Refer a Patient

Four Types of Problems

Article by Moody Neuro

People are fantastic at finding problems to worry over.  We worry about the weather, the economy, our children, our homes and a myriad of other problems.  Think about it – news and sports radio are businesses that are essentially built on a 24/7 discussion of problems!  Generally, this is not an impediment to success and most people can worry about a whole host of problems while still completing necessary tasks.  People can go to work, pay bills and effectively manage daily life, yet still find ample time to fret over whether a favorite baseball team should fire its manager or whether a reality television starlet should dump her boyfriend.  Sometimes, people spend so much time worrying about problems facing others that they do not focus enough on their own problems.  It’s also all too easy for people to find themselves caught needlessly worrying about problems that they have no ability to solve.  This can be especially burdensome following a brain injury or stroke, as survivors have many new problems to be concerned with yet almost always have diminished cognitive resources available to spend on solving such problems.  It is often helpful to place problems into categories and then to determine just how much time should be spent on a given problem based on the category it falls into.

It is often useful to categorize problems based on two general ideas.  First, can this be considered my problem or is it simply not my problem?  As an example, if I have diabetes then this is clearly my problem.  If a famous Hollywood actor has diabetes this is just as clearly not my problem.  That is not to say that we need to be heartless about said actor’s health difficulties, but ultimately we should be spending more time devoted to addressing our own problems than we spend on those of others.  An equally important second consideration is revealed in the answer to another question.  Do I have the power to change/affect a given problem or do I not have that power?  For instance, if I have memory problems I can do exercises to improve my memory.  If I have a terminal case of cancer, there is nothing I can do to change that fact.  We should be spending more time and energy on problems we have the ability to change and less  on those that we cannot.  If we combine these two ideas we come up with  four problem categories:

1.    My Problem-I Can Change/Affect

2.    My Problem-I Cannot Change/Affect

3.    Not My Problem-I Can Change/Affect

4.    Not My Problem-I Cannot Change/Affect

Let’s give a few examples to help clarify these four categories.  First, let’s look at the category of My Problem-I Can Change/Affect.  An example of this type of problem could be that I need money to pay my rent.  It is my problem (after all this is my apartment) and I can affect it by getting a job or asking a family member for money.  Another example could be recovery from my brain injury.  It is my injury so it is my problem.  I can affect or change it by going through rehabilitation.  Since this category involves personal problems that we can do something about, this is the category of problems we should spend the most time and effort working on.

Second, let’s give a few examples of My Problem-I Cannot Change/Affect.  As mentioned earlier, if I have terminal cancer then it is my problem but ultimately I cannot do anything to change this.  Another example could be if I am nervous about what my doctor will say following an upcoming CT or MRI scan.  It is my problem as the doctor will be talking about my health.  But frankly, all of the worrying and problem-solving in the world will not change the results of the scan or the doctor’s feedback.  Since these are my problems, spending some time thinking about them is fine.  I probably do not want to spend too much time/energy on them though, as there is ultimately nothing I can do to solve these problems.

Third, let’s give a few examples of Not My Problem-I Can Change/Affect.  This category is essentially where the idea of charity resides.  If my friend is out of a job, I can give him some money to help pay for food.  It is his problem and not mine, but I can help out if I choose.  If a child is too poor to afford notebooks for school, I can donate notebooks to meet that child’s need.  Again, this is not my problem but I’m free to do what I can to help solve the problem if I have the resources to do so.  Since I can change/affect the problem, it is fine to spend some time and energy thinking about it.  I want to be careful to limit my expenditure of time/energy here though, since it is in the end someone else’s problem.  Sometimes we tend to spend more time fixing other peoples’s problems than our own problems, which is not a healthy approach to life.

Fourth, let’s give a few examples of Not My Problem-I Cannot Change/Affect.  This is the category that is sports radio and reality television’s bread and butter.  If my favorite team is playing poorly, this is not my problem.  Unless I work for the team, whether they win or lose does not meaningfully impact my life.  Moreover, unless I work for the team, there is nothing I can do to help it to play better.  Despite sports radio’s 24/7 pot-stirring regarding the performance of given players and managers, I’m fairly certain that the team never takes playing advice from the fans.  Similarly, if the latest reality television star is about to marry someone that I consider to be a poor match, it does not truly affect me.  After all, this is a stranger’s new spouse and not mine.  Further, no matter how much I worry or complain about that potential spouse, it can have no potential effect on the decision being made.  Let’s bring this category a bit closer to home.  Another example could be if my brother is dealing with a tough drill sergeant in Army Basic Training and this is making him notably upset.  This is my brother’s problem, not mine.  He is the individual in Basic Training, not me.  Moreover, the drill sergeant is not going to change his training methods because a family member is not happy with them.  I could complain all day but nothing will change about this situation.  Problems in this category should be given the lowest priority, especially in the life of a brain injury survivor.  They should only be afforded any time and effort at all if each and every item assigned to the other three categories of problem has already been completely resolved and the survivor has surplus time that he or she chooses to spend on them.

