It was long taught that when someone acquired aphasia* following a stroke or other injury to the brain, the most dramatic recovery in speech and language would occur within the first 6 months, and after that period of time further recovery would be unlikely. But, current research paints a different picture about recovery from aphasia and suggests that some people can continue to make improvements in their communication abilities for years following the original insult, and those who heard Representative Gabby Gifford speak recently at the Democratic convention witnessed the result of years of therapeutic interventions, and Ms. Gifford’s own determination to recover her ability to communicate.*(Aphasia is an acquired language disorder due to stroke or other brain injuries. It can affect speaking, understanding spoken language, reading, and writing – but it does NOT affect intelligence).
Will He/She Improve?
The most common question I receive from a spouse or other family member when I am working with a patient with aphasia has to do with their recovery. And, when my own mother suffered a stroke in 2012, resulting in a severe expressive aphasia, my own family, along with me, wondered the same thing. Will she recover her speech?
The most honest answer I can give is to say: “I don’t know.” The symptoms of aphasia can be quite different for every individual, and age, social supports, and internal motivation will all be factors influencing recovery. I try to re-assure patients and their family that recovery is indeed possible, but will require time, patience, and hard work. In the case of my mother, even at the age of 89, I witnessed the influence of her own determination and resilience in the recovery of her language which allowed her to return to her home, play bridge, and enjoy her family and friends.
Is More Therapy Better?
Is it better to have a given dose of speech therapy at a higher intensity or lower intensity? This question is important to get the best outcome from patients’ time and effort, and for the best use of funding, and researchers are still attempting to answer this question. In a recent systematic review comparing higher and lower treatment intensity schedules for indivdiuals with aphasia, the investigators reported:
“Higher intensity treatment is supported by principles of neuroplasticity – the brain should make stronger connections with high repetition in a short period, but this is based on movement and animal models, not aphasia. Lower intensity is supported by cognitive learning – repeating things over a more distributed period should improve long-term recall.”
The review indicated that all treatments were effective, from 3 to 15 hours of treatment per week, but the researchers were left with many unanswered questions, and the recommendation that larger high quality studies are still needed. The study investigators also acknowledged that there are so many other factors in what makes treatment effective, it may not be possible to have a black and white answer. Instead, they suggested that “the best schedule may depend on sophisticated algorithm that combines a person’s age, aphasia characteristics, and area of brain injury or lesion properties.”[i]
Help is Available and Online Programs Offer Ongoing Support
Anyone recovering from a communication problem will benefit from opportunities to interact with others facing the same difficulty, and over the last few months several aphasia support groups have made their programs accessible to a wider audience offering ZOOM chat groups.
National Aphasia Association is a non-profit organization founded in 1987 dedicated to advocating for persons with aphasia and their families. Their goal is to provide access to research, education, rehabilitation, therapeutic and advocacy services to individuals with aphasia and their caregivers. The NAA acts as a syndicate of resources, promoting sense of community among individuals and caregivers.You can join them for a monthly online, Aphasia Café. Visit: https://www.aphasia.org/aphasia-cafe/
Voice of Hope for Aphasia is a non- profit community-based center in Florida that now is offering many of its programs online. Visit them at: https://www.vohaphasia.org/
In addition to online support groups, several online therapy programs are available at no or low cost, and may support the work that you may be doing with your speech therapist or once you are discharged from therapy. These include:
Aphasia Therapy online, a free program developed by John E. Pierce, a speech-language pathologist and researcher https://www.aphasiatherapyonline.com/
AphasiaToolbox.com is the outgrowth of work begun by William Connors, a speech-language pathologist and aphasiologist. There is a fee for services, which include telepractice options and weekly online groups. https://www.aphasiatoolbox.com/
Constant Therapy an app developed in conjunction with Dr. Swathi Kiran, an aphasiologist and researcher in Boston. The app provides evidence-based exercises and real-time feedback and reports. The app can be downloaded and used for up to 15 days at no cost, and then annual subscriptions are available. https://constanttherapyhealth.com/constant-therapy/
Talk Path Therapy an online platform available to clinicians and patients, provided at no cost by Lingraphica, a company dedicated to helping adults with aphasia improve their communication and quality of life through devices and applications. https://therapy.aphasia.com/
[i] John E. Pierce, Robyn O’Halloran, Maya Menahemi-Falkov, Leanne Togher & Miranda L. Rose (2020) Comparing higher and lower weekly treatment intensity for chronic aphasia: A systematic review and meta-analysis, Neuropsychological Rehabilitation, DOI: 10.1080/09602011.2020.1768127
Join Me on October 15, 2020 for a free webinar hosted by PCLA
Register now: https://pcla.org/event/lets-talk-parkinsons-speech-and-voice-event/
My MissionTo enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice
Hello, John, thank you for your comment. Yes, I do remember that you have an MSA diagnosis, which may require special attention to your symptoms which may be different than someone with idiopathic PD.
I REGRET MISSING THE WEBINR ON OCTOBER 15,2020. MY PRIMARY CONCERNS THESE DAYS ARE BALANCE AND COMMUNICATIONS ( PLEASE RECALL THAT I WAS DIAGNOSED WITH MULTIPLE SYSTEMS ATROPHY , MSA, RATHER THAN PD.)
Denise, thank you for your comment, and how nice to hear from you. I know that in your many years as a speech-language pathologist you addressed many of the same questions and concerns from patient and their families. I hope you are now enjoying retirement.
Very nice and helpful article with great references
Hope you are doing great