- What is Aphasia?
- How many people have Aphasia?
- How are aphasia syndromes classified?
- What is the benefit of group therapy for aphasia?
- I was told my family member with aphasia has reached a “plateau” and can’t benefit from further therapy. Can gains still be made months or years after a stroke?
- Why isn’t the Aphasia Group Program covered by insurance?
- What is Apraxia?
- What is Dysarthria?
- What are the typical speech symptoms in Parkinson’s Disease?
- Can the LSVT program for Parkinson’s Disease be spread out over 8 weeks, twice a week?
- How long do the results from LSVT last?
- Why is daily vocal exercise needed in LSVT?
- Why does the LSVT program only target vocal loudness? My family member with PD also speaks too quickly and mumbles.
- What are the typical swallowing symptoms in Parkinson’s Disease?
- Why should we be concerned about swallowing difficulties?
- What should I do if I suspect a swallowing difficulty?
- What is dysphagia?
- Can I be evaluated and treated for swallowing disorders at The TalkSpot?
- Is the LSVT program covered by Medicare?
Aphasia is a LANGUAGE disorder, typically caused by a stroke. The person who has aphasia will have difficulty understanding and using language. However, cognitive abilities, such as memory, reasoning, problem solving and attention are INTACT. The person's intellectual skills have not been affected. The areas that ARE affected are the four “language domains,” speaking, understanding, reading and writing. These areas will be affected to different degrees, depending on the location and severity of the stroke.
There are a number of different “aphasic syndromes” depending on the specific symptoms an individual has. At the most basic level, aphasia is a difficulty retrieving the right words to express thoughts. No two people with aphasia are exactly alike; some may understand what they hear very well, but have trouble thinking of the right words to formulate phrases or sentences. Others may have much difficulty with listening comprehension, and speak easily with many “wrong” words coming out. Some people have difficulty both understanding and speaking, even for simple information. Many people have trouble with spelling and reading comprehension, even for single words. Others may read paragraphs or short articles well, but have difficulty comprehending a whole book.
It is estimated that over 1 million people have Aphasia in The United States. Approximately 50,000–60,000 people are newly diagnosed with Aphasia each year, and 25–40% of people who’ve had a stroke have some degree of Aphasia.
Aphasia syndromes are split into two groups. Those considered “fluent” and those considered “non-fluent.” People with a fluent aphasia speak easily and effortlessly, yet may often use the wrong words or even made-up words. They may or may not be aware of these errors. Their way of speaking can be very long-winded and not always directly to the point. You may notice very few nouns in their speech. Someone with fluent aphasia may say “in the time of water the one who is there under when going is to using the rod” to mean “The boy is going fishing.”
Those who have “non-fluent” aphasia may not speak at all, or may speak in single words or short phrases, usually with much effort and hesitancy. They may struggle when trying to think of the word they want, and then get the wrong word or a word that is mostly correct but with one or two sounds incorrect. They are usually aware of their errors. You will notice mostly just nouns, strung together without much grammar (such as past tense or plurals) or “little words” (such as and, on, the). Someone with non-fluent aphasia may say “boy…fish…go” to mean “The boy is going fishing.”
These two groups of aphasia are further delineated depending on how much a person can understand what they hear or read and on how well they can repeat words and phrases after another person. Once all factors are looked at, a diagnosis may be made of Broca's Aphasia, Trans-Cortical Motor Aphasia, Global Aphasia (all non-fluent) OR Wernicke's Aphasia, Trans-Cortical Sensory Aphasia, Conduction Aphasia or Anomic Aphasia (all fluent). These classifications can be helpful in understanding an individual's skills, but there are many people whose aphasia doesn't fit neatly into one of these diagnostic categories, and may show symptoms across several types of aphasia.
Group therapy provides a normal social environment in which adults can converse and practice their speech and language skills. Therapy is provided at a conversational level, rather than traditional speech therapy, which addresses individual skills such as understanding single words or naming objects. Group therapy allows for communication to happen in a natural environment — conversation with other adults. In addition, there is great benefit to the social aspects of conversation as well as the benefit of meeting and getting to know others with similar communication challenges. Beyond conversation and therapy, the group provides mutual support and understanding among members. Studies have shown that group therapy for aphasia is at least as beneficial as individual therapy and that in certain situations individuals actually demonstrate BETTER communication skills in the group environment.
I was told my family member with aphasia has reached a “plateau” and can’t benefit from further therapy. Can gains still be made months or years after a stroke?
