Stroke Information is a one-page source for information on strokes, aphasia, and related subjects.

Picture of my wife Mary taken three months after a left-brain stroke which initially left her completely paralyzed on her right side, and unable to understand or speak even one-word statements.



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stroke information
introduction

introduction | what is a stroke? | what is the effect of a stroke? | what is the treatment for a stroke? | what is aphasia? | what role may a caregiver play in a stroke patient's recovery? | what resources are available to a stroke patient or caregiver? | glossary of stroke-related terms


On April 17, 2002, at about 12:20 in the afternoon, the phone in my home office rang.

Checking caller ID, I saw the call was from my wife's office. I had just spoken to Mary a few minutes ago, we always spoke at noon to compare how our day was going, so I picked up the phone assuming she had something else she wanted to joke about.

Instead, it was her assistant, who told me she had discovered Mary sitting behind her desk, eyes glassy. Mary was unable to talk, or move. The people at Mary's work had called an ambulance. Her assistant said, "I think Mary's had a stroke."

I've written about that day, Mary's nine-day stay in the hospital, and her return home, in my on-line diary, here, here, and here.

During those first scary days following Mary's stroke, I searched on the Internet for information which might help me understand what a stroke is, and its ramifications. I found a lot of sites devoted to stroke information, but most of them covered the subject piecemeal. I couldn't find a site that had a general overview of stroke information.

Since my writing about Mary's stroke in my on-line diary, I've received a number of e-mails from people whose loved ones have themselves suffered strokes, and who have had the same problem finding a "one-source page" for stroke information.

In response to this situation, I've created this "Stroke Information" page on my website, hoping it might help all of you who face the same "out-of-the-blue" emergency I did.

This page is a work in progress, so please feel free to e-mail me with suggestions as to how I can improve it.

Suggestions should be sent to:

Finally, before we get into the informational part of this page, let me say there is life after a stroke. Mary had a blood clot the size of an egg inside her brain. Her outpatient neurologist, looking at CT scans of her brain after she was discharged, said if he only had the CT scans to go by, he would have assumed Mary had died as a result of her stroke. Instead, Mary is living an active life now, and we are closer than we have ever been.

I cannot emphasize how important it is to never give up hope.


stroke information
what is a stroke?

introduction | strokes resulting from blood clots | strokes resulting from hemorrhage | warning signs of a stroke | the cincinnati stroke scale (FAST) | health, lifestyle and other factors that may lead to a stroke

Stroke is the third most common cause of death in the United States, and a leading cause of long-term disability.

Unlike survivors of a heart attack, who may spend a brief period of time in the hospital, but who can then go back to their normal lives intact, albeit with some lifestyle changes, people who survive a stroke often face months or years of rehabilitation to regain physical or mental capabilities lost as a result of their stroke.

A stroke is caused when blood to the brain is blocked as a result of a clot (known as an "ischemic stroke"), or when a blood vessal in the brain bursts, spilling blood into the spaces surrounding the brain cells (known as a "hemorrhagic stroke"). Strokes cause damage to brain cells, as well as the motor and/or intellectual functions supported by those cells.

A stroke results from one of two events, a clot or hemorrhage.

Strokes Resulting From Blood Clots (Ischemic Strokes)

The most common type of stroke, resulting in 70% to 80% of all cases, is caused by a blood clot or other particles blocking blood flow to the brain. This type of stroke is divided into two categories: Cerebral Thrombosis, and Cerebral Embolism.

Cerebral Thrombosis is the most common type of stroke. A blood clot (known as a thrombus), forms in an artery and blocks the flow of blood to the brain. Such blood clots usually originate in arteries damaged by atherosclerosis (a fatty buildup in the artery). Cerebral thrombosis strokes usually occur at night or early in the morning. They're often preceded by a 'mini-stroke', known as a transient ischemic attack (TIA).

Cerebral Embolism occurs when a wandering blood clot or particle forms below the brain, most commonly in the heart. The clot then travels through the bloodstream until it clogs an artery either leading to the brain, or within the brain itself, blocking the flow of blood. The wandering blood clot most often forms during atrial fibrillation, a disorder affecting two to three million Americans. Instead of beating normally, the heart's two upper chambers (the atria), quiver. This quivering causes blood leaving the heart to pool and clot, rather than being pumped completely out. The resultant clot then travels to the brain, blocking an artery.

