Author: Monique Beeler

As well-wishers bearing bouquets filed into a rehearsal room in the Music Building on a chill December afternoon, 14 choir members dressed in red-and-black had already taken their seats, preparing to warm the hall with their first performance.

A diverse group of men and women who once worked in professions including rock musician and in-home caregiver and ranging in age from 40s to 80s, choir members share one common trait: Each is a client of the Aphasia Treatment Program offered by Cal State East Bay’s Department of Communication Sciences and Disorders. Most commonly caused by a stroke, asphasia is a disorder that impairs a person’s ability to communicate but doesn’t affect intelligence.

“Through the choir, people have talked about the power and magic of music,” said Ellen Bernstein-Ellis, director of the Aphasia Treatment Program and founder of the choir –– the only one of its kind in the Bay Area and one of a handful offered nationwide. “Maybe Ella Fitzgerald said it best: The only thing better than singing is singing some more. So without further ado, may I introduce to you the choir.”

Following the welcoming remarks, graduate student and Choir Musical Director Michelle Lussier steps to the music stand set up before the group. At her signal, they launch into a series of familiar tunes including holiday standards, Motown favorites and pop hits such as Ben E. King’s “Stand By Me.”

“No, I won’t be afraid, no, I won’t be afraid/Just as long as you stand, stand by me …” choir members sang in unison.

Despite difficulty communicating, research has shown that music and singing can help those with aphasia access language in a way they can’t through regular speech, explained Lussier, 40.

“There are a couple people in the group who can speak really only one word at a time but who can sing songs they know pretty fluently,” she said.
Read More .

Author: Jillian Dworak

The following is from an Article from the Rehabilitation Institute of Chicago Life Center, reviewed March 2006:

For most people, being able to drive is a sign of independence and freedom. Driving enables people to get to the places they want to go and do what they want to do. It is something that many of us have done for much, if not most, of our lives. Nevertheless, driving is a very complex skill. Our ability to drive safely can be affected by changes in our physical, emotional, and medical condition. The goal of this brochure is to:

assist you, your family, your physician, and other health care professionals address how a stroke may affect your ability to drive; and
introduce you to the Driver Rehabilitation Program at the Rehabilitation Institute of Chicago.

To access more information from RIC please Click Here.

The American Stroke Association also has the following article. You can access it by clicking Here .

Another great article was filed in the Stroke Connection Magazine, September/October 2010 issue: Survivors at the Wheel.

THE BOARD OF DIRECTORS FOR THE APHASIA HOPE FOUNDATION:
Mr. J.A. Felton
Dr. Audrey Holland
Mr. James R. Hunt
Mr. T. Randall McCabe
Mr. J. Michael Stradinger
Mr. Joseph B. Stradinger

THE ADVISORY BOARD FOR THE APHASIA HOPE FOUNDATION:
Pelagie M. Beeson, Ph.D.
Roberta J. Elman, Ph.D.
Margaret Forbes, M.A.
Anita halper, M.A.
Leonard LaPointe, Ph.D.
Kristine Lundgren, Ph.D.
Nan Musson, M.A.
Claire Penn, Ph.D.
Carole Pomilio, M.A.
Maura English Silverman, M.S.
Anne Ver Hoef, M.A.
Mary Beth Clark

Read about upcoming dates and news from The International Stroke Converence .

Author: Health Day News .

In the first 24 hours after suffering a stroke, body temperature might predict the patient’s chances of survival, researchers report.

“Temperature is toxic to the brain,” said lead researcher Dr. Richard E. Temes, a postdoctorate fellow in neurology at Columbia Presbyterian Medical Center, in New York City. “Temperature affects the brain, brain metabolism, it can increase size of stroke, it increases the generation of free radicals in the brain, which can add to ischemia and damage the brain.”

His team found that a patient’s temperature during the first day after a stroke may be an important predictor of survival at 30 days.

The findings were presented Thursday at the American Stroke Association’s annual stroke conference, in Kissimmee, Fla.

“There is a lot of study going on about reducing fever following stroke,” Temes noted.

To better understand the effect temperature has after stroke, the Columbia team collected post-stroke temperature data on 337 stroke patients. All these patients had been brought to the hospital within 24 hours of having their stroke.

By 30 days after the stroke, 22 of the patients had died.

“Patients who had temperatures greater than 99.4 degrees F had significantly higher odds of death at 30 days following stroke than patients with temperatures lower than that target temperature,” Temes said.

In addition, patients with mild-to-moderate strokes seemed to be at higher risk of dying with elevated temperature. “This suggests that we should target not only patients with large devastating strokes, but patients with moderate stroke [who could] also benefit from aggressive treatment of any elevated temperature after stroke,” Temes said.

