How effective are treatments for a stroke?
ASHA has written a treatment efficacy summary for aphasia resulting from left hemisphere stroke [PDF] and for cognitive communication disorders resulting from right hemisphere brain damage [PDF] that describe evidence about how well treatment works. These summaries are useful not only to individuals with stroke and caregivers, but also to insurance companies considering payment for much needed services for stroke.
What does a speech-language pathologist do when working with individuals with a stroke?
The treatment program focuses on improving the skills that have been affected by the stroke, depending on what the areas are affected.
For expressive and/or receptive language skills, the SLP will work on specific drills and strategies to improve them, such as the following:
- Participating in group therapy sessions to practice conversational skills with other stroke survivors
- Holding structured discussions, focusing on improving initiation of conversation, turn-taking, clarification of ideas, and repairing of conversational breakdowns
- Role-playing common communication situations that take place in the community and at home, such as talking on the telephone, ordering a meal in a restaurant, and talking to a salesperson at a store
If cognitive skills are affected, some activities may include:
- Using a memory log to keep track of daily happenings to help with memory
- Using an organizer to plan tasks
- Using checklists
- Increasing awareness of deficits in order to help self-monitoring in the hospital, home, and community
Eventually, persons are taken on individual and group community outings to practice their use of compensatory strategies outside of the hospital. They are asked to plan, organize, and carry out these trips using the compensatory strategies they have learned. For example, persons may practice using daily planners and checklists to plan the outing. They may practice functional reading and writing skills by using a telephone book to find the phone number of a restaurant and to writing it down. They may practice telephone skills by calling the restaurant and making a reservation. They may practice reading maps, taking public transportation to the restaurant, and counting the change needed to purchase a ticket. They may practice their functional conversational skills by ordering their food in the restaurant.
Later on in the recovery, the SLP may work with a vocational specialist to help transition the person back into work or school, if applicable. The SLP may also work with employers and/or educational specialists to implement the use of compensatory strategies in these settings. The SLP may work with them to modify the patient's work/school environment to meet language and/or cognitive needs.
If speech muscles are weak, the SLP may teach exercises to strengthen these muscles. The person will practice the exercises at home and in therapy. The person may also be taught strategies to make speech more intelligible and to compensate for the muscle weakness.
If swallowing is a problem, the SLP may teach exercises to strengthen or improve the coordination of swallowing muscles, or strategies to compensate for muscle weakness and improve the safety of swallowing. The SLP works closely with doctors, nurses, and the dietitian to recommend the food consistencies that are safest and most appropriate for the patient's needs. As the person gains more strength and coordination in swallowing muscles, the SLP works with these professionals to "upgrade" the person's diet. For example, the SLP may recommend upgrading the diet from a pureed/blended consistency to a chunky consistency.
If the person is learning how to use an augmentative or alternative communication aid, treatment will focus on teaching use of the aid in structured conversation, with other stroke survivors, with family, and eventually in the community.
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