Getting The Word Out

Patients recovering from stroke may need therapy to recover their speech as well

Imagine having a normal conversation, but then suddenly being unable to say the next word you wanted to say. For example, the word “telephone.” You know what a telephone is, you can see one in your mind, but the word just won’t come to you.

Or imagine knowing you want to say “telephone,” but then struggling to create the sounds that would make the word. 

Yes, it is just as frustrating and disheartening as you imagine. 

These and other similar difficulties with language are known as aphasia. Any injury to the brain can cause aphasia, and the symptoms can be mild to severe. The most common cause is a stroke.

Expressive And Receptive

Speech Language Pathologist Courtney Horne treats patients with post-stroke aphasia at the Candler Hospital Outpatient Rehabilitation Center. She typically sees patients referred by their neurologist or sometimes their primary care physician. And the sooner, the better.

“Once a patient is out of the hospital, there is a window of time that we like to see patients because they are more likely to have better success,” Horne says. “I encourage a family member to come in as well, if possible, to help with communication and to help fill in the gaps of the case history.”

There are different ways that aphasia presents itself, but generally the aphasia is either expressive or receptive. With expressive aphasia, the patient has difficulty finding the words to say, or even saying the sounds that they need to get those words out. With receptive aphasia, the patient has difficulty understanding others. 

Many patients experience both of these deficits to some degree. There is also a type known as fluent aphasia, in which the person is able to carry on a normal flow of conversation but may accidentally include random words or jargon in their speech.
“Depending on the type of aphasia a person has, some patients may be aware of the errors they are making while others may not,” Horne says.

After the evaluation, Horne devises an individual treatment plan. Every patient is different, but for moderate aphasia Horne typically sees a patient twice a week for about six weeks. If at that point they feel well-established in their care, the sessions may be reduced to once a week for another six weeks.

Repairing The Connections

When patients come in for a session, there are several tasks and exercises that Horne will guide them through in order to help them find the words they need. She also will advise them in simple strategies to help spark the memory of a word or to help get the meaning across to the listener. For example, even just waiting a few seconds can give the patient’s brain time to recover the word. Or they may describe what an object looks like or what it does or use gestures to act out the word. For the telephone example, they could put their hand to their ear with their thumb and pinky extended.

“We also use communication devices to help patients express their wants and needs,” Horne says. “A device with different drinks illustrated, and they can request the one they want by pressing it.”

Horne encourages family members to take pictures of objects in the house.

“Objects that they see frequently can help them make the associations between the object and its word, so they can build back their vocabulary,” Horne says. “That’s just one of many word-finding strategies that can help those deficits in the brain and repair those connections.”

Not all patients will get back to the speech and language level that they were on before the stroke. But the hope of expressing yourself is not lost.

A New Baseline

“There is a counseling component to treatment,” Horne says. Her patients have already gone home from the hospital and experienced the inability to communicate and engage with not only their loved ones, but everyone they encounter. Even if they are improving well physically, their struggles with speech can still negatively impact their quality of life.

“It is very hard when people realize they aren’t going to be back where they were,” Horne says. “But there is a new normal for them, and we will find out what that is.”

The severity of the aphasia will determine where the new baseline is set and the most effective way to reach it.

“We are that next step after you’ve gone home from the hospital,” Horne says. “That’s when you’ll be facing more obstacles in your daily life. My goal is to get you to be able to communicate your wants and needs, which is crucial in those early weeks of recovery from a stroke.”

A referral is needed for outpatient speech therapy. Sessions can last up to an hour, once or twice a week and up to 12 weeks depending on the severity of your condition. For more information, help with a referral or to schedule an appointment, call the Candler Hospital Outpatient Rehabilitation Center at 912-819-6176.