Sunday, September 14, 2014

Language and Memory - Dealing with the Five Disabilities Resulting from Stroke Part II

In last week's article written by Walt Kilcullen you read about two of the five disabilities caused by a stroke. This week's article deals with two more of the remaining disabilities he addressed, and next week I will conclude the series with what Walt wrote about emotions. Part 2 was originally posted in the September issue of the StrokeNet Newsletter at:
http://www.strokenetwork.org/newsletter/articles/disability02.htm

If you wish to contact Walt, he may be reached at:
newsletter@strokenetwork.org

-----------------------------------------
by Walt Kilcullen

Part 2.

III. Problems with language
IV. Problems with Memory and Reasoning

III. Problems with language: Language difficulties include the ability to speak, understand, write, read, add and subtract. All of these problems occur as a result of a left brain stroke.

Aphasia, which has many components, can be simplified by using just two terms. Expressive aphasia is the lack of ability to verbally express thoughts. The survivor can understand what is said, but response can be one word, or just a few words. Sometimes speech can be extremely slow, while other patients speak so rapidly, it is difficult to understand them. The second category is receptive aphasia. Sounds are heard but the patient cannot understand what was said.

Alexia simply means the lack of the ability to read. My experience is that both expressive and receptive aphasia patients experience difficulty in reading.

Agraphia simply means the lack of ability to write. This usually, but not always, goes along with Alexia.

Acalculia is the loss of mathematical ability including addition, subtraction, division, and multiplication.

Treatment options for problems with language:

An article that I wrote for the June, 2009 issue of the Strokenetwork.org newsletter deals extensively with aphasia. I recommend the following:

● Join an aphasia support group. Check www.aphasia.org to find one in a location near you.

● Investigate the use of computer software and speech devices to see if they can help you with speech therapy on your own.

Bungalow software, Parrot software, Communication Script Inc, and Lingraphica are examples.

● Investigate clinics and community groups that specialize in aphasia. Again visit www.aphasia.org to see what is available in your state. Be sure to get details such as cost, and success rate before you invest your time and money.

I also wrote an article for the July, 2011 issue of the StrokeNet dealing with alexia. Although there are numerous exercises available, none to date have a high success rate.

Hope for the future

● Pharmaceutical companies are testing drugs such as Piracetam, amphetamines, and Bromocriptine to improve speech for aphasia patients.

● Neural Regeneration has also shown promise. Researchers have used cell transplantation which is designed to restore brain tissue after a brain injury.

● Constraint Induced Aphasia Therapy has also shown positive results. During CIAT, the speech therapist spends three hours per day, five days per week, for three weeks giving intensive speech therapy targeting the patient’s specific weaknesses.

IV. Problems with Memory and Reasoning: Stroke can result in problems with short term memory, judgment, and also the ability to plan, comprehend meaning, learn new tasks, and solve problems.

Apraxia is the impairment or loss of ability to carry out learned movements despite having the desire and the physical ability to perform the movements.

Anosognosia is a deficit of unawareness. The patient seems unaware of the existence of his or her disability.

Treatment options for problems with memory and reasoning:

● Most stroke survivors recognize their short term memory loss and are able to adjust to it. Cognitive therapists develop strategies such as keeping a daily planner which focuses on organizing activities one day at a time.

● There is little consensus on assessing apraxia but treatment includes speech, occupational and physical therapy. Some patients show significant improvement while others do not. Unfortunately, those patients that do not respond to therapy may not be able to function independently. There is no drug available to treat apraxia.

● No long term treatment is known to help anosognosia, however, the condition usually disappears in time.
---------------------------------------------------------------------

Next week, I will post what Walt wrote about emotions. I thought emotions deserved a posting by itself. Stroke survivors can experience very strong emotions such as anger and depression and they and their caregiver must learn how to own these emotions rather than let the emotions own them. I would also like survivors know that they are not alone with these emotions and that other survivors are dealing with them also. The survivor and caregiver must come to realize that these feelings are the result of the stroke and not always under the control of the survivor yet they can be dealt with to some degree with medication and therapy. Walt addresses these issues next week. 
*******************************************************************************