The Saddest Story

Article by Moody Neuro

I would like to tell you the saddest story of my professional career. I was working at a major city hospital and one of my jobs was consultation neuropsychological testing. When a patient was admitted to the general medical unit of the hospital but the attending physician suspected the patient also had cognitive deficits (such as memory problems) I was asked to conduct a neuropsychological evaluation. It was in this role that I experienced the saddest case of my career.

One day, I was contacted by a doctor to conduct neuropsychological testing on a patient. The doctor told me the patient’s room and bed number. Naturally, I asked for the patient’s name. The doctor responded that he didn’t have the patient’s name, as the patient had been too confused to give it. He had been found injured at the side of the road and his brain was still in the beginning stages of healing, and the hospital had yet to be contacted by anyone who could provide his name. As I had never encountered such a situation before, I asked how long the patient had been in the hospital. The doctor replied that he had been in the hospital for two weeks. Two weeks had passed without any kind of contact from anyone that might know the patient.

I met with the patient and conducted the neuropsychological evaluation. Although he could respond verbally with excellent clarity, he could not give his name. He was so confused that at one point during testing, his responses indicated that he thought he was in a television show. I completed my testing and wrote up the evaluation. A week later, I asked the referring doctor if we’d finally found out the patient’s name. Three weeks later, we still had no name for the patient. He could not remember his name and no one had come to find him.

The saddest part of this story is not the patient’s severe confusion. I have assessed plenty of patients who struggled with recalling and conveying basic personal information. That is a large part of my role as a professional. The saddest part is that for three weeks, not a single family member, friend or co-worker had come to look for him. It was as if he was a lone deserted island in the middle of an ocean, and no one knew he existed.

There are several important lessons that I take from this story. As an adult, no one has to support you after you are injured. Legally, in most cases everyone can walk away and leave you on your own. Whether it be a spouse, child, other family member or anyone else, no one has to stick around when you are down. For instance, a spouse can choose to file for divorce or a parent can choose not to take responsibility for an adult child. This means that every single person who has decided since your injury to remain in your life has made a personal decision to remain. Every single visit, call, text or even a “like” on social media is completely voluntary. No one is being forced to do this. These individuals are choosing to be a part of your life. This means it is incumbent upon you to appreciate that each individual who has taken the time and effort to be a part of your life has made this decision willingly. Whether it be out of romantic or familial love, a strong friendship connection or any other reason, they have chosen to remain in your life following your injury. That is a big deal and it is important to appreciate their choices.

It is also incumbent upon you to recognize that your relationship with that other person is something that they find valuable even after your injury. If there were no value in the relationship, it would be easy for the other person to leave. So, you still contribute to that valuable relationship. He or she finds something about your relationship exceptional, even though you may not be in the same state of health as before your injury. You are still special and it is vital to appreciate your importance in the relationship.

It has been approximately 15 years since I saw the patient with no name and no loved ones. I hope life has turned out better for him than it was those many years ago. When I see the amazing love and caring that Moody Neuro patients receive from family, friends and co-workers, I think back and remember with sadness that not everyone has such great support. This makes me appreciate the relationships between Moody patients, family, friends and co-workers that much more.

Learn about brain injury treatment services at Moody Neurorehabilitation! Visit us at: https://www.moodyneuro.org/

 

Strokes are medical conditions that affect millions globally. In the United States, more than 795,000 people have a stroke each year, with about 610,000 cases being first or new strokes. 

These can lead to a wide range of physical and cognitive impairments. Speech and language disorders are among the most common and most challenging consequences of strokes, occurring in about a third of stroke survivors. 

Understanding Stroke-Induced Speech & Language Disorders

Stroke-induced speech and language disorders significantly impact communication abilities. Among these, aphasia, dysarthria, and apraxia of speech are prevalent. Understanding how they are diagnosed and their specific symptoms can aid in prompt and effective management.

