Stroke patients can keep recovering, even after a year

One takeaway from a recent story about stroke recovery shows something to remember - "it's highly unethical to say nothing can be done after 12 months" in recovery. Personally, it took me years to get back to my almost-100 percent recovery. Stroke recovery can be incremental.

Now, will horses and music definitely help? One small study doesn't prove that it does, but it's worth studying further. Read how long-term stroke survivors believe they do better with horse, music therapy:

A small Swedish study of stroke patients finds that activities such as horseback riding and rhythm-and-music therapy can help them feel like they're recovering faster, even if their stroke occurred years earlier.

Positive research development for those facing a weakened hand

Stroke is the most common reason for adult disability in the United States - thousands each year have weakened limbs.

One area of research is electrical stimulation, and some positive news recently highlighted that innovative electrical stimulation glove improves hand function:

According to new research published in the American Heart Association journal Stroke, researchers at the MetroHealth System, Case Western Reserve University, and the Cleveland Functional Electrical Stimulation Center have developed a therapy whereby patients can be in control of the stimulation to their weak hand.

How I learned about aphasia and intelligence - the hard way

The note on the right was written by my wife back in 1998. I was trying to say "Jonesboro," the last word on the list. Instead, I said the top three words on the list.

Nonsense, in other words. And maddening, in that I knew what I was trying to say but something was in the way. My intelligence was intact - just couldn't get out.

I'd never heard of aphasia before I had my stroke. Now, you do see it in the news from time to time, but it's still frequently misunderstood.

Here's a good rundown on how aphasia is a little-known, yet growing, health problem:

At least 25 percent of the estimated 795,000 Americans who will have a stroke this year will acquire aphasia, according to Williamson's nonprofit organization. Symptoms can vary widely. While many have trouble speaking, others also struggle to process words being spoken to them, to read and to write.

Past routine therapy - brain stimulation via electrodes

Brain stimulation - perhaps a key to improving stroke recovery.

The more it's offered, recent research suggests, the better the recovery. In my own experience, I tried to do at least something every day as "brain stimulation" via reading, writing and other mental exercise. Now, they are talking about applying stimulation via electrodes. And the research indicates that brain stimulation after stroke aids recovery:

Stroke patients undergoing rehabilitation who receive repeated brain stimulation do better in terms of recovering movement than those who don't, a new study shows. ...

How would you cope with saying just two words?

I feel for this man - a stroke takes away most of his speech ability and leaves him with physical issues.

It's hugely frustrating when you can understand what is said, but you respond only with difficulty. I struggled after mine, and the man in the story below is having a far worse time in that sense. But as mentioned here more than once, aphasia doesn't decrease intelligence.

Follow this link to read about the man who can only say yes and no:

It's not strictly true that Graham can only say "yes" and "no". He can say "and", "no" and "mmm", which means yes, and he also makes an "urr" sound. When he says "and urr…" it means he has something else to say and wants you guess what it is. ...

Singing for stroke patients - aphasia therapy

I've previously told my story about how singing seemed to help in my recovery from aphasia, an effect of my 1998 stroke.

Now, here's another story of how singing does stroke patients good:

Photo from Scott W. Vincent via Flickr

In a hospital atrium at Mount Sinai Beth Israel this week, a choir gave its first public performance. Wearing light-up necklaces and accompanied by drums and guitar, the performers rang bells and sang such holiday classics as “Silver Bells” and “Joy to the World,” occasionally breaking out in harmony.

Language skills and aphasia recovery - connected?

Should have taken those French classes in high school.

Turns out that for stroke patients suffering from aphasia, a language problem that affects thousands a year, bilingual brains sustain less stroke damage:

Compared to patients who spoke only one language, bilingual stroke patients were more than twice as likely to have normal cognition following their stroke and they also performed better on tests measuring post-stroke attention and function.

