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For our brain to
function, we need a constant blood supply, which provides vital nutrients and
oxygen to the brain cells. A stroke happens when the blood supply to part of
the brain is cut off and brain cells are damaged or die.
About a third of people
who have a stroke make a significant recovery within a month. But most stroke
survivors have long-term problems. It may take a year or longer for them to
make the best possible recovery. Sadly, in the most severe cases, strokes can
be fatal or cause long-term disability.
Strokes are sudden and have an immediate effect!
After stroke a person
may become numb, weak or paralyzed on one side of the body. The speech may become
slur. The person may find difficult to find words or understand speech. Some
people lose their sight or have blurred vision, and others become confused or
unsteady.
A stroke can
damage mind and body.
Strokes affect people
in different ways, depending on the part of the brain that was affected, how
widespread the damage was and how healthy the person was before the stroke. But
strokes can damage:
bodily functions
thought processes
ability to learn
and how we feel and communicate.
A stroke is always a medical emergency!
It is important to be
able to recognize the symptoms of
a stroke and to get an immediate help.
Visual Stroke Symptoms and The FAST Test
FACE,
ARMS, SPEECH, and TIME - identifies the most common symptoms of a stroke.
Facial Weakness:Can
the person smile? Has their face fallen on one side?
Arm Weakness:Can
the person raise both arms and keep them there?
Speech Problems:Can
the person speak clearly and understand what you say? Is their speech slurred?
If you see any one of
these three signs, it’s TIME to call 911.
The quicker a patient
arrives at a specialist stroke unit, the quicker he/she receives appropriate
treatment and the more likely he/she is to make a better recovery.
What Is A Stroke? - Narration and Animation by Cal Shipley, M.D.
Ischaemic strokes - happen when something blocks an artery that carries
blood to the brain.
There are several possible causes:
a
blood clot forms in a main artery to the brain
a
blood clot, air bubble or fat globule forms in a blood vessel and is carried to
the brain
a
blockage in the tiny bloody vessels deep inside the brain.
Haemorrhagic strokes - happen when a blood vessel bursts and bleeds into the
brain (a haemorrhage).
The haemorrhage may be due to:
a vessel
bursting within the brain itself, or
a
blood vessel on the surface of the brain bleeding into the area between the
brain and the skull.
Temporary symptoms may indicate a mini-stroke - Transient Ischaemic Attack (TIA). It is
the same as a stroke, except that the symptoms last for a short amount of time
and no longer than 24 hours. This is because the blockage in patient’s artery
is temporary - it either dissolves on its own or moves, so that the blood
supply returns to normal and patient’s symptoms disappear.
Although the symptoms may not last long, a TIA is still very
serious. It is a sign that there is a problem and patients are at risk of going
on to have a stroke. Because of this it
is often called a 'warning stroke' it must be taken in a serious consideration
and treated immediately.
It is estimated that
around a third of people will have some level of communication difficulties
(called aphasia or sometimes dysphasia) after a stroke. At least 40 % of stroke
survivors will initially experience some difficulty swallowing, though many
people recover their swallow quite quickly.
Difficulties with
communication can affect patient’s social relationships, independence and
self-confidence.
Swallowing problems can
put a patient at risk of infection and affect his/her enjoyment of food.
Speech and language
therapy may be helpful if a patient has the following difficulties:
swallowing - including problems with coughing
or choking when eating or drinking
understanding language (called receptive
aphasia)
speaking, including speaking any words
or saying the correct word (called expressive aphasia)
forming words and speech sounds due to weak
muscles in your mouth (dysarthria)
moving the muscles needed for speech in the
correct order and sequence (dyspraxia),
A stroke should be
followed by a formal language assessment, like for instance, patient’s understanding
of yes/no questions, e.g. Do you put your
shoes on before your socks? The patient may be asked to describe the surroundings
as a test patient’s spontaneous speech or asked to repeat simple phrases or sounds.
A stroke may also cause
new problems, including loss of vision or memory, which can make communication
more difficult.
There is some overlap
between the tasks a patient will be asked to do for assessment and therapy. A
therapist should keep checking patient’s progress.
The techniques a speech
and language therapist uses to help with communication difficulties will depend
on the particular problems a patient has.
Therapies that target
the specific area of communication a patient finds difficult are most effective.
For example:
If there
is a difficulty understanding the meanings of words (receptive aphasia) a
patient may be asked to match words to pictures, sort words according to their
meaning and judge whether words have the same meaning. These activities aim to
strengthen patient’s ability to remember word meanings and link them to the
spoken and written forms of words.
If a patient presents
difficulty finding the words he/she want to say (expressive aphasia) a therapy
might include practicing naming pictures, judging whether words rhyme or not or
repeating words a therapist says. A therapist may provide prompts, for example,
making the first sound of a word or writing the first letter. A therapist may
also show objects that patient can touch and see while speaking their names.
