Stroke Aphasia a Community Based Center for Support

Stroke, Aphasia & a Community. Based Center for Support

What is a stroke? A stroke is an interruption in the blood supply to any part of the brain for any significant period of time.

Ischemic (blockage): a clot blocks blood flow in an artery that leads to the brain (83%) 2 major categories of stroke Hemorrhagic (bleed): blood escapes from an artery; aneurysm - weakness or ballooning causing it to burst (17%) ……………………… TIA (“mini stroke”): blood supply to the brain is temporarily blocked causing symptoms that resolve WARNING - do not ignore!

Stroke is the No. 5 cause of death and leading cause of disability in the United States. Stroke Statistics Women make up nearly 60% of all stroke deaths. African-Americans between ages 45 and 64 have 2 -3 times the risk of stroke. Although stroke is more common among the elderly, a lot of people under 65 also have strokes – including children and babies. Source: American Stroke Association, strokeassociation. org

Impact of Stroke Every 40 seconds someone has a stroke in the U. S. About 795, 000 Americans experience a stroke every year. Stroke costs the U. S. $34 billion annually. Stroke is leading cause of disability in the U. S. Source: Centers for Disease Control and Prevention, cdc. gov

And yet…………… In a recent survey, 40% of people could not identify a single symptom of stroke!

Know the signs of stroke and act F. A. S. T. Time is brain! Every 10 minutes can save up to 20 million brain cells.

Where was the stroke? Left hemisphere of the brain controls the right side of the body Right hemisphere of the brain controls the left side of the body

LEFT logical RIGHT creative

Left hemisphere is also home to LANGUAGE

Aphasia is the communication disorder that affects a person’s ability to use LANGUAGE 4 components of language: Listening Reading Speaking Writing Aphasia is not a loss of intelligence

Approximately 2 million Americans have aphasia. Aphasia Facts There are over 250, 000 new cases each year; the numbers are expected to rise. Aphasia is more common than cerebral palsy and muscular dystrophy, yet most people have never heard of it.

Aphasia Wide variation in the severity of symptoms Aphasia may be accompanied by a weakness in the muscles of speech (dysarthria) Or also accompanied by an inability to coordinate mouth movements (apraxia)

Famous Faces with Aphasia

Broca’s Aphasia: Non-fluent Speech output is reduced to mainly short utterances of the main content words Halting and effortful quality of speech

Wernicke’s Aphasia: Fluent Speech is produced easily, but often does not make sense. Because of fluent nonsensical speech and comprehension difficulties, may be confused with mental illness or other problems.

Listening & Comprehension Challenges Too much content Too rapid speech Too many people! Use of idioms or figurative language

Ways to help with comprehension “Chunk” the content One topic at a time Speak at a slower pace Do NOT shout Do NOT speak “down” or condescend ALWAYS VALIDATE UNDERSTANDING

Speaking & Language The most obvious consequence of aphasia “Tip of the tongue” syndrome May be agrammatical, lacking content, or containing misused words Extremely frustrating for the speaker and the listener Speech vs. language difficultes: Speech – impacted by muscle weakness or apraxia; Language – impacted by the inability to find the right word But they can sound alike!

Ways to help with speaking Give choices Use support: pictures, objects Allow extra time Do not fill-in-the-blanks unless requested Restate what you understood and verify accuracy Acknowledge frustration NEVER speak over or around the person with aphasia

Reading Changes can vary from simply reading slower to words looking “scrambled” or foreign Many survivors enjoy looking at written material – even if they cannot comprehend all of it, they can frequently get something out of it Online news summaries are a good source of short, simple reading (USA Today) There is limited value in having a survivor read aloud (it has therapeutic value but is not typically recommended) Many survivors report huge frustration with reading if they enjoyed reading prior to their stroke – it now becomes effortful rather than enjoyable

Ways to help with reading e. Books and audiobooks – used together, can improve reading speed and comprehension Pacing – read in short bursts and stop before the brain gets tired Stop Use and check for comprehension supports – keep a list of characters and places

Writing Difficulties range from spelling and grammar errors to being unable to copy simple geometric designs or letters There is high value in writing every day – at whatever level is appropriate for the individual; copying or self-generating Paper and pencil vs. keyboarding is a personal choice

Ways to help with writing Technology is making life easier! Emoji – selecting a symbol can be easier than writing a word Keep a list of common messages to cut and paste in texts or emails Voice-to-speech Word dictation (Siri) prediction, spellcheck, and text-to-speech editing

Communicating with people with aphasia A P H A S I A ask simple questions provide choices help communicate if asked acknowledge frustration speak slowly and clearly if you don’t understand, say so allow extra time

Recovery from Stroke & Aphasia Spontaneous recovery: Period of rapid recovery of symptoms in the first few weeks to about 6 months after stroke Long term recovery: Research has shown that recovery continues indefinitely

Neuroplasticity Long term treatment of aphasia is based on the knowledge that continued stimulation of the brain will continue to result in improvement - indefinitely.

Stroke Recovery and Insurance Here is the contradiction… Average length of acute hospital stay - less than 5 days Average length of stay in a rehab hospital – 3 weeks Typical insurance coverage for outpatient speech therapy is 30 sessions

A long-term solution for survivors and their families

Stroke Comeback Center a 501(c)(3) nonprofit organization Opened in January 2005 with 12 stroke survivors with aphasia and 4 classes Now: > 120 members and ~45 classes weekly Centers in Vienna, Rockville, Leesburg and virtually!

Stroke Comeback Center Groups address the 4 main components of language, cognition, fitness, life skills, technology, and social events Individuals are welcome regardless of the time since their stroke, level of communication/cognition/fitness, and ability to pay Uses a Life Participation Approach to Aphasia Offers a community of support for the whole family

Life Participation Approach Explicit goal of increased life participation Everyone affected by aphasia is eligible for services Success measures include documented life enhancement changes Both personal and environmental are intervention targets Emphasis on availability of services needed at all stages of recovery (American Speech-Language Hearing Association. The LPAA Project Group. (2000))

Member & Family Events Family Picnic Holiday Party Stroke Comeback Day at Nationals Park

What We Have Learned Individuals with aphasia continue to progress indefinitely Caregivers are as much a part of the recovery process as the survivor It’s less about the speech output and more about overall “communication” Confidence is perhaps the most significant outcome Success is measured in CANS, not in CANNOTS It’s all about Quality of Life

Belonging to a Community 72% of survey respondents said the center has helped them make new friends be more hopeful about their future “We laugh together and we cry together, there is no other place like this. ” KR, member

That there is no STOP sign on The Slow Road to Better

Aphasia is not fixable…. . but it is livable

Learn more about us at strokecomebackcenter. org Blog: Aphasia will not be Silent aphasiawillnotbesilent. blogspot. co m Podcast: The Slow Road to Better Available on Sound. Cloud, i. Tunes and Google Play

Follow us on Social Media Learn about our upcoming community events!

Our Four Centers Vienna 145 Park St. , SE Vienna, VA 22180 703 -255 -5221 Rockville 50 West Edmonston Dr. , Suite 301, Rockville, MD 20852 301 -605 -7620 Leesburg (Loudoun Headway Project) 224 -D Cornwall St. NW, Suite 305, Leesburg, VA 20176 571 -919 -6090 Virtual Center Virtual groups use technology (computer with camera and microphone, smartphone or tablet) and free software (Zoom) to deliver classes at a distance by linking survivors with clinicians for groups, education or individual consultation.

“You gave us hope when there was none” S. W.