Aphasia after stroke: Regaining communication skills with speech-language therapy
Aphasia after stroke: Regaining communication skills with speech-language therapy
After a stroke, depending on the area of the brain affected, various communication problems may occur, including creating sentences, using incorrect words, repeating words or sentences, misunderstanding others, inability to read and write, or slurred speech. Aphasia is the term given to problems with language expression or comprehension. In this video, Dr. Wes Oczkowski discusses the importance of speech-language therapy to help regain language after a stroke.
Learn the answers to the following questions:
0:00 Meet Jason
2:03 How do strokes affect communication?
3:13 What are the treatment approaches for communication challenges after a stroke?
6:00 What professionals are involved in an assessment?
8:40 What does a speech-language therapist do?
13:26 Does research support speech-language therapy as a post-stroke communication recovery tool?
Learn more at: https://www.mcmasteroptimalaging.org/…
This work is supported through the McMaster Institute for Research on Aging and funds provided by the Dean and Vice-President, Faculty of Health Sciences at McMaster University.
Disclaimer: These videos are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The videos may be used for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal ([email protected]).
Content
0.16 -> jason is helping to provide care to his
2.639 -> father who recently experienced a stroke
6.08 -> after a few weeks in the hospital
8 -> jason's father was discharged to go home
10.96 -> his father's working to regain many of
13.2 -> his physical abilities but is continuing
15.599 -> to struggle with regaining his
17.199 -> communication skills
19.279 -> jason and his father are keen to know
21.52 -> what else they can do to improve his
23.6 -> speech and language a stroke happens
26.96 -> when blood stops flowing to any part of
29.519 -> the brain
30.8 -> this interruption causes damage to the
33.2 -> surrounding brain cells which cannot be
35.84 -> repaired or replaced
38.12 -> 1.9 million brain cells die every minute
41.76 -> during a stroke
43.44 -> every year in canada there are more than
45.44 -> 62 000 strokes with more than 405 000
49.52 -> people in canada living with the after
52.16 -> effects of a stroke
54.079 -> after a stroke depending on the area of
56.399 -> the brain affected various communication
59.28 -> problems may occur
61.44 -> common communication difficulties
63.44 -> include creating sentences using
66.799 -> incorrect words repeating words or
69.6 -> sentences
70.76 -> misunderstanding others the inability to
73.6 -> read and write or slurred speech
77.2 -> typical communication difficulties are
79.92 -> often referred to in two categories
83.2 -> aphasia a term given to problems with
86.159 -> language expression or comprehension
88.799 -> and dysarthria a term given to problems
92 -> with muscles used for speech which may
94.799 -> cause slurred speech or slow speech
97.6 -> we've asked dr weskowski to talk about
100.4 -> regaining language after stroke and what
102.96 -> the research says about speech language
105.52 -> therapy
106.72 -> dr skowski is a professor of medicine at
109.119 -> mcmaster university and the neurology
111.759 -> division director thank you so much for
114.079 -> joining us today uh dr roskowski
116.96 -> my pleasure thank you for having me
119.119 -> so uh let's start with the can you just
121.439 -> talk about how strokes may affect
124.399 -> communication
126.88 -> so
127.6 -> one of the the most common uh serious
130.08 -> neurological problem is actually stroke
132.48 -> so it affects many individuals uh uh in
135.68 -> the country it's more common when you're
137.44 -> older but it can affect younger and
139.599 -> older people
141.52 -> the brain is
143.04 -> is divided into specific
145.76 -> parts that do specific things and in
148.16 -> human beings
149.84 -> most people their language centers their
152.4 -> ability to understand and their ability
154.8 -> to express themselves
156.72 -> is situated in the left side of the
158.319 -> brain
159.2 -> and depending on
161.2 -> what type of stroke someone has and what
163.12 -> part of the brain it involves it may
165.599 -> involve their language centers
167.92 -> so in other words
170 -> including some weakness or some numbness
172.8 -> or problems with other parts of the
174.4 -> brain function a person may have a
176.64 -> language disturbance and that happens
178.56 -> quite commonly
180 -> uh probably in half of everybody who has
182.56 -> a stroke that will have some language
184.879 -> disturbance
186.159 -> and those will be very obvious in terms
188.319 -> of being able to express yourself or
190.159 -> being able to understand what are some
192.64 -> of the treatment approaches for
195.519 -> communication challenges after stroke
198.159 -> treating language problems or aphasia is
202 -> um very challenging
204.64 -> it's much more obvious when we see
207.519 -> somebody who's had a stroke who has a
209.2 -> weakness involved in an arm or a leg
212.239 -> where you can actually manipulate the
