Mitigating Communication Problems After a Stroke.
Strokes, or cerebrovascular accidents (CVA), are caused by a disturbance of oxygen and blood flow to the brain. This kills off brain cells, which interferes with various bodily functions and can even lead to death. Although many people may initially think of the physical consequences that can occur from a stroke, (e.g. motor and/or sensory problems), the Stroke Association reports that nearly one-third of individuals experience communication problems after a stroke. This includes speaking, reading, writing, and understanding what others say (Palmer & Pauranik, 2021).
Speech-language pathology (SLP) is the primary discipline with content expertise to specifically assess and address communication problems after a stroke. However, the interprofessional rehabilitation team, including physical and occupational therapy practitioners, should be knowledgeable about basic communication disorders. They should understand basic strategies to integrate into their daily interactions with patients who have had a stroke and experience communication problems.
Recommended course: Addressing Post-Stroke Swallowing and Communication Challenges
Types of communication problems after stroke
Aphasia is an acquired language disorder that results from injury to the brain, typically in the left brain hemisphere. There can be varying degrees of impairment in four primary areas: spoken language expression, written expression, spoken language comprehension, and reading comprehension.
Based upon the National Aphasia Association, the four main types of aphasia are:
Person knows what they want to say but is unable to verbalize or write it
*Also known as Broca’s aphasia, due to brain damage occurring in Broca’s area in the brain
Person can hear or read words but cannot understand what the words mean
*Also known as Wernicke’s aphasia due to brain damage occurring in Wernicke’s area in the brain
Person has difficulty finding written or spoken words
Person is unable to speak, read, write or comprehend words
A person experiences a gradual loss of the ability to communicate.
Additional post-stroke communication problems
Dysarthria is a motor-speech disorder caused by impaired movement of the muscles needed for speech production. Just like a person may experience gross motor difficulties with their limbs after a stroke, limited tongue, lip, or jaw movement causes dysarthria. This may present in slurred, choppy, or mumbled speech. The patient may also use abnormal pitch, speed, or rhythm during speaking, and exhibit changes in voice quality.
Apraxia of speech is a motor-planning speech disorder which impacts a person’s ability to initiate and/or execute the movement needed to produce speech. They may not be able to move their lips or tongue to say sounds correctly, even though muscles in the face and neck are intact.
Cognitive deficits resulting from a CVA may cause language and communication problems after a stroke. The patient may experience decreased awareness and arousal, memory, problem-solving, judgment, or difficulty with abstract concepts such as humor.
Reading and writing difficulties are another communication problem stroke victims may experience. They may be unable to read (acquired alexia) or unable to write (agraphia).
Occupational therapy strategies and recommendations
Some general recommendations supported by the American Speech-Language Association to mitigate challenges with communication after a stroke include:
- Normalize the environment. Reduce background noise and eliminate distractions.
- For fluent aphasia, if the patient can write and not speak orally, introduce alternative means for communication such as a communication board or encourage them to write with pen and paper.
- Encourage the use of gestures when appropriate.
- Modify questioning to include close-ended vs. open-ended questions.
- Speak slowly and pause frequently to allow time for processing and response. Be patient.
Adapting your interactions and approach to service delivery with a person who has a communication disorder post-stroke should also carry over to patient education and health literacy principles. For instance, recent evidence suggests that “aphasia-friendly modifications” such as “modifying tests, adding supportive images and using gestures” can be helpful when rehabilitation professionals are designing home exercise programs (Wallace et al., 2020).
To support the carryover of specific communication techniques implemented by speech-language pathology, interprofessional communication and collaboration is key among the rehabilitation team.
This article was written by Elizabeth D. DeIuliis, OTD, OTR/L, CLA, FNAP.