Aphasia

Aphasia is a common outcome of stroke, manifesting as difficulty in speaking, understanding, reading, and writing. There are many different types of aphasia, depending on the affected brain area, and are categorized based on the symptoms present:

  • Expressive Aphasia (Broca’s Aphasia): Characterized by broken speech, limited vocabulary, and difficulty forming complete sentences. Patients often understand what is being said to them but struggle to verbalize responses.
  • Receptive Aphasia (Wernicke’s Aphasia): Patients can produce fluent speech but may lack meaning or include nonsensical words. They often have significant difficulty understanding spoken language.
  • Global Aphasia: A severe form of aphasia where individuals have extensive difficulties with both speech production and comprehension.
  • Anomic Aphasia: Individuals have difficulty finding words, particularly nouns and verbs, making their speech sound vague.

Dysarthria

Dysarthria is a speech disorder that affects 20-30% of stroke survivors. It occurs when stroke impacts the muscles responsible for speech, leading to slurred or slow speech that can be hard to understand. It is typically diagnosed through a physical examination and a series of speech evaluations conducted by a speech-language pathologist (SLP). 

It is characterized by the following symptoms:

  • Slurred or slow speech that can be difficult to understand
  • Monotone or robotic-sounding speech
  • Difficulty controlling the volume of speech, which may be too loud or too soft
  • Challenges with the rhythm and flow of speech, including rapid speech that’s hard to interrupt or slow, drawn-out speech
  • Respiratory issues affecting the ability to speak loudly or for extended periods

Apraxia of Speech (AOS)

Apraxia of speech is a neurological disorder characterized by difficulty sequencing the movements needed for speech. This is caused by the impact of the stroke on the brain’s pathways involved in producing speech. 

Patients with AOS know what they want to say but struggle to coordinate the muscle movements to articulate words correctly. This results in distorted speech, difficulty initiating speech, or the inability to accurately produce speech sounds or sequences of sounds. 

How Long Is the Stroke Speech & Language Recovery Time?

According to one study on post-stroke speech and language therapy, approximately one-third of stroke patients experience speech problems after a stroke. Many of these individuals begin to recover within a few months, with significant progress typically observed within three to six months.

In another study, 62% of subjects had speech challenges after suffering from a stroke. By six months post-stroke, 74% were able to completely recover their communication abilities. 

However, the figures above provide a general timeline for post-stroke speech and language recovery. Stroke speech recovery time is highly individualized and can vary depending on several factors. These can include the following:

  • Severity of the Stroke: More severe strokes often lead to extensive brain damage, resulting in longer and more challenging recovery periods for speech.
  • Location of the Brain Injury: The brain’s specific regions control different speech and language functions; damage to these areas directly impacts recovery complexity and duration.
  • Age and Overall Health of the Patient: Generally, younger patients with better overall health before the stroke tend to experience faster and more complete recoveries.
  • Pre-existing Conditions and Comorbidities: Conditions such as diabetes or hypertension can slow down recovery by complicating the overall health scenario and rehabilitation process.
  • Individual Variability and Resilience: Personal resilience, the support system’s strength, and the individual’s motivation significantly influence the pace and success of speech recovery efforts.

The first three months after a stroke is a crucial period for recovery, as a majority of stroke patients see the most significant improvement during this period. However, it’s also important to note that, although at a slower pace, recovery can continue well past the 6-month mark with continued therapy and practice. 

This underpins the importance of early intervention and ongoing rehabilitation efforts, including speech therapy, to maximize each patient’s recovery potential. 

What Does the Stroke Speech & Language Recovery Process Look Like?

The journey to regain speech and language after a stroke is multifaceted and varies significantly from one individual to another. Understanding the structured phases of recovery can provide insight into what patients and their families can expect during this challenging time. 

Here’s a closer examination of each phase in the stroke speech recovery process.

Initial Assessment and Diagnosis

Before recovery can begin, a thorough evaluation is conducted by a team of healthcare professionals led by an SLP. This assessment aims to identify the type and severity of the speech and language disorder, be it aphasia, dysarthria, or AOS. The evaluation may include cognitive-linguistic assessments, comprehension tests, speech production analysis, and functional communication measures. 