If a patient presents weak
muscles in his/her mouth, he may initially need to do exercises to help improve
the muscle strength. A speech and language therapist may also give an advice on
body positioning and where the tongue, lips and jaw should go when producing
particular sounds.
Difficulty controlling breathing
muscles can force a patient to take a breath in the middle of a sentence. A
speech and language therapist may teach a patient breathing exercises and how
to plan pauses within sentences to help with this.
One approach to help
dyspraxia is to use natural melodic patterns for everyday phrases. For example,
the phrase ‘Good morning!’, when said very cheerfully, has an almost musical
melody. A therapist can teach a patient to use this in an exaggerated way to
co-ordinate a speech. As the patient’s speech improves, the melody and rhythm
cues can be gradually dropped.
If a patient has
difficulty making the right sounds in the right order to form words, a therapy
should include tasks such as listening to differences between spoken words,
repeating words of increasing length and developing the ability to monitor your
speech.
Some people who can do
tasks involving single words, such as naming pictures, have difficulty
constructing sentences. A therapy should also work on patient’s ability to
understand and produce simple and complicated sentences.
An important part of
the speech and language therapist’s role involves finding alternative or
additional ways of communicating, which may include:
gestures
writing
communication charts
a letter board, or
drawing.
For some people an
electronic communication aid may be beneficial so a speech and
language therapist can advise on what would be helpful; may also help to
family members on adapting communication to make it easier to understand.
Reading
and writing
If a patient has problems
with speech, it is quite likely that he/she will have problems with writing (dysgraphia),
spelling and reading (dyslexia). The areas of the brain
which are important for these tasks are quite close together. Therefora speech and language therapist may also help with reading and writing. This is because all ways of
communicating use similar abilities; for example, finding the right words and
constructing them into a sentence. However, if a patient has difficulty with
one particular way of communicating, a therapy should focus on this.
How
can my family help?
Communication problems can be frustrating and lonely for family and caregivers as well as for a person who has these difficulties. When therapy starts, a
therapist will usually give written instructions so that a patient and his/her
family can practice specific exercises between sessions. It may be helpful if a
family member can attend some therapy sessions to observe the exercises, and
help a patient to practice them.
The family should try to resist the temptation to
do all the talking for the patient. Many people who have had a stroke are
capable of understanding and producing speech but their speech may be slow at
first. It is easy to overwhelm someone by asking more questions before they
have had a chance to process the first one. For some people it can help to wait
as long as half a minute. To begin with, family members can try asking questions
that only need a ‘yes’ or ‘no’ answer. Later, they can increase the complexity,
just like learning a foreign language. Repetition and hard work are important.
Brain
injury is a damage to the brain that may be caused by a traumatic injury to the
head or by a non-traumatic cause such as a tumor, aneurysm, anoxia or
infection.
Traumatic Brain Injury
A
traumatic brain injury (TBI) is a blow or jolt to the head or a penetrating
head injury that disrupts the function of the brain. Not all blows or jolts to
the head result in a TBI. The severity of such an injury may range from
"mild," i.e., a brief change in mental status or consciousness to
"severe," i.e., an extended period of unconsciousness or amnesia
after the injury. A TBI can result in short or long-term problems with
independent function.
The
leading causes of TBI are:
Falls (28%)
Motor
vehicle-traffic crashes (20%)
Struck by/against
(19%)
Assaults (11%)
Blasts are a
leading cause of TBI for active duty military personnel in war zones.
What
are the long-term consequences of TBI?
TBI
can cause a wide range of functional changes affecting thinking, language,
learning, emotions, behavior, and/or sensation. It can also cause epilepsy and
increase the risk for conditions such as Alzheimer's disease, Parkinson's
disease, and other brain disorders that become more prevalent with age.
Traumatic
Brain Injury (TBI) Part I: 2D/3D Medical Animation by MediVisuals, Inc.
A
Nontraumatic Brain Injury can be the result of an illness, oxygen deprivation,
metabolic disorders, aneurysms, cardiac arrest, near-drowning experience, etc.
In short, it includes injuries to the brain that are not caused by an external
physical force to the head. Other nonviolent circumstances like tumors and lead
poisoning can also damage the brain. Even though the effects of a Nontraumatic
Brain Injury are comparable to those affiliated with a Traumatic Brain Injury
(TBI), there are some dramatic differences. Previously mentioned and most
important, they do not feature any outer blow to the head. It also has a direct
impact on cells throughout the brain. Since it attacks the cellular structure,
a Nontraumatic Brain Injury has the ability to spread to all areas of the brain
as opposed to TBI, which only affects concentrated areas.
The
most common instances of Nontraumatic Brain Injury include:
Anoxic injury -
brain receives inadequate levels of oxygen, usually following cardiac arrest
when there is minimal to no blood reaching the brain.