Strokes Resulting From Hemorrhage (Hemorrhagic strokes)

Hemorrhage strokes fall into two categories, a subarachnoid hemorrhage, and a cerebral hemorrhage.

A Subarachnoid Hemorrhage occurs when a blood vessal on the brain's surface ruptures. The hemorrhage then bleeds into the space between the brain and the skull, but not into the brain itself.

A Cerebral Hemorrhage occurs when a defective artery within the brain bursts, flooding the surrounding brain tissue with blood.

Strokes resulting from hemorrhage are often caused by a head injury, or by a burst aneurysm. An aneurysm is a blood-filled pouch that balloons out from a weak spot in an artery. Aneurysms are often made worse by high blood pressure.

The Warning Signs of a Stroke

The American Stroke Association lists the following symptoms as warning signs of a stroke:

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.

  • Sudden confusion, trouble speaking or understanding

  • Sudden trouble seeing in one or both eyes

  • Sudden trouble walking, dizziness, loss of balance or coordination

  • Sudden, severe headache with no known cause

It's important to note that these symptoms may vary in severity, depending on the nature of the stroke. With one person, a stroke may be obvious, because the person has suddenly lost the ability to speak, or move one side of their body. With another person, the symptoms may be less dramatic, for example a sudden difficulty completing a sentence. In all cases, it is extremely important that 911 or an equivalent emergency medical service be called immediately. Administration of a clot-busting drug known as tPA can reduce long-term disability for the most common type of stroke, caused by a blood clot, but in order to be effective, it must be administered within three hours of the stroke.

The Cincinnati Stroke Scale (FAST)

Many Emergency Medical Technicians (EMTs) now use the Cincinnati Stroke Scale, also known as FAST, to quickly determine if an individual has had a stroke. FAST provides a quick identification of symptoms, and has proven to be remarkably accurate in assessing whether or not someone has had a stroke. If you suspect someone has had a stroke, or is the middle of a stroke, FAST can be a great aid in deciding whether or not to call for an ambulance. Remember, though: If in doubt, always call for emergency medical assistance. Minutes lost means brain lost.

FAST stands for:

Face
Arm
Speech
Time

Face Ask the individual to smile. If they smile with both sides of their lips lifting equally, that's normal. If they smile with one side of their mouth not lifting as much, or drooping, that's a sign that person has had a stroke.

Arm Ask the individual to close their eyes and extend their arms, palms up. If their arms extend equally, or drift equally, that's normal. If one arm drifts down compared to the other, that's a sign that person has had a stroke.

Speech Ask the individual to repeat the phrase, "You can't teach an old dog new tricks." If the person is able to repeat the phrase accurately with clear pronunciation, that's normal. If they can't repeat the phrase, slur their words, or use substitute words, that's a sign that person has had a stroke.

Time Determine when the individual last behaved normally, as an assist in determining when the stroke occurred.

If an individual fails a single one of the Face, Arm, or Speech tests, that individual has had a stroke, and needs immediate, emergency medical care. Every second counts. Each second lost is brain cells lost.

Health, Lifestyle and Other Factors That May Lead to a Stroke

Health Factors

  • High Blood Pressure. Recognized as the greatest risk factor for a stroke. The higher one's blood pressure, the greater the possibility of suffering a stroke.

  • Diabetes Mellitus. Although diabetes is treatable, a person with diabetes is at an increased risk of having a stroke. This risk is greater if the diabetic is also overweight, and/or has a high cholesterol level.

  • Carotid Artery Disease. The carotid arteries, located in the neck, supply blood to the brain. If a carotid artery has become damaged by atherosclerosis (a fatty buildup of plaque in the artery wall), there is an increased risk the artery may become blocked with a blood clot, causing a stroke.

  • Heart Disease. An individual is more than twice as likely to have a stroke if they have existing heart problems, particularly atrial fibrillation (rapid, uncoordinated beating of the heart's upper chambers).

  • High Red Blood Cell Count. Red blood cells thicken the blood, making clots easier to form.