He believes more studies are needed to confirm the effect of temperature on stroke patients. “We also need to determine the best method to control temperature following stroke,” Temes said.

However, one expert cautioned that the study didn’t take other risk factors into account.

“It is quite possible that a patient admitted to the hospital with stroke and a fever from some other process, such as the flu, will have a very good outcome despite the elevated temperature,” said Dr. Roger E. Kelley, a professor of neurology at Louisiana State University. As it stands now, he said, “I don’t think that this study allows the insightful clinician to inform the family that the prognosis is poor because the temperature elevation is to a certain degree.”

American Heart Association scientific statement

DALLAS, May 3 – The first scientifically proven treatments for intracerebral hemorrhage, or “bleeding,” strokes, are on the horizon, including a new drug that holds promise for slowing bleeding and limiting brain damage resulting from such a stroke, according to updated American Heart Association/American Stroke Association guidelines.

The guidelines, published in Stroke: Journal of the American Heart Association, also address the feasibility and timing of surgical options and different ways to take pictures of the brain to diagnose a hemorrhagic stroke, as well as offer guidance on end-of-life issues such as putting “do-not-resuscitate” orders on hold for a full day after such a stroke occurs.

Read More .

Author: By Mike Biel, M.S., CCC-SLP, Member American Speech-Language-Hearing Association

Imagine yourself in a situation where you can’t communicate. You know what you want to say, but you can’t find the words. People speak to you, but you don’t understand everything they say. Your ability to read and write is also impaired. How do others treat you? Do they think you’re unintelligent and unable to make decisions? How frustrating is it to fully recognize your competence yet lack the ability to demonstrate it to others? Unfortunately, this is a common experience for individuals with aphasia, particularly in case of severe aphasia.

Supported Conversation for Adults with Aphasia (SCA -trademark), a technique developed at the Aphasia Institute to Toronto, Canada, helps conversation partners promote successful communication and engage in adult conversation with individuals who have aphasia. The a SCA (trademark) approach has two main goals: first, to acknowledge the competency of the individual with aphasia, and second, to help reveal that individual’s competency with simple techniques.

Acknowledging Competency

Because individuals with aphasia often fear being labeled unintelligent or incompetent, it’s important to treat them in a manner that affirms their competency. You can do this by speaking naturally in an adult tone of voice and by not shying away from adult conversations. Moreover, when someone with aphasia has trouble finding the right words you can say, “I know you know.” This simple statement conveys that you know that he or she is an intelligent adult with something important to say. Another way to diffuse frustration during a communication breakdown is to explicitly attribute some of the problem to your own limitations, as a communicator. And showing a sense of humor can promote an atmosphere of two individuals having a normal adult interaction.

Inevitably there will be times when communication breaks down. Be honest about difficulties and frustrations. You can openly acknowledge to express and ask permission to come back to the topic later. Don’t pretend that you understand or abandon the conversation without openly acknowledging the breakdown.

Revealing Competency

SCA (trademark) places most of the burden of successful communication on the conversation partner who doesn’t have aphasia. Conversation partners use a combination of speech, gestures, written words and pictures or drawings to help individuals with aphasia understand and express themselves.

Getting the Message Across

The following practices can promote comprehension, particularly for individuals with severe aphasia.

• Speak in short, simple sentences, using an expressive (but not childish) voice.
• Remove as many distractions as possible, including noise and excessive visual materials.
• Notice the facial expression, eye gaze and/or gestures of the individual with aphasia to determine whether or not they comprehend your message.

Speech alone may not be sufficient for an individual with aphasia to fully comprehend what you are trying to communicate. Adding another means of communication, such as gesture, can often get the individual with aphasia “over the hump.” Because you want to promote the feeling of a flowing conversation, it’s best to use as few techniques as possible. You can supplement your conversation by:

• Using gestures that the individual with aphasia can understand
• Writing key words or the main idea.
• Using pictures (focusing on one at a time).
• Drawing a picture

Getting the Message Out

To help individuals with aphasia get their message out, make sure they have a way of responding or starting a conversation. Here are a few techniques:

• Ask “yes/no” questions in a logical sequence from general to specific. Make sure the individual with aphasia can respond by saying “yes/no,” nodding or gesturing or pointing to a card that has “yes” and “no” printed on it.
• Write out multiple-choice questions or answers from which the individual with aphasia can choose.
• Ask the person with aphasia to give clues about what they are trying to express by gesturing or pointing to objects/pictures and written key words
• Give the person with aphasia time to respond.

