Life after Stroke: the Conversation Partner Scheme

By Kimberly Bond
For people suffering after a stroke, life can be very difficult. But a scheme that helps both Aphasia patients and professionals understand the route to recovery is starting to become a success.

The Conversation Partner scheme, which was started in the UK by the Communication Disability network ‘Connect’ in 2006, uses trained volunteers to support Aphasia sufferers in their own home.

Aphasia is a communication disorder often caused by Stroke –affecting one in three stroke survivors. It affects the sufferer’s ability to speak, read and write, sometimes leaving them with little or no speech at all.
Dr Simon Horton is a lecturer in the Faculty of Health at the University of East Anglia in Norwich, and is one of the chief organisers of the scheme. The University was the first site to train their students in the scheme, which is now a national network of more than 20 in the UK and Ireland.

The programme sees all first year Speech and Language therapy students at the University go into the homes of Aphasia sufferers to provide them with stimulating conversation once a week for six months.

Dr Horton said: “The scheme is based on evidence that people suffering from Stroke and Aphasia are vulnerable to isolation- as they are typically elderly and often have physical disabilities. This means they are unable to get out and access the stroke treatments and clubs available in the community, which are normally run by the Stroke Association.”

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New Treatments May Help Restore Speech Lost to Aphasia – Loss of language skills can stem from stroke or other brain damage, an article By Maureen Salamon for Healthday Reporter

FRIDAY, Sept. 28 (HealthDay News) — Most people know the frustration of having a word on the “tip of your tongue” that they simply can’t remember. But that passing nuisance can be an everyday occurrence for someone with aphasia, a communication disorder caused by a stroke or other brain damage that impairs the ability to process language.

About 1 million Americans — roughly one in every 250 — are affected by aphasia, which can also impact reading and writing skills. But how they acquire the problem and how long they’ll endure it differ from person to person, explained Ellayne Ganzfried, a speech-language pathologist and executive director of the National Aphasia Association.

“No two people with aphasia are alike because everyone’s brain responds to the injury in a different way,” Ganzfried said. “About half of people who have aphasia recover quickly, within the first few days. If the symptoms of aphasia last longer than two or three months, a complete recovery is unlikely … [though] some people continue to improve over a period of years and even decades.”

Strokes are the most common cause, followed by head injuries, tumors, migraines or other neurological issues. Depending on the damage to the brain regions controlling language, which are typically in the left hemisphere, the resulting aphasia can be broken into four broad categories:

Difficulty expressing thoughts through speech or writing
Difficulty understanding spoken or written language
Difficulty using the correct names for objects, people, places or events
Loss of almost all language function, with no ability to speak or understand speech.
“Processing language requires the collaboration of lots of different parts or systems of the brain,” explained Karen Riedel, director of speech-language pathology at the Rusk Institute of Rehabilitation Medicine at NYU Langone Medical Center in New York City. “The whole brain ‘talks’ — the whole brain has something to do with the use of language.”

Because of this, a variety of therapies are used to help people regain as much speech and language as possible. But regardless of the injury, people with aphasia have the best chances for recovery when language therapy begins immediately, Riedel said.

Because aphasia is so variable, a therapy that helps one person might not help another, she noted. Tried-and-true techniques include melodic intonation therapy, which uses melody and rhythm to help improve the ability to retrieve words, and constraint-induced therapy, which forces people to use speech over other communication methods.

But technology, Riedel said, has introduced new language-improvement techniques into the mix over the last few years that are both exciting and fun. Several apps available for iPhone or iPad involve synthetic speech that helps engage those with aphasia in yet another realm of communication.

“Our patients have much more access to different kinds of programs that are computer-based,” she said. “There’s always something new around the corner.”

What remains a constant concern, however, is the misunderstanding many people have of those with language difficulties and how to treat them, Ganzfried and Riedel agreed.

“Many people with aphasia will become socially isolated because of their communication difficulties, which can lead to depression,” Ganzfried said. “There are also many misconceptions about aphasia, including that the person is mentally unstable or under the influence of drugs or alcohol. It’s also extremely frustrating. Imagine knowing what you want to say in your head but you can’t get the words out.”

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Aphasia Programs & Centers: The National Aphasia Association has a list of Aphasia Programs & Centers, listed State by State.

To view programs and centers in your state, click on a state’s abbreviation in the State’s Table at www.aphasia.org.

If you are a person with aphasia or caregiver and do not see a listing near you, a good tip is to check with a local hospital or college/university. Most hospitals will have at least an affliated rehabilitation center, while a majority of colleges and universities who offer degrees in Speech or Communication Disorders will have an on-campus clinic (that may even offer services at a sliding pay scale).

The University Center for the Development of Language and Literacy (UCLL) first started its aphasia treatment program in 1947, offering intensive speech and language therapy for veterans returning from World War II.