  • Previous Transient Ischemic Attack. A transient ischemic attack (TIA) is referred to as a "mini-stroke", in that it creates stroke-like symptoms (but causes no lasting damage). However, an individual who has experienced a TIA is ten times more likely to have a full stroke than someone of the same age and sex who has never had a TIA.

  • High Blood Cholesterol and Lipids

Lifestyle Factors

  • Cigarette Smoking. The nicotine and carbon monoxide in tobacco smoke damage the cardiovascular system, significantly increasing the risk of stroke. This risk is increased to an even greater degree if the smoker also uses birth control pills.

  • Obesity

  • Lack of Exercise

  • Excessive Alcohol Use

  • Substance Abuse. Particularly intravenous drug use (drugs injected with a syringe), which greatly increases the risk of a cerebral emboli stroke, and cocaine use.

Other Factors

  • Age. After age 55, the chance of having a stroke more than doubles each decade (however, over a quarter of all strokes occur to individuals under age 65).

  • Gender. Although gender is not a factor in having a stroke (a roughly equal number of men and women have strokes), more women than men die as a result of a stroke.

  • Race. African-Americans have a much greater incidence of death or disability from strokes, in part because high blood pressure is more common among African-Americans than it is among other racial groups.

  • Family History/Personal History. A stroke is more likely in individuals whose family members have had a stroke, or who themselves have a history of stroke.

  • Climate. Stroke deaths are more common during periods of extremely hot or extremely cold temperatures.

  • Income and Education. Some evidence suggests individuals in lower income groups, and/or individuals with limited formal education, are more susceptible to strokes.


stroke information
what is the effect of a stroke?

introduction | left-hemisphere strokes | right-hemisphere strokes

The brain has two hemispheres, the left hemisphere and the right hemisphere. Each hemisphere controls the opposite side of the body (the left hemisphere controls the right side of the body; the right hemisphere controls the left side of the body). In addition, each hemisphere is responsible for certain intellectual functions.

The effect of a stroke depends on the hemisphere in which the stroke occurs.

In very general terms, the most noticeable effect of a left-hemisphere stroke is often loss of the ability to understand speech and written language, whereas the most noticeable effect of a right-hemisphere stroke is often physical impairment.

Not all stroke patients experience the same disabilities, or to the same degree. The impact of a stroke on a specific individual is affected by whether or not that individual received tPA (a clot-busting drug) within three hours of the stroke, if the stroke was caused by a blood clot; the location of the clot; the amount of brain tissue affected; the individual's age and general health; and follow-up therapy.

In many cases, the initial severity of a disability will lessen as the stroke patient recovers from his or her stroke. Recovery of physical or speech functions damaged by a stroke can be greatly improved if the patient begins appropriate therapy (speech, physical, occupational), as soon as possible following a stroke (therapy should begin while the patient is still hospitalized).

Left-Hemisphere Strokes

A stroke which occurs in the left hemisphere of the brain can produce one, several or all of the following disabilities, to varying degrees of severity:

  • Paralysis on the right side of the body

  • Speech and language problems (known as aphasia)

  • Cautious behavior

  • Memory loss

Paralysis may be complete, an inability to move the right limbs, wiggle fingers or toes on the right side, or may be less severe. Many left-hemisphere stroke patients recover all or some of their right-side function, so that they may walk and climb stairs without assistance, although they may retain a numbness on the right side of their body.

Because the left side of the brain contains the "speech center" of the brain, individuals with left-side strokes often have difficulty understanding speech and written language following their stroke, a condition referred to as aphasia. Because this is such a common effect of a stroke, a special section on this page has been devoted to aphasia.

Some left-side stroke patients may exhibit a more cautious behavior than before their stroke, although others may find themselves reacting more spontaneously and/or intensely than before to outside stimuli.

Right-Hemisphere Strokes

A stroke which occurs in the right hemisphere of the brain can produce one, several or all of the following disabilities, to varying degrees of severity:

  • Paralysis on the left side of the body

  • Vision problems

  • Cognitive problems

  • Inappropriate behavior

  • Memory loss

Paralysis may be complete, an inability to move the left limbs, wiggle fingers or toes on the left side, or may be less severe. In some cases, paralysis or milder physical impairment caused by a right-hemisphere stroke may require a more intensive physical therapy than a paralysis or impairment caused by a left-side stroke.

