One of the most common symptoms of a stroke is slurred speech. Speech impairment coupled with numbness of the face or the extremities, visual impairment, dizziness and loss of coordination, and severe headache, calls for immediate medical attention.
Stroke and speech impairments
A stroke is the interruption of blood flow to the brain, depriving brain cells from oxygen. These cells die after a few minutes, causing a loss of the neurological functions controlled by those cells. Strokes affecting the parietal lobe, Broca’s center or Wernicke’s center are likely to affect speech.
There are several types of speech difficulties which may arise after a stroke:
– Aphasia is an acquired language disorder affecting the ability to produce and understand language, as well as reading and writing.
– Dysarthria is a motor disorder affecting the control of speech muscles. Information transmitted to the tongue, throat or lips is disrupted, resulting in poor articulation.
– Apraxia of speech (or verbal apraxia) is the inability to produce information commanding speech muscles.
In the case of aphasia, speech impairment results when the damage occurs in the left hemisphere of the brain, which contains the person’s language centers. These centers are responsible for the processes of speaking, listening, reading and writing.
2. Dysarthria and apraxia
Dysarthria and apraxia are speech problems which involve the physical act of speaking.
Apraxia is often regarded as a result of the speech muscles re-learning their ability to move and produce specific and accurate sounds, which were affected by the stroke.
Dysarthria, on the other hand, refers to weakness (or tightness) in the muscles affecting speech production.
Thus, speech impairment does not only refer to the inability to move the mouth and lips in speech, but also in the decreased ability to use and comprehend words. It is recognized as one of the more pressing problems for stroke survivors as it makes it difficult to communicate with other people.
Treating language disorders
The goal of rehabilitation of speech impairments, therefore, is to restore a person’s confidence in communicating with others. This may prove to be a difficult task, but people giving assistance should realize that the ordeal a stroke patient endures because of speech difficulties can be frustrating and should be met with a greater deal of patience and understanding.
Since aphasia affects use and comprehension of words, the effective goal for therapy is restoration of language ability. Focus should also be set on improving the patient’s ability to communicate by helping him use his remaining language abilities and compensate for language problems. It must be recalled that the brain damage caused by the stroke may erase some abilities, which must be re-learned during the rehabilitation process.
Most patients with aphasia will have difficulty understanding words or expressing thoughts to words. Rehabilitation should be trained on understanding spoken language, making use of additional aids, if necessary. For example, one can use pictures which the patient can try to identify. This will help in recognition of several objects and translation of thoughts into words. Another exercise recommended is to give multiple clues leading to a word, stimulating the patient to think.
Patients may also be allowed, at first, to use hand gestures or signals to compensate for lack of appropriate words or just to help in carrying out a train of thought during a conversation. But, this should not let the patient and his therapist deviate from the ultimate goal of reestablishing the language capabilities. The hand gestures should only be used as an initial tool, so as not to contribute to the patient’s frustrations. It is important to keep in mind that together with rehabilitating the language capabilities, the patient’s confidence needs nurturing as well.
2. Verbal apraxia
In verbal apraxia, the patient knows what words to say, but the brain has trouble coordinating the necessary muscles for speaking. This impairment manifests as difficulty in producing or imitating desired speech sounds and incorrect rhythm and rate of speaking.
Patients suffering from apraxia may utter illogical words and phrases arising from this. Simple words such as “kitchen” may come out as “biden” or “chicken”. Another notable symptom is struggling to say words that have more than two syllables, for example, “institution” or “rehabilitation”.
The difference with this impairment is that the speaker is well aware of his mistakes, but still has difficulty in correcting them. Common therapy approaches for apraxia include teaching sound production, rhythm and rate. Again, the exercises entailed in the therapy are aimed at practicing speech patterns, such that the brain sends out the necessary impulses to coordinate facial muscles for generating speech. Tasks may involve repetition of syllables and words to train the lips, mouth and tongue into making these sounds once again. Providing tips on proper placement of the tongue or shape of lips and mouth while producing sounds also helps in this therapy.
Dysarthria, on the other hand, leaves a patient struggling to move the speech muscles because they become too weak or too tight as a result of the stroke. Additional medical help from healthcare personnel should be heeded to identify the specific type of dysarthria, since it is crucial for the treatment. For example, strengthening exercises are appropriate when the muscles are weak, but may be harmful when the muscles have too much tone. A speech language pathologist should be able to aid in the identification and consequently recommend the proper therapy.
Usually, dysarthria rarely requires therapy and often disappears a few months after the stroke. But, in the event that the impairment persists, a more rigid therapy program may be suggested by the speech language pathologist.
Ultimately, the goal in the rehabilitation of stroke patients with speech difficulties should be to try and bring the patient to his normal, usual speaking self. This can only be achieved with providing the patient not just the therapeutic exercises but also with the environment that minimizes their frustration in having to re-learn common, everyday activities such as speech. This is very important in the recovery process, because speech does much in enabling the patient, making him a more independent and confident individual.