For over 65 years, adults with language disorders resulting from stroke, brain injury, or brain tumor have come from around the globe to receive the highly individualized and concentrated therapy offered at UMAP.

The diversity of the therapy and social experiences offered at UMAP provides ongoing opportunities for stimulating and improving your speech and language skills beyond traditional therapy. By creating opportunities to communicate in a variety of ways throughout the day, you can enhance your communication skills and confidence.

The program also offers caregiver education and support, because empowering caregivers is a critical component of effective therapy. We understand that caregivers face their own challenges as well, so through both structured and informal activities, we help them learn to cope with this dramatic life change.

Stroke Smart Magazine answers questions about UMAP.

Read-Right is a therapy and research application accessed over the internet. It has been developed by UCL Institute of Neurology and UCL Multimedia. The project is funded by The Stroke Association. The aims of the project are twofold: 1) to provide a web-based therapy for patients with hemianopic alexia (HA); 2) to find out if the therapy works over the internet. To do this, we need to collect information from users to see if they are improving with practice.

This is an article on Stroke Association (UK).

Thousands of stroke survivors with visual problems could improve their sight from the comfort of their own home using two new web-based therapies.

The online therapies developed by UCL (University College London) and funded by the Stroke Association are designed to help stroke survivors with visual problems perform everyday tasks like reading the newspaper and identifying individual objects.

One in five stroke survivors are left with partial or total loss of vision to one side following a stroke (known as hemianopia), which can severely affect their quality of life. The two websites, Read-Right and Eye-Search are the first web-based rehabilitation techniques to be introduced in the UK and could mark the beginning of a new online era for stroke rehabilitation.

Patients with hemianopia find reading difficult as they are unable to see the full page. Some patients abandon reading altogether, and others are unable to return to their jobs as they cannot read quickly enough.

The website, Read-Right which has been trialled by 194 stroke survivors to date, helps them improve their reading by encouraging them to read text as it scrolls across a screen. It is thought that this retrains the brain to perform more efficient scanning eye movements which can then be transferred to the reading of normal, static text.

Many people with hemianopia also find it incredibly difficult to find specific objects, particularly in a busy scene. For example, picking up a mobile phone from a range of objects on a table and dialling a number can be very frustrating for some people. The website, Eye-Search, helps stroke survivors to find objects through a series of online games that retrain eye movements.

Tim Hobbs from London had a stroke in November last year at the age of 40 which resulted in the loss of his right visual field. Before his stroke Tim had worked at Sky Sports as the deputy editor for the Sky Sports website for 12 years.

Tim says; “Following my stroke I lost half of my vision to the right. As a result I frequently bump into people as I walk down the street, I can’t drive and watching football on TV is very hard. However, my biggest challenge has been reading.

“Reading and writing is a fundamental part of my job, so when I found I had lost some of my sight I was incredibly worried I wouldn’t be able to return to journalism.

“I was introduced to Read-Right and it has helped me enormously – I can now read much faster and I was recently able to return to work.”

Tim also worked alongside UCL to develop Eye-Search and he is now using this website to help him better distinguish between objects and gain more holistic sight.

Dr Clare Walton, Research Communication Officer from the Stroke Association comments; “Websites like Read-Right and Eye-Search have proven to be incredibly effective in helping stroke survivors who struggle with visual problems after their stroke. The programmes can help with everyday tasks which many of us take for granted like reading a shopping list or identifying an item of clothing from your wardrobe.

“Many stroke survivors have told us how the websites have helped them to regain some of their independence; we’re delighted to have funded the projects.”

Dr Alex Leff, Lead Researcher for the project says; “We have shown that proven behavioural therapies for visual disorders can be translated to the internet where patients can run them for themselves. I think that this is a good way to open up access to proven behavioural therapies for many other disorders caused by stroke or brain injury.”

Stroke survivors with visual problems can find out more about the treatment here: Read-Right.

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5 Best Kept Secrets about Music Therapy
by SARAH (LAWTON) THOMPSON on MARCH 25, 2013
in ABOUT MUSIC THERAPY, ABOUT US, FUNDING, REIMBURSEMENT

March is officially Music Therapy Month in Colorado! We wanted to take a moment to shout out some of the best kept secrets about music therapy that really shouldn’t be secrets. We think they should be shouted from the rooftops. Even if you have been working with us for years, you may not know some of these best kept secrets!

1) Physicians can write orders for music therapy. Your doctor can write an script for music therapy, just like they do for physical therapy. In fact, you may want an order from your doctor in order to attempt reimbursement.

2) Your health care insurance may cover music therapy services. While music therapy may not be a listed benefit on your health insurance plan, it is probably not excluded. The American Medical Association has advised music therapists on what codes are most appropriate to bill for music therapy.

3) Music therapy may be more difficult for musicians. Musicians who experience a change in their health or independence may struggle to engage in music therapy because they will compare their current musical abilities to their abilities prior to their current struggles. It can be a very difficult and emotional thing to realize that you can’t do what you love to do in quite the same way or with the same level of expertise.