Vision problems are more likely to be present if the stroke occurs towards the back of the brain.

Cognitive problems can include difficulty with concentrating, remembering previously-known information (such as phone numbers or addresses), learning new information, being able to relate information (such as directions) in a correct sequence, having difficulty with abstract language (such as metaphors), and problem-solving. Individuals with right-hemisphere strokes may also develop "left-side neglect", meaning an inability to be aware of the left side of their body, or the left side of objects. Individuals with this deficiency will generally not comb the left side of their hair, eat food on the left side of their plate, or read the left side of a book page. This impairment is not caused by their physical inability to see the left side, but rather by the fact that it does not occur to them that there is a left side.

Inappropriate behavior resulting from a right-side stroke may manifest as laughter at inappropriate times, or making inappropriate comments, including sexual comments, without the individual realizing the social inappropriateness of the behavior.

stroke information
what is the treatment for a stroke?

in the hospital | medication after discharge | change in lifestyle | therapy after discharge | what is the eventual recovery for a stroke patient?

In the hospital

Most stroke patients are initially treated in the emergency room of a hospital, often after having been transported there by ambulance. The patient's present condition will be assessed, which includes, in addition to many other investigations, a blood pressure check and a determination of whether or not the patient is able to communicate, and if so, if the patient is experiencing any paralysis or numbness.

Emergency room neurologists will ascertain if the drug "tissue plasminogen activator" (tPA), a clot-busting drug, would be appropriate treatment. tPA is generally indicated if the stroke is caused by a blood clot. tPA is contraindicated if the stroke is caused by an intracranial or subarachnoid hemorrhage, or if the patient had recent intracranial surgery, or a recent head injury. Whether or not a hemorrhage is present is often determined through a CT scan. Because tPA significantly thins blood, in order to dissolve a clot, use of tPA is not appropriate, and indeed harmful, if a stroke is caused by internal bleeding, rather than a clot.

If tPA is appropriate, it must be administered within the first three hours of a stroke to be effective. If administered within the three-hour timeframe, tPA can often have a dramatic effect in halting the damage caused by a stroke, and aiding the stroke patient's recovery. Given that timing is so important in the administration of tPA, most hospitals record the time the patient arrived at the emergency room, and the precise time tPA was administered.

Because tPA is such a powerful blood thinner, patients to whom it is administered will generally develop large, dark bruises. These bruises will go away, although it may take days or weeks.

Once the patient is stabilized, he or she will be brought to the critical care or intensive care section of the hospital, where they will be monitored to make certain their condition remains stable. During the patient's stay in CCU or ICU, if the stroke was caused by a clot, additional tests may be performed in an attempt to determine where the clot originated. Most clots originate in the heart area, in the neck, or in the brain itself. In many cases, the origin of the clot is never discovered.

During this time also, the patient will typically be visited by speech and physical therapists, generally on a daily basis, who will perform assessments of the patient's current condition, and will help the patient begin recovering damaged speech and/or physical functions. During one of these visits, a therapist will test the patient's ability to swallow liquids and foods (some stroke patients acquire difficulty swallowing). If the patient is able to swallow properly, the I.V. feeding tube is removed, and the patient is transitioned back to solid food.

As the patient continues to improve, he or she will be transferred out of the CCU or ICU section, usually to either the neurological wing or therapeutic wing of the hospital. Physical and speech therapy will continue on a daily basis.

It is not unusual for a severe stroke patient, particularly a left-brain stroke patient, to have complete paralysis on one side of their body initially, but then have function return to that paralyzed side of their body (although numbness may remain), so that in a relatively brief period of time, sometimes within a week, depending upon the severity and location of the stroke, they are able once again, with the help of physical therapy, to walk.

It is also not unusual for left-brain stroke patients who have had their speech centers damaged by a stroke to initially believe they are speaking normally, even though, in fact, their speech does not make any sense. This confusion can obviously cause a great deal of frustration for the stroke patient, who may believe the people he or she is "communicating" with are ignoring his or her requests.