But the two groups had similar frequencies of aphasia, at 11.8% among monolinguals and 10.5% among bilinguals (P=0.354), which might be explained by a higher level of cognitive control in patients speaking two or more languages, Suvarna Alladi, DM, of Nizam's Institute of Medical Sciences in Hyderabad, India, and colleagues wrote online in Stroke.

Assigning homework for aphasia recovery patients

As you might have seen before, I used some technology myself in recovering from aphasia - a borrowed child's toy called GeoSafari. It was a teaching toy, and I was able to use it as a language-building tool.

Fast-forward 17 years, and we're more sophisticated now - snazzier video games, education toys, tablets - offering even more possibilities for aphasia recovery.

Plus, it gives a chance to study this on your own timetable. Check out the recent story how self-delivered speech therapy is feasible for aphasia patients:

Aphasia frustration - maybe spread-out therapy could help with recovery

It took a long time for my language skills to come back adequately - at least, under my definition of "adequately." One thing that persists over the last 17 years, though, is that when I am tired or stressed, speaking becomes harder.

So, this study makes a certain amount of sense to me - work too hard, you'll tire out. And initially, my stroke left me easily tired. This study looked at the time involved in speech therapy and recovering speech skills and found that aphasia recovery better when therapy is spread out:

Is something right happening in health care?

Something right might be happening.

In catching up on stroke-related news of late, I was reminded about a story showing that emergency departments are seeing fewer strokes and TIAs:

The rate of adult emergency department (ED) visits for ischemic stroke or TIA fell 35%, from 40 to 26 per 10,000 persons from 2001 to 2011 in the National Hospital Ambulatory Medical Care Survey (NHAMCS) data. The rates fell across age groups -- a relative 51% in the 55-to-74 range and 26% for those ages 75 and older, Anjali Talwalkar, MD, MPH, and Sayeedha Uddin, MD, MPH, both of the CDC's National Center for Health Statistics in Silver Spring, Md., reported in the March issue of NCHS Data Brief.

But among younger people who came to the ED for ischemic stroke or TIA, fewer were arriving by ambulance.

Strokes are generally preventable, with fairly common-sense diet, exercise and medication use leading those methods of prevention. I've put links under each of those categories, where you can read more about stroke prevention.

Stroke treatment is still vitally important, and improving stroke treatment through better medication, better therapy techniques and tools are key elements of stroke treatment. But preventing a stroke is the best treatment of all. So do what you can - the life you save could be your own.

Young stroke survivor finds strength in determination

Photo from the U.S.
Centers for Disease
Control and Prevention

Are we all destined to run after a stroke? No. BUT, I still like stories like this because they do illustrate that after a stroke, determination is often key.

If you've visited this blog before, you'll know that was a runner before my stroke in 1998, started running again several weeks later, and continue to run. People, though, have different outcomes - physical, speech, vision, etc. - and not everyone can run. In fact, as the last post noted, stroke is the most common cause of permanent disability in the United States.

But the story is more than running. It's about a stroke survivor who found strength, a story that can echo in other lives. People might have different levels of abilities and strengths, different disabilities, different challenges. The important thing is to keep those challenges challenged.

So, here's a link, an excerpt and a video about a young stroke survivor finds strength in running:

As more stroke patients survive, more needs arise

Photo from the National
Library of Medicine

You've likely seen recent stories about how more people survive strokes. Generally, a good news story.

However, as this story illustrates, it also means that as more stroke patients live, more need rehab treatment:

More stroke patients now survive brain attacks that would have killed them a few years ago, and stroke has dropped from the fourth- to the fifth-leading cause of death in the U.S., the federal government said in late 2014.

With higher survival rates comes an increasing need for stroke rehabilitation programs for people like Cleveland, 41, who deal with varying disabilities.

In fact, stroke is one of the leading causes of disability.

App might help with aphasia

My speech stopped then garbled on the day I had my stroke. It took me quite some time to get back close to normal,  thanks to speech therapists, family and friends.

Now, there's something that might help supplement speech therapy - a new app that puts speech therapy in patients' pockets:

Patients can use the app to practice matching pictures and associated words, according to Dr. Stephen Hughes, who helped build the app.