In review, when faced with problems it is often helpful to categorize those problems based upon their relevancy to our lives and then to determine according to those categorizations how much time and effort should be expended on solving each one.

Learn about how Moody Neuro can help with neuropsychology and counseling, speech and language disorders, physical therapy, outpatient rehabilitation assistance, community integration programs, and occupational therapy.

Strokes are medical conditions that affect millions globally. In the United States, more than 795,000 people have a stroke each year, with about 610,000 cases being first or new strokes. 

These can lead to a wide range of physical and cognitive impairments. Speech and language disorders are among the most common and most challenging consequences of strokes, occurring in about a third of stroke survivors. 

Understanding Stroke-Induced Speech & Language Disorders

Stroke-induced speech and language disorders significantly impact communication abilities. Among these, aphasia, dysarthria, and apraxia of speech are prevalent. Understanding how they are diagnosed and their specific symptoms can aid in prompt and effective management.

Aphasia

Aphasia is a common outcome of stroke, manifesting as difficulty in speaking, understanding, reading, and writing. There are many different types of aphasia, depending on the affected brain area, and are categorized based on the symptoms present:

  • Expressive Aphasia (Broca’s Aphasia): Characterized by broken speech, limited vocabulary, and difficulty forming complete sentences. Patients often understand what is being said to them but struggle to verbalize responses.
  • Receptive Aphasia (Wernicke’s Aphasia): Patients can produce fluent speech but may lack meaning or include nonsensical words. They often have significant difficulty understanding spoken language.
  • Global Aphasia: A severe form of aphasia where individuals have extensive difficulties with both speech production and comprehension.
  • Anomic Aphasia: Individuals have difficulty finding words, particularly nouns and verbs, making their speech sound vague.

Dysarthria

Dysarthria is a speech disorder that affects 20-30% of stroke survivors. It occurs when stroke impacts the muscles responsible for speech, leading to slurred or slow speech that can be hard to understand. It is typically diagnosed through a physical examination and a series of speech evaluations conducted by a speech-language pathologist (SLP). 

It is characterized by the following symptoms:

  • Slurred or slow speech that can be difficult to understand
  • Monotone or robotic-sounding speech
  • Difficulty controlling the volume of speech, which may be too loud or too soft
  • Challenges with the rhythm and flow of speech, including rapid speech that’s hard to interrupt or slow, drawn-out speech
  • Respiratory issues affecting the ability to speak loudly or for extended periods

Apraxia of Speech (AOS)

Apraxia of speech is a neurological disorder characterized by difficulty sequencing the movements needed for speech. This is caused by the impact of the stroke on the brain’s pathways involved in producing speech. 

Patients with AOS know what they want to say but struggle to coordinate the muscle movements to articulate words correctly. This results in distorted speech, difficulty initiating speech, or the inability to accurately produce speech sounds or sequences of sounds. 

How Long Is the Stroke Speech & Language Recovery Time?

According to one study on post-stroke speech and language therapy, approximately one-third of stroke patients experience speech problems after a stroke. Many of these individuals begin to recover within a few months, with significant progress typically observed within three to six months.

In another study, 62% of subjects had speech challenges after suffering from a stroke. By six months post-stroke, 74% were able to completely recover their communication abilities. 

However, the figures above provide a general timeline for post-stroke speech and language recovery. Stroke speech recovery time is highly individualized and can vary depending on several factors. These can include the following:

  • Severity of the Stroke: More severe strokes often lead to extensive brain damage, resulting in longer and more challenging recovery periods for speech.
  • Location of the Brain Injury: The brain’s specific regions control different speech and language functions; damage to these areas directly impacts recovery complexity and duration.
  • Age and Overall Health of the Patient: Generally, younger patients with better overall health before the stroke tend to experience faster and more complete recoveries.
  • Pre-existing Conditions and Comorbidities: Conditions such as diabetes or hypertension can slow down recovery by complicating the overall health scenario and rehabilitation process.
  • Individual Variability and Resilience: Personal resilience, the support system’s strength, and the individual’s motivation significantly influence the pace and success of speech recovery efforts.

The first three months after a stroke is a crucial period for recovery, as a majority of stroke patients see the most significant improvement during this period. However, it’s also important to note that, although at a slower pace, recovery can continue well past the 6-month mark with continued therapy and practice. 

This underpins the importance of early intervention and ongoing rehabilitation efforts, including speech therapy, to maximize each patient’s recovery potential. 