Patients are discharged from the hospital once it is felt the immediate danger of a stroke is past, and the patient is being discharged to an environment where they will receive adequate care as they continue their recovery. Discharge is usually to the patient's home. If the effects of the stroke are still severe, there is generally the option, if the patient's insurance will cover it, of discharge to a residential rehabilitation clinic, if that is the stroke patient's and caregiver's decision. Stroke patients who still have severe physical disabilities are generally held longer in the hospital than patients with severe speech disabilities. Most hospital discharges occur on Fridays and Saturdays.

Medication After Discharge

Medication after discharge falls into three categories:

  • Medication to prevent another stroke

  • Medication to help the patient cope with their changed circumstances

  • In the case of intellectual disability, such as loss of the speech function, medication to help repair the cognitive and communication functions of the brain

Medication to prevent another stroke focuses on controlling those physical conditions a patient has which are known to contribute to stroke incidence. If a patient has, for example, high blood pressure, or high cholesterol, he or she will be prescribed medicine to help moderate those conditions. If the cause of a stroke was a blood clot, the patient may also be asked to take a blood thinner. Depending on the nature of the patient's stroke, the blood thinner may be over-the-counter aspirin, taken daily, or may be coumadin, or one of its many variants. Coumadin is a prescription blood-thinner that is taken daily. Because of its powerful effect, patients taking coumadin usually have to have a blood test performed on a regular basis, generally once a month, once the coumadin level in their blood has stabilized, to make sure the coumadin level within their blood is at an acceptable level. The acceptable level for coumadin is between 2.0 and 3.0. Lower than 2.0, clots are more likely to form. Higher than 3.0, excessive bleeding is possible. A blood test may be the drawing of a sample of blood with a syringe, or a "blood stick" test, in which a fingertip is pricked, and a small sample of blood removed. Coumadin levels are adversely affected by foods which contain high levels of vitamin K, such as spinach and other dark green, leafy vegetables. Patients who have had a clot-based stroke should generally avoid large doses of vitamin K, such as are found in some one-a-day vitamins.

After a stroke, it is quite common for the patient to feel depressed, because of the touch of mortality a stroke, much like a heart attack, brings, and also because of the patient's reduced intellectual and/or physical capabilities. It is not unusual for a stroke patient to be prescribed an anti-depressant to help cope with their depression.

There has been much research done on drugs which might help the brain to repair itself following a stroke, particularly speech and other cognitive functions, and several studies suggest anti-depressants might aid the brain's recovery from a stroke, in the sense of helping the re-routing of impaired brain functions to new, unaffected areas of the brain. Ritalin, taken in small doses for a period of several months, has also been looked at as an aid in brain repair of speech and cognitive functions. All such possibilities should be discussed with the patient's physician.

Change in Lifestyle

Someone who has suffered a stroke must, obviously, avoid those activities which have been shown to cause strokes.

Stroke patients must:

  • Control their high blood pressure

  • Stop smoking

  • Drink moderately

  • Control their cholesterol level

  • Exercise regularly

  • Take medication to regulate their coumadin level, if applicable

  • Avoid stress

Therapy after discharge

Disabilities such as paralysis or aphasia caused by a stroke exist because an area of the brain in charge of that function has been damaged.

The brain does repair itself, to the extent it can.

As mentioned above, some anti-depressants, as well as low doses of Ritalin, may help the brain to knit together again.

The greatest aid to the brain's recovery of damaged functions, however, is therapy.

Physical therapy can help the paralyzed patient learn to use their limbs again.

Speech therapy can help the patient regain the speech function. The key to speech recovery is to have the patient attempt to speak as much as possible. Depending on the severity of a stroke, this may begin by helping the patient to recite the alphabet, the days of the week, or the months of the year. Although this can be a difficult task for some stroke patients, the effort itself, trying to recall, for example, the days of the week, helps the brain repair itself, since the brain is being actively used to attempt to perform a task. The more the brain must try to produce a correct answer to a question, the more the brain finds new routes towards recovery. In other words, especially during the early stages of speech therapy, it really does not matter if the patient is able to answer a question correctly. What is more important is that the patient uses his or her thought processes to try to produce a correct answer, since the attempt itself, whether successful or not, aids cognitive repair.