Based on this assessment, a personalized therapy plan is crafted to address the patient’s specific needs.

Acute Phase

The acute phase typically occurs within the first days to weeks following a stroke. During this period, medical stabilization is the primary focus, with healthcare teams working to manage the immediate effects of the stroke. 

Speech therapy may begin with simple exercises or assessments to gauge the patient’s abilities. However, intensive therapy usually does not start until the patient is medically stable. During the acute phase, the goal is to support overall recovery and prevent complications immediately after the stroke.

Subacute Phase

The subacute phase generally spans from two weeks to three months post-stroke and is characterized by more intensive speech therapy interventions. As the patient’s medical condition stabilizes, the focus shifts to active rehabilitation. Therapy during this phase is tailored to the individual’s specific speech and language deficits and may include:

  • Exercises to improve articulation, fluency, and voice control for those with dysarthria.
  • Language therapy to enhance understanding, speaking, reading, and writing skills in patients with aphasia.
  • Motor speech exercises and strategies to improve speech planning and production in apraxia of speech.

The subacute phase is crucial for taking advantage of the brain’s natural recovery processes and neuroplasticity, where the brain begins reorganizing and adapting to the loss of function.

Chronic Phase

The chronic phase of recovery extends from several months to years after the stroke. It focuses on long-term rehabilitation and adjustment to any residual speech deficits. During this time, patients may continue to see gradual improvements in their speech and language abilities, although the rate of recovery may slow. Therapy in the chronic phase often includes:

  • Advanced communication strategies to cope with ongoing challenges in daily life.
  • Maintenance exercises to preserve and enhance speech gains achieved in earlier phases.
  • Supportive technologies and aids, such as communication devices, to assist in effective communication.
  • Community reintegration activities to help patients return to as normal a life as possible, engaging in social, vocational, or recreational activities.

What Is the Role of Neuroplasticity in Speech & Language Recovery?

Neuroplasticity refers to the brain’s fundamental property to change and adapt its responses to new experiences, learning, and environmental changes. This adaptive capacity enables the brain to reorganize itself by forming new neural connections.

When the brain, or a part of the brain, is damaged after a stroke, neuroplasticity is what allows the other parts of the brain to take over the functions of the damaged area. Through targeted rehabilitation and therapy, such as speech therapy for stroke survivors, patients can retrain other brain areas to perform the lost functions and facilitate recovery.

Enhancing Stroke Speech & Language Recovery Time

Adopting a comprehensive approach involving several key strategies is vital to enhance the stroke speech and language recovery time. This multifaceted approach can maximize the chances of regaining speech and communication abilities.

This comprehensive approach must incorporate the following strategies:

  • Early intervention to leverage the brain’s highest potential for neuroplasticity in the initial period following a stroke, significantly improving the chances for recovery.
  • Alternative communication strategies, such as gestures, writing, and visual aids, to help maintain communication during the recovery process. 
  • Adopting technology, including speech-generating devices and software applications designed for speech rehabilitation, for personalized exercises and continuous practice, which is vital for progress.
  • Providing continuous support from psychologists, support groups, and therapy to help manage feelings of frustration, depression, and anxiety, fostering a positive mindset essential for rehabilitation.
  • A healthy diet and lifestyle to supply essential nutrients that support brain function, along with regular physical activity, adequate sleep, and management of medical conditions.

Begin Your Post-Stroke Recovery Journey With Moody Neurorehabilitation

Moody Neurorehabilitation understands the complexities and challenges that come with post-stroke rehabilitation. We are dedicated to supporting patients and their families through this critical time with specialized care and personalized treatment plans.

Since our inception in 1982, Moody Neurorehabilitation has been a leader in brain injury rehabilitation. Our approach centers on providing comprehensive care tailored to each patient’s needs and goals. We believe in treating the whole person, not just the symptoms, to improve overall quality of life.

We invite you to start your recovery journey with us. Contact Moody Neurorehabilitation today to schedule a consultation with our experts. Let us help you navigate the path to recovery with care, compassion, and expertise.

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