Speech and language therapy after a stroke
A stroke is a life-changing experience and stroke patients can often experience real challenges in their ability to understand, to speak and to swallow following a stroke.
The statistics are sobering, with roughly one third of stroke patients experiencing communication difficulties (dysphasia) and 40% of stroke patients experiencing difficulty when swallowing (dysphagia).
Speech, language and the ability to swallow are all controlled by specific parts of the brain. Should the stroke damage certain parts of the brain, it could affect speech, language and/or swallowing ability.
Language describes the words that we understand and use to communicate. This can be described as the input and output of language.
‘Input’ is used to describe what is understood by a person. A speech and language therapist will seek to examine how much is understood of the spoken word or their ability to understand what they read.
‘Output’ describes the ability of a person to speak, write (and gesture) in order to communicate. Depending on the severity of the stroke, any or all of these outputs can be affected to different degrees and will be assessed to determine the level at which therapeutic intervention should commence.
Dysarthria describes a dysfunction in speech and is heard as reduced articulation and difficulty pronouncing words. Following a stroke, the tongue, lips and voice may not work correctly. There may be a weakness and their speech can be difficult to understand. As you can imagine, this will often be very frustrating for the person recovering from a stroke as well as their family members and friends, as they find they are unable to communicate as effectively as they would like.
The severity of the stroke will determine the extent of the loss of speech function, which can range from mild to severe.
Swallowing is a complex process and in strokes where the brain stem is affected, a loss in swallowing function is common. Cerebral strokes can also result in swallowing difficulties. The medical term for swallowing difficulties is dysphagia, and as with all problems following a stroke, can vary in its severity.
Some people find that following a stroke they have great difficulty swallowing certain foods or liquids. Others may be unable to swallow safely at all and a feeding tube to maintain adequate hydration and nutrition may be needed as a temporary or permanent measure. Swallowing assessment may be an informal clinical bedside assessment or objective assessment namely FEES (a nasendoscopy to look at swallow function) and/or videofluoroscopy (radiographic examination of swallowing). Therapy aims to return swallow function to the optimum level achievable for that individual.
A speech and language therapist will need to assess the extent of any loss of function of speech, language and swallowing, and at Circle Rehabilitation this is done by both informal (observation) and formal assessment.
Informal assessment is carried out from the time you arrive at Circle Rehabilitation until the time you are discharged, while formal assessment is carried out at regular intervals using specific formal assessments.
For formal assessment, our speech and language therapist uses a battery of assessments such as the Comprehensive Aphasia Test (CAT) and the Mount Wilga high level language test, amongst many others. These tests help to assess the extent of any functional loss and to determine the level of support you will need to optimise function.
A speech and language therapist can be a great help in restoring function in language, speech and swallowing following a stroke. Regaining the ability to communicate effectively can be a huge practical and emotional relief to people, and the work the speech and language therapists carry out at Circle Rehabilitation is absolutely vital in stroke rehabilitation.
The priority for a speech and language therapist is to optimise the ability of a patient to communicate. Regaining as much function as possible for language, speech and swallowing is key. For some patients, this may a relatively simple process, while for others who have experienced a significant stroke, the process may be much longer and more involved. The aim is to start work at the level a person is at and then give them the tools, the techniques, the practice and the support they need to progress and improve.
Generally, our speech and language therapist will see patients for a 45-minute session, which is the national guideline. Some patients may require shorter sessions and so we always make sure that each session is an appropriate length for them.
Should you have a family member or carer visiting with you at Circle Rehabilitation, they are welcome to sit in on your speech and language therapy sessions. We find this can be very helpful for them, as it helps them to get a good understanding of any language and speech difficulties you may have. While they are not going to be able to replicate what a speech and language therapist does, it can help to have someone you know well encouraging you, helping to keep things as normal as possible.