Bonnie Moore M.Cl.Sc.

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Aphasia in stroke is not just Aphasia

• Bonnie Moore M.Cl.Sc.
• Speech Language Pathologist
• York Durham Aphasia Centre

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Oral communication

• Voice, speech and language
• Sometimes used interchangeably but important to
  distinguish
• Voice is produced by the vibration of the vocal
  cords
• Voice is not always speech but can be produced by
  vertebrates using the lungs and the vocal cords

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What is speech?

• A way that humans express thoughts, feelings and
  ideas orally
• Done through a series of complex movements that
  alter and mold the basic tone created by voice
  into specific, decodable sounds

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What is language?

• Language is our ability to recognize and use
  words and sentences.
• We use language to understand what others say to
  us, to ask questions, give commands, comment and
  interchange.
• Through language we listen, speak, read, and
  write.

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Differences

• How are language and speech different?

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What is

• Dysarthria??????

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Dysarthria

• speech that is slurred or hard to understand as a
  result of damage to the control centre in the
  brain
• a group of related motor speech disorders
  resulting from disturbed muscular control over
  the speech mechanisms (Rosenbek and LaPointe)

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What is

• Apraxia???

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Apraxia of speech

• A disruption of motor planning/programming
• impairment in the ability to program
  sensori-motor commands for the positioning and
  movement of muscles for speech

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Say this phrase

• Anee rotzelilmodet at hasefer shel haeeshah
  hazeh alyad ha shulchan
• Apraxia includes inconsistent articulation
  errors, groping oral movements to locate the
  correct articulatory position, and increasing
  errors with increasing word and phrase length

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Motor-systems affected???

• Respiration (breathing)
• Phonation (ability to make sounds)
• Resonance
• Articulation
• Prosody (intonation, rate of speech, stress)

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What might be wrong with the muscles?
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What can be wrong with the muscles?

• paralyzed
• weak
• spastic (too much tone)
• flaccid (not enough tone)
• uncoordinated

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What can be wrong with the muscle movements?

• overshoot (move too far)
• undershoot (cant move all the way to the target)
• move in wrong direction
• too much strength
• too little strength
• poor timing
• involuntary movements

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Treatment of the disability - improving access
to communication

• compensation strategies
• shorter breath groups
• high level of effort for voice
• exaggerated consonants
• slower rate

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Enhancing participation

• Environmental management
• partner training
• augment communication
• alternative communication

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your challenges

• 1) trouble understanding client
• 2) encouraging better speech
• What do you do when you cant understand
  someone?

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You cant understand

• establish subject
• ask questions that can be answered with a few
  words
• clarify what you think that you heard
• ask yes/no questions
• remind client to use speech strategies
• watch facial expression, body language
• ask the person to spell

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Encouraging better speech

• ? honest feedback
• tell person what they have to do in order to make
  speech more clear

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Encouraging better speech

• rate control
• louder speech
• a few words at a time
• move your mouth more

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What is Aphasia?

• Aphasia is a general language impairment
• Affects speaking, listening, reading, and writing
• relatively common sequel of stroke and is also
  present in about one third of all head-injured
  persons who have been in a coma
• Communication changes affect well being and self
  confidence

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WHO terms

• Impairment reduced speaking, listening, reading
  and writing ability
• Disability restricted ability to communicate
  with others
• Handicap limitation on the fulfillment of a
  persons role in society and reduced
  psycho-social well-being

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Impact of the Loss on the Family

• Loss of the person they did know
• Loss of the lives they had together
• Loneliness resulting from desertion by friends,
  colleagues etc.
• Seeking ways to compensate for role changes
• Learning to communicate again

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For Aphasic Adults, we recognize their needs for

• As much information as possible about aphasia
• Communication support
• Involvement in decision making
• Waiting and patience in conversations

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For family members, friends, and caregivers

• Information about aphasia understand what has
  happened to the person and how they can be
  supportive communicative partners
• Understanding experiencing loss, sadness,
  anger, frustration, fatigue, overwhelmed with new
  roles to take on

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When a stroke affects the posterior part of the
left hemisphere

• People can have great difficulty understanding
  what they hear or read
• Analogy to hearing foreign language spoken
• Know that people are speaking to them, follow
  melody of sentences, but have difficulty
  understanding the specific words or how words go
  together to convey complete thought

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Also

• People with serious comprehension problems may
  say or write, many words that dont make sense
• This is because our dictionary of words is
  shelved in a similar region of the left brain
• They may not realize that they are saying the
  wrong words

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When a stroke injures the front regions of the
left hemisphere

• Different kinds of language problems can result
• This part of the brain is important for putting
  words together to form complete sentences
• May get out the basic words but leave out little
  words like is the or ing
• Example carbump.boom
• May say or write a word close to the intended one
  but not exactly correct
• Understand much of what they hear but not all

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When a stroke affects an extensive portion of the
front and back region

• May result in a more global aphasia
• Have great difficulty in understanding and
  formulating words and sentences
• May understand some words and may get out a few
  words but have severe difficulties communicating

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Distinction between language and intelligence

• When their only problem is aphasia, they cannot
  use language to communicate what they know.
• They can think, but just cant say what they
  think
• Still remember faces, know how to get from one
  place to another, have opinions

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Challenge for all caregivers and healthcare
personnel

• To provide individuals with aphasia a means to
  express what they know.
• Make appropriate adaptations in the
  communication environment so that they grasp the
  content of conversations
• Allow equal opportunities to participate in
  conversation, share ideas, news, opinions, and
  feelings

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Communication Strategies

• Help ensure that people with aphasia can get
  their message out and get their message in
• Different techniques work with different types
  and severity of aphasia
• Never rely only on speech as he/she may only
  understand some of what you say

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To set the scene

• Use face to face communication
• Identify the topic ( write in large bold on pad
  with marker)
• Use visual aids as much as possible
• - maps, photographs, pictures, drawings

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To help get the message in

• Use key words ( written )
• Use drawings, photo, pictures, or real objects
• Use gestures, body and facial expressions
• Speak slowly, clearly, with frequent pausing
• Use simple vocabulary, short sentences and always
  verify that they understand

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To Help Get the Message Out

• Encourage drawing, gestures, writing
• Ask yes/no questions
• Use rating scales and offer verbal and/or written
  choices
• Use visual aids ( maps, pictures, photos,
  drawings )
• Always verify their message
• Always have paper and marker handy
• Learn to use cueing strategies for speech
  production

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Remember

• Let the person know if his/her message is not
  being understood
• Take extra time and set a slower pace
• Speak directly to the person with aphasia dont
  exclude them from conversation
• If you ask a question, make sure a means of
  response is available ( pad and marker, yes/no
  gesture etc.)
• Keep conversation in the here and now as much as
  possible
• A picture is worth a thousand words

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Aphasia, Dysarthria, Apraxia

• Disorder Difficulty getting message
• IN OUT
• Aphasia X X
• Dysarthria X
• Apraxia X