Therapy, physical, speech, or otherwise, should begin as soon as possible, while the patient is still hospitalized. Once the patient has been discharged, therapy should continue almost immediately after discharge, and certainly within the first week of discharge. Studies have shown that the early months following a stroke are the optimum time for a patient to make tremendous gains in recovering physical or speech functions. The further away from a stroke, the more difficult it is for the patient to recover functions, although recovery continues, at a diminishing rate, for years.

What is the Eventual Recovery for a Stroke Patient?

Most stroke patients experience an improvement from their initial condition following a stroke. Those who have been paralyzed regain at least some function in the affected limbs; those who have lost the ability to understand speech recover some of that facility.

The degree to which a patient recovers functions lost because of a stroke depends on a number of factors, including whether or not the patient received tPA, if applicable, within three hours of their stroke, the severity of the stroke, the age of the patient, and the amount of therapy the patient receives following the stroke.

Stroke specialists generally regard the first three months following a stroke as the optimum period for the stroke patient to recover lost functions, followed by six months after the stroke, one year, and two years. The further in time from the stroke, the more difficult it may be to reacquire physical or speech functions, although improvement does continue, but at a slower pace. Initially, it was believed stroke patients do not generally improve after two years, that they plateau, but extensive anecdotal evidence suggests improvement does, in fact, continue indefinitely.

Because the greatest recovery of lost functions is realized in the first three months, it is vitally important that stroke patients receive as much physical and/or speech therapy as possible during this period. Depending upon the severity of the stroke, patients may require therapy, at a diminishing frequency, for one or two years following their stroke. At least initially, therapy may be required five days a week.

Studies suggest a stroke patient who has been administered tPA, if applicable, within the first three hours of a stroke, and who receives adequate therapy afterwards, may recover up to ninety percent of their affected functions. For most stroke patients, full, one hundred percent recovery does not occur. Although this statement may appear disheartening, it must be remembered that many stroke patients die during their stroke, and that any patient who survives a stroke, and recovers nearly all their functions, has much for which to be grateful.

stroke information
what is aphasia?

introduction | how do you communicate with an aphasia patient? | what exercises can an aphasia patient do to recover speech?

Aphasia is a mental disorder in which the patient loses the ability to understand language.

Their language-processing center in the brain has been damaged to where words no longer make sense.

Although aphasia affects many areas of communication, the most evident impact is when the patient attempts to speak.

For example, a patient with aphasia may initially be unable to make sense. Rather than saying a sentence that can be understood, the patient may make nonsense sounds instead, or may string together a group of words that, although each word is a real word, do not make sense when combined with each other. In both cases, the patient may believe he or she is making sense, and may become quite agitated, understandably, when their "requests" are ignored, or puzzled over.

To understand how aphasia affects a stroke patient, one must realize that aphasia is not a physical impediment to speech, such as stuttering, but rather a conceptual impediment.

Someone with aphasia may, for instance, if asked what animal makes a "meow", be able to immediately draw a picture of a cat, but be unable to come up with the word "cat".

For most aphasia patients, common words are on "the tip of the tongue" but unrecallable, or only recallable after much concentration, like someone trying to remember an actor's name. This difficulty in retrieving the right word from memory is referred to as "anomia", and is very common with aphasia patients.

Aphasia patients, in addition to having great difficulty speaking, also have great difficulty comprehending language spoken by others. A sentence such as, "What would you like for lunch?", may, to them, appear to be nothing more than a series of sounds.

It is also not uncommon for an aphasia patient, in the early stages of recovery (a year or longer in severe cases), to not retain language-related information. For example, a patient may, during therapy, eventually recognize that the letters c,a,t spell "cat", but then, when the therapist writes the letters c,a,t on a piece of paper a moment later, no longer remember what word those letters represent.

Aphasia patients often have the greatest difficulties communicating during what is known as "confrontational speech", meaning when the aphasia patient feels pressure to produce speech. For example, an aphasia patient may find it easier to spontaneously, unbidden, remark, "It's hot outside", than to have to answer the question, "What is the temperature like outside?", where the patient feels pressure to respond. Stress generally impairs the aphasia patient's ability to communicate.

