Speech Therapy

Speech and communication are complex functions we take for granted until something goes amiss. After a stroke or brain injury, the level of impairment may range from minor to severe, and it is not uncommon for multiple aspects of communication to be impaired. Just 10% of people will fully recover, 25% will have a minor impairment, and 40% will have a moderate impairment—daunting statistics. To varying degrees, individuals can learn strategies to speak and communicate again. Matt was one of these statistics, but there was no way to predict where on the prognostic spectrum he would fall, and it didn’t look good. Most of his brain swelling had been in the region that controls language skills, and the permanent damage was unknown.

Establishing a means of communicating a yes/no response was essential. Despite best efforts, early attempts to encourage Matt to mouth the words, shake his head, or make thumbs-up and thumbs-down gestures proved unsuccessful. Not until early June did he occasionally select a yes/no card, once indicating yes that he wanted to go outside but no that he didn’t want to play the piano.

As time permitted and he was able, the speech therapists attended to Matt’s memory loss and cognitive deficits—it was a juggling act of priorities. In one session, she worked on object and word identification. When given pictures of two objects (e.g., a shirt and pants), he selected the requested item 75% of the time and did even better pointing to a desired number from 1 to 10.

The therapist continued to monitor and address Matt’s swallowing disorder. Eventually, when offered ice chips, Matt began to move them slowly around in his mouth, chew, and swallow them. A swallow study or videofluoroscopy was ordered to evaluate the anatomy and movement of food and liquids through the mouth, throat, and esophagus to assess if he was ready to eat actual food and what consistency was safe. Up to now, he was being fed through a tube inserted into his stomach. His first nourishment by mouth in seven weeks was three bites of applesauce. It didn’t come naturally. The therapist had to verbally encourage and externally massage his throat to trigger a swallow response. His progress was measured by the spoonful, the quality of movement of the applesauce in his mouth (no hard food or water yet), and the number of successful swallows. By degrees, he was able to sip thickened water without choking or worse. Finally, on June 13th, Matt greedily ate two graham crackers without choking, attesting to the old adage that slow and steady wins the race.

In addition, speech therapy worked on recognizing written words and practicing writing. His printing was big and squiggly. By early August, he had added the days of the week, months, and numbers (1-10) to his repertoire—but struggled with letters, the latter of which would prove difficult for years to come. Matt’s vocabulary expanded as common phrases were added, such as thank you, you’re welcome, I love you, and my name is Matt.

We had much to learn about the nuances of language and effective communication, things we had taken for granted until now. A conversation involves listening, understanding, formulating a response, finding the right words, and, in Matt’s case, hoping his vocal cords would resound strongly—loud and clear. Listeners were obliged to lean in close to hear and read his lips, to make sense of his jumbled words, low volume, and hoarse voice. It was reminiscent of the patience required to listen to a child learning to speak and how tiring it was for those on the receiving end.

How does the depth and breadth of different speech therapy approaches, philosophies, and treatment techniques offer greater opportunities to enhances patient outcomes?