understanding and caring for the stroke patient self study module

3. MODULE III Learning Objectives Aphasia Broca's Aphasia Wernicke's Aphasia Global Aphasia Diagnosis of Aphasia and Some Related Interventions Dysarthria Dysphagia

4. Learning Objectives After completion of this module, the participant will be able to: Verbalize the differences between aphasia, dysarthria, and dysphagia. Identify the characteristics of each. Identify treatments associated with aphasia, dysarthria, and dysphagia. Verbalize techniques to improve communication between caregivers and individuals affected by one or more of these conditions. Verbalize the importance of monitoring and treating dysphagia.

5. Aphasia nanonline.org/.../ClinNeuro/pics/aphasia.GIF

6. Aphasia Aphasia is an impairment of the power to use or comprehend words. Aphasia is caused by damage to one or more of the language areas of the brain (Encyclopedia of Nursing and Allied Health, 2007). Most commonly, the cause is from a stroke, but it can also result from a head injury, brain tumor, or infection. Approximately half of those who initially show signs of aphasia recover completely within a few hours or days. This is known as transient aphasia. If symptoms of aphasia persist beyond 2-3 months after the stroke, a complete recovery is unlikely but some improvement is possible. Recovery is a slow process and often requires up to a year of treatment. Aphasia does not affect intelligence.

7. Aphasia Aphasia can be broken down into three different types: Broca's Aphasia Wernickes Aphasia Global Aphasia

8. Broca's Aphasia

9. Broca's aphasia Broca's aphasia is caused by damage to the frontal lobe of the brain. Frequently, these patients will speak in short, meaningful phrases that may take great effort to express. Broca's aphasia is sometimes also call nonfluent aphasia (Adams & Ropper, 2001). This is due to the issue that this type of aphasia causes individuals to speak in broken sentences often omitting words such as "is", "and", and "the". People with Broca's aphasia are usually able to understand the speech of others to varying degrees and read. Writing ability may be limited. Because of this, they are often aware of their language difficulties and may become easily frustrated by their speaking problems. These individuals may also have right sided paralysis or weakness because the frontal lobe is also important for body movement (Adams & Ropper, 2001).

10. Wernicke's Aphasia

11. Wernicke's aphasia Wernicke's aphasia results from damage to the temporal lobe and is also referred to as fluent aphasia. Individuals with this type of aphasia may speak in long sentences that have no meaning, use unnecessary works, and/or create new words (Adams & Ropper, 2001). These individuals usually have difficulty understanding speech and therefore are often unaware of their mistakes. Reading and writing are severely impaired. They may or may not have body weakness.

12. Global Aphasia Global aphasia is the most severe form of aphasia. This applies to individuals who can produce few recognizable words and understand little or no spoken language (Adams & Ropper, 2001). These individuals have severe impairments in their reading and writing skills also. This type of aphasia results from extensive damage to the language areas of the brain.

13. Aphasia is usually recognized by family, physicians, nurses, or other caregivers and is most often referred to a Speech-Language Pathologist for a comprehensive examination of the person's ability to speak. Treatment of aphasia is usually speech therapy. Some of the factors which influence the amount of improvement include the cause of the brain damage, the area of the brain that was damaged, the extent of the injury, and the age and health of the individual. Treatment may be provided to an individual or in group therapy with family involvement, which is often helpful (Encyclopedia of Nursing and Allied Health, 2007).

14. Wait---give the person the time to speak. Resist the urge to finish sentences or offer words unless the individual states or signals that helping is acceptable. Be Sensitive to Noise---turn off distracting items such as the television, radio, etc. Keep your own voice at a normal level. Shouting does not help. A relaxed and supportive atmosphere facilitates reciprocity between the patient and the nurse (Sudin & Jansson, 2003). Be Open---to different ways of getting and sending messages like drawings, gestures, writing, and facial expressions. Confirm----that you are communicating effectively. This may be achieved by repeating what you heard and using yes/no questions to check key points (Fursland, 2005).

15. Dysarthria Dysarthria refers to a group of speech disorders resulting in slowness, weakness, or incoordination of the speech mechanism. Dysarthria is often caused from a stroke or brain injury. This injury can make the muscles of the mouth, face, and respiratory system become weak, move slowly, or not move at al (Adams & Ropper, 2001). The resulting speech condition is called dysarthria.

16. Symptoms of dysarthria depend on the extent and location of the damage to the brain. These symptoms may include: Slurred speech Speaking softly or barely able to whisper Slow rate of speech Rapid speech with a mumbling quality Limited lip, tongue, and jaw movement Abnormal rhythm when speaking Changes in vocal quality Hoarseness Breathiness Drooling or poor control of saliva

17. Brain injury Tumors Cerebral Palsy Parkinson's Disease Lou Gehrig's Disease (ALS) Huntington Disease Multiple Sclerosis

18. Pay attention to the individual and watch them as they speak Reduce distractions Let the person know if you have difficulty understanding them Repeat what you can understand so the individual knows what to repeat Encourage use of writing or gestures if one is still unable to understand speech Encourage the speaker to speak slowly and tap out sounds or letters on their fingers to increase intelligibility

19. Dysphagia occurs when there is a problem with any part of the swallowing process (Adams & Ropper, 2001). Dysphagia can be caused by a number of items. Any conditions that weakens or damages the muscles and nerves used for swallowing may cause dysphagia. Examples of such conditions are Cerebral Palsy, Parkinson's Disease, head, neck, or esophagus cancer, or stroke (Adams & Ropper, 2001). Stroke or head injury may affect the coordination of the swallowing muscles and/or limit the sensation in the mouth and throat. Dysphagia affects nearly 15 million Americans and 50-75% of all stroke patients (Dysphagia, 2007).

