Speech Pathology after Stroke

by Care Speech 
20 April 2022

The World Health Organisation reports that strokes are one of the leading causes of death and disability worldwide. Strokes can significantly impact an individual’s communication and swallowing function which can in turn affect their sense of self, employment prospects and social and emotional wellbeing.

Speech Pathologists play an important role in post-stroke rehabilitation in the areas of speech, language and swallowing. Speech Pathologists work with stroke survivors alongside their family, friends and even employers to support them to adapt and thrive across various settings.

What is a stroke?

The broad definition of a stroke is when the cells in the brain do not receive the oxygen and nutrients they need to survive. This can either be caused by a bleed in the brain or by a clot that has blocked the blood from getting where it needs to go.

A stroke can happen unexpectedly, and can affect a person’s physical, emotional, and mental health. It may also result in communication and swallowing difficulties and become a risk factor for dementia and Alzheimer’s disease.

What is a mini-stroke?

A mini-stroke, otherwise known as a Transient Ischemic Attack (TIA), is different to other strokes. During a mini-stroke, blood flow to the brain is briefly interrupted for a maximum of 5 minutes. A mini-stroke can have similar symptoms to a major type of stroke so it is important to contact emergency services and receive immediate care. Mini-strokes are also an early warning sign for future strokes so it is important to recognise the signs and seek treatment as early as possible.

What might I experience after a stroke?

Speech Pathologists play an important role in the management of speech, language and swallowing difficulties that a patient may experience after a stroke. These include:

  • Difficulty understanding and using words. This may also extend to reading and writing and can lead to high levels of frustration. This is known as aphasia.
  • Difficulty sequencing the movements required for speech. This may result in ‘groping’ actions of the mouth and speech that sounds uncoordinated. This is known as apraxia.
  • Unclear or slurred speech when talking. This is caused by weakness, or even paralysis, of the muscles required for speech production. This is also known as dysarthria. Read more about Dysarthria in Adults here.
  • Difficulty when eating and/or drinking. This can include difficulty managing fluids and food of various textures, keeping food inside the mouth, chewing and/or swallowing safely. You may also notice coughing at mealtimes. This is known as dysphagia.
  • Change in the quality of the voice. A person’s voice may sound different to how it did before the stroke, and may suddenly sound hoarse, breathy, or rough. This is known as dysphonia.

How can a Speech Pathologist help after a stroke?

A Speech Pathologist can assist with all of the symptoms listed above. A Speech Pathologist may help a stroke survivor to:

  • Improve and practise their talking, listening, reading and writing.
  • Learn how to use other communication methods (either short-term or long-term) so that they can keep in touch with their friends and family.
  • Strengthen and/or re-coordinate the muscles required for speech and swallowing.
  • Rehabilitate high-level language and problem-solving skills.
  • Better understand what they are experiencing right now, what they can do next and what they can expect in the future.

When accessing Speech Pathology services post-stroke, a Speech Pathologist may:

  • Conduct a communication or swallow assessment to better understand the nature of the current difficulties and the impact they are having on daily functioning. This will help to highlight the areas that have or have not been affected by the stroke.
  • Schedule regular appointments to target the areas of difficulty. A Speech Pathologist may recommend higher or lower intensity depending on what is being experienced.
  • Work with the family in a collaborative model so that the family can play an active role in the care of their loved one. Speech Pathologists will want to know how the stroke has impacted family life and how communication among the whole family can best be supported. Speech Pathologists often provide families with individualised communication strategies that are tailored to the client’s most significant areas of need.
  • Work with the employer and provide education and advocacy to ensure that a client’s communication needs are being supported appropriately across all different environments.
  • Collaborate with other health professionals in the management of the client’s care. This may include Psychologists, Occupational Therapists, Physiotherapists, Dieticians and of course the medical team.

What does online therapy look like after a stroke?

