Most frequent consequences stroke, traumatic brain injury, neurosurgical intervention, etc. (approximately 40-50% of the total number of patients) are disturbances of speech function, manifested in the form of aphasia and dysarthria, which are often combined with pathology of other higher mental functions ( various types agnosia and apraxia).
Speech disorders after a stroke occur due to damage to the speech areas of the cerebral cortex and their pathways. Depending on the location and size of the affected area, speech disorders can manifest themselves in the form of aphasia:
Motor aphasia:
- Afferent - manifests itself in the disintegration of individual articulatory postures, or otherwise, articulation. IN oral speech In patients this manifests itself in: the search for articulation.
- Efferent - speech becomes broken, accompanied by getting stuck on separate fragments statements. The patient pronounces individual sounds relatively easily, but experiences significant difficulties when pronouncing words and phrases.
Sensory aphasia. Disorder phonemic hearing, cause gross violations of impressive speech-understanding. Sounds lose their stable sound and are perceived distorted each time, mixed with each other according to certain parameters.
Dynamic aphasia. A speech defect manifests itself in speech spontaneity and inactivity. Their speech is characterized by poverty and monosyllabic answers in the dialogue.
Amnestic disorders. Patients lose the ability to retain auditory information in memory, narrowing the scope of memorization.
Semantic aphasia. That is, the inability to perceive complex logical and grammatical figures of speech.
Choosing a speech rehabilitation method
Speech disorders are considered the most difficult consequences of stroke. It takes a very long time to restore speech functions, on average 2-3 years, and in some cases up to 6 years. At the same time, the effectiveness of treatment largely depends on how quickly the rehabilitation process begins and on the methods of influence.
To restore speech after a stroke, work with a speech therapist should begin within the first three months after the attack. As a rule, the form of the disorder and its degree can be determined after just a few weeks, and already at this time it is possible to outline a basic program and select a set of exercises.
Speech rehabilitation after a stroke is a mandatory part of a comprehensive rehabilitation education program. It must be remembered that the ability to speak will not return to a person spontaneously - this can only be achieved through daily classes with specialists according to an individual program depending on the speech pathology. The methodology and duration of classes are determined individually.
A treatment course for speech restoration by a speech therapist after a stroke.
Regardless of the degree to which speech impairments are expressed in patients, classes with a speech therapist after a stroke are a mandatory component of the rehabilitation process. Regardless of whether they take place in a clinic or at home, a qualified specialist will be able to correctly assess the patient’s readiness for a particular type of activity, determine their optimal duration, and adjust the program depending on the patient’s condition.
Speech restoration after a stroke is carried out in combination with adequate drug therapy. Rehabilitation training lasts 20-45 minutes (depending on the degree of fatigue of the patient). If, while working with a speech therapist, headache, shortness of breath, weakness, increased blood pressure and other negative manifestations, the lesson is reduced to 10 minutes.
Speech restoration at the Rehabilitation Center
Speech rehabilitation after a stroke in our clinic is carried out by qualified speech therapists, aphasiologists, and clinical psychologists. After preliminary diagnosis and examination of the patient, specialists draw up an individual program for the restoration of speech and other higher mental functions. Consultations are also carried out with the patient’s relatives, including regarding activities at home.
The form of work with patients is individual, group.
Department specialists:
- conduct a primary neuropsychological examination of speech and other higher mental functions of patients, carry out a detailed qualitative assessment of the identified symptoms in the prescribed form.
- carry out speech therapy, neuropsychological, pathopsychological, express diagnostic examinations.
- determine the strategy and tactics of neurorehabilitation. Together with doctors, specialist physical therapy develop neurorehabilitation programs for patients taking into account their individual characteristics and states of higher mental functions.
- carry out dynamic observation with a qualitative assessment of the state of speech and other higher mental functions in the middle of the course of neurorehabilitation in order to adjust the patient’s individual neurorehabilitation program.
- evaluate the effectiveness of therapeutic and rehabilitation effects at different stages.
- carry out consultative work with the patient’s closest relatives for the purpose of specialized psychological and neurologopedic assistance.
- carry out prognostic assessment of neurorehabilitation.
