Loss of speech after a stroke. Aphasia and the role of the speech therapist in the therapy process.
Anna Barabas
speech and language therapist, educator, neurological speech and language therapist
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Aphasia is the loss of the ability to understand and produce speech as a result of damage to brain structures. These language impairments may also be accompanied by difficulties with reading, writing and counting, as well as other neuropsychological deficits such as apraxia, agnosia, memory impairment or a weakening of other cognitive functions.
After a stroke, a patient may simultaneously struggle with weakness of the hand and upper limb (paresis), visual disturbances, dysphagia and a heavy emotional burden. Apathy, low mood and depression, fatigue, irritability and a loss of self-esteem often appear. That is why loss of speech after a stroke is not solely a language problem, but part of a wider neurological picture.
The most common causes of aphasia
The most common causes of aphasia are cerebrovascular diseases, above all strokes, but these impairments can also occur after traumatic brain injuries, which require separate rehabilitation after a traumatic brain injury, and in the course of brain tumours. In Poland, around 75,000 people have a stroke each year, and strokes account for the vast majority of cases of aphasia.
- Strokes are the most common cause of aphasia in adults.
- Traumatic brain injuries (TBI), especially after road accidents, can also lead to loss of speech.
- Aphasia can also occur in the course of brain tumours and after their surgical treatment.
- A significant proportion of people who survive a stroke need further help from others and multidisciplinary rehabilitation.
Loss of speech after a stroke – types of aphasia
For clinical purposes, several basic types of aphasia are distinguished. This classification helps to describe the dominant difficulties, but in practice the pattern of impairment in an individual patient is often mixed and changes over the course of therapy.
- Sensory (receptive) aphasia – impaired comprehension of speech predominates.
- Motor (expressive) aphasia – the main problem is an inability or great difficulty in speaking.
- Amnestic aphasia – the patient has difficulty naming things and finding the right words.
- Mixed aphasia – deficits affecting both speaking and comprehension occur together.
- Global aphasia – both comprehension and speech are lost or very profoundly impaired at the same time.
Loss of speech after a stroke – rehabilitation
The consequences of brain damage call for comprehensive rehabilitation, delivered by an interdisciplinary team and tailored to the individual needs of the patient. Targeted speech rehabilitation after a stroke and the work of the speech therapist play a very important role in this process, because their aim is not only to improve speech, but also to rebuild other lost skills related to communication.
The therapy plan depends on the type of aphasia, the patient’s general condition, the presence of other neurological deficits and the stage of treatment. At the beginning, it usually focuses on restoring basic contact with the surroundings, and later on developing more complex language and cognitive functions.
Motor aphasia
In the therapy of motor aphasia, it is particularly important to encourage the patient to attempt contact, to stimulate spontaneous utterances, to elicit automatic speech, to repeat words and to gradually learn to build simple sentences. Specific speech therapy exercises after a stroke can also be done at home, because what counts is patience, frequent repetition and noticing even small progress.
Sensory aphasia
In sensory aphasia, therapy focuses above all on improving comprehension: of simple instructions supported by gesture, of situational context, of single words, sentences and logical-grammatical relationships. Just as important is curbing the flow of words and teaching attentive listening.
The later stage of therapy
At a later stage, rehabilitation is aimed at improving cognitive and communication functions as much as possible, so that the patient can take part as fully as possible in social and family life and, where possible, working life too. Progress is often spread out over time, but regular therapy offers a real chance of improving quality of life.
Aphasia remains a serious social problem, not only because of how common it is, but also because it affects the functioning of the whole family. The sooner the patient comes under specialist care and begins well-planned therapy, the greater the chance of rebuilding communication and achieving greater independence.
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