4) Music therapists and neuroscientists are in cahoots! There is increasing collaboration between neuroscientists and music therapists. Neuroscientists have been researching music and the brain for years, and they are excited to see their work translate outside of the lab to help people on a daily basis. This collaboration is taking place in many ways, including the Society for Music Perception and Cognition, the International Society for Clinical Neuromusicology, the American Music Therapy Association, and the World Federation for NeuroRehabilitation.

5) Your music therapist may know more about neuroscience than some members of your treatment team. Music therapists complete a wide range of courses in their education. Did you know that you can get your undergraduate degree, master’s degree and/or PhD in music therapy? Most music therapists have at least been through anatomy and physiology courses. Some programs include high level neuroanatomy classes where students work with brains and spinal cords, and problem-solve clinical cases.

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Treatment Programs

Massachusetts General Hospital understands that a variety of factors influence patients’ health care decisions. That’s just one reason why we’re dedicated to ensuring patients understand their diagnosis and treatment options. Because a single option might not serve all patients, we offer a wide range of coordinated treatments and related services across the hospital. Patients should consult with their primary care doctor or other qualified health care provider for medical advice and diagnosis information.

Aphasia at Mass General

Ruth E. Lycke, stroke survivor and co-author of the book Hope Help and Healing: Traveling for Treatment in China explains in the first few pages of the book that Chinese Medicine “views the body as a whole. The result is treatment that reflects that observation. An individual is seen as a composite of emotional, spiritual, and physical. One part of the body cannot be treated without affecting the rest.”

Stroke and Traditional Chinese Medicine
Traditional Chinese Medicine (TCM) is a relatively new treatment in North America. And yet, it is over 3500 years old. In China, as well as in Japan, TCM has been continuously practiced and as such, is a rich resource for historical as well as practical clinical experience. In fact, it is an integral part of treatment and rehabilitation for stroke victims.

TCM treatments options commonly used for helping people recover from stroke are acupuncture, Tui Na massage, movement therapies like Qi Gong (Chi Gung) or Tai Ji (Tai Chi), or Chinese herbal medicine such as NeuroAiD™.

NeuroAiD™ is a treatment for stroke-recovery which has been shown to stimulate neuronal growth after a stroke. NeuroAiD™ is a natural treatment made of 14 ingredients from the Chinese pharmacopoeia, which main ingredients are: Radix Astragali, Radix Salviae Miltiorrhizae, Radix Paeoniae Rubra, Radix Polygalae, and Radix Angelicae Sinsensis. NeuroAiD™ started as a hospital prescription in the 1990s, and received approval as a traditional medicine in China after conclusive clinical trials. The treatment then became a standardized manufactured product, estimated to have since reached over half a million patients. The treatment was so effective it has been adapted to fit western medicine standards and is now distributed worldwide by Moleac; a Singapore based bio-pharmaceutical company founded in 2003.

Moleac has set up an international team of leading researchers and clinicians, to develop innovative treatments for unmet medical needs worldwide. Moleac has also established partnerships with leading research institutes in Europe (the CNRS in France), China and Singapore and a number of internationally renowned specialists, such as Prof. M G Bousser (France), Prof. G Donnan (Australia) or Prof. C Chen (Singapore), are also leading these projects. The bio-pharmaceutical company focuses on neurological and cardiovascular diseases, and natural medicine. With NeuroAiD, the first treatment of its kind, Moleac is proud to have bridged the gap between TCM and western medicine. Supported by extensive clinical data, NeuroAiD is constantly gaining approval as an innovative natural treatment for stroke recovery, and the increasing number of peer reviewed articles helps NeuroAiD gain strong international recognition.

NeuroAiD™ is produced in China and respects stringent raw material selection and manufacturing processes. Each batch of NeuroAiD™ is assessed for quality by an independent laboratory.

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The Aphasia Center at Steps Forward (www.theaphasiacenter.com) offers intensive, individualized speech therapy programs for people with aphasia and their caregivers. Clients receive a total of five (5) hours of therapy daily, Monday through Friday, with experienced and knowledgeable speech therapists. When we talk about “intensive” treatment, it means aphasia therapy for 10-30 hours per week for a certain number of weeks. An intensive treatment schedule provides more therapy hours in a concentrated, compressed way – over a shorter period of time. The typical outpatient treatment is a schedule of 2-3 sessions per week for 1-2 months. This is equal to about 24 hours of therapy (3 hours per week for 8 weeks). In an intensive schedule at The Aphasia Center, 24 hours of therapy would be offered in one week.

Clients of The Aphasia Center (located in St. Petersburg, Florida) come from all over the country to participate in one of our individualized programs. Please visit our website, www.theaphasiacenter.com, for information on the variety of programs, the Individual Action Plan TM, and housing options we provide.