Recovery from Stroke: Learning to Talk Again

Part 1: Aphasia and rehabilitation

by Joy Simpson

So it happened to your father. A brain attack. That's what they call a stroke. He survived, but he has trouble speaking and understanding what people say to him. It's a condition called aphasia. What are his chances of full recovery?

The National Aphasia Association says more than half the people with symptoms of aphasia recover in the first few days. But there are many factors to consider if recovery takes longer.

What is aphasia?
Aphasia can be caused by a health crisis like stroke or a brain tumor, or it can be the result of a head injury from an accident. It's probably the left hemisphere of the brain that has been injured -- the language control center.

Aphasia has different forms. It can affect the brain's ability to comprehend language and it can also limit the ability to talk. Sometimes the person can speak, but he doesn't make much sense.

Learning to communicate again is one of the important functions of rehabilitation therapy. "The desire to connect with another person through language - that's the essence of our humanity," said Susan Jackson, a speech-language pathologist and faculty member at the University of Kansas Medical Center.

Factors to consider in recovery
If your father is fortunate enough to be in the right place at the right time, he'll get the new clot-busting drug that reverses the damage caused by stroke. It is called t-PA or tissue plasminogen activator. You must get to the Emergency Room within three hours for it to be effective. Be aware that the kind of treatment he'll be offered depends on the kind of stroke. If a clot caused it, then t-PA will help. But this is not the right course of action if the stroke was caused by a brain hemorrhage.

"Everyone should know the signs of stroke and be ready to get to the hospital," said Jackson. The National Institutes of Health has been educating the public on this point in their campaign called Know Stroke: Know the Signs. Act in Time.

• Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)


• Sudden confusion or trouble speaking or understanding speech


• Sudden trouble seeing in one or both eyes


• Sudden trouble walking, dizziness, or loss of balance or coordination


• Sudden severe headache with no known cause

When you talk with the doctor, three pieces of information will help you know more about the chances of recovery: the type of stroke, the part of the brain that was affected, and the size of the injury. If the stroke was caused by a blockage of the blood vessels, recovery can take place rapidly in the first few months. If it was caused by blood vessels that burst, healing will take longer. Knowing the location of the injury in the brain gives the medical team information about skills that will likely be affected. The size of the injury is also important. "In general, the larger the lesion, the less recovery," said Jackson.

Age is a factor in recovery. If your father is younger than 80, he'll have a better chance. Most people in the last decades of life have a precarious medical profile that complicates everything else.

Regardless of his age, the body will initiate a healing process. But rehabilitation therapy can take him the extra mile. With the help of a speech-language pathologist he can recover his ability to talk, or learn ways to compensate. "Every patient should have a shot at rehab," says Susan Jackson.

Policy issues
In a landmark study of more than 100 stroke patients with aphasia, the Veterans Administration recorded significant gains when patients had intensive, individualized sessions with a trained professional for at least 12 weeks. Patients who were not in treatment improved, but the folks in therapy made greater strides. "The brain does heal itself over time, but intervention makes for a better recovery," said Jackson.

Despite evidence that rehabilitation is beneficial, the National Institute of Neurological Disorders and Stroke stated in their report Stroke Priorities for the Twenty-first Century: "Many stroke survivors receive limited therapy and are then discharged to the community, where they often remain chronically disabled, socially isolated, and at risk for common post-stroke rehabilitation complications…" (Stroke Progress Review Group, 2002, p. 86).

"The reason stroke survivors receive limited therapy," said Jackson, "is in part because insurance companies make decisions about discharge instead of the professional in charge of their care." Therapists say it takes time to assess a person's potential and rebuild their skills. Discharge from the hospital or outpatient services may cut this short.

This is the first in a three-part series with Susan Jackson and Susan Kemper -- scientists at the Schiefelbusch Institute for Life Span Studies at the University of Kansas.

Read Part 2: What is speech-language therapy like?

References
Kirshner, H. (1995). Classical aphasia syndromes, In H. Kirshner (Editor). Handbook of neurological speech and language disorders. New York: Marcel Dekker, Incorporated.

National Institute of Neurological Disorders and Stroke -- National Institutes of Health (2002, April). Report of the Stroke Progress Review Group. Stroke Priorities for the Twenty-first Century. www.ninds.nih.gov/about_ninds/04_2002_stroke_prg_report.htm

Wertz, Robert T., et al. (1986). Comparison of clinic, home and deferred language treatment for aphasia: A Veterans Administration cooperative study. Archives of Neurology 43, 653-658.

Online Resources
American Speech-Language-Hearing Association -- www.asha.org
See Information on Aphasia

National Aphasia Association -- www.aphasia.org

National Institute on Deafness and Other Communication Disorders -- National Institutes of Health -- www.nidcd.nih.gov
See Research on Adult Aphasia

National Institute of Neurological Disorders and Stroke - National Institutes of Health -- www.ninds.nih.gov

Kansas Speech-Language-Hearing Association -- www.ksha.org

U.S. Department of Health and Human Services. Patient and Family Guide to Stroke Recovery on the University of Kansas Center for Aging web site