Much attention is also paid to the formation of a positive emotional state of the patient, the choice of a form of motivation for exercise and social adaptation patient.
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After suffering a stroke, some patients lose the ability to pronounce sounds and formulate sentences. This effect is due to damage to the area of the brain responsible for understanding and constructing speech structures. Therefore, restoring speech after a stroke is a slow and difficult process. As therapeutic measures patients can benefit from the help of a speech therapist, medications and daily exercise.
Why is speech function impaired?
If speech is lost after a cerebral circulation disorder, it is necessary to find out the cause of the disorder. When the ability to speak is lost due to cerebral hemorrhage or ischemia, damage to the speech center in the subcortex of the cerebral hemispheres is observed. It is localized in the left cerebral hemisphere in people who are fluent right hand. For lefties it's the opposite. In some cases, speech loss occurs due to damage to the temporal lobe, parietal lobe, frontal lobe, or cerebellum.
When the frontal or parietal region is damaged, the patient develops motor aphasia. The patient is unable to construct complex speech structures. In rare cases, paralysis of the vocal cords, tongue, pharynx and lips progresses. Speech is restored slowly. As a result, the timbre of the voice changes, words are pronounced with difficulty, especially consonants.
Types of speech disorders
There are 3 main types of pathology for speech disorders after suffered a stroke: dysarthria, aphasia and dyspraxia. In some cases, several types of disorders develop at once.
Aphasia
Among the consequences of a stroke, aphasia is the most common type of speech disorder. As pathology develops, the patient loses the ability to perceive the meaning of what people around him say and forgets how to read and write. At the same time, there is no deterioration in cognitive functions.
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Aphasia after stroke is divided into several types:
- sensory - as this type progresses, a person stops understanding the speech of other people;
- motor aphasia - a person perceives the meaning of what is said, but cannot express thoughts in words;
- global or mixed consists of a combination of motor and sensory speech disorders.
Dysarthria
When the brain is damaged, speech muscle weakness may occur. In this case, speech impairment during a stroke is called dysarthria. The pathological process does not affect speech understanding and selection the right words. A progressive disorder causes changes in the voice, and there is a lack of clarity in spoken sounds and words. Difficulty in breathing may develop, in which the patient begins to speak in fragments of phrases. The exhaled air is not enough to form sentences.
Dyspraxia
With dyspraxia, motor skills and coordination of the facial muscles and muscles of the tongue responsible for speech are impaired. The muscles do not move in the correct sequence required to produce sounds.
It is important to understand that this is not facial paralysis. They are able to contract, but they do not do so in the correct order. The patient can repeat 1 word 4-5 times to correct articulation.
How to restore speech after a stroke
Complex therapy requires not only properly formulated treatment, but also the active participation of the patient. 50% of rehabilitation time depends on the patient’s motivation and activity. Methods for restoring aphasia and other disorders include:
- taking medications;
- stem cell therapy;
- help from a speech therapist;
- classes at home;
- working with a psychologist to prevent depression.
After a stroke, speech restoration takes a long time and is a labor-intensive process.
Useful exercises
For effective recovery the patient should practice speech function speech therapy exercises after a stroke at home. This is due to the fact that in 85-90% of cases people suffer from sensorimotor aphasia. Therefore, you need to work intensively during rehabilitation not only with a specialist, but also do exercises at home.
Speech impairment is one of the most common consequences of stroke. You can restore the ability to speak fully using several methods, but you should approach the issue with maximum responsibility in order to achieve results in as soon as possible. To do this, you need to know not only the treatment methods, but also the specifics of the problem.
Aphasia and treatment features
Stroke is most often experienced by older people, because... changes in the body associated with aging lead to poor circulation. One of the most common symptoms of vascular damage in the brain is partial or complete loss of the ability to speak, which is accompanied by paralysis when parts of the body begin to be taken away, loss of coordination of movement, as well as a severe headache.
