Do you have a problem thinking, problem solving, or memory issues?

I do!  Read the article that Mary Burns wrote.

Did you know studies have shown up to 72% of patients have some form of cognitive impairment after stroke? Even as a medical speech-language pathologist (SLP), I found this statistic shocking. It’s a common misconception that an SLP only helps people regain their ability to speak. One of the most meaningful ways an SLP can help someone after stroke is by helping them improve and regain cognitive abilities.

Because of damage to the brain, a stroke survivor may experience changes in thinking, problem solving, memory, or attention. Factors such as the location and type of the stroke will impact the presence and severity of these side effects. Changes in cognition can make it hard for people to communicate, control emotions, perform daily tasks, or return to work or hobbies.

Stroke survivors are often reluctant to seek out services for cognitive rehabilitation because they struggle with embarrassment, fear, or denial. In order to help break down these barriers I want to provide a window into what cognitive therapy after stroke may look like.

Step 1: Your medical team will send a referral to an SLP. Depending on your abilities, this may be for in-home or outpatient therapy. The clinic will likely check your insurance benefits and call you with details. Remember, just because your team sent a referral to one clinic, does not mean you have to go there.

Step 2: You will schedule an evaluation appointment with an SLP. This appointment will typically be 60-90 minutes long. Sometimes it is helpful for a caregiver to be present, so please ask about this when you schedule your appointment. During this appointment your therapist will ask you questions about your medical history, hobbies, and goals. After a short interview, your SLP will administer a cognitive test. This test may feel discouraging and exhausting at first, but the purpose of the test is to identify your strengths, weaknesses, and how to improve. You may feel very tired after this appointment so you may want to schedule time to rest after.

Step 3: After your evaluation, you will work with your SLP to form a therapy plan. This means deciding how many times to attend therapy weekly, how long therapy may last, and goals to address. It’s important to be honest with your therapist about what schedule is reasonable for you and what you want to accomplish.

Step 4: Therapy sessions may last anywhere from 30-60 minutes. During these sessions you and your therapist will work on different activities to help your brain heal and you achieve your goals. Ask your therapist questions such as “why are we working on this?”, give feedback about what doesn’t work for you. Let your therapist know if you left an appointment feeling exhausted. This will help make your therapy more effective. You will likely leave each session with exercises or strategies to practice throughout the week. You and your SLP should work as a team to help you recover.

Recognizing that cognition has changed and asking for help can be scary. But the services that speech-language pathologists can offer can help support your return to a full life after stroke. Please talk to your doctor and let them help connect you with the right provider.

Visit us on Facebook or Instagram to share your goals. Let’s work together to make 2020 a great year for all of us.  Check back each month as we help break down an overwhelming process piece by piece in our newsletter.

Special requests or questions? Email me today.

Mary Burns, MS, CCC-SLP has been working as a medical Speech-Language Pathologist since 2014. She specializes in working with adults with swallowing or communication disorders, especially after a stroke.

Working across the continuum of care gave Mary a unique perspective on strengths and needs in the rehabilitation system. This developed her passion for advocacy of person-centered care and the inclusion of patient and community education as a part of the recovery process.

Mary was drawn to Stroke Awareness Oregon because of their dedication to breaking down barriers that allow stroke survivors and their loved ones to access the services they need.  She can be reached at contact@overlandslp.com

9 Things NOT to Say to Someone with a Brain Injury

Brain injury is confusing to people who don’t have one. It’s natural to want to say something, to voice an opinion or offer advice, even when we don’t understand.

And when you care for a loved one with a brain injury, it’s easy to get burnt out and say things out of frustration.

Here are a few things you might find yourself saying that are probably not helpful:

1. You seem fine to me.

The invisible signs of a brain injury — memory and concentration problems, fatigue, insomnia, chronic pain, depression, or anxiety — these are sometimes more difficult to live with than visible disabilities. Research shows that having just a scar on the head can help a person with a brain injury feel validated and better understood. Your loved one may look normal, but shrugging off the invisible signs of brain injury is belittling. Consider this: a memory problem can be much more disabling than a limp.