213.76 -> arm and the leg and see how it moves and
216.48 -> how it recovers
218.56 -> language the ability to understand the
221.04 -> ability to express yourself is very
223.76 -> complex
225.519 -> and that you can't the person helping
228 -> someone with a language problem can't
229.76 -> actually
230.72 -> see the problem directly they have to be
233.92 -> able to
235.519 -> assess
236.799 -> the difficulties by
239.599 -> listening to the individual getting the
241.439 -> individual to try to talk
244 -> to test the individual how they
246.159 -> understand
247.599 -> um and those things are more challenging
250.72 -> than dealing with what i would consider
252.959 -> is much more simple weakness problem
255.439 -> after a stroke
257.44 -> the first step in dealing with
260.16 -> a language problem or aphasia after
262.24 -> stroke is to understand what the problem
265.12 -> is
266.32 -> and the injury to the brain in everybody
270 -> will be slightly different
272.08 -> and how somebody has and what kind of
274.8 -> problems they have
276.16 -> will be different from person to person
279.04 -> the first step the therapist needs to
281.36 -> understand
282.4 -> is to do an analysis an understanding of
286.24 -> is the problem
287.84 -> difficulty understanding what somebody
289.84 -> says
291.12 -> is the problem difficulty with
293.12 -> expressing yourself
295.759 -> is the problem
297.36 -> more
299.04 -> specific such as being able to write
302.56 -> or is the problem more specific being
304.32 -> able to read those are also language
306.479 -> functions as well
308.4 -> so the first step a therapist does is to
311.36 -> identify what the problem is to be able
314.4 -> to then to say this is what we're going
316.56 -> to work on we're going to work on your
319.36 -> ability to express yourself
321.759 -> it's the ability to express yourself a
323.6 -> difficulty with finding words
326.16 -> finding sentences
327.84 -> controlling your mouth or your tongue
330.4 -> or is it ability to on difficulty and
332.72 -> understanding so it is an ability to
335.039 -> understand
336.24 -> people talking more than one person
338.88 -> talking to you is it difficulty
341.039 -> understanding
342.56 -> written language or is it just verbal
345.039 -> language
346.08 -> so the first step in any type of
347.84 -> approach to helping somebody with
349.68 -> aphasia is to understand exactly
352.56 -> what the problems are
354.88 -> and and would that assessment typically
357.12 -> be done by
358.8 -> uh a speech language pathologist or
361.36 -> speech language therapist or are there
363.6 -> other um types of therapists that would
366.56 -> be involved in that type of assessment
369.199 -> so the primary assessment the detailed
371.52 -> assessment would be by a speech language
373.36 -> therapist that those are the individuals
375.36 -> who have
376.319 -> trained and are skilled in in doing that
379.759 -> speech language
381.12 -> therapists have assistance that can
383.28 -> actually help them once they understand
385.36 -> what the difficulty is and once they
387.36 -> have a therapeutic plan
389.199 -> once the therapeutic plan is in place
391.039 -> sometimes assistance and assistance can
393.52 -> actually include trained family members
396.08 -> and or other individuals who work with
398.8 -> with the patient themselves to then work
401.199 -> on their their treatment plan
403.919 -> and and when would that type of
406.96 -> assessment typically happen would it
408.88 -> happen you know within a short period of
411.919 -> time after a stroke if somebody's still
414.56 -> in hospital or does it usually is there
417.199 -> usually a waiting period around that
419.039 -> type of assessment
421.36 -> um the assessment uh speech language
423.759 -> therapists are involved virtually from
425.919 -> day one
427.12 -> when somebody comes in and has a stroke
429.52 -> uh they
430.72 -> for example one of the things that they
432.4 -> do early on even before assessing
434.479 -> language problems one of the things that
436.639 -> often
438.4 -> happens at the same time as a language
440.24 -> problem is a swallowing problem which
441.84 -> includes the mouth and the throat
443.84 -> so
445.039 -> as part of the best practices in stroke
447.28 -> care speech language therapists assess
449.68 -> every individual comes into the hospital
452.16 -> for swallowing difficulties
455.199 -> that has to be the priority to prevent
457.199 -> problems complications such as
458.639 -> developing pneumonia from swallowing the
460.479 -> wrong way and getting food into your
462 -> lungs
463.68 -> immediately within the first few days
465.599 -> after a stroke a speech language
467.12 -> therapist will do that assessment that
469.84 -> evaluation to help all the other team
472.56 -> members understand what language
475.759 -> problems your patient may have
478.8 -> all the other team members who are
480.16 -> working with the patient in doing their
482.16 -> daily care helping them mobilize helping
485.68 -> them address themselves take care of
488.08 -> themselves need to understand
490.879 -> what language problems the person may
