Here is a highlight of a recent question for our Professional for the Month and the Pro’s reply:

Question from “aphasiawife” Regarding “Window of Recovery:
Is there a window of recovery from anomic aphasia after a stroke? Can any more progress be made through therapy though the stroke happened 10 years ago? Thanks.

Our Professional of the Month answers:

Absolutely!!!! There has been so much research in the last 5-10 years focusing on what we now know about about brain and it’s plasticity! It’s exciting information for individuals who were told that they would make all of the progress that they ever would make in the first 6 months or year after their stroke/insult. It’s just not true. The brain can continue to change and new pathways can be forged… it does take work, but if you do it right, the work will be stimulating, salient and fun!

First of all, check out the work that is out there written by people that have gone through this…there are several wonderful books from My Stroke of Insight (Jill Bolte Taylor), The Miracle Mind (Sonya’s Story), Healing Into Possibility (Allison Shapiro), etc. There are so many wonderful testimonials for individuals to realize they are not alone and that there is much to be done.

Secondly, understand the main tenants of recovery and new pathways are: 1) Opportunities: an individual needs lots of opportunities to communicate; fun, social, educational, vocational… the more opportunities, the more practice! 2) Challenge: the brain changes, and does what we teach it to do… the more we do for the person with aphasia, the ”easier” it may seem, but it actually denies the individual that communicative pressure they need. Instead of filling in, teach those around you to ”cue” the person… give them direction vs. the answer. 3) Support: This can be found with groups that have others that have aphasia,… a local university may have a program, or graduate interns that are looking for clinical experience, … look for aphasia groups and aphasia centers in your area for purposeful, engaging and satisfying experiences.

Let me know if I can help you further.

Maura

On May 29, National Stroke Association is hosting an educational event for members of Congress and their staff to raise awareness about stroke on Capitol Hill. Why is this important? Congress makes laws that impact the stroke community in a number of ways. For example, bills are currently pending that would make it easier to access Medicare rehabilitation services and would fund critical stroke-related medical research.

You can help make sure your members of Congress attend or send staff to this stroke awareness event so they understand the ways they can help the stroke community. We’ve already sent them an invitation, but the message is much stronger coming from a constituent—that’s you! Send your representatives in Congress a message asking them to attend this event today. We’ve made it easy to TAKE ACTION!

Congress should be a partner with the stroke community to help reduce the incidence and impact of stroke. Make sure they understand the challenges and needs of the stroke community and what they can do to help. Help your members of Congress better understand stroke and its impacts today!

Tricks to Help Speech Lessons Carryover into Daily Life, an article by BETSY SCHREIBER, APRIL 30, 2013 for ASHA

How can our clients better incorporate new skills into their speech in their daily lives? It seems that they are often limited by their social interactions with caregivers, parents or spouses, so that they can’t practice or complete speech homework between sessions.

Some of my adult clients will avoid practice sessions with their spouses altogether. How can we encourage use of newly acquired skills between visits? Wouldn’t the duration of therapy be reduced and functional communication improved? Research has supported more intensive therapy approaches to promote a more efficient, complete healing process. Because time and funding often limits therapy frequency, we send patients home with work for practice. Follow-through with homework generally rests on the motivation of the client or the client’s family. We need to find ways to make the therapy process efficient and functional.

In Pam Marshalla’s 2010 book “Carryover Techniques (in Articulation and Phonological Therapy),” she defines the term carryover are referring to “a client’s ability to take an individual speech skill learned in the therapy room and to apply it broadly in all speaking situations.”

Getting our students and clients to use their articulation and communication skills outside the therapy environment requires that we begin the process of carryover as soon as the skill is demonstrated in a variety of environments. For children, it might mean saying a fluent word or phrase during a game to get to the next square, or using the correct production of /r/ and /l/ during a short conversation about sports. For adults, the rules of learning after a stroke or traumatic brain injury still may require learning a new skill, like writing the first letter for phonemic placement or using cognitive-semantic linking to ask for coffee.

We need to get more creative to promote carryover across all our clients because of additional sensory, physical, psychological or cognitive difficulties that may impede the process. Charles Van Riper in 1947 wrote that while we cannot rush carryover, we must facilitate its progress.

