What is a stroke?
A stroke is when a clogged or burst artery interrupts blood flow to the brain. This interruption of blood flow deprives the brain of needed oxygen and causes the affected brain cells to die. When brain cells die, the functioning of the body parts that they control is impaired or lost. A stroke can cause paralysis or muscle weakness, loss of feeling, speech and language problems, memory and reasoning problems, swallowing difficulties, problems of vision and visual perception, coma, and even death.
What causes a stroke?
Stroke can be caused by either blockage of blood vessels in the brain (by clots that have either formed in the brain or that were formed elsewhere and migrated to the brain) or by bleeding in or around the brain (from burst arteries due to weak spots in the artery wall or due to high blood pressure).
How common is stroke?
According to the Centers for Disease Control and Prevention, each year strokes affect more than 795,000 Americans, almost 130,000 of whom die as a result.
What are the signs/symptoms of a stroke?
Common warning signs of a stroke include:
- sudden numbness or weakness of the face, arm, and/or leg;
- sudden confusion, trouble speaking, or difficulty understanding speech;
- sudden difficulty seeing in one or both eyes;
- sudden trouble walking, dizziness, loss of balance, or loss of coordination;
- sudden severe headache with no known cause.
How is a stroke diagnosed?
A stroke is diagnosed by medical professionals. Special tests that allow doctors to look at the person's brain (CT scan, MRI) are often used to determine where the stroke occurred and how severe it is.
What deficits result from a stroke?
Because of the organization of the nervous system, an injury to one side of the brain affects the opposite side of the body. The consequences of a stroke may include physical, sensory, cognitive-communication, swallowing and emotional issues.
- Physical deficits after stroke are characterized by muscle weakness or paralysis, typically on one side of the body. Often, the person loses movement and/or feeling in the arm and/or leg opposite the side of the brain affected by the stroke. So, if a person has a stroke on the left side of the brain, he or she may have weakness or paralysis in the right arm and leg. This makes it difficult for the person to perform activities of daily living (e.g., dressing, feeding, bathing, tying shoes, etc.). Physical effects also include pain, fatigue, changes in muscle tone, and gait disturbances.
- Sensory deficits can involve all sensory modalities depending on the areas of the brain that are involved. A stroke can result in the individual being either less or more sensitive to sensations, experiencing altered sensations, or being unable to synthesize sensations to identify his or her own location in space. Sometimes (more typically in right hemisphere brain damage) a person may be able to see objects in only certain parts of his or her field of vision after the stroke. Sensory deficits may also impact gait and balance.
- Communication deficits are characterized by difficulty in understanding or producing speech correctly (aphasia), slurred speech consequent to weak muscles (dysarthria), and/or difficulty in programming oral muscles for speech production (apraxia). These deficits vary in nature and severity depending on the extent and location of the damage. Some individuals may also have difficulty in social communication, such as difficulty taking turns in conversation and problems maintaining a topic of conversation.
- Cognitive deficits include (but are not limited to) difficulties in attention, awareness, orientation, memory, problem solving, and reasoning skills. Individuals who have suffered a stroke may also have trouble concentrating when there are internal and external distractions (e.g., carrying on a conversation in a noisy restaurant, dividing attention among multiple tasks/demands).
• Swallowing deficits (dysphagia) may also result from a stroke due to weakness and/or incoordination of muscles in the mouth and throat.
- Emotional deficits may be marked by the display of inappropriate emotions and extreme mood fluctuations. The affected individual may laugh when something isn't funny or cry for no apparent reason. This behavior is particularly common early in the recovery process. A stroke survivor may become very frustrated with the inability to function independently—a situation that may lead to anger and depression.
What does a speech-language pathologist (SLP) do when working with individuals with a stroke?
As part of a medical team, the SLP diagnoses and treats cognitive-communication and swallowing deficits after a stroke. The treatment program focuses on improving the skills that have been affected by the stroke, depending on what areas are affected.
To improve the patient's ability to understand or produce language, the SLP will work on specific drills and strategies, such as:
- retraining word retrieval;
- having the patient participate in group therapy sessions to practice conversational skills with other stroke survivors;
- holding structured discussions, focusing on improving initiation of conversation, turn-taking, clarification of ideas, and repairing of conversational breakdowns;
- role-playing common communication situations that take place in the community and at home, such as talking on the telephone or ordering a meal in a restaurant.
Later in the recovery process, the SLP may work with a vocational specialist to help transition the person back into work or school, if applicable. The SLP may also work with the employer and/or an educational specialist to implement the use of compensatory strategies—for example, modifying the patient's work/school environment to meet language and/or cognitive needs.
Individuals may also require speech-language pathology services to improve speech production if they have difficulty due to muscle weakness or deficits in motor programming. They may also be taught strategies to make speech more intelligible and to compensate for the muscle weakness. The SLP can also evaluate a person's ability to use augmentative or alternative communication (AAC) devices and techniques to supplement the individual's verbal communication.
The SLP can evaluate a person's swallowing function and make recommendations that involve positioning issues, feeding techniques, diet consistency changes, and education of the person with stroke, family members, or caregivers.
If cognitive skills are affected, some treatment strategies may include:
- using a memory log to keep track of daily happenings to help with memory;
- using an organizer to plan tasks;
- increasing awareness of deficits in order to help self-monitoring in the hospital, home, and community.
How effective are treatments for a stroke?
ASHA has written a treatment efficacy summary for cognitive-communication disorders resulting from right hemisphere brain damage [PDF] that describes evidence about how well treatment works. This summary is useful not only to individuals with stroke and their caregivers, but also to insurance companies considering payment for much-needed services for stroke.
What other organizations have information about stroke?
This list is not exhaustive and inclusion does not imply endorsement of the organization or the content of the website by ASHA.