Toxic or metabolic
injury - occurs after coming into contact with unsafe substances (e.g.,
lead) or the detrimental accumulation of chemicals manufactured within the
body (e.g., kidney failure).
Encephalitis -
caused by an infection of the brain.
How
effective are speech-language treatments for TBI?
The
American Speech-Language-Hearing Association (ASHA) www.asha.org has written a
series of treatmentefficacy summaries that describe evidence about how well treatment works.
These summaries are useful not only to individuals with TBI and caregivers but
also to insurance companies considering payment for much needed services for TBI.
What
does a speech-language pathologist do when working with people with TBI?
A
treatment plan is developed after the evaluation. The treatment program will
vary depending on the stage of recovery, but it will always focus on increasing
independence in everyday life.
In
the early stages of recovery (e.g., during coma), treatment focuses on:
·getting
general responses to sensory stimulation
·teaching
family members how to interact with the loved one
As
an individual becomes more aware, treatment focuses on:
·Maintaining
attention for basic activities
·Reducing
confusion
·Orienting
the person to the date, where he or she is, and what has happened
Later
on in recovery, treatment focuses on:
·finding
ways to improve memory (e.g., using a memory log)
·learning
strategies to help problem solving, reasoning, and organizational skills
·working
on social skills in small groups
·improving
self-monitoring in the hospital, home, and community
Eventually,
treatment may include:
·going
on community outings to help the person plan, organize, and carry out trips
using memory logs, organizers, checklists, and other helpful aids
·working
with a vocational rehabilitation specialist to help the person get back to work
or school
Individual
treatment may continue to improve speech, language, and swallowing skills, as
needed. If the person is learning how to use an augmentative or alternative
communication device, treatment will focus on increasing efficiency and
effectiveness with the device.
The
Preferred Practice Patterns for the Profession of Speech-Language Pathology outline
the common practices followed by SLPs when engaging in various aspects of the
profession. The Preferred Practice Patterns for cognitive-communication
assessment and intervention are outlined in sections 22 and 23. The Preferred
Practice Patterns for a comprehensive speech and language assessment are
outlined in section 10.
In
2003, ASHA developed a technical report that describes the role of the SLP in
the management of individuals with TBI. Check http://www.asha.org/policy/TR2003-00146/
for
“Rehabilitation of Children and Adults with
Cognitive-Communication Disorder After Brain Injury”
ASHA
has developed a series of treatment efficacy summaries that describe research
findings about how well treatment works for different disorders. These
summaries are useful not only to parents and caregivers but also to insurance
companies considering payment for much needed services for adults and children
with communication and related disorders.
“For children,
handwriting is extremely important. Not how well they do it, but that they
do it and practice it,” said IndianaUniversity Professor
Karin Harman James.
IndianaUniversity researchers found that those children
who printed letters in a four-week study, rather than saying them, showed
brain activity more similar to adults.
The printing
practice also improves letter recognition, which is the No. 1 predictor of
reading ability at age 5.
Handwriting is
faster. Researchers who tested second-, fourth- and sixth-graders found
that children compose essays more prolifically - and faster - when using a
pen rather than a keyboard. In addition, fourth- and sixth-graders wrote
more complete sentences when they used a pen, according to the study, led
by Virginia Berninger, a University
of Washington
professor of educational psychology who studies normal writing development
and writing disabilities. Her research has also shown that forming letters
by hand may engage our thinking brains differently than pressing down on a
key.
Handwriting
aids memory. If you write yourself a list or a note - then lose it -
you're much more likely to remember what you wrote than if you just tried
to memorize it, said occupational therapist Katya Feder, an adjunct
professor at the University of Ottawa School of Rehabilitation.
Good
handwriting can mean better grades. Studies show that the same mediocre
paper is graded much higher if the handwriting is neat and much lower if
the writing is not.
Legible
cursive writing averages no faster than printed handwriting of equal or
greater legibility. The fastest, clearest handwriters are neither the
print-writers nor the cursive writers. The highest speed and highest
legibility in handwriting are attained by those who join only some
letters, not all of them – making only the simplest of joins, omitting the
rest, and using print-like shapes for letters whose printed and cursive
shapes disagree.
Handwriting
proficiency inspires confidence. The more we practice a skill such as
handwriting, the stronger the motor pathways become until the skill
becomes automatic. Once it's mastered, children can move on to focus on
the subject, rather than worry about how to form letters.
Handwriting
engages different brain circuits than keyboarding. The contact, direction
and pressure of the pen or pencil send the brain a message. And the
repetitive process of handwriting "integrates motor pathways into the
brain," said Feder. When it becomes automatic or learned,
"there's almost a groove in the pathways," she said. The more
children write, the more pathways are laid down. But if they write them
poorly, then they're getting a faulty pathway, so you want to go back and
correct it," Feder said.
