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Stroke Smart Magazine

January/February 2008
Q & A

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Leading Experts Provide Hope for People with Aphasia

Audrey Holland, Ph.D., Steven Small, M.D., Ph.D., Martha Sarno, M.D.

What do you consider to be a successful outcome of speech therapy for people with aphasia?

HOLLAND: When people with aphasia have shown some significant positive changes in language, and when they have chosen ways to get along with their lives and are learning to live with its aftermath - then speech therapy has been successful.


SARNO: Success is achieved when the person has developed new and/or alternative ways for communicating, and when communication with family and friends has become easier.


SMALL: My biggest priority is that they have improved communication with their families and community enough that they can do the things they enjoy. Also, I'd like to see younger people in the workplace.


Why does language improve more in some people than in others?


HOLLAND: There are many reasons, but the most important one for me is how much of the brain's language area has been damaged by the stroke.


SARNO: That's right. Strokes occur in different parts of the brain and some are more severe than others. This makes recovery unique to each individual. Also, a person's emotional response to having aphasia plays a role in the recovery process.


SMALL: Lesion size and location make a difference, but do not predict recovery. Emotional state and other motivational factors - not always under the control of the patient - also make a big difference. Finally, a person's ability to engage in an intense recovery effort makes a huge difference.


When do improvements occur?


SARNO: Improvements in communication may occur indefinitely.


HOLLAND: And learning to live more successfully with aphasia can continue for many years.


SMALL: True - Improvements can continue until the day the patient dies, so long as the patient does not develop new medical problems such as dementia a decline in intellectual functioning.


Is there a time no more improvements are expected?


HOLLAND: The greatest improvements usually occur in the first year following a stroke. That is certainly NOT the case, however, for learning to live well with aphasia. Language changes can also continue to occur, but may not be as dramatic as the early changes.


SARNO: The timing and amount of improvement expected vary according to the type and severity of the aphasia. Expectations for improvement are best determined on a case-by-case basis.


SMALL: There is no time at which no more improvements are expected. Maximum improvements generally occur early, but I expect this to change. New research will allow even greater improvements.


What new research may help people in the future?


HOLLAND: A lot! Some is aimed at reducing the language impairment, such as working to improve grammar. Some is geared more towards function. Researchers are even adapting treatments from other fields to aid aphasia patients, including an approach called "constraint-induced language treatment." Other research shows that participation in aphasia groups can be effective. To get involved in research studies, contact the speech clinic of your local university campus or hospital. If you don't live near any active studies, be patient. Most research is designed to help all of us later down the road.


SMALL: I believe that a combination of biological treatments - such as drugs, devices and tissue transplants - along with specific work on behaviors, will help people in the future. With a lot of specific practice, the brain can reconfigure and send signals to your body around the damaged or dead areas. This process, called "plasticity" because the brain is malleable and can be reshaped can occur even years after a stroke. If you have questions, please contact me personally via the Comprehensive Aphasia Center of Chicago at small@aphasiatherapy.org or 773 834-7780.


SARNO: To learn about the latest research, check with the National Aphasia Association, which has a list of places where aphasia research is ongoing and provides links to NIH and other related websites.



National Stroke Association: www.stroke.org, 800 STROKES or 800 787-6537

National Aphasia Association: http://www.aphasia.org/, 800 922-4622

National Institute for Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/




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