Mechanism
Speech disorders are called aphasia, which according to the ICD has code R47.0. They can occur either in ischemic or hemorrhagic stroke, and with a microstroke. Damage to blood vessels leads to the death of cells in the speech department, which is responsible for transmitting signals from the brain. This is only possible with hemorrhage in the left hemisphere. It can disrupt the functioning of many components of the body, which completely depends on the scale of the problem. If the stroke is extensive and affects both sides of the brain, the victim may lose memory and the ability to think clearly, and if left untreated, he may die.
Kinds
Aphasia is divided into several types, which determine the degree of disorders associated with the speech apparatus. The success of future treatment depends on them. There are 5 types in total:
- Motor. Occurs when Broca's center, located in the third cerebral gyrus, is damaged. The patient has problems pronouncing words or sentences; he can only pronounce sounds or incoherent words, but his hearing is preserved.
- Sensory. The cause of such aphasia is damage to the speech zone of the same name, which is located in the Wernicke center. The victim ceases to understand the speech of those around him, and he himself begins to pronounce words incoherently and without any meaning.
- Amnestic. In amnestic aphasia, bleeding may slightly affect several areas of the brain. The patient communicates normally, has no problems with reading and auditory perception, but often forgets the names of things he knows, which is why he experiences serious difficulties during the conversation and cannot find the right word.
- Semantic. This type of aphasia is caused by damage to the area of the brain located at the junction of the crown, temple and forehead. A person suffers from a deterioration in the understanding of word combinations, does not perceive the difference in words expressed by prepositions or endings, and does not understand complex speech structures.
- Total. With extensive strokes, the patient develops total type aphasia. It is characterized by a complete lack of speech, as well as the patient’s lack of understanding of what other people are saying.
Some patients with mild aphasia can recover on their own, but for severe aphasia, treatment is mandatory.
Forecast
For aphasia, it is very important to start treatment in a timely manner. All patients can get rid of speech impairments during a stroke, but this should be done in the first few months after the stroke. Delaying this will slow down the future rehabilitation process and also reduce the chances of a full return of speech skills. For mild impairments, the prognosis is very positive, and the first successes in recovery are evident after a month of training. If you do not carry out all the basic measures for rehabilitation, then there is a risk of remaining forever with various speech defects, as well as facing a mental disorder.
During the treatment of aphasia, we must not forget about basic recovery, which involves taking various medications and following strict regime day. If this is not done, the risk of suffering a second stroke will increase, and the chances of recovery will significantly decrease. It is important to understand that the recovery period will last a long time, and you need to take it very seriously.
Treatment rules
It will be possible to restore speech only if you strictly adhere to the special rules of rehabilitation and treatment. They are aimed at increasing the effectiveness of all therapy, as well as reducing the risk of complications.
What conditions must be met:
- Follow all doctor's recommendations.
- Work with a speech therapist and do home exercises.
- Eliminate stress and provide a comfortable environment.
- Have a positive attitude towards treatment, do not doubt the result.
- Communicate with loved ones.
- Spend more time on fresh air, limit the load.
- Watch your diet and don’t eat junk food.
Close people should show understanding towards the patient. It is important that they speak to him in simple sentences, give him more time to respond, and actively participate in the rehabilitation process.
A person may also experience aphasia due to a pinched nerve, brain tumor, dental prosthetics, and some other diseases.
Treatment
A qualified physician should develop a treatment plan. This is the only way to achieve significant results in a short period of time. When the patient is discharged from the hospital, he will be prescribed special medications and procedures aimed at restoring speech and health. Therapy should be comprehensive, and the participation of the patient’s relatives is important, because support from loved ones is very important for rehabilitation.
Drug treatment
In modern medicine there are no special drugs that would help restore speech function when treated with pills. Nevertheless, doctors very often prescribe medications to patients aimed at improving blood flow. They normalize the functioning of all nerve endings, which has a positive effect on the ability to pronounce words. When used correctly, problems begin to gradually disappear, and the clarity and volume of the voice increases.
Additionally, they may prescribe medications to stimulate brain function, which also strengthen memory and increase attention. All this leads to significant improvements in health. However, this is not enough to completely restore speech to a person.
The most popular drugs:
- "Semax";
- "Cereton";
- "Ceraxon";
- "Mexidol";
- "Neuromidin."