“So we’re looking at the kinds of things that they’re doing already with paper and pencil and saying, ‘Can we use the technology to help them manage that experience better?’” Hughes said.

The Name That! app isn’t meant to take the place of traditional treatment. Rather, the creators hope that it will supplement what speech therapists already do in sessions. Hughes and Burda are currently working on expanding the app’s simplistic design in order to fit more needs of aphasia patients.

I used some educational "toys" myself - really more suited to children learning English for the first time. But an app specifically tailored to people struggling with aphasia would be better. It's important to note that aphasia does not affect intelligence. The thoughts are there - aphasia causes difficulty in getting thoughts out.

Playing 'games' to improve recovery

We've see stories before about the idea of adapting video games and other technology for stroke recovery therapy.

As the motion sensor-based technology improves, more advances seem to be coming. For example, check this blurb and video how stroke recovery might be assisted by Microsoft's Kinect, specifically upper-limb motor functioning:

Stroke patients can get direct feedback about their recovery from the Kinect, which is able to capture the skeletal movements in real-time and relay the information back to the user. Stroke Recovery with Kinect features “three game-like exercises,” each of which requires the user to test his or her dexterity. This software could serve as an affordable, accessible addition to the recovery process for future sufferers. Check out a video of the program in action at Microsoft Research.

Brain therapy might help stroke rehab

Stroke is the leading cause of permanent disability in the United States. So many people need physical, occupational and speech therapy to recover. I recently read about research that might lead to better tools to help stroke patients to recover.

This article describes how brain therapy helps rehabilitate stroke patients:

A new interventional therapy that uses a brain–computer interface appears to change brain activity in patients with stroke, new research has shown.

The therapy alters specific areas of the brain that correlate with both the affected and unaffected hands. The activation of these areas of the brain appears to correspond to executed and imagined tasks of the affected hand, and may represent neuroplastic recovery.

"Brain activity fed back to the patient is key for the therapy," explained Vivek Prabhakaran, MD, director of functional neuroimaging in radiology at the University of Wisconsin in Madison.

(Photo from the University of Wisconsin School of Medicine and Public Health) 

New treatments for those going through aphasia

Catching up on news about aphasia, which I went through after my stroke some years ago. Check out the story on how new treatments may help restore speech lost to aphasia:

But technology, Riedel said, has introduced new language-improvement techniques into the mix over the last few years that are both exciting and fun. Several apps available for iPhone or iPad involve synthetic speech that helps engage those with aphasia in yet another realm of communication.

"Our patients have much more access to different kinds of programs that are computer-based," she said. "There's always something new around the corner."

What remains a constant concern, however, is the misunderstanding many people have of those with language difficulties and how to treat them, Ganzfried and Riedel agreed.

"Many people with aphasia will become socially isolated because of their communication difficulties, which can lead to depression," Ganzfried said. "There are also many misconceptions about aphasia, including that the person is mentally unstable or under the influence of drugs or alcohol. It's also extremely frustrating. Imagine knowing what you want to say in your head but you can't get the words out."

This problem can indeed by frustrating. It doesn't affect your level of intelligence - just getting those thoughts out in the form of language.

What the heck is aphasia?

If you've read this blog much, you'll know. But most people don't know much about aphasia, a language disorder that affects many stroke patients.

June is Aphasia Awareness Month, and my Google alerts found an article with a great point: People with aphasia can struggle to find the right words, use the wrong words, or speak haltingly, or speak very little.

All that being said - and I've been through all of those things myself - aphasia does not remove your intellect. People with aphasia are, by and large, just as intelligent as always. The problem is not intelligent. The problem is language.

I found this article on the National Aphasia Association website - sorry, but the PDF version is the only one I could find. A few sentences:

A National Aphasia Association survey found that because of their difficulty in communicating, over 70% of people with aphasia report that people avoided contact with them and 90 percent felt isolated, left out, ignored and lonely. This isolation, coupled with the fact that intellect remains intact, makes depression another serious result of aphasia.