Over time, most aphasia patients improve, and recover much of their ability to speak, and to understand speech from others. Professional speech therapy is absolutely essential, as soon as possible following a stroke, to help the aphasia patient regain language concepts.

How Do You Communicate with an Aphasia Patient?

Because an aphasia patient's grasp on language is initially quite limited, it is important to "break down" statements as much as possible, so the patient is able to grasp each concept, and also important to phrase each question as much as possible to where the patient has to only give a Yes or No answer, rather than having to spontaneously come up with a previously unspoken word. For example, if the patient doesn't understand the question, "What would you like for lunch?", he or she might be asked, "Are you hungry? Would you like some lunch? Would you like fruit, a sandwich, or a microwave meal? A sandwich? What type of sandwich would you like? Ham? Roast beef? Tuna fish?"

Many aphasia patients also find it easier, at least initially, to respond to verbal questions by writing their answers (many aphasia patients are able to write words they still have problems enunciating).

At least at first, aphasia patients should also be encouraged to use hand gestures, or pantomime, to indicate what they wish to say.

In many cases, aphasia patients will first recover the ability to use concrete words, such as nouns and verbs. Understanding more abstract words, such as prepositions, may take longer.

Caregivers should recognize also that the best of all communications, a hug, a kiss, a smile, are non-verbal.

What Exercises Can an Aphasia Patient Do to Recover Speech?

Aphasia patients need to receive professional speech therapy.

If for some reason (financial, geographic), professional speech therapy is not available, I have complied a series of lessons which are typical of the lessons a speech therapist performs with an aphasia patient. These lessons may also be used as supplementary lessons while the patient is in speech therapy.

The speech therapy lessons I have created are available here.

The lessons are in Microsoft Word format. There is no charge. I offer them free, in the hope they may help. The current version offered is Version 1.1, revised May 21, 2013. Check back here for updates. If you have any problem downloading the lessons, please contact me at robmary@swbell.net.

It must be emphasized though that there is no substitute for professional speech therapy.

If professional speech therapy is available, it should always be utilized. If a patient's healthcare coverage will not pay for speech therapy, or has limited benefits which have been exhausted, the caregiver should contact local hospitals to see if a free speech therapy program is available. Many hospitals offer such programs.

Whenever a caregiver performs speech therapy at home, either as the only source of speech therapy, or as a supplement to professional speech therapy, he or she must take into account the fact that most patients tire after an hour or so of therapy. Accordingly, lessons should be spaced apart, with rest and fun activities in between.

stroke information
what role may a caregiver play in a stroke patient's recovery?

A caregiver is the person primarily responsible for a stroke patient's well-being and recovery.

The caregiver can be a spouse or significant other, a parent, a son or daughter, but is almost always someone who lives with the patient.

The caregiver helps the stroke patient adjust to day-to-day life post-stroke, takes over most household chores, arranges for physician and therapy appointments, attends such appointments with the patient, handles insurance issues, researches new treatments which might assist the patient, helps the patient recover his or her affected functions, and provides emotional support.

The caregiver must be patient, non-argumentative, and tireless.

Caregiving is the "in good times and bad" provision of the marriage contract. As daunting as many of a caregiver's responsibilities may seem, it is heartening how people rise to the challenge of caregiving, and succeed.

Above all else, a caregiver must be someone who loves the stroke patient, truly loves him or her, and is willing to forsake all other goals to join the patient's journey towards recovery.

There are few opportunities in life to so profoundly affect for the good another person, as there is with caregiving.

stroke information
what resources are available to a stroke patient or caregiver?

A stroke is the time to call on family and friends for assistance.

The caregiver should spend as much time with the stroke patient as possible, to provide reassurance by a near-constant presence. All other tasks, at least initially, should be delegated as much as possible to other people.

Many stroke patients and caregivers benefit from support groups which meet on a regular basis to discuss life after stroke. Contact your local hospital, or your family physician, to learn if there are any support groups in your area.

The Internet includes a number of sites devoted to stroke information. Chief among these are:

The American Stroke Association, which provides a free, one-year subscription to Stroke Magazine, a print magazine that is highly recommended.

The National Stroke Association.

