NHS Greater Glasgow and Clyde
Advancing Skills in Stroke Care
Communication
Issues
Content
• Speech and
language disorders
of stroke:
• Dysphasia
• Dysarthria
• Dyspraxia
• SLT assessment
• SLT therapy
• SLT discharge
• Patterns of recovery
• Alternative aids
• Strategies for Multidisciplinary team
Speech and Language Disorders of
Stroke
• Dysphasia
• Dyspraxia
• Dysarthria
• Right
hemisphere
syndrome
Dysphasia
• Dysphasia is a disorder
of language that can
occur as a result of
stroke
• It can range from mild
to severe.
• It can affect:
 Speech
 Understanding speech
 Reading
 Writing
Fluent Dysphasia
•
•
•
•
Normal speed and intonation
Nonsense words/jargon
Poor self-monitoring and awareness of errors
Understanding often poor
“Cookie Theft” Picture
Example of fluent speech
(Based on description of cookie theft
picture.)
“Well this is…….mother is away here
working her work out o’here to get her
better, but when she’s looking, the two
boys looking in the other part.”
Non-fluent dysphasia
•
•
•
•
Slow and hesitant
Articulation errors
mostly uses nouns
Understanding is usually intact
Example of non-fluent speech
(Based on a description of the cookie
theft picture)
“Cookie jar…fall
over….chair…water…empty”
Fluent/non-fluent dysphasia
• In reality, it is not always that clear cut.
People do not always fall neatly into one type
of dysphasia.
• People can change from one to the other in
the early days after a stroke.
• Sometimes people have some of the
symptoms of one type and some of the other
eg. good comprehension but jargon words.
Swearing
•People often swear
when they have
dysphasia.
•This is because there is
a lack of control in the
brain over what is said.
•Don’t be offended! They
can’t help it.
Singing and automatic speech
•People with dysphasia
can often sing songs or
recite days of week or
other learned utterances.
•These are stored in the
person’s memory in a
different part of the brain
than the language centre
for making up sentences.
Dysarthria
• Dysarthria is a motor
speech disorder.
• Dysarthria affects the
movement of the
individual speech
muscles.
• It can vary from mild
slurring to completely
unintelligible speech
Dysarthria
Dysarthria can affect:
• Lip movements
• Tongue movements
• Jaw movements
• Soft palate movement
• Muscles of respiration
• Muscles of voice production
Dysarthria v’s Dysphasia
• Dysarthria is not a language problem.
This means there is no difficulty finding
the words to say or word choice errors.
• Dysarthria purely affects how the words
are uttered. E.g. how clear the sounds
are articulated
• Some people have both dysarthria and
dysphasia as a result of a stroke.
Speech Dyspraxia
• Speech Dyspraxia is another speech
impairment which can occur after
stroke.
• It rarely occurs on its own and usually
occurs alongside Dysphasia or
Dysarthria
Symptoms of Speech Dyspraxia
• The person with speech dyspraxia has
difficulty moving the speech muscles in
the correct way.
• The muscles are not weak as in
dysarthria but the problem is that the
message sent from the brain to move
the speech muscles is impaired.
Symptoms of Speech Dyspraxia
• The person usually tries again and
again to say the word and may silently
practise too.
• Someone with speech dyspraxia knows
what they want to say but the muscles
do not make the correct sounds .
• It is a very frustrating condition.
Right hemisphere syndrome (RHS)
• Damage to the right
hemisphere as a result
of stroke can result in
difficulties with
understanding and use
of some more complex
areas of language.
Symptoms of RHS
•
•
•
•
•
•
Poor eye contact
Difficulty staying on topic
Easily distracted
Lack of emotion in speech
Interpret words literally
Difficulty understanding humour
Example of RHS speech
“My husband and I like going out for a drink
on a Friday night to The Talbert Arms in
Milngavie. I once went to Jersey for my
holidays and it was beautiful weather.”
Role of the SLT
•
•
•
•
Assessment
Diagnosis
Therapy/Support/AAC
Discharge planning
Assessment of Dysphasia
Informal
Formal
•Conversation based
•Reading
•Writing
•Understanding
•Speaking
•Everyday abilities
•Several published tests
•Baseline measurement
•Informs treatment plan
Treatment for Dysphasia and
Dysarthria
2 approaches:
• Impairment based model
• Social model
Impairment based therapy
• Traditional model looks
at assessment results
and targets areas
where mistakes were
made.
• Eg. someone making
sound errors in speech,
therapy would work on
sound order and
awareness
“Tac” for “Cat”
Social model of therapy
• Newer approach
• Learning to cope with
living with a speech
problem.
• Using aids/strategies to
help improve
communication
• Re-establishing
independence.
Pattern of therapy
• 3 months is the casebook time given for
recovery from stroke.
• With speech and language problems
recovery can continue for up to 2 years.
• Ideally, therapy should be 3-4 times a
week in the early stages and gradually
scaled down as appropriate.
Factors affecting recovery of
speech and language after stroke
• Practicality of attending
3-4 times a week
• Degree of brain
damage from stroke(s)
• Time since onset of
stroke
• Deaf/visual impairment
• Motivation/Cooperation
• Age
• General health/mobility
Communication Aids
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•
•
•
•
•
•
Alphabet chart
Picture Chart
Communication book
PABA
Lightwriter
Go talk
Dynamo
Communication Aids
and dysphasia
• People with dysphasia
can make use of aids
depending on their
comprehension.
• They have to be able to
identify/understand
what a word or symbol
means eg. If they are
thirsty they must point
to a ‘drink’ symbol.
Picture communication board
To help with understanding….
• Talk SLOWLY
• Give the person plenty of TIME to take in what you
are saying
• Use SIMPLE but ADULT language
• Swap longer words for short simple words eg use pill
instead of medication
• Don’t shout
• Use GESTURE, WRITING and DRAWING
• Rephrase if not understood
• Ask questions to check that you have been correctly
understood and confirm what has been established
• Emphasise key words e.g. “Take one pill in the morning”
• REPEAT information as required
• Leave a WRITTEN RECORD of any plans or decisions
• Always have a notepad and pen handy
• RECAP to check that the person has understood
• REMEMBER Aphasia affects communication NOT
intelligence
To help with expression….
• Give the person plenty of time to get their message
across
• Encourage the person to use any method to
communicate eg speech, writing, drawing, facial
expression, gesture, pointing to pictures
• Don’t interrupt or “fill in” too soon. If you do have to
guess what the person means, check that you have
understood correctly.
• Provide written words for the person to choose from
e.g. Are you having difficulty walking? YES / NO
Do you want TEA / COFFEE / JUICE?
• The person may get their message across,
but may make errors. If you’ve understood
the message, don’t push for a correct
production of the word.
• Don’t pretend to understand the person if you
haven’t understood their message. Work
together to try and establish what the person
is trying to say. You won’t always be able to
work it out, but the person with aphasia will
appreciate that you’ve tried.