Pam Marshalla listed some functional ways to promote carryover in children and adolescents, including use of:

- Fill-in sentences or fill-in stories to stimulate spontaneity.
- Idioms to stimulate spontaneity.
- Negative practice to help break the incorrect speech habit.
- Nonsense syllables and words to strengthen the carryover process.
- Over practice to cause a hyper-awareness of the goals of therapy.
- Rapid-fire questions and answers to promote naturalness.
- Reading aloud as a step between word productions and conversational speech.
- Rhyming to capture a client’s attention and encourage practice outside of therapy.
- Riddles because they cause a client to combine practice material with creative thinking.
- Shortening productions to encourage naturalness.
- Singing to help children remember their speech work and to encourages effortless practice.
- Spelling out errors to help the client think about what she is saying and how she is saying it.
- Story-telling and re-telling to cause stimulate spontaneity and to cause a breakthrough in carryover.
- Tongue twisters to teach children how to control their articulation.
- More on promoting carryover in speech-language treatment can be found on Pam Marshalla’s website.

Many of these techniques are useful for adults as well as children. Here are some additional carryover ideas for adults:

- Create a script to practice at a favorite restaurant.
- Use the carryover phrases and substitute other items at a counter deli or a department store.
- Make a to-do list (or grocery list) each day. Practice writing and reading.
- Talk about the programs you will watch.
- Use carryover phrases for conversation, such as, “Hi. How are______?” “What is____?” ”I’m _____.” “Who is____?”
- Use a calendar and an 8 by 10 dry-erase board to practice drawing,writing and gesturing.
- Use your smart pad, apps, whiteboard, AAC, text-to-speech, and speech-to-text to send emails and do alphabet board, speech tutor and naming practice.
- Play your favorite brain games daily. They will help you with focus, learning, word-finding and memory.

If you encourage your clients to engage in games and functional activities daily, the overall quality of your clients’ understanding and speech production will improve because you are encouraging the growth of new neural connections. Your clients are naturally acquiring and using the new skills in their daily lives because they are using them. Becoming more functional can be the most motivating effect of carryover.

Betsy C. Schreiber, MMS, CCC-SLP, is a clinical supervisor at Ladge Speech and Hearing Clinic at LIU/Post on Long Island, and a partner at Hope 4 Speech Associates, P.C. She is an affiliate of ASHA Special Interest Groups 2, Neurophysiology and Neurogenic Speech and Language Disorders, and 18, Telepractice.

Read, print or email the original article by clicking on ASHA .

This is a message from The American Heart Association/The American Stroke Association:

Think about two people you care about who may smoke, be overweight, have high blood pressure, diabetes or a family history of heart disease and stroke. People with these risk factors are at increased risk of being disabled or dying from a stroke.

Review the special health messages created by the American Heart Association and send them to people you care about, it just might save their lives. You can pick a message and send it out in any number of ways – send an email, make a phone call, text, tweet or donate your Facebook status for the day to get these great messages out to those you love.

Power To End Stroke asks that you send at least two health messages to two people that you know are at risk for stroke. Click the type of message you would like to send from the options to see the pre-written health messages that you can simply cut and paste or read to a loved one.

EMpower .

Stroke survivors struggle with emotional impact, report finds – Social care professionals play a crucial role in ensuring that people get support
Article by Emma Nye for Guardian Professional, on May 1st,2013 05.25 EDT

New study from the Stroke Association found that a large proportion of stroke survivors suffer feelings of depression.

Anyone who works with stroke survivors will know that, while the physical effects are obvious, they’re not the whole story. Feeling overwhelmed, the latest research report for the Stroke Assoication, surveyed more than 2,700 survivors. It found that the emotional impact of stroke can be just as devastating as the physical effects.

The full emotional impact often only becomes clear when people return home from hospital: stroke survivors often don’t know where to turn. One told us: “Many of the emotional issues arrive not at the time of stroke, when all you are doing is trying to get well again physically. But it’s months later, at home, when the reality hits you that you’ll never be the person you once were.”

Information, practical advice and emotional support is vital to helping stroke survivors and carers manage their everyday lives better. People who responded to our survey reported high rates of anxiety (67%) and feelings of depression (59%). Almost three-quarters said they felt less confident after their stroke and 40% felt abandoned to cope with their feelings and fears alone after leaving hospital.

Without early identification and solution, emotional issues can develop into more serious psychological problems. Depression increases the risk of cardiovascular disease by one and a half times compared with the general population. So stroke survivors with depression are more likely to have another stroke. Yet the majority of post-discharge care concentrates on physical rehabilitation.

This is not just an issue for stroke survivors; there are huge implications for carers too. More than half people caring for stroke victims are stressed, and it gets harder the longer they are caring. When the stroke survivor’s condition changes, they may be facing their own health problems, but by that time health and social care services have tailed off. Carers are both physically and mentally exhausted, with six in ten not getting enough sleep. We found that levels of anxiety and feelings of depression are as high for carers as they are for stroke survivors.

Stroke can also destabilise relationships. A third of survivors said they had broken up with their partner or considered doing so. Some carers tell us they feel they have brought a different person home than the one they took to hospital.

So what needs to change? Many of the tools to address this are already in place, they just aren’t being used. The National Stroke Strategy recommends all stroke survivors should have regular reviews of their health and social care needs, and that this should include an assessment of their emotional wellbeing. But the Stroke Association’s Struggling to Recover report last year showed only 39% of survivors in England were offered it. Carers are also entitled to a needs assessment that covers their psychological wellbeing, but many are unaware of this; only a quarter knew where to get an assessment.

Social care professionals play a crucial role ensuring people don’t have to struggle alone. The Stroke Association provides services to stroke survivors and in some parts of the country we are in regular contact with those back in the community, but better co-ordination between health and social care partners to meet emotional needs will make a real difference.

We can signpost those in need to key sources of support such as stroke services, clubs and groups. We have a UK-wide stroke helpline which is resourced to provide information to professionals as well as stroke survivors and carers.

Some brilliant work is being done to support survivors and carers with the emotional impact of a stroke. One great example is the multi-disciplinary team in the north-west, where clinical psychologists work alongside stroke co-ordinators in a stepped care model. Together they identify and solve emotional and psychological problems, both in the hospital and out in the community.

The emotional needs of stroke survivors must be acknowledged and addressed and adequate support put in place. Working together we can enable many more survivors and carers achieve a better life.

Read, print or share this article by going to theGUARDIAN

Act FAST for Stroke Texting Campaign

Do you know the warning signs and symptoms of a stroke? “Experience” the signs of a stroke by signing up for the National Stroke Awareness Month texting campaign.

How it works:

In May, you will receive a total of six text messages.
Each message describes a different warning sign of a stroke.
Message delivery will be sporadic and sudden, just like a stroke.
Each message leads to a mobile-optimized page, which will show you how to recognize a stroke FAST, step by step.
After the last message, you’ll have an easy-to-remember way to recognize a stroke in yourself or others. Be sure to read all of the messages and become an expert at recognizing the signs of a stroke!

JOIN THE CAMPAIGN

The American Heart Association/American Stroke Association’s Together to End Stroke, sponsored nationally by healthcare products leader Covidien, raises stroke awareness and educates Americans that stroke is largely preventable, treatable and beatable. The campaign now includes a free mobile app that highlights the acronym F.A.S.T. to help people recognize a stroke:

Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile.
Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
Speech Difficulty – Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.” Is the sentence repeated correctly?
Time to call 9-1-1 – If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to the hospital immediately.

TWEET THIS

One in three stroke emergencies don’t use EMS

April 30, 2013
Study Highlights:

More than a third of stroke patients don’t get to the hospital by ambulance — the fastest way to get there.
Ethnic minorities and rural residents were less likely to call 9-1-1 at the onset of a stroke.

The American Heart Association/American Stroke Association wants you to know the signs of a stroke and call 9-1-1 immediately for help.

EMBARGOED UNTIL 12:01 a.m. ET, Tuesday, April 30, 2013
DALLAS, April 30, 2013 — More than a third of stroke patients don’t get to the hospital by ambulance, even though that’s the fastest way to get there, according to new research in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

Researchers studied records on more than 204,000 stroke patients arriving at emergency rooms at 1,563 hospitals participating in the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke quality improvement program in 2003-10.

Emergency medical services (EMS) transported 63.7 percent of the patients, with the rest arriving in various other ways, researchers said.

During a stoke emergency, quick treatment is critical. EMS transported 79 percent of those who got to the hospital within two hours of the start of their symptoms. That resulted in earlier arrival, quicker evaluation and faster treatment, said the researchers who found:

Almost 61 percent of people transported by EMS got to the hospital within three hours of the first symptoms, compared to 40 percent who didn’t use EMS;

Almost 55 percent using EMS had a brain scan within 25 minutes of hospital arrival, compared to 35.6 percent who didn’t use EMS;

Of patients eligible for a clot-busting drug, 67.3 percent using EMS received it within three hours of symptom onset, compared to 44.1 percent who didn’t use EMS.

EMS are able to give the hospital a heads up, and that grabs the attention of the emergency room staff to be ready to act as soon as the patient arrives,” said Jeffrey L. Saver, M.D., senior author of the study and director of the UCLA Comprehensive Stroke Center in Los Angeles, Calif. “The ambulance crew also knows which hospitals in the area have qualified stroke centers. Patients don’t lose time going to one hospital only to be referred to another that can provide more advanced care if needed, whether that’s drugs to bust up the clot or device procedures to remove it.”

Minorities and rural residents were less likely to call for EMS at the signs of a stroke, researchers found.

“A number of factors can fuel the reluctance to call 9-1-1,” said James Ekundayo, M.D., Dr.P.H., lead author of the study and assistant professor in the Department of Family and Community Medicine at Meharry Medical College in Nashville, Tenn. “People may not recognize symptoms and may delay seeking medical care or call their doctor instead.

We hear people say they just didn’t want to be a bother, but many times there could have been a better outcome if EMS had been called.”

About 795,000 Americans experience a new or recurrent stroke each year — a stroke every 40 seconds or a related death every four minutes.

Boosting public awareness efforts and education is critical to improving stroke outcomes in the short- and long-term, researchers said.

The American Heart Association/American Stroke Association’s Together to End Stroke, sponsored nationally by healthcare products leader Covidien, raises stroke awareness and educates Americans that stroke is largely preventable, treatable and beatable. The campaign now includes a free mobile app that highlights the acronym F.A.S.T. to help people recognize a stroke:

Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile.
Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
Speech Difficulty – Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.” Is the sentence repeated correctly?
Time to call 9-1-1 – If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to the hospital immediately.

“Your life, your brain, depends on calling 9-1-1,” Saver said. “Know the signs and act fast if you or someone you’re with is having stroke symptoms.”

The American Stroke Association has more information about STROKE.

An implantable loop recorder established new diagnoses of atrial fibrillation in 25% of patients with cryptogenic stroke.
(Definition: A stroke which cannot be attributed to any specific cause after an extensive search for the most common causes, such as cardiac and other emboli, large or small artery thrombi or atherosclerosis.)

One third of ischemic strokes remain cryptogenic even after thorough inpatient evaluation. Numerous studies suggest that some of these patients may have paroxysmal atrial fibrillation (AF) that remains undiagnosed during their stroke hospitalization. Failing to detect these cases of AF may result in suboptimal antithrombotic therapy. However, what type and duration of cardiac monitoring should be used to rule out subclinical AF remain unclear.

To address this question, investigators placed implantable loop recorders (ILRs) in 51 patients who had received standard stroke evaluations, including vascular imaging, echocardiography (transthoracic in all patients and transesophageal in 30), and at least 24 hours of Holter monitoring without evidence of AF. The ILR software automatically detected AF episodes 2 minutes in duration. Two cardiologists independently reviewed any AF episodes detected by ILRs.

ILRs were implanted an average of 174 days after stroke. In 13 patients (25.5%), AF was detected after a median 48 (range, 0–154) days of monitoring. The other patients remained AF-free throughout an average 229 days of monitoring. AF was associated with older age, more-frequent premature atrial contractions during baseline Holter monitoring, and larger left atrial size.

Comment: In the recently completed EMBRACE trial, 15% of cryptogenic stroke patients assigned to 30-day external loop recorder monitoring received new diagnoses of atrial fibrillation, versus 3% of patients assigned to 24-hour outpatient Holter monitoring. It is possible but unlikely that some of these poststroke episodes of AF are incidental, because subclinical AF lasting only a few minutes has recently been shown to increase stroke risk, and the majority of cryptogenic strokes appear radiographically to have resulted from cardiac embolism. On these bases, several weeks of noninvasive cardiac monitoring should usually be performed in patients with cryptogenic stroke. The current study results suggest that longer periods of monitoring might detect even more cases of AF. However, relatively invasive and expensive implantable loop recorders cannot be routinely recommended until we see the results of the ongoing CRYSTAL-AF trial, which is comparing use of ILRs to routine clinical follow-up in patients with cryptogenic stroke.

— Hooman Kamel, MD

Read more about these Embrace – Clinical Trial and
Crystal – Clinical Trial

Dr. Brian Levine, CSR Baycrest Site Leader, describes how Baycrest has pioneered Goal Management Training (GMT), a very effective way to help people with white matter disease or covert stroke to improve decision making and planning skills. Deirdre Breton, a survivor of covert stroke, talks about how GMT helps her remain active and focused. Click Here

Read Moreabout GMT.