Calls for greater help for stroke victims

Stroke is the third most common cause of death among adults in Scotland. While nearly half the number of people affected will make a good recovery, the same number again can be left with considerable disabilities. Now a leading charity is calling on the Government to help stroke patients whose speech is badly affected.

Around 12,500 Scots will have a stroke this year. Whilst most victims will be over the age of 65, some 20% will be younger than that. It is one of the most common causes of adult death after heart disease and cancer, and can leave many survivors with severe disabilities. One of

Angela McLeod

the hardest to cope with is the loss of speech and communication. Now leading charities as well as The Royal College of Speech and Language Therapists in Scotland are joining forces to call for more support.

Angela Macleod of The Stroke Association said: "Having a communication disability affects the ability to speak and to understand language, and you can imagine that's got a huge impact on people's lives in terms of being reintegrated into their family and the wider community once they've had a stroke and they're going from the hospital back home. It can affect their ability to get back to work, relationships with friends, and again with family, and also can cause huge amounts of frustration and depression and distress. Which has been shown to happen with people who've got a communication disability".

According 'Lost Without Words', a report by the Stroke Association, a top priority should be an audit to establish just how many people in Scotland are affected. This will enable better patient referral to relevant support services. It's hoped that the current review of the Executive's Coronary Heart Disease and Stroke Strategy willl result in vastly imrpoved communication support services.

Stroke support was a 'life saver'

Most stroke patients struggling with communication problems receive little support, the Stroke Association says, despite groups available to help them.

One carer, Julia Hilder, explains how her husband was helped by the association after his stroke left him almost speechless.

John Hilder suffered a heart attack in December 2002, followed almost immediately by a stroke while he was in hospital.

"It took all his speech away and in the morning all he could say was 'yes' and 'no'," says Julia, 66.

Mr Hilder had aphasia - communication problems caused by damage to the brain - which is very common in stroke patients and can severely impact on quality of life.

Mr Hilder received some speech therapy in hospital, "but we were not told that he had aphasia and nobody would give us a prognosis".

"In hospital the speech and language therapist was great and gave us some leaflets, but when he was discharged there was no speech and language therapy."

It has made him more determined to progress Julia Hilder Carer

They were, however, told about a communication support group in a neighbouring town.

The only drawback is that it takes an hour to get from their home in Bude, Cornwall to the group in Bideford, and she would prefer to have one closer.

Despite the travel time, Mr Hilder and his wife have been attending it once a week for the past five years.

John, now 65, has benefitted in various ways.

"It's a very, very sociable group," says Julia, "and the stimulation is wonderful for him, as well as being able to help others in the same situation as he is."

The group is focussed on conversation skills, with discussion exercises prompted by newspaper articles, and there are also outings to the theatre and lunches.

"It has made him more determined to progress," Mrs Hilder says.

"His communication was pretty minimal at first, but now it's pretty good. He does have blockages though - where the words are in there, but he just can't get them out."

Frustration

Initially he was unable to categorise to words, such as knowing that blue was a colour and a dog was an animal, but he continues to improve.

"There's a lot of frustration, he used to be a big talker. You have to give him time to assimilate what you say and then the response is slower as his brain works through the words," Julia says.

She has also been helped, describing the group as "a life-saver".

"It gave me the only two and a half hours I had during the week to myself. I also go on all the trips with the group and have met the other carers there.

"This gives me the opportunity to meet with other people in the same situation as me and discuss our shared experiences."

Stroke patients 'need more help'

Many stroke patients with speech problems are being left isolated once they are discharged from hospital, campaigners say.

The NHS offers those with communication problems access to community support groups led by stroke specialists.

But the Stroke Association estimates 90% of patients in England who need such help are not getting it.

The government said extra money is being invested to improve services in the community.

About 150,000 people a year have a stroke, and about a third of survivors are left with a communication disability as a result.

