The role of speech and language therapy in stroke rehabilitation

By Sheena Howell, Speech and Language Therapist at Priory Grafton Manor, Northampton

In the UK, a person suffers a stroke every five minutes. Globally, that figure increases to every two minutes. Initiatives like the FAST test, which is a simple method to help people to recognise the symptoms of stroke, along with greater prevention awareness and advancements in treatments, have been credited with improving the survival rate of stroke. Over the last 15 years, the rate of people who die as a result of a stroke has decreased dramatically by almost 50%.

Stroke survivors are often left with brain injuries and require rehabilitation to help them to re-build their independence. This means that more individuals will require specialised programmes offered through services such as Priory Grafton Manor, Northampton, which provides an established care pathway of support for people who have had a stroke and as a consequence, have a neurodisability.

As the speech and language therapist at Grafton Manor, I work alongside our wider transdisciplinary team which also includes neuropsychology, neuropsychiatry, occupational therapy, physiotherapy and nursing.

Speech and language therapy is involved through all phases of stroke recovery, and helps people to manage the communication and swallowing difficulties they may face after a stroke.

Specifically, speech and language therapy is involved in:

• Initial assessment of swallowing and communication difficulties following the acute stages of a stroke (recommended within 24 hours)
• Training other healthcare professionals to carry out screening
• Providing long-term rehabilitation as part of the transdisciplinary team
• Coaching and training family members, friends, carers and other professionals to be ‘communication partners’ for people with communication difficulties
• Support with mental capacity assessments in cases where it is difficult to obtain consent

Communication

One third of stroke survivors experience a communication difficulty. It is important to remember that communication difficulties do not affect a person’s intelligence but may make it difficult for them to understand what is said to them and to express their thoughts.

Stroke survivors report that communication difficulties can reduce their confidence in returning to daily activities such as work, shopping and social occasions. Speech and language therapists support stroke survivors and their families, friends and colleagues to improve social conversations and reduce the impact of communication difficulties.

Speech therapists assess all aspects of communication that can be impacted by stroke, including:

• Difficulty understanding what has been said (receptive aphasia)
• Difficulty using words and sentences to express what they want to say (expressive aphasia)
• Difficulty thinking of the words they want to use (word-finding difficulties)
• Reading difficulties (dyslexia) and writing difficulties (dysgraphia)
• Muscle weakness which may make speech slurred or difficult to understand (dysarthria)
• Difficulty with moving the muscles in the correct sequence to speak clearly (dyspraxia)

Speech and language therapists work with each individual on their personal communication goals. There are many different approaches including intensive therapy, online therapy and therapy programmes that can be done at home, and reviewed and updated regularly by the therapist.

Speech and language therapists are also able to assess and advise on communication aids and assistive technology to minimise the impact of communication difficulties following a stroke.

Eating, drinking and swallowing

Up to 78% of stroke survivors will initially experience some level of difficulty in swallowing (dysphagia). This results in an increased risk of malnutrition and dehydration, choking and aspiration.

Speech and language therapists assess and support stroke survivors to minimise the risk of aspiration and choking. If left untreated, swallowing difficulties can result in aspiration pneumonia, increased hospital admissions and longer hospital stays.

Dysphagia therapy is important to avoid further health complications. Many people enjoy eating and drinking and it can be an important part of our social life. Stroke survivors with dysphagia may report feeling embarrassed about eating and drinking in front of others, and may become socially isolated. 

Speech and language therapists also support stroke survivors to enjoy food and drink as safely as possible and devise strategies for them to enjoy and be involved in eating out and socialising.

May is national Stroke Awareness Month, and as a timely reminder, I’d like to share the FAST test, which is recommended by the NHS to help people to identify the symptoms of stroke:

• Face – the face may have dropped on one side, the person may not be able to smile, or their mouth or eye may have dropped
• Arms – the person with suspected stroke may not be able to lift both arms and keep them there because of weakness or numbness in one arm
• Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake; they may also have problems understanding what you're saying to them
• Time – it's time to dial 999 immediately if you see any of these signs or symptoms

There are three different types of strokes:

• Ischaemic stroke – occurs when the arteries that lead to your brain are blocked or narrowed, preventing blood from reaching the brain
• Haemorrhagic stroke – caused by a leaking or ruptured blood vessel in your brain, which damages brain tissue, preventing the flow of blood and oxygen
• Transient ischaemic attack (TIA) – also known as a mini-stroke, is a temporary decrease in the brain’s blood supply and does not cause lasting damage

Our rehabilitation programme for those living with the effects of stroke is holistic and encompasses all aspects of neurorehabilitation, including:

• Physical
• Behavioural
• Cognitive
• Emotional
• Communication
• Social

Resources​

• Stroke Association’s State of the Nation report
• Public Health England
• NHS stroke information page