Speech and Language
A Speech and Language Therapist (SALT) will assess your speech, language and swallowing abilities. He/she will decide with you if therapy is appropriate and plan with you when therapy will stop.
Therapy may be one-to-one or in a group. Speech and Language Therapists will help you find the easiest way to communicate. They may suggest a communication aid to help with communication difficulties.
You may have been told that you have aphasia. Aphasia is a communication disorder that occurs when the part of the brain that is responsible for language becomes damaged as a result of a stroke or head injury.
If you have aphasia you may find if difficult to understand words, speak, use gestures, read, write and/or use numbers. The severity varies from person to person. Aphasia can be so severe as to make communication almost impossible, or it can be very mild. People with aphasia have difficulty understanding and using language despite being able to think clearly.
Some people recover their ability to communicate quickly but for others recovery is a long slow process. Some individuals with aphasia see signs of improvement many years after their stroke. Many people with aphasia report that living with aphasia becomes easier as they and their families and friends become more accustomed to the language impairment and strategies to cope with it. The severity of aphasia can vary slightly from day to day and it can seem worse if you’re tired or upset.
Reading and Calculation
Many individuals experience significant difficulties with reading and writing following a stroke. Common difficulties include; reading words or reading long paragraphs and understanding what you have read. Many individuals are unable to write at all following a stroke. Other individuals may have difficulty with spelling, planning or organising what they want to write or forming grammatical sentences.
Severe impairments of calculation often accompany aphasia, yet in some instances individuals retain good calculation in spite of the loss of language. Many people experience difficulties with time and money.
Motor Speech Disorders
Apraxia is a difficulty that results in problems putting speech sounds together correctly. It varies in severity from being unable to put any meaningful words together to mild speech errors in words.
Individuals are generally aware of the errors they make and are sometimes surprised by their mistakes. Speech errors are inconsistent and are variable on repeated attempts. On some occasions when the individual repeats the word they reach the target word. Speech errors include; substituting one sound in a word for another such as “lello” for yellow; mixing up sounds in words such as “tefalone” for telephone; omitting sounds in words such as bush for brush. Frequency of errors can increase with longer words and phrases.
Automatic speech, such as counting or saying days of the week, is generally less impaired than spontaneous speech. Days of the week, prayers, alphabet and songs are often the only words that some people with severe apraxia can produce after a stroke.
Dysarthria refers to a group of speech disorders resulting from weakness, slowness, or in-coordination of the speech mechanism due to damage in the nervous system particularly to the facial nerves. Muscles become weak and do not work smoothly and efficiently together as they did before. These muscles include the lips, tongue, soft palate and the vocal cords. Speech can become slurred and is difficult to understand.
Again severity varies across people. For some this is a minor problem for others it can be difficult to say anything clearly and make themselves understood. Dysarthria is often accompanied by difficulties with swallowing.
After a stroke it can be difficult to eat and drink. You may cough or choke when you are eating or drinking. This can happen if the muscles involved in swallowing and chewing are affected by the stroke. Food or drink may go down the wrong way into your lungs which has the potential to cause chest infections.
Some signs that you may have swallowing difficulties are:
- Choking or coughing whenever you try to swallow food or drink
- Certain foods and drinks going down the wrong way
- Coughing fits especially after mealtimes
- Your voice sounds ‘gurgly’ after swallowing
- Food is left in your mouth after a meal
- Feeling chesty and unwell with a high temperature
- Losing weight
- Feeling slightly of out breath during or immediately after eating or drinking
It can become frustrating and people often get upset when not understood. However, if you are communicating with a friend, patient or a loved one who has had a stroke and they do not understand you, it is not your fault and nor is it their fault.
To aid communication here a few tips so help you:
- Reduce background noise and eliminate distractions when possible.
- Face the individual when talking.
- Listen carefully.
- Pause between sentences.
- Speak in shorter and grammatical simpler sentences but speak with natural intonation and loudness (you do not need to shout!).
- Use non verbal cues to improve communication such as drawings, writing, gestures and facial expression.
- Let the individual know if you are having difficulty understanding him/her.
- Use a slower rate of speech with frequent pauses.
- Do not turn conversation into therapy by correcting or requesting repetition unnecessarily.
- Repeat and rephrase as needed.
- Confirm that you are being understood. Ask simple questions and avoid loaded or multiple questions.
- In a group, one person should speak at any one time.
- Introduce one idea at a time; Change topics slowly.
Remember that communication is a multi-way process. You are one part of that process and what ever you can do to aid good communication will result in a better message being communicated.
Help Someone With Talking?
- Encourage the individual with aphasia to use gestures.
- Give plenty of time for the individual to respond.
- Allow the individual to complete his or her own statements.
- It is not always appropriate to try and anticipate and fill in the end of sentences for people with difficulties speaking. Find out first if the individual requires assistance or if they would rather have more time to finish the sentences themselves.
- Ignore the grammatical errors and poor articulation if you understand the message.
- Confirm your understanding by a natural response or statement.
- Remain positive and encourage all attempts at communication.