2. Maybe you’re just not trying hard enough (you’re lazy).

Lazy is not the same as apathy (lack of interest, motivation, or emotion). Apathy is a disorder and common after a brain injury. Apathy can often get in the way of rehabilitation and recovery, so it’s important to recognize and treat it. Certain prescription drugs have been shown to reduce apathy. Setting very specific goals might also help.

Do beware of problems that mimic apathy. Depression, fatigue, and chronic pain are common after a brain injury, and can look like (or be combined with) apathy. Side effects of some prescription drugs can also look like apathy. Try to discover the root of the problem, so that you can help advocate for proper treatment.

3. You’re such a grump!

Irritability is one of the most common signs of a brain injury. Irritability could be the direct result of the brain injury, or a side effect of depression, anxiety, chronic pain, sleep disorders, or fatigue. Think of it as a biological grumpiness — it’s not as if your loved one can get some air and come back in a better mood. It can come and go without reason.

It’s hard to live with someone who is grumpy, moody, or angry all the time. Certain prescription drugs, supplements, changes in diet, or therapy that focuses on adjustment and coping skills can all help to reduce irritability.

4. How many times do I have to tell you?

It’s frustrating to repeat yourself over and over, but almost everyone who has a brain injury will experience some memory problems. Instead of pointing out a deficit, try finding a solution. Make the task easier. Create a routine. Install a memo board in the kitchen. Also, remember that language isn’t always verbal. “I’ve already told you this” comes through loud and clear just by facial expression.

5. Do you have any idea how much I do for you?

Your loved one probably knows how much you do, and feels incredibly guilty about it. It’s also possible that your loved one has no clue, and may never understand. This can be due to problems with awareness, memory, or apathy — all of which can be a direct result of a brain injury. You do need to unload your burden on someone, just let that someone be a good friend or a counselor.

6. Your problem is all the medications you take.

Prescription drugs can cause all kinds of side effects such as sluggishness, insomnia, memory problems, mania, sexual dysfunction, or weight gain — just to name a few. Someone with a brain injury is especially sensitive to these effects. But, if you blame everything on the effects of drugs, two things could happen. One, you might be encouraging your loved one to stop taking an important drug prematurely. Two, you might be overlooking a genuine sign of brain injury.

It’s a good idea to regularly review prescription drugs with a doctor. Don’t be afraid to ask about alternatives that might reduce side effects. At some point in recovery, it might very well be the right time to taper off a drug. But, you won’t know this without regular follow-up.

7. Let me do that for you.

Independence and control are two of the most important things lost after a brain injury. Yes, it may be easier to do things for your loved one. Yes, it may be less frustrating. But, encouraging your loved one to do things on their own will help promote self-esteem, confidence, and quality of living. It can also help the brain recover faster.

Do make sure that the task isn’t one that might put your loved one at genuine risk — such as driving too soon or managing medication when there are significant memory problems.

8. Try to think positively.

That’s easier said than done for many people, and even harder for someone with a brain injury. Repetitive negative thinking is called rumination, and it can be common after a brain injury. Rumination is usually related to depression or anxiety, and so treating those problems may help break the negative thinking cycle.

Furthermore, if you tell someone to stop thinking about a certain negative thought, that thought will just be pushed further towards the front of the mind (literally, to the prefrontal cortex). Instead, find a task that is especially enjoyable for your loved one. It will help to distract from negative thinking, and release chemicals that promote more positive thoughts.

9. You’re lucky to be alive.

This sounds like positive thinking, looking on the bright side of things. But be careful. A person with a brain injury is six times more likely to have suicidal thoughts than someone without a brain injury. Some may not feel very lucky to be alive. Instead of calling it “luck,” talk about how strong, persistent, or heroic the person is for getting through their ordeal. Tell them that they’re awesome.

8 Ways to Get Your Memory Back After Stroke

 

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While drugs won’t help reverse memory loss after a stroke, activities, therapy and rehabilition can. Feeding your brain with mind games and a healthy diet can help with memory after a stroke.

