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Aphasia and rehabilitation

Aphasia and rehabilitation

12h20 20/08/2018,

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Here are some interesting facts about aphasia rehabilitation.

1 - Recovery


Recovery varies according to various factors of which the main ones are :

  • The extent and cause of brain injury

  • The presence or absence of associated disorders (partial hemiplegia)

  • The patient's motivation and will

  • Treatment modalities undertaken


Some aphasic people recover almost completely their ability to communicate, while others may remain very disabled. The level of recovery differs considerably from one individual to another. This is why it is best to avoid comparisons between people with aphasia. During rehabilitation, recovery "trays" can be observed, i.e. more or less long periods during which the aphasic person no longer seems to make any progress.
h3 style="font-family: Century; color: #23B4F3;">2 - The diagnosis
The speech-language pathologist is responsible for making a detailed evaluation of all aspects of the language in order to determine difficulties but also residual abilities. The speech and language therapist will base himself on the initial examination and then elaborate a rehabilitation plan adapted to each aphasic.

3 - L'avant rééducation


A - Access to and motivation for rehabilitation


It is important that the speech-language pathologist examine the aphasic as soon as possible and begin regular work as soon as his general condition permits. If the person with aphasia is not motivated to undergo rehabilitation, he or she should not be forced to undergo it in the first instance because nothing can replace his or her motivation.
The person with aphasia, who chooses to undergo rehabilitation, can make progress, especially in the first few months following the installation of the aphasia. It is possible to constate progress by resuming exercises even after stopping speech therapy if the aphasic's environment continues to stimulate it.

B - Types, Forms and Language Habits of the Aphasic Person


Rehabilitation must take into account the types and forms of language, as well as the individual's previous language habits. Did he tend to talk very little or a lot? Did he speak several languages? Was he used to reading, writing? What is his level of education? What are their interests and activities (work, leisure)?
The answers to these questions are important, as rehabilitation aims to help the individual find the language they used before.

We find as"type of language":

  • Automatic language is the one that arises under the influence of an emotion or a need, including swearing. He also understands what has been memorized, such as naming the days of the week, counting, reciting the alphabet and prayers.

  • Voluntary language is the thoughtful one; he asks that words be chosen and organized into sentences to convey a message. This message can be simple (e.g. "Pass me the salt!"), or complex and abstract (opinions, stories, explanations).

There is 3 " language forms " :

  • oral

  • written

  • Gesture

Each of them has an expressive aspect (speaking, writing, gesturing) and a receptive aspect (understanding oral, written or gestural messages). Aphasia usually affects these forms of language to varying degrees. Thus, the understanding of spoken language may be greater than that of written language and the ability to write is often more impaired than the ability to speak.

Since not all these forms are necessarily achieved to the same degree, it is desirable to take them into account in the course of rehabilitation. We can start with what is best preserved to stabilize and consolidate it or, conversely, try to improve the most affected forms first.

The speech-language pathologist plans and adapts rehabilitation activities according to the aphasic person's needs, lifestyle habits and level of recovery. We can therefore understand that there is no universal recipe for the rehabilitation of aphasic people.

4 - Re-education of oral expression / spoken language


When the aphasic person no longer speaks, it is often mistakenly believed that he will have to learn to speak, read and write again, letter by letter or word by word, as the child does at school. This is not the case because, in rehabilitation, the speech-language pathologist tries, by various means, to restore functional communication , i.e. language that is as close as possible to the language that the aphasic person used before.
Thus, the speech-language pathologist encourages the production of familiar expressions associated with everyday situations: "Good night! ", "Water!

A - In the presence of a joint disorder (arthritic disorder)


The speech-language pathologist can work each of the distorted sounds through systematic exercises of repetition or read aloud. Sometimes it will be necessary to start with exercises prélinguistiques, such as mouth, tongue and lip movements.

B - The lack of the word in the aphasia of Broca


In the case of the lack of the word for example with a aphasia of Broca, the exercises aim to name people, objects and actions. At the beginning of the treatment, the speech therapist provides many facilities (images, gestures, beginning of the word or sentences to be completed), which will be reduced as the aphasic person recovers his vocabulary.

There is no need to repeat the word several times in the hope that the person will remember it better. Time helping, words will be found more and more often by a simple association with an object or with the current situation.

C - Wernicke's aphasia


Conversely, the person with a Wernicke's aphasia parlargely and often gets the word wrong without being aware of it. It is necessary to interrupt him to get his attention and allow him to concentrate, so that he gradually recognizes his mistakes. Thereafter, the speech-language pathologist will use various means to help the patient correct his errors and to make him say the expected words.

Whatever the expressive problem of the aphasic person, it is not necessary to ask him a perfect production, nor always to require from him the good answer, particularly in the first times of the re-education. On the contrary, it is important to encourage her to try and try again, and to congratulate her for her efforts, even if the answer remains imperfect.

5 - Re-education of oral comprehension


We have already mentioned that aphasia can also cause comprehension disorders. These disorders focus on language comprehension and not on the situations or events that occur.
It may happen that the aphasic person grasps a few words here and there; the context, facial expressions and intonation help him to guess the rest.

Score that the comprehension problem is not a deafness problem. The aphasic person does not understand the meaning of the words or does not hold them back, even if he hears well. In some more severe cases, this phenomenon can go so far as to give him the impression that he is spoken in a foreign language.

Understanding can also vary according to situations. Thus, in order for the aphasic person to better understand what is being said to him, he must be spoken to slowly, spoken to in short sentences, used familiar words and chosen subjects that interest him, without however speaking to him as if he were a child.
The speech-language pathologist takes into account all the factors described above in the rehabilitation.

6 - Re-education of written expression

Re-learning to write for an aphasic person is often difficult. The aphasic person should not be expected to write what he or she cannot say aloud because, in many cases, the aphasic person who cannot speak also has difficulty expressing himself or herself in writing. The speech-language pathologist does not place more importance on the written language than she did before the onset of aphasia, but she uses this mode of expression to facilitate the re-education of spoken language.

Aphasia can also almost exclusively affect written language. In this case, rehabilitation will focus on this aspect of language. From the beginning of the rehabilitation, the aphasic person is encouraged to write or copy very common words such as name, address, names of relatives, days of the week, numbers, date, etc.

7 - Re-education in written language comprehension


Some people with aphasia may have difficulty understanding what they read, even if they can read aloud. Conversely, others understand the meaning of what they read, even if reading aloud is disturbed.

In some cases, familiar and concrete words are recognized and understood, while the sentence that contains them is not. In other cases, the sentence promotes a better understanding of a word thanks to the clues provided by the other words.

In rehabilitation, the speech therapist begins to work on understanding written language with simple and concrete words, or with short sentences, depending on the case. Many aphasic people report difficulty concentrating on a text or remembering what they read. These problems obviously reduce their interest in reading, since they often have to revisit what they have read.

Understanding written language, like spoken language, is rarely completely lost. Thus, many aphasic people look at the newspaper every day even if they have difficulty understanding what they read. They can recognize titles, certain familiar words and words written in large print. The photos also help them to get an idea of the content of the articles.

Conclusion


The follow-up and orientation of rehabilitation exercises by a speech therapist is crucial. However, it is not always easily possible on a sustained basis in areas remote from a professional. Today there is a need to create tools that would allow a more continuous and autonomous reeducation of the patient.


That is why we work in cooperation with speech therapists to create a tool allowing them to create exercises adapted to the patient in the application Vocalyx : to be able to practice at home and have remote monitoring of the speech therapist .