Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, “Minding Our Elders: Caregivers Share Their Personal Stories,” a portable support group book for caregivers. In this post, she interviewed Kathryn Kilpatrick for insight into aphasia. Kathryn has been a speech-language pathologist for over four decades and is the author of the popular 5-volume Therapy Guides for Language and Speech Disorders workbooks.
The only experience I’ve had with the speech and language problem called aphasia was after my uncle had a series of strokes. This was a man who had lived for reading and word games. The worst part of watching him struggle to find words was that he knew the words he found were wrong. He was not only frustrated, but humiliated too.
Aphasia is not uncommon, and, as caregivers, we must learn to assist our loved ones with the disorder however we can. With this in mind, I asked my friend and colleague Kathryn Kilpatrick for help. Kathryn has been a speech-language pathologist for over four decades and is the author of the popular 5-volume Therapy Guides for Language and Speech Disorders workbooks.
CBB: What is aphasia?
KK: A person with a diagnosis of a stroke, traumatic brain injury or other neurological causes may have this disorder. The National Aphasia Association explains that it is an acquired communication disorder that impairs the ability of a person to process language.
This can impact a person’s ability to communicate and understand both the spoken and the written word. The specific symptoms and the severity will vary depending on the location and extent of the brain damage. In some cases, a person’s symptoms may also include weakness or paralysis of their arm and/or leg. Some will make improvements more quickly than others, but many could improve over a period of months or even years.
CBB: What kind of aphasia therapy is available?
KK: First of all, it is important for a person to have an evaluation by a speech-language pathologist to determine not only what areas of language are affected, but also the extent of difficulties. In this way a rehabilitation program can be created to maximize safety, communication and quality of life.
There are a variety of therapy techniques that can be effective in the rehabilitation of a person with difficulty speaking. U.S. Representative Gabrielle Giffords’ traumatic brain injury resulted in aphasia, and one of the strategies used in her treatment program with a speech-language pathologist was Melodic Intonation Therapy. This approach uses melody and rhythm to help patients recover words and language patterns. Each situation is unique, and a person’s support system is an essential part of the rehabilitation team.
Part of the process is learning the best strategies to cue a person with speech problems. For example, several years after a stroke, a younger woman was frustrated with her word-finding problems. Also she could not spell even though she could read words without any issues. Her therapy focused on creating a categorized list of words—including names—that she struggled with, but wanted to use on a regular basis. As a result, she was able to write down her shopping list or read a word aloud that she could not recall by referring to her personalized word list. For the first time she was able to start addressing cards to her family by copying their addresses and even picking some appropriate personalized comments from a list created especially for her. Another client learned how to use an iPad to type what he wanted to say since his speech was very difficult to understand.
CBB: How can caregivers and family members help a person with aphasia?
KK: Each patient may have different needs, but there are several things caregivers can do to minimize their stress when trying to communicate.
- First of all, reduce distractions such as the television, music, multiple conversations in the background, or involvement with electronic devices.
- When the person is trying to explain something, do not rush them. Give the individual time to process what they are trying to say.
- When there is difficulty coming up with a word, encourage the person to describe the item, gesture or even draw.
- Use yes and no questions instead of asking for very specific details.
- In some cases, the person may not be able to say a word, but might be willing to accept your cue of two word choices if you know what the person is trying to say.
- If there are problems with comprehension of the spoken word, it may be helpful to speak in shorter and less complex sentences.
- It is important to slow the rate of your speech and provide directions one or two steps at a time.
- The individual may no longer be able to read books or the newspaper due to the length and complexity of the information. Depending on their interests and what an assessment of their difficulties reveals, reading shorter stories could be something the person might be able to handle.
- An assessment by a speech-language pathologist will help families and friends understand what the person struggles with and also provide specific recommendations.
CBB: Can you tell us something about the prognosis of those with aphasic speech?
KK: One of the important things to consider is how to provide them with a good quality of life.
Early in my career, I had a client in her forties who became an inspiration to me because, although she was paralyzed on her right side and initially had significant speech problems, she was determined to make the most out of her life. She lived alone and learned how to cook. Baking was her specialty.
One year she made me an amazing birthday cake with roses on it. That’s hard to imagine since she could not use her right hand, but with the help of her family, she attached a decorator to a Fisher Price radio that she wound up.
Over the years, she became more fluent with her speech. In an interview we did for a therapy video tape for word practice, she proudly told the interviewer that she can now do it all. At times she would need to take extra time to express herself, but it did not interfere with her socialization.
She also learned how to crotchet with only her left hand and, decades later, with the help of a friend, she made a quilt. Like many patients, she participated in therapy in the hospital, in rehab and then at home. Later, she had outpatient therapy for speech, as well as occupational and physical therapy.
Once the course of treatment has been completed, a support group can be an excellent resource for continued support and socialization.
CBB: Thank you, Kathy, for your expert help. All I saw was my uncle’s frustration and anger. Since his life was ended shortly thereafter by a final stroke, I never had followed up on this important issue. Now, I’m much better informed, as are our readers. We appreciate your taking the time to help us.
Kathryn Kilpatrick’s website, Communication Connection, is an excellent resource for memory fitness and successful aging.