Some degree of memory loss affects about a third of people who survive a stroke, according to the National Stroke Association. But it’s good to know there are things you can do to help get your memory back.

“Memory deficits after a stroke can vary,” says Melissa (Muller) Meyers, OTD, an occupational therapist at MossRehab in Philadelphia. The extent of your memory loss can depend on how old you are, the severity of your stroke, where your stroke occurred, and even the support you have from family and friends.

No medication is known to help reverse memory loss after a stroke, Meyers says. But where drugs won’t help, you can take steps with activities, therapy, and rehabilitation to help recover your memory after stroke.  

How to Regain Your Memory After Stroke

1. Stimulate your brain. “Games that require you to use your brain, whether as simple as checkers or complex as chess, can help you regain your memory,” says Allen Kaisler-Meza, MD, medical director of the Good Samaritan Hospital Independent Rehabilitation Program in San Jose, California.

2. Work with rehab specialists. Speech-language therapy enhances recovery. It helps by stimulating the brain to make neural connections from uninjured parts of the brain to those parts affected by stroke, Dr. Kaisler-Meza says.

Bob Mandell, now 71, who had a hemorrhagic stroke in 1996, credits various types of therapy, including speech therapy, with getting his memory back. Right after his stroke, Mandell of Naples, Florida, couldn’t get three words out and his memory loss was frustrating. But his determination to recover worked in his favor, and he believes others can do the same. “I worked really hard at therapy,” he says. He wrote about his recovery in the book Stroke Victor. “I did what psychologists called engaged therapy. I went all in, and that jarred my memory and my mind.”

3. Post reminders for yourself. Leave notes in key areas, such as a sign in the bathroom reminding you to brush your teeth, says Stephen Page, OTR/L, PhD, an occupational therapist and associate professor at the School of Health and Rehabilitation Sciences at The Ohio State University College of Medicine in Columbus. Use the alarm on your smartphone or even an old-school clock to remind yourself of appointments and when to take your medications, Page adds. Once you form a routine, it will help you re-establish your memory. Meyers agrees that in her work with patients as a therapist, “creating a routine that is repetitive and consistent can help.”

4. Make up mnemonics. Mnemonics are creative ways to remember things. They often take the form of an acronym, like the popular RICE: rest, ice, compression, and elevation — a shortcut to remember how to treat a sprain. You might make up your own mnemonic for the steps to cook a familiar meal, Page suggests. Rhymes also work, that associate a name with an object, like: “Shirley is the woman with curly hair.”

5. Get organized. Making it easy to see items you need for daily activities will help you remember what you need to do and when to do it, Meyers says. For example, lay out your clothes for the morning before you go to bed at night. Put your toothbrush on the sink where you’re sure to see it.

6. Repeat and rehearse. When you’re given new information, repeat it to yourself several times, the American Stroke Association recommends. Go over the material as many times as you need for it to sink in. Don’t be afraid to repeat back, in your own words, what you’re told to be sure you understand it correctly. If you have to make a presentation or give a speech, break up the material into smaller segments. These will be easier to remember.

7. Stay active. Get out of bed and move as much as possible, Kaisler-Meza says. A six-month exercise training program for patients promoted not only memory but also attention and conflict resolution in a small study of stroke survivors. And aerobic exercise promotes the recovery of brain function after a stroke, according to a study done on animals and published in the International Neurourology Journal.

Mandell, who was paralyzed on his right side after his stroke, believes exercise helped him regain his memory. “I always feel better after exercising,” he says. Exercise helps relieve stress and stress relief is important to brain health, he adds, noting that he tries to exercise almost every day.

RELATED: The Best Diet to Prevent Stroke

8. Feed your brain. A brain-healthy diet includes lots of fresh fruits and vegetables and fish rich in omega-3 fatty acids, according to the American Stroke Association. Eating this way will help your brain recover optimally, Kaisler-Meza says.

A healthy diet and smaller portions helped Mandell lose the 30 pounds of excess weight he was carrying when he had his stroke. He believes that helped his mental recovery. He felt better, and feeling better improved his mental outlook.

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