The National Aphasia Organization.

stroke information
glossary of stroke-related terms

Aneurysm means a blood-filled pouch that balloons out from a weak spot in an artery. Aneurysms are often made worse by high blood pressure.

Aphasia means the loss, to varying degrees, of the concept of language. Aphasia patients often are unable to recognize words or sentences, whether spoken or written. Aphasia is most common with left-hemisphere strokes.

Brain Attack means a stroke. The term "brain attack" has increased in usage in recent years to emphasize the severity of strokes in the public mind, by equating them with heart attacks.

Cerebral Embolism means an event where a wandering blood clot or particle forms below the brain, most commonly in the heart. The clot then travels through the bloodstream until it clogs an artery either leading to the brain, or within the brain itself, blocking the flow of blood. The wandering blood clot most often forms during atrial fibrillation, a disorder affecting two to three million Americans. Instead of beating normally, the heart's two upper chambers (the atria), quiver. This quivering causes blood leaving the heart to pool and clot, rather than being pumped completely out. The resultant clot then travels to the brain, blocking an artery.

Cerebral Hemorrhage means an event when a defective artery within the brain bursts, flooding the surrounding brain tissue with blood.

Cerebral Thrombosis, the most common type of stroke, means an event when a blood clot (known as a thrombus), forms in an artery and blocks the flow of blood to the brain. Such blood clots usually originate in arteries damaged by atherosclerosis (a fatty buildup in the artery). Cerebral thrombosis strokes usually occur at night or early in the morning. Such strokes are often preceded by a 'mini-stroke', known as a transient ischemic attack (TIA).

Cincinnati Stroke Scale refers to a quick, accurate test to determine if someone has had a stroke. To see the actual test, look at What Is a Stroke?/The Cincinnati Stroke Scale, above. Also referred to as "FAST".

Coumadin means a prescription drug used to thin a patient's blood, to avoid the creation of a blood clot. A patient's ideal coumadin level should be between 2.0 and 3.0. Lower than 2.0, and the chances of clot formation increase. Higher than 3.0, and the chances of hemorrhage increase. Because coumadin is a powerful drug, coumadin use usually requires periodic blood tests (usually monthly, once an acceptable coumadin level has been established), to monitor the coumadin level in a patient's blood. In less severe stroke cases, the patient may be advised to take an aspirin a day to achieve blood thinness.

FAST See Cincinnati Stroke Scale.

Hemorrhagic Stroke means a stroke caused when a blood vessal in the brain bursts, spilling blood into the spaces surrounding the brain cells.

Ischemic Stroke means a stroke caused by a blood clot, which blocks normal blood flow to a specific area of the brain, causing the destruction of brain tissue in that area.

Left-Hemisphere Stroke means a stroke that occurs in the left hemisphere of the brain. In very general terms, the most noticeable effect of a left-hemisphere stroke is often loss of the ability to understand speech and written language, sometimes combined with some physical paralysis of the right side of the patient's body. Also referred to as "left-side stroke" and "left-brain stroke".

Mini-Stroke means a "transient ischemic attack", or "TIA". TIAs often herald the imminence of a major stroke.

Right-Hemisphere Stroke means a stroke in the right hemisphere of the brain. In very general terms, the most noticeable effect of a right-hemisphere stroke is physical paralysis of the left side of the patient's body. Also referred to as "right-side stroke" and "right-brain stroke".

Stroke means an event in which a blood clot blocks blood flow to an area of the brain ("ischemic stroke"), or a blood vessal in the brain bursts, spilling blood into the spaces surrounding the brain cells (hemorrhagic stroke).

Subarachnoid Hemorrhage means an event where a blood vessal on the brain's surface ruptures. The hemorrhage then bleeds into the space between the brain and the skull, but not into the brain itself.

Thrombus means a blood clot.

TIA means "transient ischemic attack", often referred to as a "mini-stroke". TIAs often herald the imminence of a major stroke.

tPA means "tissue plasminogen activator", a powerful blood-thinning drug administered in the emergency room following an ischemic (blood clot) stroke. To be effective, tPA must be given within three hours of a stroke. When administered within the three hour timeframe, tPA can significantly improve a stroke patient's chances for recovery, and degree of recovery. tPA generally causes widespread bruising on the patient's body, which fades in time.



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