to dangerously believe they are able to perform the same activities they could prior to the stroke, including driving a car and walking without assistance.

• Left-sided neglect. Some stroke survivors will experience left-sided neglect, which causes them to forget objects or people on their left side.

• Short-term memory loss.

Stroke survivors who experience a stroke in the left hemisphere of the brain, the part that controls movement on the right side of the body and controls speech and language abilities, often experience different effects such as:

• Weakness or paralysis on the right side of the body.

• Trouble with speech and language, known as aphasia. Aphasia can impact a person’s ability to communicate whether through speaking or writing and can affect the ability to understand words.

• A slow and cautious behavioral style that may cause a stroke survivor to require frequent instruction and feedback.

• Shortened attention spans and difficulty understanding new information.

In addition, strokes in the cerebellum of the brain may cause unsteady walking due to difficulty with balance, dizziness and nausea. Strokes in the brain stem can be especially debilitating as the brain stem controls the body’s life support functions.

While recovering from a stroke takes time — generally, anywhere from six months to two years — rehabilitation is helpful and enables many patients regain skills they possessed prior to the stroke.

Rehabilitation often requires a multi-disciplinary approach that involves physical therapy to strengthen and retrain muscles; occupational therapy to help survivors with daily living skills; speech therapy; swallow therapy, and therapeutic recreation therapy, which helps stroke survivors reintegrate socially.

Rehabilitation nursing is also an integral part of the process for close patient monitoring, education and medication teaching. The patients work with nursing staff throughout the day and night on applying skills taught during rehabilitation therapies.

The ultimate goal of inpatient rehabilitation is to provide patients with the building blocks to continue their recovery either at home with or without assistance or in a longer-term care facility.

After a loved one experiences a stroke, it is often left to family members to determine where the patient will receive treatment. Finding the best rehabilitation program, especially during a stressful and emotional time, can be an overwhelming and daunting task.

In evaluating rehabilitation programs, the National Stroke Association recommends choosing a program that is accredited by the Commission on Accreditation of Healthcare Organizations (CARF). Requirements for CARF accreditation include:

• A medical director and doctors who are board-certified in rehab-related specialties, such as physiatry or neurology.

• A team approach for patient care.

• Regular rehab team meetings to evaluate each patient’s progress.

• Involvement of family members in the program, and regular family meetings to keep them up- to-date with the progress of their loved ones.

• Patient and family education and support.

• A defined process for handling emergencies.

• Ongoing assessment of each patient’s progress in terms of abilities and level of independence in activities of daily living, such as dressing and walking.

Experiencing a stroke is a significant life change for survivors and their families, and rehabilitation and recovery take time. With patience and commitment, however, many people realize there is life after stroke.

For more information about University Medical Center at Princeton’s CARF-accredited Acute Rehabilitation Unit or to find a physician with Princeton HealthCare System, call (888) 742-7496 or visit www.princetonhcs.org. If you would like to receive a free magnet card listing the signs and symptoms of stroke to place on your refrigerator or near your phone, please call UMCP at (609) 430-7107.

Dr. Carol Sonatore is the medical director of the Acute Rehabilitation Unit at University Medical Center at Princeton and is chair ...........

Signs and Symptoms of Learning Disability

Learning disabilities as defined by the Individuals with Disabilities Education Act (IDEA) is a disorder in one or more of the basic, psychological processes involved in understanding or in using spoken or written languages. These may be manifested in disorders of listening, thinking, talking, reading, writing, spelling, or arithmetic. They include conditions which have been referred to as perceptual handicaps, brain injury, minimal brain dysfunction, dyslexia, developmental aphasia, etc. They do not include learning problems which are due primarily to visual, hearing, or motor handicaps, to mental retardation, emotional disturbance, or to environmental disadvantage.

all the fears you hold so dear, turn to whisper in your ear

ok, so i think that the meltdown earlier stemmed from a sever epistemological crisis initiated by a conversation with UNT's computational neurology prof. it would seem that he is a proponent of epiphenomenalism... think hardcore behaviorist but instead of pretending the mind doesn't exist at all they just think that its an accidental side effect of brain activity with no actual control over the activity of the brain. while clearly a philosophical point of view, he seems to be sure that it is the only reasonable aproach to neuro-science that does not bring unsupported assumptions into the process.

a key feather in the epiphenomenalist hat is a series of latency experiments that claim to show that we don't experience a conscious feeling of making a choice until after the brain has already made the choice, thus proving the conscious mind superfluous. to me the major flaw in this logic is that the experiment only shows that there is latency in reporting a conscious experience. it says nothing about whether the brain activation is the experience of making a choice and the reporting gets put off for a few milliseconds, or (according to the claim) that the mind is simply getting a memo from the brain telling it that it made a great decision. and there are other possible readings of the experiment that can go either way.

UCSC project aims to provide a virtual speech therapist via cell phone

Researchers at the University of California, Santa Cruz, have received funding from Microsoft Research to develop a virtual speech therapist, accessible on a cell phone, to aid stroke survivors in Malaysia. The self-contained language rehabilitation program will use a computer-generated talking head that provides realistic speech and mimics the natural movements of lips, tongue, and jaw.

About 40,000 people suffer from stroke every year in Malaysia, and communication impairments are common among stroke survivors, said principal investigator Sri Kurniawan, an assistant professor of computer engineering in the Baskin School of Engineering at UCSC. As in many developing countries, however, access to speech therapy is limited. A shortage of speech therapists in Malaysia is one obstacle, and patients often have difficulty traveling to existing speech therapy centers.

"This project aims to create a virtual speech therapist on a cell phone," Kurniawan said. "Initially, the patient will meet with a therapist to work out individualized therapy programs. Then the programs will be loaded onto a cell phone and given to the patient."

Learning disabilities linked to later language problems

A Chicago university has suggested that a degenerative condition that affects language is linked with learning disabilities.
Scientists at Northwestern University found that people who suffer with primary progressive aphasia, a neurodegenerative condition affecting language, are more likely to have had a history of learning disabilities.People who have the condition experience deterioration in their language capabilities as they get older. The signs of aphasia include struggling to speak expressively, trouble understanding speech, and difficulty with writing and reading. In the report, the scientists state: "This relationship may exist in only a small subgroup of persons with dyslexia without necessarily implying that the entire population with dyslexia or their family members are at higher risk of primary progressive aphasia."The effects of aphasia differ depending on the individual and the symptoms can sometimes be eased by working with a speech therapist.Northwestern University's study has been published in the February edition of Archives of Neurology.

Gesture and aphasia: Helping hands?

Background: The study of communicative gestures is one of considerable interest for aphasia, in relation to theory, diagnosis, and treatment. Significant limitations currently permeate the general (psycho)linguistic literature on gesture production, and attention to these limitations is essential for both continued investigation and clinical application of gesture for people with aphasia.

Aims: The aims of this paper are to discuss i ..............