1. Communication after Stroke
This is not an Agored Cymru publication. It has been developed by colleagues from Cwm Taf University Health Board and is currently being hosted by Agored Cymru until a more suitable site becomes available.
Communication after Stroke

2. Aims of the session
To be aware of possible difficulties communicating after a stroke
To think about how it might feel to have difficulty communicating
Be aware of practical ideas to use when communicating on the ward

3. Ice-breaker
Split into pairs. Person A has a communication difficulty and can only use one their non preferred hand. Person A has to tell Person B as much about their last holiday as they can without using speech.
The tutor asks what this feels like for both parties, what helped to get the message across and what did not help.
Time: 5 minutes.
What ways were the best to use instead of speech to communicate? What helped and what did not? How did it feel for A&B?

4. Some facts…
Around 20% of stroke survivors have a persisting communication difficulties
Estimated to be over 250,000 people suffer from permanent aphasia in UK
Aphasia (language difficulties) generally occurs in stroke affecting the left side of the brain (therefore those with a right sided weakness)
About half of the people who show signs of aphasia experience temporary aphasia and recover completely within a short time

5. Why we need to communicate
To share information
To give opinions
To comfort someone
For enjoyment
To re-tell stories
To gossip
To talk about feelings
To show who you are
Imagine having these skills taken away from you. It makes it difficult to convey who you are, your character.
Now lets look at communication skills in more detail.

6. COMMUNICATION PROBLEMS AFTER A STROKE What can go wrong?
Damage to the language centre of the brain
COMMUNICATION PROBLEMS AFTER A STROKE
What can go wrong?
Speaking
Understanding
Non-verbal
Making speech sounds
Using numbers Reading
Reading
Writing
Using numbers

7. Different Types of Communication Disorder
Terminology
Different Types of Communication Disorder
Aphasia/Dysphasia
Dysarthria
Apraxia/Dyspraxia
>> not fully covered today
Communication disorders can broadly be divided by these definitions. The focus of today's talk is dysphasia. Dysarthria and dyspraxia are not fully covered but we will look at definitions of these

8. Definition of Aphasia A language impairment affecting the ability to:
Put ideas/intentions into speech and writing
Spell
Form grammatical sentences
Understand speech and writing
Understand and use other forms of communication e.g. gesture
(Pound et al., 2000)
Aphasia can be long-term and may have a significant psychosocial impact on the individual

9. Dysarthria
“a motor speech deficit caused by impaired strength, speech, or coordination of the speech musculature.”
(Darley et al. 1975, cited in Chapey 2001, p )

10. Apraxia of Speech
“a motoric impairment that disrupts central motor planning, and consequently, voluntary positioning of the speech musculature and sequencing of muscle movements in the absence of an impairment in muscle control.”
(Darley et al. 1975; Square-Storer & Roy 1989; cited in Chapey, 2001, p. 55)

11. Complicating factors Mixture of impairments Cognitive impairments
Perceptual difficulties
Hearing and vision
Fatigue
Physical disabilities
Mood – depression
Social and emotional effects
Psychological effects

12. Group task 1
Identify the impact of aphasia after stroke upon a) the patient and b) their carer.
In your groups, please discuss and list how you think aphasia affects the person who has acquired it and their carer. I will be looking for everyone to participate in this task. After the task has finished, ask people to shout out answers and discuss. N. B. it does not matter if people comment on hospital or community scenarios.

13. “Cocooned in this lonely shell.”
“Newborn.”
“I felt really low.”
“Speak...blank...start again...muddled.”
“I was stuck inside.”
“I...dumb.”
“I was absolutely devastated.”
“Cocooned in this lonely shell.”
“Like falling down from a plane.”
“er...just...wake up and er...just horrible.”
We asked some people with aphasia after stroke to describe what living with this language loss is like. Here is what they said.
N.B. at this point, discussing a case study known to the speaker will be used to highlight issues of living with dysphasia ( speaker to discuss a case known to them / relevant to their setting)
“My bloody body wasn’t working.”
“Angry, angry.”
“I see my wife working. I upset really”

14. How can you help?
If you think back to the ice breaker activity that we did at the start of the talk, what helped get your message across and what did not?

15. Ideas to help? GESTURE WRITING DRAWING SPEECH COMMUNICATION AIDS
e.g. AMPLIFIERS, KEYBOARDS,
PICTURE CHARTS
FACIAL EXPRESSION

16. More ways of helping Allow time for communication
Don’t pretend you understand if you don’t
Get person’s attention
Make eye contact and limit distractions
Use straightforward language, avoiding complex medical terms
One things at a time, pause in-between
Use normal voice, but slightly slower speed

17. Group task 2
Mr. A is a person with aphasia after stroke. He is trying to tell you something. List the actions you might take in order to help him convey his message to you.
Split into groups to do this task. Again, I will be looking for everyone to participate. When the task is finished, ask people to shout out some answers and discuss these.

18. Summary
The ability to understand as well as talk can be affected by a stroke.
Changed communication skills can affect the carer too.
You are now aware of strategies that you can take that will ease communicative breakdown.
Consider referral to Speech and Language Therapy for those patient with communication difficulty.

19. Any Questions?