Engage: Why there’s fresh hope for stroke patients who are struggling to communicate
“I have something to say. I want to share it with you.” By tapping a few keys in a specific sequence, I have made a code emerge on the screen. When you see these words, the language area of your brain (usually the left side) converts the sequence into meaning. If I have selected well, this meaning will match the message I wanted to convey.
But this is only possible if the language area of your brain is functioning normally. For approximately 50,000 people in the UK each year, writing, reading, speaking and understanding may be affected by stroke-related damage. This is known as aphasia.
Language is complicated. To read and understand my opening paragraph, for instance, you need visual skills to see the words, sustained attention to read to the end of each sentence, and a memory of the meaning of earlier sentences. Meanwhile, spoken communication can be undermined by stroke-related impairments to the muscles required to produce speech (dysarthria), to hearing ability, and by other effects such as depression or fatigue.
To add to the challenge, language operates at different levels of complexity – from single-syllable words to lengthy and highly technical texts. Additionally, a growing number of people in today’s societies use more than one language – take London, where more than 100 different languages are in daily use. When it comes to rehabilitating someone’s language skills, specialist therapists have to take all of these issues into account.
There are various different kinds of therapy that we use to treat people with aphasia. Constraint approaches, for example, involve blocking elements of the environment that can aid the communication of meaning. For instance, therapists put patients behind screens to force them to use spoken language rather than relying on facial expressions or pointing to help them convey a message. By focusing on this one means of communication, the patient has no option but to try and improve that skill.
Another approach is called melodic intonation therapy. It aims to take advantage of the fact that melody, rhythm and song are often stored on the right side of the brain and may thus be unaffected by the stroke. This is why many people having problems using spoken language can sing with relative ease. They “sing it better than saying it,” as we say.
We know that therapies such as these benefit people with aphasia. The therapy regimen also seems to have an impact. Therapy delivered at a high intensity of between five to 17 hours per week appears to yield more benefit than therapy at a lower intensity – though only for those people that can tolerate this regimen.
Many other questions remain, however. We need more insights into designing the optimum approach to rehabilitation for each person. How often, how much and for how long should therapy be delivered, for example? Can a trained volunteer or family member play a role? Can group therapy work as well as individual therapy? What benefits are there in using computers to deliver therapies such as the one in the video below?
Improved communication between researchers
To address these and other questions, I am one of a group of more than 125 aphasia researchers from 30 countries and many disciplines in an EU-funded initiative called the Collaboration of Aphasia Trialists. Among our activities over the past two years, we have been adapting a common tool to support language measurement with people with aphasia across 13 different languages. The purpose is that many international therapists have no access to a valid and reliable tool for assessing their patients’ language.
We aim to support a more coordinated approach to international aphasia research through an agreed definition of aphasia and an overview of approaches to aphasia rehabilitation. Finally, we aim to progress our research by developing research priorities for aphasia after stroke and by reviewing the aphasia rehabilitation interventions that have been covered in research papers.
And rather than destroying the data that we collect as researchers, we have received funding from the UK Department of Health to create a shared database. We will use this information to examine key research questions, which will make our research activities more efficient and hopefully improve treatments for people with aphasia and in turn their recovery. We should have our first findings from analysing this database by 2017. We also hope to make the data available across the international aphasia research community.
Yet all of this sharing and collaboration is based on the fundamental skill of communication, a skill acquired in the early years of life and used daily without thought. The ability to share these developments with you with just a few key strokes is truly amazing. The more of those abilities that we can restore to people who have had a stroke, the better their lives will be.
About the Author
Marian Brady is Professor of Stroke Care and Rehabilitation at Glasgow Caledonian University. She currently directs a programme of work on stroke rehabilitation in the CSO funded Nursing, Midwifery and Allied Health Professions Research Unit, which specialises in the development, conduct and delivery of high quality evidence relating to the effectiveness of stroke rehabilitation interventions.