492.879 -> have
493.84 -> that they don't understand when you say
495.599 -> something to them or that they have
497.599 -> difficulty expressing their needs and
499.52 -> their and their wants so a speech
501.919 -> language therapist is instrumental in
503.759 -> the first few days in identifying
506.4 -> if there is an aphasia a language
508.56 -> problem
509.52 -> and what the problems are so that the
511.68 -> rest of the team
513.279 -> and the family can engage appropriately
516.08 -> with the person what exactly does a
518.24 -> speech language therapist do for people
520.719 -> recovering from a stroke
523.2 -> so a speech language therapist
525.36 -> provides one-on-one
527.92 -> uh therapy
529.68 -> so in other words the
531.76 -> patient and the speech language
533.2 -> therapist sit together and are engaged
536.399 -> on a one-to-one approach
538.48 -> and as i said earlier the first step is
541.04 -> this the speech therapist does testing
544.16 -> and the testing is to look at what is
546.88 -> the problem
548.72 -> is my patient with me are they having
551.44 -> difficulty
552.72 -> manipulating their tongue and their
554.56 -> mouth and it's a problem with slurred
556.56 -> speech or something called dysarthria
559.839 -> or
560.88 -> when i test them are they having
563.279 -> difficulty understanding what i'm asking
566 -> them
566.959 -> are they having difficulty understanding
569.12 -> words or sentences or complex ideas
574.16 -> on the other side does the person have
576.959 -> difficulty
578.32 -> expressing
580.72 -> simple words
582.72 -> complex sentences or complex thoughts
587.04 -> first step is to sit on a one-to-one
589.36 -> basis and to identify what the problems
592.32 -> are
593.44 -> then the next step is
595.2 -> on a regular basis
597.36 -> and this is with as much intensity as
600.399 -> appropriate
602.079 -> the therapists
603.68 -> addresses those specific problems so for
606.32 -> example if it's comprehension or
608.079 -> understanding
609.36 -> or expression or talking
612 -> and the therapist will engage the
613.92 -> individual
615.12 -> in trying to enhance their ability to do
618.16 -> those things correctly or understand
620.56 -> things correctly
622.32 -> they will start with simple approaches
624.8 -> and build on those on a regular basis
627.04 -> into complex
629.04 -> therapies
630.839 -> complex for example
632.959 -> um
633.92 -> saying more complex words or complex
636 -> sentences
637.2 -> being able to understand
638.88 -> simple words or simple or complex
641.04 -> sentences
642.48 -> the therapist does that on a regular
644.959 -> basis the recommendation is is actually
648.24 -> quite intensive therapy
650.48 -> an hour every day
652.32 -> five days a week
654 -> to start a after a stroke
657.36 -> for up to the first
659.2 -> four to six weeks would be the
660.959 -> recommendation by the best practice
662.959 -> guidelines and is it also the case that
665.2 -> it's it's sort of
666.48 -> not only intense but
668.16 -> the sooner the better you mention the
670.24 -> the speech language therapist getting to
672.64 -> do the swallowing assessment up front
674.48 -> but is it also recommended that the
677.04 -> speech language therapy for supporting
679.68 -> language would also be early and often
684.32 -> yes we believe so
685.92 -> the reason we believe so is that for
688.079 -> example
689.44 -> um most of the um the literature or the
693.04 -> science of recovery after a stroke is
696.48 -> based on recovery of arm and leg power
700.079 -> and function because again it's much
702.16 -> simpler easier to see how things improve
705.6 -> and when we intervene we see how they
707.76 -> respond
709.839 -> language
711.76 -> there is no reason to think that
713.36 -> language did not behave the same way so
715.44 -> recovery from language
717.519 -> when somebody has a stroke there will be
719.36 -> the early day or two where the brain
721.68 -> will automatically
723.68 -> there'll be a healing an early healing
726.32 -> but then after that we know that the
729.12 -> bulk of the recovery of function
732.639 -> and the bulk of the ability to
735.6 -> intervene in helping recovery of
737.839 -> function overall in stroke is within the
740.72 -> first three months
743.68 -> therefore if we're going to make a big
746.399 -> difference in
747.839 -> enhancing recovery
749.68 -> that needs to occur
751.36 -> early first few days first few weeks
754.72 -> and the first few months
757.12 -> having said that though there was a
759.44 -> there was a theory in the past that in
761.76 -> fact if someone had a language problem
765.2 -> that was still there at six months or if
767.68 -> it was there still at one year
770.079 -> that was what they were going to have
771.279 -> forever
772.56 -> that's not true
774.72 -> the recovery we see happens very rapidly
777.36 -> over the first three to six months
779.839 -> that's the time to intervene as
781.92 -> aggressively as possible to help help
784.959 -> recover in a better way in a more
787.2 -> profound way
788.959 -> however we also know that ongoing
790.88 -> therapy and ongoing practice by the
793.68 -> patient themselves will continue to