These drugs can be replaced by similar ones, as well as supplemented with other drugs. The need to take them is determined by the attending physician.
Traditional methods
To get rid of speech inhibition and normalize it, folk remedies can be used. The most effective decoctions are made from cones, viburnum berries, juniper, thyme, and sage. They need to be prepared by brewing in boiling water and leaving for 20-30 minutes. Restoring speech after a stroke at home using such means should be careful, because some people may encounter negative consequences associated with individual intolerance to the components of the decoction.
Brewing more complex drinks is also allowed. They improve the patient's condition and help in treating loss of speech functions. The following mixtures are effective:
- Leaves of plantain, yarrow, St. John's wort.
- Agrimony, calendula, rose hips.
- Walnuts, strawberries, eyebright leaves.
Other methods
Aphasia can be treated not only with the help of medications and folk remedies. Other methods also show good results. The appropriateness of their use is determined individually. Most patients are prescribed at least one of these.
Popular methods:
- Physiotherapy. Helps with paralysis of the muscles responsible for speech functions. In most cases, exercise therapy shows the highest effectiveness.
- Physiotherapy. Massage helps relax muscle tissue and improve blood flow, which is important after.
- Acupuncture. This method is used to correct articulation and normalize speech. Particularly effective for motor type of aphasia.
- Functional biofeedback. The method shows good results in improving speech functions and consists of visual control of muscle tissue associated with the pronunciation of words.
- Working with a psychotherapist. Classes with a specialist help to quickly normalize the mental state, which is very important when recovering from a stroke, which is accompanied by aphasia.
- Surgical intervention. Surgeries to restore speech are performed very rarely. Their goal is to connect the speech center with a healthy part of the brain. But the patient’s speech after this remains slurred and intermittent, which makes the method less popular.
Special sessions with a speech therapist and home exercises are especially important for the treatment of aphasia. They allow you to recover as quickly as possible without any complications.
Modern medical technologies make it possible to treat aphasia using stem cells. This method is used in a limited number of advanced countries and shows high efficiency.
Classes with a speech therapist
Special lessons with a speech therapist after a stroke are the most important component of treatment. You should start visiting a specialist immediately after determining the type of speech impairment. The sooner the patient begins to train the ability to speak fully, the greater the chances of achieving desired result. All classes are divided into 2 stages.
First stage
Classes at the first stage are aimed at restoring basic speech functions. It is applicable for both adults and children. If the patient suffers from mild aphasia, then the first stage can take place in a shortened form. It involves the use of the following practical exercises:
- Conversation between a speech therapist and a patient, forcing the perception of information. To do this, the specialist speaks on various topics, making the patient understand the speech.
- Posing questions that require a detailed answer. The doctor asks the patient a special question, in which there is no possibility of answering only with an affirmative or negative gesture.
- Photo recognition. The patient is shown photos with objects or familiar people, and he must name what exactly he sees.
- Reading letters or numbers. The patient is shown numerical or letter series where the elements are arranged without any ordering. His job is to read what he sees.
- Writing and reading. For minor speech impairments, the patient is asked to write phrases or sentences, as well as read prepared texts aloud.
If classes bring poor results, they can be repeated in a more simplified form.
Second phase
At the second stage, the patient is offered a more complex set of tasks. It is very important to exclude unnecessary load, because... it can reduce the effectiveness of classes. Therefore, the speech therapist must carefully monitor the patient’s condition and give him time to rest.
Exercises:
- Restoring the connection between words and images. To do this, the patient is given complicated tasks similar to the exercises from the first stage. He is also asked to compose stories based on related pictures, work on intonation, retell texts, and also independently read and write short essays or letters.
- Speech recognition. The patient must classify the words he hears according to certain criteria, follow instructions expressed in complex sentences, improvise on any topic, and strive for standard speech.
- Correction of articulation and pronunciation. Working through template phrases, trying to pronounce phrases as clearly as possible, developing intonation and speech coloring skills, and verbally expressing all thoughts.
- Restoring basic abilities. Reading books or letters, analyzing what you read, working on recognizing letters and numbers, writing long essays with a gradual increase in the complexity of tasks.
