HARRIS S. HARRELL

I once saw a sign that said, “Without Speech-Language Pathologists, Halloween would forever be a night of Twick-ow-Tweating.” While this statement is true, because we do work on the /r/ sound with children, that is not all speech-language pathologists or SLPs are capable of, though that is what we are most known for.

I love my job as an SLP (also known as speech therapist) at Vidant Beaufort Hospital because I see such a variety of patients of different ages with a variety of different diagnoses. One of the most prominent populations I work with are individuals who have experienced a stroke.

According to the American Stroke Association, a stroke is a “brain attack.” A stroke is a disease affecting the arteries leading to the brain and is the No. 5 cause of death and leading cause of disability in the United States. Strokes can be caused by either a clot stopping blood flow to the brain (ischemic stroke) or by a blood vessel bursting and preventing blood flow to the brain (hemorrhagic stroke). When this happens, part of the brain can no longer get the blood and oxygen it requires, so brain cells die. There is also a “mini stroke” or transient ischemic attack, which is a temporary clot. Strokes typically affect one side of the body. If the stroke occurs on the right side of the brain then the left side of the body is affected and vice versa, if the stroke occurs on the left side of the brain then the right side of the body is affected.

What does speech therapy have to do with a stroke? When a stroke occurs, what function declines depends on where in the brain it happens and how large the area of the brain is affected when the blood and oxygen was cut off to that part of the brain. After a stroke, one’s speech can be affected by dysarthria or apraxia. Dysarthria is “slurred speech” caused by muscle weakness on either side of the face. It may also affect the tongue. Apraxia is a “motor planning disorder” where there is a disconnect between the brain and the movements of the mouth. The brain knows what it wants to say but the mouth produces incorrect words or incorrect parts of words, making speech difficult to understand.

If the stroke occurs on the left side of the brain then one’s language may be affected through aphasia. Aphasia can cause problems reading, writing, speaking, understanding, using gestures but it does not reduce intelligence. There are two types of aphasia. Fluent aphasia is when an individual is able to speak in long sentences (five words or more); however, the words may not make sense or may be “nonsense” mixing sounds (“mird” for “bird”). These individuals generally have poor understanding. The other type of aphasia is non-fluent aphasia. These individuals speak fewer than five words at a time. They have effortful and halting speech with “word finding” difficulty. They often know what items are, as they generally have good understanding, but have difficulty naming items. Speech therapy can help with dysarthria, apraxia and aphasia. We help with oral motor exercises to strengthen facial and mouth muscles, we work on pronouncing words, and we use strategies and treatment for the different types of aphasia to help people be able to communicate their wants and needs.

I have many patients who, when I visit their room and introduce myself as a speech therapist, say “my speech is fine” after a stroke and many times it is. However, the stroke may have impacted their swallow function. Dysphagia is difficulty swallowing. Sometimes after a stroke a person may experience coughing or choking when eating or drinking. SLPs have the ability to diagnose and treat dysphagia. We can help with exercises to strengthen the muscles involved in swallowing. At times, we may have to alter an individual’s diet with softer food or thicker liquids for safe swallowing but with exercises, the goal is to return to a regular diet.

Often when people have a stroke, they expect to see physical therapists and occupational therapists, however speech therapists can be a great help as well if their speech, language or swallowing is affected. After a stroke, physical therapists, occupational therapists and speech therapists work as a rehab team to help the whole person return to as functional, or as close to their baseline function, as possible.

Harris S. Harrell, MS, CCC-SLP, of Vidant Beaufort Hospital – Rehab Services, can be reached at 252-975-4395.