The loss of these basic skills can leave stroke survivors feeling imprisoned and depressed Joe Korner, of the Stroke Association 'Support was a life saver'

Not all of the stroke sufferers will need long-term help, but for those who have lost the ability to speak or find it difficult to use and understand language, the NHS provides communication support therapy.

This is normally delivered in a group setting and led by a stroke specialist. The groups help patients improve their speech or develop basic sign language to allow them to communicate.

The Stroke Association, which runs most of the services for the NHS, found that just 1,300 people in England are accessing the care.

This figure represents just 12% of those who have severe communication difficulties.

Services

The charity's report said the situation was a little better in Wales and Scotland, but improvements could still be made.

It said NHS trusts need to monitor the progress of stroke patients more carefully and ensure there were sufficient services to help them.

Joe Korner, of the Stroke Association, said: "We all need to communicate. Whether it's through speaking, a hand gesture or the blink of an eye, the ability to interact with others is crucial.

"The loss of these basic skills can leave stroke survivors feeling imprisoned and depressed."

The Department of Health said money was being invested in a range of counselling and support services.

A spokeswoman added: "We know that long-term support needs to be better coordinated."

May is about better hearing, speech

As May is Better Hearing and Speech Month nationally, now is a good time to refresh our memories of speech and hearing wellness. When we take good care of our overall health, we reduce the risk of damaging our abilities to speak and hear. Of course the standard health regime does apply.

Good nutrition promotes brain growth, may prevent subtle fetal brain abnormalities, heart disease and reduce the risk of some cancers. These health problems can have a damaging effect on our abilities to use speech and language. Heart and circulatory problems can also affect hearing.

Regular professional health care promotes constant monitoring of health status. It may prevent illness, disability, high blood pressure, which all affect hearing. Routine health care also may prevent voice disorders and aphasia (the loss of ability to use and understand language). Exercises and stress management increases physical and emotional well-being, which reduces the dangers of stroke and the resulting possibility of aphasia. Remember to buckle up for safety when driving any vehicle. Head injuries cause memory deficits and difficulties with thought processing and language understanding as well as language expression.

Alcohol affects the brain and common “street” drugs are even more toxic. The language and learning areas sensitive to and easily damaged by substance abuse include memory, problem-solving, deriving meaning, decision-making, and anticipation of consequences. Substance abuse can even dry the mucous membranes of the vocal tract. For those of us who enjoy cigarettes and smokeless tobacco, we must remember that neonatal problems, laryngeal and oral cancers, respiratory distress, developmental disabilities and even strokes are possible.

Let’s be reasonable about protecting ourselves.

Avoid extended periods of exposure to loud noise.

Wear ear plugs or ear protectors when around loud noises, contrary to popular belief, cotton in our ears does not work.

Keep the volume down in our cars and on our personal music systems.

Do not try to clean our ears with cotton swabs or such “foreign” objects as bobby pins and pencil tips.

Have our hearing checked periodically. If we have trouble understanding what is said to us, have constant ringing in one or both ears, are not startled by noises that startle others, or frequently need to ask others to repeat what they said, we need a hearing test.

Do not misuse the voice by shouting or using a pitch level that is too high or too low for comfort.

Parents: Take time to listen, talk and read to our children, beginning at birth.

Accept some speech mistakes as the child learns. Do not ask the child to slow down and repeat, this brings attention to the mistake and may cause anxiety in the child — which causes more speech problems.....

Recognizing symptoms of stroke saved doctor’s life

Susanne Nadeau, Herald Staff Writer
Published Tuesday, May 06, 2008

Knowing the signs and acting fast saved Tom Cariveau’s life. Physically fit with a good blood pressure reading, low cholesterol levels and no family history, Tom, a doctor at East Grand Forks MeritCare, wasn’t considered high risk for a stroke. But he recognized the symptoms when he suffered a major one Nov. 8. A stroke is a blood clot plugging an artery or a blood vessel that breaks in the brain, disrupting the flow of blood. When blood flow to the brain stops, brain cells die and the abilities controlled by that area of the brain are lost, which is why some stroke survivors lose the ability to speak or use certain body parts. A stroke can be small, causing only minor damage; major, immediately affecting the ability to use certain parts of the body; or massive, resulting in death. Tom, in family medicine for the past 21 years, was in his ...

