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In the first few days and weeks after a stroke, almost half of stroke patients will have problems with speaking, reading or writing, and some patients will have difficulties in recognizing or understanding the meaning of words. In addition, one-third of stroke patients have difficulty swallowing.
When the right side of the body is affected by a stroke, the communication and expression problems of the patient are more affected, because the main language control center is located in the left half of the brain.
When the brain language center is damaged, language barriers will appear. There are two main types of language disorders, one is aphasia and the other is a motor speech disorder. Most patients with aphasia have difficulties in language understanding and expression. In terms of expression, naming difficulties are more common. They can tell the purpose of an item, that is, they cannot tell the name, and they are more likely to say “knife" as “fork." The motor speech disorder is caused by neuromuscular damage and the incoordination of the articulatory organs. The main manifestations are inaccurate pronunciation and unclear speech.
Fig 1 - patients suffered from stroke usually lost their writing skill
Neurological communication disorder
Stroke damages the brain nerves and may cause the following communication disorders: (1) Aphasia: loss of language comprehension and expression skills; (2) Dyslexia: loss of reading and writing skills; (3) Dysphonia: due to damage to vocal and pronunciation organs Causes problems with pronunciation, vocalization, breathing, resonance, or rhythm, leading to unclear speech; (4) apraxia: problems with coordination and control of the oral muscles. When speaking, it seems that the oral muscles cannot be controlled, such as Movement of lips, tongue, and cheeks; (5) Cognitive communication disorders: Communication disorders are caused by problems such as memory, concentration, problem-solving ability, learning ability, and thinking ability. After the speech therapist evaluates the patient's condition, he will design an appropriate treatment plan for the patient. Through practice, it can enhance the control ability of the patient's facial and oral muscles and improve communication skills. The family members will also receive training to master the skills of communicating with patients. If necessary, the speech therapist will use other communication tools to assist in the treatment.
Dysphagia
Patients with dysphagia have problems in coordinating and controlling the movement of the oral muscles. When speaking, they seem to be unable to control the movements of the oral muscles, such as the lips, tongue, and cheeks. Moreover, the patient may easily swallow food by mistake and cause choking. Difficulty in swallowing or breathing, severe cases can cause pneumonia and suffocation. Speech therapists and specialist doctors will provide special barium swallow X-ray examination (VFSS) or endoscopic swallow examination (FEES) for in-depth comprehensive swallowing assessment, in response to reports to understand the patient’s condition, and then set up an individual treatment plan for the patient; Such as improving the concentration of food and muscle training to improve the ability of patients to swallow.
The communication difficulties in stroke patients vary and the degree is also different, but the help and encouragement of relatives are definitely very important. Family members should communicate with the patient more so that he has more opportunities to practice different communication skills and give him more encouragement and consideration for the difficulties he encounters so that he can adapt more easily and gradually rebuild his self-confidence. Coupled with speech therapy, the patient's ability to communicate or swallow can be improved.
