Valentine’s Day

Article by Moody Neuro

Valentine’s Day is coming in just a few days so this is a good time to talk about a few ways that brain injuries may affect Valentine’s Day for injury survivors and ways in which a brain injury survivor can make his or her Valentine’s Day experience a more successful one.

For survivors with speech deficits (generally referred to as “aphasia”), Valentine’s Day can be particularly stressful.  On Valentine’s Day people say “I love you” to loved ones and survivors with aphasia may find it frustratingly difficult to reciprocate, as effecting this once simple vocalization is for them no longer simple in any way to achieve.  They know what they want to say but cannot get the words out.  Some survivors may feel let down that they are not able to adequately express this heartfelt sentiment.  Speech therapists often work with survivors struggling with aphasia in order to help them to say important phrases like “I love you” and it is generally a good idea for those survivors to practice repeating these useful phrases on a daily basis.  Many survivors with aphasia can say simple phrases if someone starts to say the phrase with them or just accompanies them through the entire vocalization.  For instance, the survivor may be able to say “I love you” if his or her loved one helps him or her to initiate by saying “I lo….”.  Even if it takes some help getting the words out, most brain injury survivors will feel good about the accomplishment of having said the full phrase correctly.  Even if the survivor cannot quite get the words out, he or she is clearly trying to express his or her love.  Loved ones should accept and acknowledge the emotion behind the attempt.  In the end, it is truly the emotion that counts.

Another big Valentine’s Day change possibly seen in a survivor’s post-injury life relates to the way in which the holiday may now be celebrated.  For example, many survivors are accustomed to arranging for loved ones extensive meals, large events or extravagant celebrations on Valentine’s Day.  They may be used to purchasing huge bouquets, pricey wines or expensive chocolates.  After a brain injury, survivors and their families are often forced to adapt to a considerable decrease in potential household income and just as often struggle with substantial medical debts.  Some survivors may feel guilty that their injuries cause this change in holiday celebrations.  Many survivors that are hospital-bound may feel like they have ruined the holiday with their injuries.  From the perspective of those family members though, the joy of simply being able to celebrate another holiday with the survivor after the survivor’s near-death experience is greater than any gift that could be purchased.  There are a number of helpful ways in which to approach these issues.  Survivors may need to be reminded that they did not ask for the brain injury to happen, so they should therefore not blame themselves inappropriately.  Instead of purchasing items, they may be encouraged to make a gift or a card for their loved ones.  Families often appreciate hand-made items at least as much as (if not even more than) purchased items.  In cases in which survivors  do purchase items, loved ones may wish to take special care to reassure those survivors that a small item purchased is appreciated just as much as a larger such item would be.  In some situations, such as when a survivor is spending time as a patient in an inpatient rehabilitation facility, that survivor may need a friend or family member to purchase on the survivor’s behalf an item the survivor intends to give as a gift.  Most importantly, loved ones may need to help the survivor focus on what everyone values the most.  Above all else, those involved should never lose sight of how precious the opportunity to celebrate their love together is.  That this opportunity for shared appreciation was very nearly permanently lost as a result of the injury suffered should only emphasize its incomparable value.

Sometimes there are dietary issues that may be brought to the fore when engaging in Valentine’s Day festivities.  Valentine’s Day gifts tend to involve copious amounts of chocolate and sweets.  For survivors with diabetes, eating large amounts of chocolate and sweets is invariably accompanied by significant risk of serious health complications.  Loved ones may want to give non-food gifts like flowers or other such items to diabetic patients.  Also, people tend to go out to eat for Valentine’s Day meals.  Any instructions by speech therapists such as using thickener to make drinking liquid less of a hazard or adhering to safe swallowing techniques need to be carried out in restaurants just as they would be at a home or at a rehabilitation facility.  It may not seem romantic to thicken a drink during a candlelit dinner at a white tablecloth dining establishment, but there is certainly nothing romantic about contending with an identified swallowing issue leading to a serious problem such as aspiration pneumonia.

As mentioned above, many people like to go out for Valentine’s Day.  This may include going to restaurants, movies or plays.  As Valentine’s Day tends to be a busy day for these venues, there are a few issues that may need to be considered as regards a brain injury survivor’s participation.  If a survivor has physical mobility issues, that survivor and his or her loved ones need to hold accessibility as a key aspect of any venue selection.  Though all public buildings must by law meet a minimum threshold of accessibility, some venues are simply better suited to the needs of those with significant mobility issues than others.  One relevant question to consider would be which restaurants have wider spaces between tables allowing greater ease in wheelchair navigation.  Is there a separate accessible entrance that a survivor can use to make it easier to enter the venue?  As an example, many movie theaters have separate entrances for those with mobility deficits so as to make it easier to enter and leave while avoiding the normal crowd of movie-goers.  If a survivor would do best with a particular seating arrangement (such as being closer to the door to limit the distance he or she will be required to walk), venues will almost always assist in such a scenario as long as they are contacted in advance.  A simple phone call to a restaurant can often guarantee that the most appropriate seating will be reserved for the survivor and his or her loved ones.  Survivors and loved ones may also want to consider patronizing any of these establishments at off-peak hours.  This can not only mitigate challenges faced by those with mobility issues, but it is also usually the best choice for survivors that have a tendency to become easily agitated when in large crowds.  Some survivors may do best with a home-based or facility-based celebration rather than going out into the community if they have too significant a difficulty with mobility or managing agitation.  Others may do best by celebrating Valentine’s Day a day early or a day late so as to avoid the holiday rush and stress.

One oft-ignored issue is that many brain injury survivors simply do not feel attractive faced daily as they are by ever-evident knowledge of permanent changes their injuries have wrought.  They may look at themselves and see body parts that do not move, now necessary constantly present aid devices, prominent scars or other injury-related alterations to their physical appearance that make them feel ugly.  In almost all cases, loved ones will still feel  strong love for and a powerful sense of connection to the survivors.  Sometimes, contending with life in the aftermath of such an injury will have the effect of even increasing these feelings.  It is vital for loved ones to express their feelings to the survivors and to be sure that they let the survivors know how much the survivors are loved.   Survivors may need more encouragement and reassurance of their attractiveness than they needed in the past.  Further, survivors should be encouraged to dress as they normally would have (or as best as they can now manage given their needs).  For instance, if a survivor normally wore make-up prior to her injury, she should be encouraged to still wear make-up.  We tend to feel better when look better, even when we do not have an injury.  When we see ourselves in the mirror looking our best, we are more likely to feel our best.

I hope this post helped to explain a few of the issues that may accompany Valentine’s Day celebrations and offered some useful suggestions to aid brain injury survivors in maximizing their holiday experiences.

Learn about the Moody Neurorehabilitation Institute’s brain injury treatment services.

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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