It’s important to try to speak and use the above techniques simultaneously. For example, you might ask about someone’s grandchildren while simultaneously writing the word “grandchildren.”

Verification

Because individuals with aphasia may not always provide reliable or understandable responses, it’s important to verify your interpretation of their messages by:

• Reflecting — Repeat the message back to the person with aphasia.
• Expanding — Add what you think they are trying to say.
• Summarizing — periodically review what you think the person is trying to say.

For more detailed information about , visit th SCA (trademark) the Aphasia Institute’s website at www.aphasia.ca /.

To locate an ASHA certified speech-language pathologist near you, go to www.asha.org or call (800) 638-8255

To sign up for this free publication click on Stroke Connection .

Author: WebMD

Strokes are the fourth leading cause of death in men, yet most guys can’t name one stroke symptom. Here’s how to recognize and prevent them.
Why should I care about strokes?

If you’re like most middle-aged guys, you probably don’t spend much time worrying about stroke symptoms. After all, strokes are a risk we associate with later in life — something to fret about after we retire and are fitted with our first pair of dentures.

But maybe we should be a little more concerned. Strokes are, after all, the fourth most common cause of death in all men — behind heart disease, cancer, and accidents. They are indeed more likely in men over 65, but they can happen at any age. Strokes are also more likely to be fatal and strike early in men than in women.

The consequences of a stroke can be devastating. Not only can a stroke kill you, if it doesn’t, it can leave you severely debilitated, paralyzed, and unable to communicate.

However, the news isn’t all bleak. According to the National Stroke Foundation, 80 percent of all strokes are preventable. So it’s time to improve your odds. If you’re at risk, you need to learn the signs of stroke and make some changes in your lifestyle.

What is a stroke?
There are actually two different kinds of strokes.

Ischemic strokes. These are the most common type of stroke. They happen when a blood clot blocks an artery, choking off oxygen to a part of the brain. Without oxygen, brain cells first go into shock and then start dying. So the longer you go without stroke treatment, the greater the damage to your brain.

While not a full-fledged stroke, transient ischemic attacks (TIAs or “mini-strokes”) cause stroke symptoms but resolve within a few minutes. We’ll talk more about them later.

Hemorrhagic strokes. While less common, these strokes are more devastating. They’re the result of a hemorrhage — a burst blood vessel — in the brain. Although the cause is very different from an ischemic stroke, the result is the same: Brain cells can’t get the blood they need. More than 60 percent of people who have a hemorrhagic stroke die within a year, and those who survive tend to be much more disabled.

How can I prevent a stroke?
Hemorrhagic strokes are best prevented by controlling high blood pressure. The less pressure there is on the walls of your blood vessels, the less likely they are to burst.

The more common ischemic strokes are caused by blood clots — the same villains responsible for heart attacks. To decrease the risks, you need to keep your arteries clear of plaque — the gunk that builds up in them and leads to clotting. Ways to do this include:

exercising for at least half an hour on most days of the week
eating right — preferably a diet low in saturated fat (less red meat) and high in fruits and vegetables
losing weight (if you’re overweight)
not smoking — smokers are twice as likely to have a stroke

Certain heart conditions — such as atrial fibrillation, which causes the heart to pump less efficiently than it should — can also cause clots that lead to strokes. High blood pressure, diabetes, and high cholesterol raise your risk too. If you have any of these conditions, you’ll need to keep them under control with lifestyle changes or medication. Low-dose aspirin can reduce stroke risk, although it may not help younger men already at low risk for stroke. Talk to your doctor before starting aspirin therapy.

Some risk factors for stroke — such as increasing age and family history — can’t be controlled. Even so, making changes to your way of life can still have a big positive effect.

What else do I need to know about strokes?
For such a common killer of men, we tend to be woefully ill-informed about strokes. A third of all men can’t name a single stroke symptom. So learn the signs of stroke. If you ever have any of the following stroke symptoms, you need treatment right away.

sudden numbness or weakness, particularly on only one side of the body
sudden confusion
trouble speaking or understanding speech
trouble with vision
trouble walking or maintaining balance

Read the complete article .

Author: Dr. Richard Steele

Speech-language pathologists have long known that music and song can help some people recovering from aphasia. There are those who can sing the lyrics to songs, for instance, yet cannot speak them without the melodic support. Over the years, various therapeutic approaches — both formal and informal — have attempted to exploit this phenomenon directly to improve communicative performance in these people.



