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Speech Therapy and Stroke Recovery

Speech Therapy and Stroke Recovery

By Phyllis Mazurski, MS ,CCC - SLP

Stroke is the third leading cause of death among Americans, claiming the lives of 160,000 people each year. Among those who survive stroke, two-thirds have some type of resulting disability. However, with immediate medical intervention and the help of rehabilitation specialists, over time many stroke victims are able to reclaim some or all of their former abilities.

The most common stroke-related disabilities we treat in the hospital setting involve speech and language skills, and swallowing. Because strokes affect different areas of the brain, the problems people face in recovery can vary widely. For example, a stroke in the left side of the brain can impair speech and language, whereas a stroke in the right side can have an impact on cognitive functions such as the abilities to reason, problem solve, and remember. Anyone who has had a stroke should be evaluated by a speech-language therapist.

Aren't speech and language the same thing?

Speech and language are connected, but different. Speech is the dynamic production of voice sounds for communication. Language comprises the organization of our thoughts into words and sentences to convey something meaningful. Stroke can impact both speech and language, or just one and not the other.

How do strokes affect swallowing?

A stroke can impact areas of the brain that control movement of the muscles in the mouth, the pharynx (or throat), and in the laryngeal area (which includes the vocal cords). Strokes can also affect enervation, resulting in reduced sensation in the throat. This means that people aren't aware of the weakness they are experiencing. They may have trouble swallowing food and liquid, which puts them at risk for aspiration, meaning that materials are passing into the lungs. For the elderly, aspiration can be fatal because it may lead to pneumonia.

What role does the speech-language pathologist play?

We are often called in within 24 hours of hospital admission to assess patients who have had strokes. During a clinical evaluation at the bedside, we observe the eating and swallowing process. We try to determine how effectively the patient can move food from the front of the mouth to the back of the throat. We assess how effectively and safely they swallow. By observing the entire cycle, we can make recommendations on diet, oral exercises, and compensatory strategies to make swallowing safe. Sometimes we will order a videofluoroscopy study to get a clearer idea if food is going into the esophagus or is heading for the lungs.

How do you help people whose communication skills have been impaired by stroke?

We start by examining all parameters of communication including language comprehension and the person's ability to find the right words and express entire thoughts. We also assess the quality of the voice and the ability to articulate clearly. Once we have determined both their capabilities and the areas in which they have difficulty, we can target treatment strategies for developing means of communication. It is important that patients recovering from stroke are able to communicate their needs. And for those patients who have lost their ability to understand what is being said to them, we start building those skills.

How long does it take to recover?

Everyone's recovery is different, depending on the location and severity of the stroke. Most spontaneous recovery occurs in the first three to six months following the stroke. Speech-language therapists can help patients make the most of that recovery and we can help patients develop compensatory strategies for areas in which they will not fully regain their abilities.

The more we challenge and stimulate the brain, the more likely we are to continue to make gains over time. This means that people should continue talking even if it is difficult. They should try to read and write and attempt to learn new skills. For many of the elderly this might even include learning to use a computer. Through continual use of each different communication mode affected by the stroke, many people continue to improve. Some recoveries are pretty miraculous.

Phyllis Mazurski is a speech-language pathologist in the Department of Rehabilitation at Cayuga Medical Center. She holds a master's degree in speech pathology from Boston University and has 20 years of rehabilitation experience, primarily in the hospital setting. She sees inpatients on the Medical Rehabilitation Unit and sees outpatients on referral from their physicians.

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