“Plateau” is a term often used by insurance companies to provide a rationale for ending speech therapy. Insurance companies will only pay for therapy for the initial stages following a stroke, and demand rapid progress. The truth is, that studies of long-term rehabilitation efforts show that gains may be made over a long period of time for people living with aphasia, if they are allowed access to therapy. The approach at The TalkSpot and other centers embracing “The Life Participation Approach for Aphasia therapy” is that low-cost group therapy may be provided over the long term allowing for continued progress in speech and language skills. In addition, this type of program allows for new learning in many areas (music, art, computers, etc), social connectedness, mutual support among members, and pursuit of social and recreational relationships and interests.
Insurance will typically only cover Speech Language Pathology services (ie: speech therapy) for the initial months following a stroke, typically in individual sessions. This program is designed to allow for ongoing therapy beyond the initial stages of recovery, and so by definition doesn’t fit the kind of therapy typically covered by insurance. We are striving to provide ongoing support and therapy for those for whom insurance benefits have run out. In addition, Medicare will only cover group therapy if it makes up 25% or less of the therapy being provided (ie, client must receive 3 individual sessions for each group session).
Apraxia is a SPEECH disorder that often occurs with Aphasia. It is a difficulty in the “motor planning and sequencing” that is needed to produce speech. In order for a person to speak, his brain needs to set up a “motor program” telling all of the muscles where to move and when, coordinating movements in the correct order to produce a given word. So, for instance to produce “pen,” the brain needs to tell all the muscles how they need to move to produce each sound, p-e-n, and then to do this in the correct order. In Apraxia, this motor program becomes mis-sequenced, and the sounds may be produced in the wrong order and even influenced by other sounds in the phrase. “Pen” may come out like “nen” or a longer phrase, “New York City” may come out “Ew Nork Nity.” Errors can be inconsistent and not always predictable, and the person is typically very aware of the mis-produced words. One client described it as “my tongue can't contort.”
Dysarthria is a SPEECH disorder that may occur with Aphasia or Apraxia, or on its own. It is simply a muscle weakness in the muscles used for speech, including the tongue and lips. Speech may sound slurred or mumbled or be very quiet or sound too nasal. Sound errors are usually predictable and consistent.
The progression of symptoms in Parkinson’s Disease is not predictable. However, most people with PD do eventually have some difficulty with their speech. Typical symptoms are rapid speech, quiet speech and poorly articulated or “mumbled” speech.
Extensive research studies have been done on the best frequency and intensity for the LSVT program. To achieve the best results in improved speech intelligibility, the program MUST be delivered 4 times weekly for 45-60 min sessions for 4 weeks. Although less intense programs have been studied, the benefits have not been the same.
Clients are giving a daily program to continue after therapy ends, made up of simple vocal exercises that need to be completed daily, for a total of about 20 minutes. When this ongoing program is followed, clients have been shown to have lasting effects of the intensive therapy program for over a year; this is in the face of a disease that is progressive.
While in therapy, clients will complete “at-home” vocal exercises 1-2 times daily for 10-15 minutes each time. Just like in any exercise program, vocal and respiratory muscles must be used and exercised daily to maintain function and use. This is especially true for people living with progressive diseases affecting muscle use, such as those with Parkinson’s Disease.
Why does the LSVT program only target vocal loudness? My family member with PD also speaks too quickly and mumbles.
LSVT targets loudness ONLY, because this speech target has been shown to have a “spread of effects.” In other words, in producing louder speech, clients will automatically use a slower rate and improved articulation as they move through the hierarchy of speech exercises with the therapist. Given that focusing on only one factor, loudness, produces these other changes, the program can be kept very simple, which in turn allows for greater success. In addition, studies have shown an improvement in facial responsiveness in people going through LSVT, as well as improvements in swallowing function.
Most people with Parkinson’s Disease, do at some point have some degree of difficulty with swallowing. Some of the symptoms include coughing when eating or drinking, or more subtly, just throat clearing during meals. Coughing may be only occasional; it need not be consistent to indicate a problem with swallowing. A wet, gurgly vocal quality can also tip you off to a swallowing difficulty.
Difficulty with swallowing can allow food, or more often liquid, to enter into the airway and lungs. This can lead to pneumonia.
If you suspect difficulty with swallowing, please let your neurologist or doctor know as soon as possible and schedule an appointment with a Speech Language Pathologist who is experienced in evaluating and treating neurologically based swallowing disorders. Exercises, therapy techniques and food modification can prevent aspiration of food into the lungs and reduce the risk for pneumonia.
Dysphagia is the medical term for “swallowing disorder.”
Yes, our therapists have extensive knowledge of swallowing disorders and can evaluate and treat difficulties in this area.
Yes, this program is covered by Medicare if the individual has had a reduction in the ability to communicate verbally. Other insurances will be considered on a case by case basis.