Now a study from Finland documents even more wide-ranging benefits, this time from simply listening to music. In addition to direct improvements in speech and language performance, patients saw improvement in several factors that promote communicative success indirectly as well. Specifically, those who listened to self-selected music for at least one hour a day in the first two months following stroke showed significantly more improvement in focused attention and verbal memory — cognitive factors — and in recovery from depression and confusion — affective factors — than patients in two comparison groups (a “books on tape” group, assigned to listen to self-selected audio books for at least an hour a day; and a control group, with no assignments involving recorded books or music). During the study, patients in all groups were also enrolled and participating in standard rehabilitation programs. 


Assessment scores showed improvements in the 10–15% range, after three months and six months of participation, in the cognitive and affective factors that play such important roles in communication. Poor memory and scattered attention impede conversational effectiveness. Depression reduces levels of engagement with others, and confusion muddles the communicative attempts that are made. Improvements in these areas can foster a virtuous cycle in which patients both (1) increase the number of communicative attempts, and (2) experience higher success rates in those attempts. They thereby gain increased confidence in their abilities and get more satisfaction from their efforts. 


The appeal of this approach lies in its extreme simplicity and acceptability. Patients in the music group were provided CDs and instructed to listen to music that they enjoyed for at least one hour each day. Most of the selections — but not all — turned out to be songs with lyrics. Patients themselves determined when they would listen, what they would listen to, and where and in what circumstances they would listen. The supervision required was minimal, the materials readily available, the activity pleasant, and the benefits important. The approach, in consequence, is worth considering in stroke rehabilitation when communication has been affected.
______________________________________________________________________________
For further reading: Teppo Särkämö, Mari Tervaniemi, Sari Laitinen, et al. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke. Brain, vol. 131, pp. 866–76, 2008.

Read, print or email this article by clicking on Lingraphica.com .

Author: Thomas Goldsmith, Staff Writer for NewsObserver.com email: thomas.goldsmith@newsobserver.com or 919-829-8929

RALEIGH – Gerald Wolberg, a distinguished immunologist and author of dozens of academic papers, recently earned applause for another achievement.
He spoke two words.

“Gold medals,” Wolberg said, softly and slowly.

As Wolberg, a stroke survivor, uttered the hard-fought words, he got applause from others in a discussion at WakeMed about pot-smoking Olympian Michael Phelps. Wolberg, 71, and fellow clients of the Triangle Aphasia Project are intelligent, capable adults working hard to overcome aphasia, the inability to communicate found in brains damaged by strokes, tumors, dementia or injury.
The disorder that Wolberg fights is increasingly common in an aging nation, with about 80,000 cases of aphasia a year cutting deep into people’s abilities to speak, read and comprehend. In North Carolina — with its stroke belt habits, dangerous rural roads and brain- injured war veterans returning from Iraq or Afghanistan — patients with new strokes and years-old problems alike have created a critical mass of people needing treatment, experts say.

“If I were only getting new brain injuries and new strokes, that would be one thing,” said speech pathologist Maura Silverman, founder and director of the Triangle Aphasia Project at WakeMed Rehab.

“But I am still getting calls and e-mails from people who say, ‘My husband is so depressed — it’s been so many years, and he still won’t get out and about because of his aphasia.’

Recovery can take place quickly, or it can extend over years and well past health insurers’ willingness to pay for therapy. That means Silverman finds plenty of patients from the Triangle and beyond who will pay modest fees for cutting-edge therapy that emphasizes social interaction, real-life skills and forging new neural paths around damaged tissue.

“Why did I make you struggle so hard when I already knew the answer?” Silverman asked Wolberg’s group. “Every time you struggle like this, it opens up pathways in the brain.”

Marilynn Wolberg, Gerald’s wife of 42 years, said family members also struggle as they work to communicate with loved ones and to explain to old friends why someone with aphasia is so drastically changed.

“As more people get older and the more we get the word out about aphasia, the general public will get more familiar with it,” she said.
* * *
Silverman, 43, thinks people with aphasia need more than the few months of hospital and outpatient therapy that most health insurance covers. Through the Triangle Aphasia Project’s approach, clients get long-term treatment focused on group interaction and everyday skills such as ordering in restaurants or making casual conversation with friends.

“The standard treatment is over a limited period of time, often in the acute phases of brain injury or stroke,” said Dr. Kenneth Carnes, of Raleigh Neurology Associates. He has often referred patients to Silverman. “But the brain reconnects and remodels over the long term.”

With a $150,000 annual budget, the program holds Aphasia Day, a weekly therapy and group session, at WakeMed, as well as sessions at other Triangle locations. Participants range from older people with brain tumors to Hope Yarbrough, 31, a former speech therapist who suffered brain injury in a catastrophic car crash five years ago.

