What to expect when a loved one has a stroke

If your loved one has had a stroke, this can be a scary and lonely time during which a lot of changes take place. CATTS Ireland have prepared a short guide on what to expect if you are faced with this situation.

 

What happens in your body when you have a stroke?

There are two common types of stroke: ischemic and haemorrhagic. During an ischemic stroke, the blood supply to parts of your brain is decreased, which also reduces oxygen flow to your brain tissues. During a haemorrhagic stroke, bleeding occurs in your brain. In both cases, if your brain is deprived of oxygen and blood for long periods, tissues become damaged. Therefore, it is crucial to seek treatment as soon as possible. Damage may be permanent or temporary and can range from mild to severe. Damaged brain cells affect how other parts of the body function, e.g.: arms, legs or face muscles.

What effects may a stroke have on your communication?

If a stroke causes damage to the certain parts of your brain, you may experience communication (i.e.: speech, language, writing and reading) problems. Often after a stroke, individuals are diagnosed with a condition called “aphasia”. Aphasia is a communication difficulty that may be caused by a stroke, head injury or tumour. Aphasia may impact on a range of communication skills, for example:

  1. Understanding language: this type of aphasia is called receptive/Wernicke’s aphasia. You may have trouble understanding language and may speak in long, confusing sentences using some made up words. Below is a link to a video of a person with Wernicke’s aphasia: https://www.youtube.com/watch?v=dKTdMV6cOZw
  2. Using language: this type of aphasia is called expressive/Broca’s aphasia. You may find it hard to select the correct words to say and to speak in long sentences. Below is a link to a video of a person with Broca’s aphasia: http://auditoryneuroscience.com/brocas_aphasia
  3. Understanding and using language: this type of aphasia is called global aphasia. The individual may experience severe difficulties across all domains of language. Below is a link to a video of a person with global aphasia: https://www.youtube.com/watch?v=IHKUwBP0xNk

Similarly, you may be diagnosed with “dysarthria” which is a neurological speech problem. After damage to the brain during a stroke, you may not be able to control the muscles that produce speech, making it difficult to speak clearly. Below is a link to a video of an individual with dysarthria:

Finally, you may be diagnosed with “apraxia of speech” which happens when you cannot move your speech muscles as smoothly as you did before you had a stroke. This makes it difficult to sequence sounds in the correct order. Below is a link to a video of an individual with apraxia of speech:

 

How can you support a loved one who has had a stroke communicate?

If your loved one has had a stroke, communication may be stressful for both of you. Below are some tips to help communication:

  1. Give the person enough time to communicate without feeling rushed.
  2. Simplify your sentences and speak at a slower pace.
  3. Reduce background noise or environmental distractions (e.g.: switch off the television/radio while talking).
  4. Don’t try and anticipate what they are going to say allow them to express it as independently as they wish.
  5. Ask them how you can support them best during conversation to find out their individual wishes.
  6. Acknowledge to your loved one that you understand they are competent and know what they want to say. Oftentimes, individuals with communication difficulties are anxious that they may appear incompetent or “stupid”.
  7. Don’t pretend that you understand what they said if you didn’t; this may appear patronising and your loved one may simply prefer if you asked them to repeat what they said. Otherwise, you can repeat what you didunderstand and pause at the section where understanding broke down.
  8. Periodically check with your loved one to see if they have understood you.
  9. Encourage your loved one to use many forms of communication depending on their skills and wishes. For example: drawing writing, gestures, facial expression, pictures and photographs.
  10. Communicate face to face so your loved one can take advantage of looking at gestures and facial expressions
  11.  Encourage your loved one to carry a card/leaflet explaining their communication difficulty for if/when they meet people who are unaware of their condition
  12. Be patient and sensitive to the new and strong emotions which they may be experiencing
  13. Attend therapy sessions with your loved one (if they are comfortable with this) so that you learn new communication strategies.
  14. Below is a link to a video of a loved one using supportive communication with an individual with aphasia: http://www.stroke4carers.org/?p=5390

 

Aphasia support groups

Many people with aphasia, and their loved ones access social support by attending aphasia conversation groups. These may be aimed at practicing communication skills in a safe environment, or simply making new friendships with similar individuals in your area. For example, Peamount Hospital, Dublin, have been running The “Chat Group” since 2007 for individuals with aphasia and their significant others. This group aims to increase communicative confidence while increasing social participation and creating meaningful friendships.

