Ever wonder what people in India think of a stroke?

Article published in The Hindu

It is a common understanding in India that stroke survivors need intense and regular physiotherapy to recover lost functions of muscles and nerves. However, do you know your dear one, who is recovering from stroke, may also need speech therapy to regain language skills, much like a child who was born deaf?

With over one million stroke cases in India annually, a large number of victims grapple with the debilitating effects of post-stroke disability. Partial or total paralysis, spasticity and aphasia (impairment of language) are common side effects of stroke. While rehabilitation with physiotherapy is a common practice, not many people realise that some patients may need speech therapy too. As a result many victims whose speaking and language comprehension ability can be rehabilitated fail to get attention and are left with permanent language impairment.

A person suffering from aphasia may face difficulty in speaking, comprehending speech, expressing himself, reading or writing. This condition requires intense speech therapy to recover. However, in India, awareness is so low about this condition that most victims fail to receive required attention.

Speech and language therapy is also sometimes needed in people with neurological disorders or memory, language and attention disorders associated with brain injury. It is also needed in patients undergoing laryngectomy rehabilitation or those suffering from feeding and swallowing disorders. Language impairment occurs in more than a third of people who survive a stroke on the left side of their brain. While some recover from it, most continue to have language and speech impairment more than six months after a stroke.

Stroke can be described as a condition when blood supply to the brain is disrupted or blocked either due to narrowing of a blood vessel or due to a haemorrhage. In patients who survive a stroke, it leaves a permanent damage to the nerve cells of the brain causing loss of control over perception, movement, speech or other bodily functions.

Aphasia or speech and language difficulty post a stroke can be classified in four parts:

Expressive Aphasia: This is a condition where the patient is unable to find the required words to express his thoughts.

Receptive Aphasia: People with receptive aphasia can hear people talking but are not able to understand the sentences being spoken.

Anomic or amnesia aphasia: People suffering from amnesia aphasia are unable to take the correct names of people, objects and places amongst others.

Global aphasia: Global aphasia occurs when the language areas of the brain are damaged. Victims of global aphasia are unable to speak, understand read or write. It can be described as the most severe form of aphasia.

Such patients may not only just need physical therapy and medication but also need elaborate speech and language therapy to help them renew their understanding of verbal communication. Some therapies which are considered effective for patients include:

Melodic intonation therapy which helps stroke survivors to sing the words they are unable to speak.

Art therapy to improve expression.

Visual speech perception therapy which is focused on associating pictures with words

Group therapy which allows them to receive rehabilitation in groups of similar people

Constraint-induced language therapy where verbal communication is used. Simple, clear and slow speech should be used so that the patient is able to understand you.

Regular and intense speech therapy can help patients recover some or most of their speaking and language comprehension ability. However lack of awareness means a vast number of people suffering from aphasia do not get access to speech therapy. Some people stop therapy in a few months, without realising that sometimes recovery may take longer.

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