Stroke - A battle of words
Human beings communicate with each other in many different ways such as speech, music, body language, gestures, the written word and pictures.
On the other hand, in aphasic patients, ideas can no longer be converted into the correct words. Losing the power to communicate comes close to being sentenced to a period of solitary confinement.
Imagine what it would be like to find yourself living in a world where you could not say the words you intended, or understand when someone is speaking to you. In the early weeks following a stroke, a spontaneous phase of recovery normally occurs in all but the most severe cases. After a few weeks or months, the pace of recovery slows, and things can become more difficult.
Proper motivation and a meaningful purpose in life (albeit a long-term goal), are essential in promoting optimum recovery at this stage Depending on the severity of the condition, patients may not be able to speak at all, or they may use the incorrect words. When they try to say a word such as "water," and the word "house" comes out instead. Or someone asks, “Are you hungry?” and the answer is meaningless garble. Another example is when they are sitting around the dinner table and they mean to compliment the cook, but end up uttering swear words without even knowing it.
In many cases, errors bear some resemblance to the intended word, and errors in speech tend to be inconsistent. The patient may refer correctly to a "bomb" one day, but call a "bomb" sounding like "womb" the next. Patients suffering from aphasia (like everyone else), try to appear as normal as possible.
They may respond positively to an invitation to tea, but gentle probing may reveal that even "yes" and "no" are used inappropriately, as the patient has lost the ability to encode and decode language and to use language correctly. It can seem if everyone, including loved ones, is speaking a foreign language in which the patient is no longer fluent. Deficits include:
- Inability to find the correct word/s.
- Use of non-sensical sayings.
- Difficulty in understanding what people are saying.
- Awkwardness in grouping words together in a sentence.
- Impairment of speech, reading, and writing. For the aphasic patient, who already has many other deficits to contend with, it feels that the frustration of misplacing words, having them on the tip of your tongue, but not to be able to bring them to mind, happens all the time.
The battle for words can be soul-destroying and, not surprisingly, the patient can feel angry, frustrated, and tearful. Stroke patients can still think, feel, and hear. They are as intellectually aware as they were before the stroke, although people often assume that an aphasic person is mentally incompetent. The difference is that they do not look intellectually aware, they cannot demonstrate intelligence, and most cruelly, they cannot necessarily communicate their astuteness - no matter how much they desperately want to.
In view of the above, carers are advised to speak in a simple, straightforward manner, using words that are easy to understand. Too much information delivered in one sentence is inadvisable as many aphasic people are easily confused by complexity. A lot of time should be allowed for ideas to be assimilated.
Carers are also advised to supplement their facial expressions by gestures or by other helpful means, and every channel of communication is useful. If the written word is more easily understood than speech, or if writing proves to be an aid to comprehension, then this could be used to communicate no matter how slow or tedious, this may seem. All that really matters in the end is that the patient recovers, and that both of you feel good.
How long this takes is of secondary importance. Every increment, however small, is a cause for celebration. Proper motivation and a meaningful purpose in life are essential in promoting optimum recovery.