We have included links below so you can see what a conversation group may look like:

  1. https://www.youtube.com/watch?v=0O7Dyf_eK-U
  2. https://www.youtube.com/watch?v=ML9YYfvDozo

Below are links to conversation groups in the Dublin area:

  1. http://aphasiaireland.ie/?attachment_id=449
  2. http://www.stroke.ie/iopen24/chat-group-t-483_512_829.html
  3. http://www.headway.ie/events/ (for individuals with aphasia following a head injury)

Self-care

Communication difficulties are often seen as a family problem, rather than an individual’s problem. If you are caring for a loved one who has had a stroke, it is important that you also practice self-care and maintain your own positive mental health. It is normal to feel frustrated, lost and angry as you have to adopt different relationship roles. Some people go to counsellors or join support groups to help express their feelings in a safe environment. You need enough good quality sleep in order to avoid exhaustion. Try to maintain contact with family and friends, even via phone calls, so you don’t become isolated. Some people avail of respite services in order to take rest periods for themselves. Avoid making major changes while you and your loved one are still adjusting to the circumstances. For example, avoid moving or changing jobs etc. if possible.

Continue with leisure activities as much as possible; remember: this is not selfish, it is self-care.

 

Below is a link to several carer’s stories:

  • https://www.stroke.org.uk/sites/default/files/feeling_overwhelmed_final_web_0.pdf

 

References:

  1. American Heart Association & American Stroke Association. (2013). Steps to improve communication for survivors with dysarthria. Retrieved from:http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/CommunicationChallenges/Steps-to-Improve-Communication-for-Survivors-with-Dysarthria_UCM_310083_Article.jsp.
  2. American Speech and Hearing Association. (n.d.). Family adjustment to aphasia. Retrieved from: http://www.asha.org/public/speech/disorders/FamilyAdjustmentAphasia/.
  3. American Stroke Association. (2013). Tips for socialising with aphasia. Retrieved from: http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/CommunicationChallenges/Tips-for-Socializing-with-Aphasia_UCM_310095_Article.jsp.
  4. American Stroke Association. (2013). Types of aphasia. Retrieved from: http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/Reg.
  5. Aphasia Help. (n.d.). Strategies to help family members cope. Retrieved from: http://strokesupport.com/info/aphasia/aphasia_resources.htm
  6. Aphasia Institute. (n.d.). Communication tools: Communicative access & SCAâ„¢. Retrieved from: http://www.aphasia.ca/health-care-professionals/communicative-acceess-sca/.
  7. Aphasia Ireland. (2013). Donagmede. Retrieved from http://aphasiaireland.ie/?attachment_id=449.
  8. Aphasia Support. (2011). Aphasia – The David Dow story. Retrieved from: https://www.youtube.com/watch?v=IHKUwBP0xNk.
  9. Auditory Neuroscience (n.d.). Vocalisations and speech. Retrieved from: http://auditoryneuroscience.com/brocas_aphasia.
  10. Connect. (2015). About aphasia. Retrieved from: http://www.ukconnect.org/about-aphasia.aspx.
  11. Davis, G. A. (1983). A survey of adult aphasia. Englewood Cliffs, NJ: Prentice Hall
  12. di Cogmonaut, C. (2010). Wernicke’s aphasia. Retrieved from: https://www.youtube.com/watch?v=dKTdMV6cOZw.
  13. Gibbs, M.J. (2013). Apraxia and aphasia disability from a stroke. Retrieved from: https://www.youtube.com/watch?v=OPjDo03rUd0&list=PLZe1NKy2U60ff68GWD9bdSaDY02PLcJcZ.
  14. Harvey, J. (2012). Speech impairment; Dysarthria. Retrieved from: https://www.youtube.com/watch?v=UF0G-u0hBns.
  15. Headway. (n.d.). Upcoming events. Retrieved from: http://www.headway.ie/events/
  16. http://www.stroke.ie/iopen24/chat-group-t-483_512_829.html
  17. Muni, R. (2007). Aphasia group. Retrieved from: https://www.youtube.com/watch?v=ML9YYfvDozo.
  18. Stroke Association. (2015). Feeling overwhelmed. Retrieved from: https://www.stroke.org.uk/resources/feeling-overwhelmed-0
  19. Stroke Association. (2015). Common problems after stroke. Retrieved from: https://www.stroke.org.uk/what-stroke/common-problems-after-stroke/communication-problems.
  20. Stroke Association. (2015). Someone I know has had a stroke. Retrieved from: https://www.stroke.org.uk/what-stroke/someone-i-know-has-had-stroke.
  21. Stroke Foundation. (2012). Communication after stroke. Retrieved from: http://strokefoundation.com.au/site/media/FS09_Communication_web.pdf.
  22. Stroke Network. (n.d.). How to help a person with aphasia express themselves. Retrieved from: http://www.stroke-network.com/articles/how-to-help-a-person-with-aphasia-express-themselves.
  23. Walsh, K. (2013). Aphasia conversation group. Retrieved from: https://www.youtube.com/watch?v=0O7Dyf_eK-U.
  24. WebMd. (n.d.). Stroke health centre. Retrieved from: http://www.webmd.com/stroke/guide/stroke-what-happens.

If you have any questions about any of the above, please don’t hesitate to contact us.

 

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