Full recovery may require large quantity classes with a speech therapist. If progress has become noticeable, then you cannot stop lessons with a specialist, because Maximum results should be achieved, as well as consolidated, so that speech skills do not begin to deteriorate again.
Speech therapists can use additional exercises to achieve even greater results.
Independent studies
Additionally, each patient should study at home independently. This will help speed up the rehabilitation process. Some doctors give patients a special manual that describes all the basic exercises for home gymnastics that should be performed every day. If it was not issued, this does not mean that you need to give up home training.
Single lessons
You can achieve success without the help of other people. It is enough to perform the following exercises to restore speech after a stroke:
- Extend your lips with a tube for 7 seconds.
- Try to curl your tongue into a tube, repeat many times until you become very tired.
- With your mouth open, stick out your tongue and stretch it as high as possible for 5 seconds. It is advisable to stretch your neck at the same time.
- Stretch your tongue to your nose, and then to your chin.
- With your mouth closed, try to reach your tongue with your throat, and do this for as long as possible.
- Move your tongue from one side of your mouth to the other. Do this at different speeds.
- Pull out the lower jaw, grabbing it upper lip, for 3 seconds. Repeat the same with the upper jaw and lower lip.
- Open your mouth slightly, bringing your lips together, move your tongue along the upper row of teeth, then repeat with the lower row, as well as with your lips.
- Smile, showing your teeth, then hide them with your lips, continuing to smile.
- Smack repeatedly, as if blowing a kiss.
- Click your tongue, trying to gradually increase the speed to the limit.
- Stretching out your tongue, hiss for a long time.
Exercises should be done in 5-10 sets unless otherwise indicated. Sometimes the number of repetitions can be increased at your discretion, but you should not forget the importance of rest.
Joint activities
Additionally, you should include in the list of home exercises special workouts that involve the help of loved ones. They are also very effective, so it is not recommended to refuse to perform them.
What you can do with outside help:
- The assistant pronounces the phrase, cutting it off mid-sentence. The patient must complete the word correctly. You should start by removing one syllable, and then complicate the task.
- Both people sing in a low voice. The assistant begins, limiting the volume of the voice, then the patient joins in singing.
- The patient reads tongue twisters to his assistant. Gradually they must be complicated, but you should start with the simplest options possible.
A speech therapist for an adult may be needed for speech disorders caused either by illness (stroke, flu, pharyngitis), or by injuries, or by defects that have not been eliminated.
Speech therapist services for stroke
Such a serious and, unfortunately, common disease as a stroke is often accompanied by speech impairment and then occurs in an adult.
Nowadays, stroke has become much younger. It increasingly affects people of working age who, when undergoing drug treatment, need to restore speech in order to return to work and daily activities. And it is very important for an elderly person to maintain his speech activity at home in order to communicate with others and be correctly understood by them.
More often speech therapy work restoration of impaired speech functions begins already in the hospital, however, after discharge, patients are most often left alone with their problems, due to the fact that most clinics for the adult population do not have a speech therapist on their staff, and getting to an assigned specialist is sometimes difficult. on the other side of the city, patients have no opportunity.
Classes with a speech therapist, begun immediately after a cerebrovascular accident, guarantee the most effective restoration of all speech functions.
In addition, it is desirable that this work does not stop after discharge from the hospital, since periods of missed classes can adversely affect the quality of speech recovery.
And since the patient’s physical functions take much longer to recover and often such patients cannot move long distances on their own without the help of others, they quickly get tired and need rest, the services of a speech therapist at home become relevant. In addition, for this category of patients, adherence to a daily routine is extremely important.
The work of a speech therapist for adults on the production of sounds, as well as the elimination of speech and accent
To correct speech in adulthood, you only need to practice for 45-60 minutes twice a week for no more than 1-2 months. During this time, almost all types of violations can be eliminated. The main thing is motivation. If you really want to get rid of your speech impediment, do not skip classes, do all the exercises assigned to work at home, and everything will work out in the shortest possible time!
We will select for free, who will conduct classes at a time convenient for the patient, taking into account his greatest activity at different times of the day, use various techniques and all necessary aids for correctional work.