Try to imagine what your life would be like if you suddenly were not able to communicate any longer. Every aspect of your life would be forever changed. Your role and responsibilities in your family would change. Your relationships with friends and colleagues would change. Completing everyday tasks like making a phone call, driving, shopping, dining out or getting cash at the bank, would become challenging or perhaps impossible without assistance, even though your intellect would remain intact.

Most of my signs of aphasia were effectively treated by speech therapy (an often unheralded but important line of work). It still can emerge during a time of stress or fatigue, which still can be frustrating.

But do know that someone you know with aphasia is still there - intellect and all.

We're all one in several billion

Interesting article was caught in my Google alert about the increasing number of different therapy techniques notes, wisely, that each stroke patient is unique and needs a special approach for best outcome. The article, in McKnight's Long Term Care News, focused on long-term care patients, but the same is true for us all:

Determining the best therapy approach isn't easy because each stroke incident, degree of impairment, rate of recovery and overall outcome is as unique as the residents themselves. Treatment approaches, too, are anything but one-size-fits-all. The good news is an ever-growing array of stroke-recovery therapies and supplemental — and, in some cases, experimental — practices are allowing therapists to add some new and promising treatment approaches to their arsenal.

“We know that the brain has a remarkable ability to regain lost function, and we also know that the route each person can take toward recovery can be very different. What works for one person might not provide the same result in another, and the goals and priorities will also differ from one person to the next, which is why therapy must be tailored to each individual,” says Jan Davis, MS, OTR/L, president and founder of International Clinical Educators Inc. She's also the spokeswoman for the American Occupational Therapy Association on issues related to stroke rehabilitation.

Aphasia treatment can be costly

Aphasia - language problems that can often be the result of a stroke - can be costly. But I'm grateful that despite aphasia after my own stroke, I was allowed to have speech therapy to bring back my language abilities to stay a productive member of society.

So when you read about how post-stroke speech problems inflate cost of treatment, remember that (1) preventing strokes can save lives and health care dollars and (2) the cost of speech therapy is small compared to the cost of doing nothing.

Help in regaining lost speech drive up medical bills, the researchers found. Medicare payments averaged over $20,700 for those with aphasia compared to about $18,700 for those without these language difficulties, an 8.5 percent difference.

The researchers also found that patients with aphasia were older and suffered more severe strokes, stayed in health care facilities 6.5 percent longer than those without impaired language, and had higher rates of illness and death.

The study appears Feb. 16 in the journal Stroke.

Each year in the United States, strokes leave about 100,000 people with language impairment.

"These findings are important because dramatic changes are occurring in health care reimbursement, specifically imposed caps on Medicare reimbursement for outpatient speech language pathology and physical therapy," study lead author Charles Ellis Jr., an associate professor of health sciences and research at the Medical University of South Carolina in Charleston, said in a journal news release.

Combo therapy may ease fatigue after stroke

I certainly relate to the chronic fatigue that happens after a stroke. It seemed to sap energy for quite some time. I was convinced at the time that going back to running helped greatly to help get past chronic fatigue.

And now, researchers have found that combo therapy may ease fatigue after stroke, as reported by Reuters Health:

The researchers recruited 83 patients who were suffering from chronic fatigue an average of four years after having a stroke.

Half were randomly assigned to 12 weeks of cognitive therapy alone, and half had cognitive therapy plus the exercise training. ...

After 12 weeks, the study found, 58 percent of patients receiving both therapies had a "clinically relevant" improvement in their fatigue, based on questionnaires. That compared with 24 percent of patients who'd had only cognitive therapy.

A clinically relevant improvement meant that patients had noticeable changes in their daily activities, [lead researcher Aglaia] Zedlitz said.

The findings, reported in the journal Stroke, suggest that a combination of cognitive therapy and exercise might help post-stroke fatigue.

(Photo from the National Institutes of Health)