What Does the Stroke Speech & Language Recovery Process Look Like?

The journey to regain speech and language after a stroke is multifaceted and varies significantly from one individual to another. Understanding the structured phases of recovery can provide insight into what patients and their families can expect during this challenging time. 

Here’s a closer examination of each phase in the stroke speech recovery process.

Initial Assessment and Diagnosis

Before recovery can begin, a thorough evaluation is conducted by a team of healthcare professionals led by an SLP. This assessment aims to identify the type and severity of the speech and language disorder, be it aphasia, dysarthria, or AOS. The evaluation may include cognitive-linguistic assessments, comprehension tests, speech production analysis, and functional communication measures. 

Based on this assessment, a personalized therapy plan is crafted to address the patient’s specific needs.

Acute Phase

The acute phase typically occurs within the first days to weeks following a stroke. During this period, medical stabilization is the primary focus, with healthcare teams working to manage the immediate effects of the stroke. 

Speech therapy may begin with simple exercises or assessments to gauge the patient’s abilities. However, intensive therapy usually does not start until the patient is medically stable. During the acute phase, the goal is to support overall recovery and prevent complications immediately after the stroke.

Subacute Phase

The subacute phase generally spans from two weeks to three months post-stroke and is characterized by more intensive speech therapy interventions. As the patient’s medical condition stabilizes, the focus shifts to active rehabilitation. Therapy during this phase is tailored to the individual’s specific speech and language deficits and may include:

  • Exercises to improve articulation, fluency, and voice control for those with dysarthria.
  • Language therapy to enhance understanding, speaking, reading, and writing skills in patients with aphasia.
  • Motor speech exercises and strategies to improve speech planning and production in apraxia of speech.

The subacute phase is crucial for taking advantage of the brain’s natural recovery processes and neuroplasticity, where the brain begins reorganizing and adapting to the loss of function.

Chronic Phase

The chronic phase of recovery extends from several months to years after the stroke. It focuses on long-term rehabilitation and adjustment to any residual speech deficits. During this time, patients may continue to see gradual improvements in their speech and language abilities, although the rate of recovery may slow. Therapy in the chronic phase often includes:

  • Advanced communication strategies to cope with ongoing challenges in daily life.
  • Maintenance exercises to preserve and enhance speech gains achieved in earlier phases.
  • Supportive technologies and aids, such as communication devices, to assist in effective communication.
  • Community reintegration activities to help patients return to as normal a life as possible, engaging in social, vocational, or recreational activities.

What Is the Role of Neuroplasticity in Speech & Language Recovery?

Neuroplasticity refers to the brain’s fundamental property to change and adapt its responses to new experiences, learning, and environmental changes. This adaptive capacity enables the brain to reorganize itself by forming new neural connections.

When the brain, or a part of the brain, is damaged after a stroke, neuroplasticity is what allows the other parts of the brain to take over the functions of the damaged area. Through targeted rehabilitation and therapy, such as speech therapy for stroke survivors, patients can retrain other brain areas to perform the lost functions and facilitate recovery.

Enhancing Stroke Speech & Language Recovery Time

Adopting a comprehensive approach involving several key strategies is vital to enhance the stroke speech and language recovery time. This multifaceted approach can maximize the chances of regaining speech and communication abilities.

This comprehensive approach must incorporate the following strategies:

  • Early intervention to leverage the brain’s highest potential for neuroplasticity in the initial period following a stroke, significantly improving the chances for recovery.
  • Alternative communication strategies, such as gestures, writing, and visual aids, to help maintain communication during the recovery process. 
  • Adopting technology, including speech-generating devices and software applications designed for speech rehabilitation, for personalized exercises and continuous practice, which is vital for progress.
  • Providing continuous support from psychologists, support groups, and therapy to help manage feelings of frustration, depression, and anxiety, fostering a positive mindset essential for rehabilitation.
  • A healthy diet and lifestyle to supply essential nutrients that support brain function, along with regular physical activity, adequate sleep, and management of medical conditions.

Begin Your Post-Stroke Recovery Journey With Moody Neurorehabilitation

Moody Neurorehabilitation understands the complexities and challenges that come with post-stroke rehabilitation. We are dedicated to supporting patients and their families through this critical time with specialized care and personalized treatment plans.

Since our inception in 1982, Moody Neurorehabilitation has been a leader in brain injury rehabilitation. Our approach centers on providing comprehensive care tailored to each patient’s needs and goals. We believe in treating the whole person, not just the symptoms, to improve overall quality of life.

We invite you to start your recovery journey with us. Contact Moody Neurorehabilitation today to schedule a consultation with our experts. Let us help you navigate the path to recovery with care, compassion, and expertise.

Sources: