Affected not recognising speech problem

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Hi friends

Will appreciate much assistance and inputs from all, especially the SLPs on situation hereunder.

A stroke affected cannot speak properly. However, he is adamant that his speech is fine and once his other limbs recover will become as it was before. Consequently he is not prepared to take any speech therapy.

Has any here experienced similarly ? What kind of aphasia or speech deficit could he be having ? And how to convince him go go for appropriate therapy ?

All inputs and experience sharing will be highly appreciated.

[6/23, 12:41 PM] Radhika Poovayya: Hi, denial of a speech problem is a sign of an wernike’s aphasia. In this condition the patient is unable to understand not only his own speech but what others are talking. His answer to common questions may be correct but generally he/she will not answer correctly and specifically to the questions. Grammer and speech output is effortless but content is poor. We cannot give any speech therapy as cooperation is a must.however, family needs guidence to manage the communication at home. As there will be lot of tempers flaring around

[6/23, 12:51 PM] Radhika Poovayya: Comprehension of written language may be relatively intact when compared to spoken language.

[6/23, 12:53 PM] Radhika Poovayya: There are different areas in the brain that control different functions.The deficits depend on the area affected by stroke.

[6/23, 12:55 PM] Dr. Melitta Menezes: So this can be checked and if intact used for communication rather than speech.. .
Eg:- send a text msg instead of a phone call…

[6/23, 1:27 PM] Aishwarya More: Denial of speech language problem is seen when there is defective self monitoring. Since the individual is unable to understand his own errors he would not correct himself while speaking incorrect. This might show that the feedback monitoring system is affected.
Speech therapy would facilitate enhancing comprehension skills and once the comprehension is improved self correction increases. Gradually when individual realises the improvements he would be interested in rehabilitation.

[6/23, 1:30 PM] Aishwarya More: Would like to add here. Apart from denial of any speech language problem there is also lack of motivation and apathy seen. So should be checked that is it a denial or lack of motivation for rehab. Individual with motor aphasias might show such emotional outbursts and lack of motivation for therapy.
In both the instances caregiver would play a crucial role to facilitate appropriate language stimulation at home and motivate the individual to attend the therapy.

[6/23, 1:50 PM] Shruthi: Thank you madam, the information you have given helps us to understand the difference between different types of aphasia.

[6/23, 2:10 PM] Hardeep Sodhi: Thanks much @⁨Radhika Poovayya⁩ ji and @⁨Aishwarya More⁩ ji for your inputs. But if the stroke affected refuses to take speech therapy, claiming that he/ she is fine then what could be the way forward ? Can one, for example, record the speech and playback to the patient to show he is indeed deficient ? Does any kind of psychological counseling help ?

[6/23, 3:22 PM] Radhika Poovayya: Agree with aiswarya. ? denial is seen in wernike’s and lack of motivation in seen generally in Broca’s.
Answering your question @hardeepji , playing back his audio sample also cannot help as he cannot understand words. It’s very very frustrating for the patient and the families. The patient can understand the situations but words suddenly became incomprehensible. We have had good progress only with mildly affected patients who are able to realise that their speech output is not exactly as they want it to be.Hence, they attend therapy regularly.

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[6/23, 10:39 PM] Hardeep Sodhi: Thinking further , indeed this can be a very frustrating experience for the family around. Will taking help of a psychiatrist – if the affected may be persuaded – help ? Is this a frequent occurrence and how is it managed ?

[6/23, 10:51 PM] Hemina Dawar: Thank you for raising this topic. I agree with the discussion above, to add the role of post stroke speech therapy is generally understood to be limited to non fluent aphasia ( where a person is unable to speak). From my experience, people focus more on physical recovery more after a stroke. But here I need to bring focus on the parts other than speech that are generally affected post stroke. Best way is to have a proper assessment covering not only neuromotor skills but also cognitive linguistic skills and post stroke participation of affected person in communication.

[6/23, 10:52 PM] Hemina Dawar: For reference, cognitive linguistic skills include Attention (selective concentration)

Memory (recall of facts, procedures, and past & future events)

Perception (interpretation of sensory information)

Insight & judgment (understanding one’s own limitations & what they mean)

Organization (arranging ideas in a useful order)

Orientation (knowing where, when, & who you are, as well as why you’re there)

Language (words for communication)

Processing speed (quick thinking & understanding)

Problem-solving (finding solutions to obstacles)

Reasoning (logically thinking through situations)

Executive functioning (making a plan, acting it out, evaluating success, & adjusting)

Metacognition (thinking about how you think)

[6/23, 10:52 PM] Hemina Dawar: A proper assessment will always lead to proper rehabilitation and treatment plan.

[6/23, 11:17 PM] Hardeep Sodhi: Thanks for your inputs @⁨Hemina Dawar⁩ ji….that is a lot to process, but stands to reason since brain impacts pretty much everything…wonder if such assessment is standard process or will vary from situation to situation or one therapist to another….are there standardized tests for these that a lay person can administer at least for some prima facie analysis ?

[6/23, 11:25 PM] Hemina Dawar: Yes sir there is a standardized test and every doctor/ therapist follows a proper protocol whenever he/she does an evaluation. All the tests that are clinically useful are validated and studied by the normal and clinically affected population before using them.

[6/23, 11:29 PM] Hardeep Sodhi: Ok, so the best will be if the affected could somehow be persuaded to undergo such test, which is an issue since, per him, there is no issue to begin with…

[6/23, 11:36 PM] Hemina Dawar: Yes Sir, I believe getting a proper evaluation done by a specialist will be better than self assessment. Also, if there is a denial for speech therapy then best way is to observe participation of affected person in daily conversations and his/her motivation to communicate.

[6/23, 11:42 PM] Radhika Poovayya: Yes,Hardeep ji, I have had patients walk out of my clinic in anger and families are helpless. For one client, he agreed for therapy after one year ,as there was an improvement and he felt the need. But it didn’t last for more than 2 months. Then the only resort is to give guidelines to families on how to cope.

There is limited research on wernike’s aphasia too for the reason that there are very less clients who seek therapy

[6/24, 12:08 AM] Hardeep Sodhi: Thanks for your inputs Hemina ji and Radhika ji ???

[Admin]

Adding here some more information on Wernicke’s aphasia :

Symptoms
Regarding speech and comprehension, people with Wernicke’s aphasia may:

string words together to make sentences that don’t make sense
make up words that have no meaning
be unaware of the mistakes in their speech
deliver words in a normal melodic line, even though the content may not make any sense
articulate their words normally
have difficulty repeating phrases
add words when trying to repeat someone
interrupt others and speak rapidly

Taken from :

https://www.healthline.com/health/wernickes-aphasia#symptoms

 

 

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