Over the past decade, research has shown that Speech Pathology via video (or online therapy) can treat a wide range of communication and swallowing disorders very effectively, including those experienced by stroke survivors.

Accessing Speech Pathology services via video has many similarities to in-person therapy and many of the exact same assessment and therapy resources are used.

Online therapy has the added benefit of eliminating travel time to and from a physical practice, as well as allowing clients to participate in sessions from the comfort of and in the familiar surroundings of their own home. This also allows the Speech Pathologist to gain insight into the home environment and ensure that their recommendations are practical, functional and tailored to a person’s surroundings. Read more about Online Speech Pathology here.

 

Contact us today to find out how a Speech Pathologist from our team can support you or your loved on their post-stroke journey. Call us on 1300 086 280 or email us at [email protected] to book an initial consultation.

 

References

Mijajlović, M. D., Pavlović, A. J., Brainin, M. B., Heiss, W.-D. M., Quinn, T. B., Ihle-Hansen, H. H., … Bornstein, N. undefined. (2018). Post-stroke dementia – a comprehensive review. BMC Med, 15(1). doi: 10.1186/s12916-017-0779-7

Deb, P., Sharma, S., & Hassan, K. (2010). Pathophysiologic mechanisms of acute ischemic stroke: An overview with emphasis on therapeutic significance beyond thrombolysis. Pathophysiology, 17(3), 197–218. doi: 10.1016/j.pathophys.2009.12.001

Johnson, W., Onuma, O., Owolabi, M., & Sachdev, S. (2017, December 8). Stroke: a global response is needed. Retrieved May 12, 2020, from https://www.who.int/bulletin/volumes/94/9/16-181636/en/

Markus, H. (2008). Stroke: causes and clinical features. Medicine, 36(11), 586–591. doi: 10.1016/j.mpmed.2008.08.009

Panuganti, K. K., Tadi, P., & Lui, F. (2020, March 28). Transient Ischemic Attack. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459143/

Speech Pathology Australia. (n.d.). Augmentative and Alternative Communication [Fact sheet]. https://www.speechpathologyaustralia.org.au/SPAweb/Resources_for_the_Public/Fact_Sheets/SPAweb/Resources_for_the_Public/Fact_Sheets/Fact_Sheets.aspx?hkey=e0ad33fb-f640-45b1-8a06-11ed2b73f293

Speech Pathology Australia. (n.d.). Communication and Swallowing Difficulties following Stroke [Fact sheet]. https://www.speechpathologyaustralia.org.au/SPAweb/Resources_for_the_Public/Fact_Sheets/SPAweb/Resources_for_the_Public/Fact_Sheets/Fact_Sheets.aspx?hkey=e0ad33fb-f640-45b1-8a06-11ed2b73f293

Stroke Foundation - Australia. (n.d.). Signs of stroke. Stroke Foundation - Australia. Retrieved March 25, 2022, from https://strokefoundation.org.au/about-stroke/learn/signs-of-stroke

Vijayan, M., & Reddy, P. H. (2016). Stroke, Vascular Dementia, and Alzheimer’s Disease: Molecular Links. Journal of Alzheimers Disease, 54(2), 427–443. doi: 10.3233/jad-160527

Viola, L. F., Nunes, P. V., Yassuda, M. S., Aprahamian, I., Santos, F. S., Santos, G. D., … Forlenza, O. V. (2011). Effects of a multidisciplinary cognitive rehabilitation program for patients with mild Alzheimers disease. Clinics, 66(8), 1395–1400. doi: 10.1590/s1807-5932201100080001

Warlow, C., Sudlow, C., Dennis, M., Wardlaw, J., & Sandercock, P. (2003). Stroke. The Lancet, 362(9391), 1211–1224. doi: 10.1016/S0140-6736(03)14544-8

Webb, W. G. (2017). Organization of the Nervous System II. Neurology for the Speech-Language Pathologist, 44–73. doi: 10.1016/b978-0-323-10027-4.00003-8

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