“It has helped me so much with my speech, helped me to talk to people one on one,” she said at WakeMed. “I couldn’t find the right words. I still have aphasia.”

The main goal of aphasia therapy should be restoring people’s ability to live their daily lives, Silverman said. Many people with the disorder otherwise wind up too anxious to venture from their homes, becoming socially isolated and prone to physical and mental complications.

For those whose need drives them to seek help, Silverman offers a mix of group therapy, encounter session and motivational speaking. During group sessions, the speech therapist pushed group members, over and again, to say something, anything, to “get it out there”.

“If you get it out there, you can fix it,” she said. “It’s OK to make mistakes. That’s why we come to Aphasia Day.”

At a recent WakeMed session, Kim Greene, 47, also a stroke survivor, held up a picture of her son, Leesville Road High School football standout Zach Greene.
Peers around a long table watched closely as Greene told her son’s story with her voice, hands, face and scrawled letters on scratch paper.

Humming “Pomp and Circumstance,” she made a flat motion above her head to indicate a mortarboard.

Greene: “Graduating!”

After writing on a piece of paper: “Leesville!”

Silverman: “Writing helped get that out.”

Greene: “He graduated early and he …. Duke.”

Silverman, smiling: “Don’t worry about every little word.”

People with aphasia need safe places to make mistakes, to forget names, to say words wrong. Friends who can deal with the long pauses and gaps in conversation can be hard come by, family members say.

Marie Pahl taught at Raleigh’s Aldert Root Elementary School for 30 years, her husband, Andy, said at Aphasia Day. Her severe stroke eight years ago caused speech problems that even old friends couldn’t handle.
“The friends all just … poof!” Andy Pahl said.

Five years ago, Silverman and early supporter Carolyn Camp ran with the idea that people with aphasia shouldn’t stop treatment when they still have room for long-term improvement. While working in hospitals including Duke, Silverman often saw patients leaving treatment because their insurance coverage had run out.

“She was frustrated because she could see people needed a lot more than insurance would pay for,” Camp said.

A former academic with a background in education and sociology, Camp got involved with aphasia work when her husband, Ray Camp, formerly a professor at N.C. State University, had a severe stroke in 2000.

As with speech therapist Hope Yarbrough, aphasia struck at the center of Ray Camp’s life. He had taught public-address rhetoric at the NCSU speech communication department.

“The ironic part now is that he is not able to speak,” Carolyn Camp said.
Ray Camp got treatment while hospitalized, then a few more months and an expensive in-patient stay at a University of Michigan aphasia treatment center, one of the few in the country.

“We started looking for other long-term treatment in this area, and at that time there wasn’t any,” Carolyn Camp said.

The Camps were up against conventional wisdom that said aphasia patients typically made little progress after the first six months to a year.

“We know that’s not true,” Carolyn Camp said.

Silverman left Duke to start a long-term aphasia treatment program with an unconventional, nonprofit approach. The current program relies heavily on donations and charges minimal fees.

“She went on little or no salary for three years,” Camp said.

Elaine Rohlik, executive director of the WakeMed Rehabilitation Hospital, said the project’s model of aphasia treatment fits into the hospital’s approach of lifelong care for people with disabilities.

“Aphasia can lead to social isolation, weight gain and depression,” Rohlik said.
“We have a commitment to look at what happens to people after the medical phase.”

WakeMed’s link with the project means that Silverman has office space, a salary and space for group sessions. Numbers of people with aphasia seeking treatment continue to rise, sometimes outstripping her resources. But she leaves Aphasia Day each week encouraged by the improvements she continues to see in clients such as Wolberg and Greene.
* * *
It was Kim Greene, the football player’s mother from North Raleigh, whom Silverman had asked to tell that complicated story about Michael Phelps. The Olympian was photographed smoking marijuana and could lose $50 million in endorsements. Kim made swimming motions with one arm, then patted her chest.

“What do they call those things?” someone asked.

“Champions,” another group member offered.

“Gold medals,” Wolberg said, smiling.

TIPS FOR COMMUNICATING WITH PEOPLE WITH APHASIA
* Use short, uncomplicated sentences.
* Repeat or write down key words.
* Turn down loud radios or TVs and minimize other distractions.
* Include the person with aphasia in conversations, asking for and valuing his or her opinions.
* Encourage speech, gesture, pointing, or drawing, anything that communicates.
* Allow the person plenty of time to talk.
* Help the person get involved in activities in the community.
SOURCE: THE NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS, NATIONAL INSTITUTES OF HEALTH

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