796.56 -> show recovery more than a year out even
799.279 -> two years old even three years old for
801.6 -> such complex brain functions such as
804.72 -> language
805.92 -> you mentioned some of the research and
808.16 -> evidence
809.44 -> there's maybe more evidence around some
811.92 -> of the motor recovery but um can you
814.32 -> talk about some of the research evidence
816.959 -> on that supports the use of uh speech
819.92 -> language therapy as a post-stroke uh
823.199 -> communication recovery tool
826 -> so there so people have done um
828.56 -> research studies or things called trials
831.6 -> or scientific experiments
833.76 -> where they look at providing people with
835.839 -> speech language therapy
838 -> at a certain intensity
840.079 -> or
841.04 -> much more or much less
843.519 -> looking at providing the therapy early
845.839 -> on or later on
848.399 -> providing the therapy in a targeted way
850.88 -> one way or in a different way
853.44 -> and overall when you look at the
855.04 -> totality the bulk of all this scientific
858.8 -> research
860.16 -> it's very clear and i think there would
862.8 -> be no debate
864.48 -> that
865.279 -> if you provide speech therapy and you
867.36 -> get a speech language therapist involved
869.36 -> with someone after a stroke
871.519 -> they do better than someone we leave on
874.399 -> their own and hope that they will
875.839 -> improve
877.04 -> it's also very clear from looking at the
879.36 -> speech recovery therapy
881.839 -> after a stroke and all the other
884.399 -> therapies that we introduced for
886.32 -> recovery after a stroke
888.079 -> that applying that early makes a
890.72 -> difference compared to applying that
892.56 -> late
893.68 -> how would you approach uh
896.079 -> helping out jason and his father with
898.8 -> respect to his communication recovery
900.8 -> after stroke
902.639 -> so it's um it's not unusual that um
906.399 -> there are many a stroke can affect many
908.32 -> functions that somebody has for example
911.279 -> being able to walk being able to use
913.68 -> your arm in your hand and what we're
915.839 -> talking about today is being able to
917.44 -> communicate to use your language
919.519 -> effectively
921.6 -> early on after a stroke
923.44 -> what people see as priorities for
925.279 -> themselves and what families see can be
927.44 -> very different
928.88 -> so that very early after a stroke the
931.279 -> priority may be actually getting up and
932.88 -> getting out of bed and being able to
934.48 -> walk around
935.839 -> the priority early on may be to use your
938.8 -> hand and your arm and your hands and
940.72 -> your arms to get yourself dressed and
942.32 -> take care of yourself
944.24 -> but it becomes um then the priorities
946.639 -> change and i'm not surprised that in
948.72 -> jason's
949.759 -> dad's case that in fact
952.16 -> the language problem uh comes out as a
955.04 -> very top priority maybe later on than
957.44 -> earlier on after all those other basic
959.839 -> functions that have recovered and become
962.399 -> more independent
964.16 -> uh being able to understand being able
966.24 -> to communicate is so
969.519 -> human
970.639 -> important soul and important human
972.8 -> function
973.759 -> such such an important thing that makes
975.839 -> us us
977.199 -> to be able to sit with your family to be
979.279 -> able to sit with your friends to be able
981.36 -> to have a discussion to be able to enjoy
984 -> people's company
985.44 -> invo
986.24 -> is important for us to be able to
987.6 -> understand them and be able to important
989.36 -> for us to express uh what we are what
992.079 -> our thoughts are
993.759 -> so what i would say to to jason and his
996.24 -> and his family is that it's very
998.24 -> important that
1000 -> one is they never give up because we do
1002.24 -> know that in the long term even after
1004.48 -> the early rapid recovery is continued
1007.04 -> improvement over time
1008.88 -> that most aphasia language problems
1011.279 -> continue to get better
1013.12 -> how do they get better
1015.36 -> listen to your speech language therapist
1018.16 -> follow their directions in terms of
1020 -> therapy that you do specifically that
1021.759 -> they've recommended
1023.6 -> the other part that's crucial is
1025.839 -> continued engagement
1028 -> family friends
1029.839 -> the person with the stroke
1031.6 -> continued encouragement to be able to
1033.76 -> express themselves to understand
1036.24 -> to relearn
1037.839 -> those functions that they lost after the
1039.919 -> stroke
1041.039 -> the the thing that the brain has um
1043.36 -> which is
1044.48 -> like a miracle
1045.839 -> is that even with an injured brain
1048.319 -> it still has the capacity to learn and
1052 -> it can learn
1053.28 -> what it lost
1055.919 -> you have to be honest with yourself to a
1057.679 -> degree
1058.799 -> but there is not
1060.72 -> um an ultimate limit and i would
1062.96 -> continue to encourage individuals to
1064.72 -> continue to practice
1066.72 -> to engage
1068.08 -> to work on their language problems
Source: https://www.youtube.com/watch?v=dOF--3-lhEU