Isolation of the speech area*

Norman Geschwind, Fred A. Quadfasel and JoséM. Segarra

Aphasia Research Center, Boston University School of Medicine, Boston, Massachusetts 02118

Abstract

References and further reading may be available for this article. To view references and further reading you must purchase this article.

The case is presented of a 22 year-old woman who survived ten years following an episode of carbon-monoxide poisoning. The patient's language behavior presented several striking clinical features. Her spontaneous speech was confined to a few stereotyped phrases and she gave no evidence of comprehension of language. By contrast she exhibited echolalic repetition with excellent articulation. In many instances she showed the “completion” phenomenon described by Stengel, i.e. the completion of stereotyped or simple phrases uttered by the examiner. In addition she was able to carry on verbal learning as shown by her ability to learn the words (as well as music) of songs which had not existed before her illness.

At post-mortem, a detailed study of serial whole-brain sections showed intactness of auditory pathways up to and including Heschl's gyrus, of Wernicke's area and Broca's area and of the arcuate fasciculus connecting these two cortical regions, of the lower Rolandic cortex and of corresponding portions of the pyramidal tract. The hippocampal region (except for Sommer's sector) and the structures of the limbic system were well preserved, as was the reticular substance of the brain stem.

This case corresponds in its clinical picture to the classical “mixed transcortical aphasia” (i.e. paucity of speech and severe comprehension deficits with excellent preservation of repetition) with some new features (capacity for verbal learning) not previously described. The pathology agrees with that advanced by Goldstein for this condition, i.e. “isolation of the speech area”. The explanation advanced for this clinical picture is that comprehension and propositional speech are lost because of the isolation of the speech region from other cortical areas, while those functions which can be carried on by the speech area itself, i.e. repetition and completion of well-learned phrases, are preserved. The ability to carry on verbal learning in this patient probably depended on the intactness of the medial temporal regions and the preservation of the connections to them from Wernicke's area.

In Praise of Literary Heroism

The Shadow Factory by Paul West.

“Can you think without words?” Paul West, a playful, prolific, and erudite master writer, was forced to contemplate this paradox in the wake of a massive stroke. The author of many remarkable and diverse novels, including The Immensity of the Here and Now, Cheops, and Terrestrials, and a string of vivid memoirs, West was already hospitalized for a drastic kidney infection when he was struck down and hurled into the void of global aphasia. His right arm was paralyzed. He could barely swallow. He could not speak. After months of heroic effort, he uttered his first complete sentence, “I speak good coffee.” His doctors were adamant: he would never write again. But over the years, West has overcome adversity in many forms. Persistent, ardent, witty, life-loving, deeply curious, and aided and abetted by his indefatigable, brilliant, and loving wife, the writer Diane Ackerman, he proved the good doctors wrong, regaining his great facility with language, and writing this astonishing work, the first aphasic memoir. A dispatch from the “shadow factory” of an abruptly silenced inner realm in which a radiant mind struggles to burn through dark matter.

West was determined “to be as sentient an observer as possible” even in this frightening, wordless state, and so he was. And in this philosophical, positive, and dream-like chronicle, a work that booms like Shakespeare and clicks like Beckett, West describes the lightning strike that changed everything, the voices he heard, and the slight alterations in sensation that gave him hope. As he ponders the nature of muteness, the solace of reason, and the maddening gap between thought and speech, he does not dwell on the fear, anger, and “silent frustration” engendered by his ordeal, but instead discerns an eerie beauty in his journey from the dim “languageless wasteland” into the full sun of life and the music of words, glorious words. “We live, most of us, in a world of dumb recalcitrance, saved occasionally by inspired seers.” West is just such a being. We all benefit from his valor and artistry. Watch for his next novel.

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