Speech Therapy for the "Non-Speaking" Stroke Patient

By: Gina O'Donohue

I am involved as a Speech Therapist on a professional basis with the Volunteer Stroke Scheme. It has been a highly rewarding and excellent experience for me.

My clients suffer from varying degrees of speech and language disorders. Referral to the VSS Scheme enables the client and their carers to benefit from more long-term and ongoing support provided by volunteers, which cannot often be provided by the speech therapy department.

The success of the VSS lies in their approach to the client and their carers' needs, helping them integrate back into their home environment and community from the protected hospital setting. The fear which often surrounds the word "discharge" for the stroke client and their family is greatly reduced.

Newton writing in 1977 described speech and language behaviours as being the "most complex of all human behaviours. Virtually every function of the central nervous system is involved in speech and language".

Indeed a speech disorder, apart from its severity, can have a devastating effect on those affected and their family and friends. An immediate feeling of isolation is replaced by frustration and often depression as the reality of living in a "world without words" is confirmed. I wish to focus on one specific speech and language disorder which can occur following a stroke, that is the complete loss of speech, or Aphasia. Spoken language is not the only form of communication, but is the most natural method.

Many of the clients that a speech therapist treats have severe speech loss. These clients will be a priority group who will be referred to the VSS and the speech therapist on discharge from hospital.

Their ability to communicate must be the key issue. The focus may shift from speech to other forms of communication.

Understanding this area is vital to carers of stroke victims. The areas of augmentative and alternative communication (ACC) must be explored fully for our non-speaking population. Everyone uses ACC strategies. Indeed our own speech is regularly supplemented by facial expression, body orientation gesture, mime and writing. "Body Language" has become a bit of a buzz word to describe communication which everybody uses but which is crucially important to the stroke person suffering from temporary loss of speech.

WHAT ARE THE METHODS AVAILABLE TO A NON-SPEAKING STROKE PATIENT?

Firstly it is important to emphasise that each case is different and must be treated individually. The aim is ultimately, that individuals can communicate their needs and feelings to others.

  • The importance of exploring a person's own natural gesture system is the first step.
  • Adequate comprehension of spoken speech, and the use of one hand, aid for the majority of ACC devices.
  • If a client has retained the ability to understand the written word, he/she can use tailor-made communication boards, with abstract and concrete pictures, words and short sentences. Pure pictorial charts for non-readers are made.
  • Spelling boards with alphabets can supplement these individually made charts if the ability to spell is retained.
  • Use of symbols, more abstract pictures and bliss symbolics can be appropriate, depending on the abilities of the individual.
  • More complicated gestural and/or sign systems can be implemented but need adequate dexterity.
  • The Cannon Communicator is a portable battery powered device which requires intact spelling ability and a fine finger manipulation to depress the required key (similar to a typewriter). Printout features and memory store facility are present.

More sophisticated communication aids include:

  • Introtalker - this is a basic portable battery powered speech output communication device for non-speaking people. Limited function device offering only speech output with a limited vocabulary. It employs digitised speech ( pre-recorded human speech) which results in natural sounding speech.
  • Touch Talker and Light Talker - these use computer technology to enable the user to store information of his/her own choice to recall at will. Messages are stored by means of pictures and activated by touch in the Touch Talker and by light sensor or control switch in Light Talker.

These are just a few of the devices/systems available to supplement the impaired speakers communicative ability. It is important to emphasise that many people who have suffered a stroke have the ability to use such devices. The speech therapist will always assess and make suitable recommendations. Research in the area of new electronic devices is very active and hold out great hopes.

The many alternatives open to the "non-speaking" population enables us to focus on "communicative effectiveness" rather than speech in isolation. The temporary loss of words need not mean an end to communication.