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Hypertension & Stroke


Conquering Speech Loss After a Stroke

Aphasia, the loss of the ability to articulate or understand spoken or written words or phrases, is one of the most common and vexing side effects of stroke. Of the 450,000 people who survive a stroke each year, about 80,000 are left with some degree of aphasia. Symptoms can include trouble saying, reading, or writing single words or phrases; problems only with complex, lengthy concepts; or an inability to produce any meaningful speech or writing. The prognosis is excellent for those with mild deficits. Even when symptoms are severe, a great degree of function can often be restored. But practice, patience, and professional guidance are necessary.

A Common Aftereffect

Aphasia results from damage to one or more of the language centers in the brain, usually when a stroke or transient ischemic attack ("ministroke") cuts off the brain's blood supply. The interruption of blood flow deprives the brain of oxygen, which can lead to tissue damage. Symptoms depend on the area of the brain that is affected and the extent of the damage.

In most right-handed people, oral and written communication skills are controlled primarily on the left side of the brain, in Broca's and Wernicke's areas. Broca's area directs the motor functions necessary for speaking and writing. If tissue in this portion of the brain is damaged, people know what they want to express but have trouble saying or writing the desired word or phrase. They also often omit small words such as "is," "and," and "the." Broca's aphasia often accompanies right-sided weakness or paralysis of the right arm or leg because the frontal lobe of the brain, where Broca's area is located, also controls voluntary limb movement.

Wernicke's area regulates oral and written comprehension. When tissue in this part of the brain is damaged, patients may be able to construct full sentences and emit a fluent, steady stream of speech but the sentences have little meaning because the wrong words are chosen or new ones are invented. Reading comprehension is also often compromised. Because Wernicke's area is not near regions of the brain that control movement, body weakness and paralysis are not usually a problem. However, vision may be impaired in the right portion of the visual field in both eyes.
In global aphasia, the most serious form of the condition, damage to tissue in many parts of the brain results in loss of nearly all language skills.

Regaining Lost Skills

The symptoms of aphasia become apparent soon after the onset of a stroke and stabilize by the time the episode resolves. Some studies suggest that improvement is twice as great in people who receive early, aggressive speech-language therapy than in those who receive none.

Treatment should be provided by a speech-language pathologist, a licensed health professional with special training in communication disorders. The program usually begins in the hospital and may continue for weeks, months, or even years. Exercises are likely to include drills to improve word retrieval and sentence construction and role-playing to practice real-life conversational skills and situations.

The greatest improvements occur within the first few months. After a year, gains tend to accrue more slowly. Although some lasting impairment may remain, improvements in speech, writing, and comprehension can continue indefinitely—especially in those who actively use and practice the language skills that return.


Communication Strategies for Stroke Survivors

Overcome the "tip of the tongue" phenomenon. Searching for a word is the most frustrating aspect of aphasia for many stroke survivors. Instead, use an appropriate but different word that does come to you—or give the listener a clue, such as the first letter of the word you are searching for or a description of the concept.

Be frank. Let people know you have had a stroke and explain its impact. If necessary, carry an index card with an appropriate description, such as "I had a stroke and have difficulty speaking, but I will understand what you say," or "I had a stroke and am having trouble understanding what you’re saying. Please repeat it."

Carry written identification. Include your name, address, and phone number.

Read aloud. This is one of the best ways to practice speaking and reading skills. When you have difficulty, ask someone to provide helpful prompts.

Use it or lose it. Talk, read, write, and maintain as much social contact as possible. Consider joining a stroke support group. For referral, contact the American Stroke Association.

Employ alternative methods of communication. Pointing, gesturing, touching, and drawing can be useful tools. But rely on them only if speech or writing becomes too frustrating or deficits persist despite your best efforts.

Eliminate distractions. Noise, especially from the television or radio, can interfere with your attempts to communicate.

Treat mood disorders. Depression, mood swings, irritation, and frustration frequently accompany stroke and may hamper the recovery of language skills. These emotional and psychological problems can all be improved with counseling, medication, or a combination of both.


From The Johns Hopkins Medical Letter: Health After 50, November 2001.


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