20. Swallowing is a complex process. Swallowing takes 50 pairs of muscles and many nerves working together to move food from the mouth to the stomach. Swallowing happens in three stages: Stage 1: The tongue moves food around in the mouth for chewing. Chewing mixes the food with saliva and makes it the correct size and consistency for swallowing. Saliva helps to moisten the food to make it easier to swallow. Stage 2: This stage begins when the tongue pushes the food or liquid to the back of the mouth. This movement triggers a swallowing reflex that propels food through the pharynx. During this stage, the larynx closes tightly and breathing stops to prevent food or fluid from entering the lungs. Stage 3: Stage 3 begins when the food or liquid enters the esophagus. Food passage through the esophagus usually occurs in about 3 seconds depending on the texture and consistency of the food. (Adams & Hopper, 2001)

21. Dysphagia can lead to many complications, some serious. It may cause a person to not be able to eat enough of the right foods to stay healthy or maintain an optimal weight. If food or liquids enter the trachea due to the dysphagia, this can lead to the growth of harmful bacteria, an empyema or lead to aspiration pneumonia.

22. There are different treatments for various types of dysphagia. A variety of tests may be conducted. These tests may be as simple as a bedside exam or a video fluoroscopy swallowing exam. The physician or speech-language pathologist will determine the severity of the dysphagia and the part of the swallowing mechanism that may be affected.

23. Treatment Options Once the diagnosis has been determined, treatment options can be determined. Treatment may involve muscle exercises to strengthen or improve coordination, teaching the person how to eat in a special way, or identifying special foods or liquids to ingest. Treatment may also involve the recommendation of a feeding tube placement for nourishment if oral intake is not safe.

24. Treatment Options Much research is being conducted on the diagnosis and treatment of dysphagia. One of the newest treatments is a therapy called Vital Stimulation Therapy. This treatment was approved by the FDA in 2001 and uses small electrical currents to stimulate the muscles responsible for swallowing. At the same time, trained specialists help patients re-educate their muscles (Union Hospital, 2007). Vital Stimulation Therapy has shown great success and has improved swallowing in patients who have had dysphagia for years.

25. Consumer Reports on Health (2007). Guarding against stroke. Consumer Reports on Health 19(5), 3-5. Encyclopedia of Nursing and Allied Health (2007). Retrieved July 1, 2007, from http://enotes.com Furslad, E. (2005). Finding the words. Nursing Standard 20(1), 24-25. Sudin, K. and Jansson, L. (2003). Understanding and being understood as a caring creative phenomenon in care of patients with stroke and aphasia. Journal of Clinical Nursing 12, 107-116. Union Hospital (2007). Retrieved July 1, 2007, from http://unionhospital.org Victor, M. and Ropper, A. (2001). Adams and Victor's Principles of Neurology. New York: McGraw Hill.

26. Module III Post Test 1. Aphasia is a term used to describe a. Problems with swallowing b .Lack of arm movement c. Impairment of the use or comprehension of words d. All of the above 2. There are three types of aphasia. a. Brocha, Rocha, and Java b. Wernicke, Peruncle, and Java c. Global, Wernicke, and Brocha d. None of the above 3. A person with Broca’s aphasia is often able to speak in meaningful, but short broken phrases. a. True b. False 4..Global aphasia applies to individuals who can a. Produce a few recognizable words and understand little or no spoken language b. Speak in clear sentences and understand what is being said c. Understand everything and speaks clearly d. None of the above 5. Tips for effective communication with a person with aphasia include: a. Shout, finish the person’s sentences, ignore gestures b. Wait, reduce noise, be open to gestures and writing, confirm c. Assume you know what the person needs according to your knowledge base 4. None of the above

27. Module III Post Test cont. 6. Symptoms of dysarthria include: a. Slurred speech b. Hoarseness c. Drooling or poor control of saliva d. All of the above 7. A person with dysarthria may also have aphasia. a.True b. False 8. One of the main causes of dysarthria is: a. Appendicitis b. Peripheral Vascular Disease (PVD) c. Stroke d. Congestive Heart Failure (CHF) 9. All of the following items can assist with communicating with a person with dysarthria, except: a. Reduce distractions b. Encourage slower speech c.Writing information or providing gestures d. Non face-to-face interactions 10. Dysphagia is the term used to identify a problem with the a. Heart b. Swallowing process c. Kidneys d. Urinary output

28. Module III Post Test cont 11. Swallowing is done in ______ stages a. 5 b. 4 c. 3 d. 2 12. Conditions which may cause dysphagia include all of the following, except: a. Parkinson's Disease b. Stroke c. Huntington Disease d. Fractured ribs 13. Dysphagia can lead to aspiration, which can cause a. Aspiration pneumonia b. Cellulites c. Edema of the tongue d. None of the above 14. Patient with dysphagia, dysarthria, and aphasia can all benefit from treatment by a a. Physical Therapist b. Pet Therapist c. Radiologist d.Speech-Language pathologist