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Therapy helps aphasia patients regain speech

Tuesday, September 21, 1999

By Kathleen N. Bishop

Imagine waking up one morning and not being able to talk.

That's what happened to 72-year-old Virginia Anguish of West View when she suffered a stroke last October.

"I woke up in the morning, got dressed and went into the living room. My husband found me sleeping sitting up. I went into the kitchen and couldn't say anything. I didn't know what to do, but I knew something was wrong," Anguish said recently.

 
    How to communicate with a person who has aphasia

Talk to the person with aphasia as an adult, not as a child.

During conversation, minimize or eliminate background noise (i.e., television, radio, other people).

Make sure you have the person's attention before communicating.

Praise all attempts to speak; make speaking a pleasant experience and provide stimulating conversation. Encourage and use all modes of communication (speech, writing, drawing, yes/no responses, choices, gestures, eye contact and facial expressions).

Give them time to talk and permit a reasonable amount of time to respond.

Accept all communication attempts (speech, gesture, writing and drawing) rather than demanding speech. Downplay errors and avoid frequent criticisms/corrections. Don't insist that each word be produced perfectly.

Keep your own communication simple, but adult. Simplify your sentences and speak slowly. Keep your voice at a normal volume level and emphasize key words.

Encourage people with aphasia to be as independent as possible. Don't be overprotective or speak for the person except when absolutely necessary. Ask permission to do so.

Continue normal home activities (i.e., dinner with family, company, going out). Don't shield people with aphasia from family or friends or ignore them in a group conversation.Involve them in family decision-making as much as possible.

-- Kathleen N. Bishop

 
 
The stroke damaged the right hemisphere of her brain, which speech expert Terri Bowser said leaves patients at a greater risk for aphasia, the impairment of the ability to use or comprehend words.

"Aphasia strikes patients suddenly and it doesn't always happen from a stroke. We see a lot of head injury patients with aphasia and, in some rare cases, a brain infection or tumor can lead to aphasia," said Bowser, director of Speech Language Pathology at HealthSouth Rehabilitation of Greater Pittsburgh in Monroeville.

The condition also can affect a person's ability to read or write.

Asphasia can be severe (a total failure to communicate at any level) or mild (the inability to remember certain names or make sentences).

Bill Connors, speech language pathologist and director of the Speech Voice and Swallowing Center at UPMC Passavant in McCandless, said aphasia is of particular concern to speech pathologists in Allegheny County because of the high percentage of elderly in the region.

The number of incidences are underreported, he said. "Elderly patients usually suffer from aphasia, and as a society we tend not to respect our elderly. In addition, aphasia patients cannot communicate so they withdraw from society and their families cover up for them," Connors said.

Anguish, who was not paralyzed from the stroke, started therapy with Connors at the Pittsburgh Asphasia Treatment, Research and Education Center at UPMC Passavant, two weeks after the stroke. She started saying words two weeks later.

Today, she continues therapy and participates in a support group at the center. She speaks clearly, but pauses often to choose words carefully.

"When I went to the hospital, I knew I would be helped. I just didn't know how. I was also sure I was going to talk again," said Anguish, who credited the support of her husband and children in helping in her recovery.

The Pittsburgh Aphasia Treatment, Research and Education Center officially opened in January, founded by UPMC Passavant's Speech Voice and Swallowing Center and the University of Pittsburgh Department of Communication Science and Disorders School of Health and Rehabilitation.

While most hospitals offer asphasia treatment as part of overall stroke rehabilitation, Passavant's center treats only aphasia patients and offers a residents program for out-of-state patients. It also treats patients who have plateaued, but have not fully recovered.

Duquesne University offers aphasia group therapy sessions as well.

Connors, who has been affiliated with Passavant since 1976, has run the Aphasia Support Group of Western PA there for 10 years.

"We combine treatment, research and training to not only treat the condition, but also teach patients how to live productive lives through different techniques and language tricks," Connors said.

Lauretta Capp, speech language pathologist for HealthSouth Harmarville Rehabilitation Hospital, said treatment for all types of aphasia is basically the same.

"First we have to see if the patient can respond to gestures. Then we try to improve their auditory stimulation by using gestures to enhance understanding. Next we try to get them to say words and read. The earlier they show signs of improvement the better the chance for recovery," she said.

Dr. Ronald Berk, chief of the Division of Neurology at The Western Pennsylvania Hospital, said, "The brain may heal itself to a certain degree or other pathways may take over depending on the age of the patient," Berk said.

Ginger Binder, 52, who lives near Annapolis, Md., had a stroke in January 1998 during brain surgery. She spent a month in intensive care at Johns Hopkins University Hospital and another two months in different rehabilitation hospitals in the same area. She was making small progress but then, for some unknown reason, lost what she had relearned.

"We have a friend who is the regional director of the National Aphasia League," said Bob Binder, Ginger's husband. "He saw the Pittsburgh Aphasia Center's Web site and put us in touch with Bill Connors."

In July, the Binders stayed at Passavant's assisted living facility, Cumberland Crossing, while Ginger underwent an intensive week-long therapy session at the center.

"We've never experienced so much 'on the mark' speech therapy before," Bob Binder said. "It was the most positive, energetic, caring group we've met."

Technology does not play a major role in treatment.

"Computers in treatment are still very primitive," Connors said. "They cannot replace a good speech therapist because that person will assess the patient as an individual and work with their special needs."

Computers, however, can be invaluable for at-home language practice.

Kim Chernicky, speech language pathologist at St. Francis Medical Center, said the most important component of therapy is the family.

"Patients who have family there to help them do much better," Chernicky said. "The family needs to be taught how they can help. Many people think aphasics don't understand, but many of them do have a degree of understanding. They just cannot communicate."

Life is much better now for the Binders than what it was a year ago.

"Ginger can say about 50 words now," Bob Binder said. "That week at the center gave her the confidence she needed to start moving ahead. She's still walking an emotional fence, but words and phrases are forming."

For more information

Pittsburgh Aphasia Treatment, Research, and Education Center -- 412-367-6467. www.upmc.edu/passavant/aphasia.htm

The National Institute on Deafness and Other Communication Disorders (NIDCD) Clearinghouse at (800) 241-1044 or (301) 496-7243; TDD/TTY (800) 241-1055.

Information on organizations that offer this kind of technology can be found on the National Aphasia Association's Web site at www.asphasia.org

Kathleen N. Bishop is a free-lance writer who lives in Shaler.



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