Aphasia Definition: Aphasia is an acquired language disorder resulting in a deficit of language functionality.
Aphasia does not affect intelligence or diminish intellectual ability.
Aphasia can result in impaired ability to comprehend written or spoken language, and difficulty producing the correct words in sequence to properly communicate.
Aphasia is the result of damage to the brain in one or more of the brain’s language areas, and usually occurs suddenly as the result of brain-damaging incidents such as traumatic head injury or stroke, but can also occur gradually with such conditions as dementia or brain tumors.
The term aphasia commonly refers to all degrees of language impairment, from partial to total, though classically the term indicated total language impairment.
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Does Medicare cover the costs of Speech therapy?
In 2010 Medicare benefits cover a maximum of $1,860 of physical and speech therapy expenses combined.
These limits apply to therapy conducted in the therapist’s office or facility, in an outpatient facility, in a skilled nursing facility, or in-home through a home health care agency.
The limits do not apply to outpatient therapy at a hospital’s outpatient department.
Prior to January 1st, 2010, there was an exception process to get coverage for additional therapy that your provider deemed medically necessary. That exception process has expired, but Congress is expected to enact an extension soon.
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What Is Primary Progressive Aphasia?
Unlike most other forms of aphasia which are caused by lesions or damaged areas to the brain, Primary Progressive Aphasia (PPA) is caused by brain cell degeneration, and is considered a form of dementia.
Primary Progressive Aphasia progresses gradually from initial symptoms including difficulty finding words and worsening to severe inability to communicate verbally. As is more typical with dementia cases than aphasia cases, memory, reasoning and other mental functions decline in patients with Primary Progressive Aphasia.
Brain Disease Causes of Primary Progressive Aphasia
Treatment of Primary Progressive Aphasia
There are presently no known cures for the degenerative brain diseases that cause primary Primary Progressive Aphasia.
There is currently no recommended pharmacological treatment for Primary Progressive Aphasia.
Therapy for Primary Progressive Aphasia
As with other forms of the aphasia, Speech language therapy focused on the language skills of the impaired is helpful for Primary Progressive Aphasia patients.
Exploration of alternate forms of communication such as gestures, drawing, and other non-verbal cues may also be helpful measures to restore functionality to the patient.
Aphasia inhibits the patient’s ability to communicate thus to express their feelings. Patients suffering from aphasia may experience depression and a sense of hopelessness.
Maintaining positive mental attitude is a key ingredient to successful rehabilitation. Encourage the patient, and praise their successes.
Be cautious of the line between encouraging them towards success, and pushing them beyond their current abilities and to frustration.
Here are a few tips for families and loved ones of those who are suffering from aphasia:
• Always ask them to be involved in family matters. Though they seem to be reluctant about it, encourage them in that way they can still feel their self-worth.
• Ask questions that are simple and answerable by yes or no. This makes expressing opinions and thoughts less stressful for them.
• Give them time to formulate the words to express their thoughts, and do not assist or interrupt them unless you see they are becoming frustrated. Let them know you value their opinion and that what they have to say is important.
• Keep things as customary as possible. Avoid making the person with aphasia feel like they are viewed as ”disabled”. Aphasia symptoms are linguistic communication deficits, not deficits in intelligence.
• Avoid background noise and make sure that you have the person’s attention before even starting the conversation. This makes verbal communication easier.
• Simplify conversations and encourage the use of physical gestures, o aid communication.
• Do not speak more loudly than usual, aphasia does not make the patient hard of hearing.
• Praises for positive improvement in their means of communication. This lets them know that you are involved with their recovery encourages them to work harder.
• Discuss with the patient the possibility of participation in therapy groups. Sharing others success is encouraging, and participation in the group reminds them that they are not alone.
Aphasia does not mean lack of intelligence. Above all else, be natural in your dealings. Don’t be condescending, and you don’t have to pretend the aphasia doesn’t exist. Let the aphasia sufferer know that their input is welcome, and you support their efforts.
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Study on the Effectiveness of Acupuncture to Recovering Stroke Patients
Emperors College of Traditional Oriental Medicine conducted a pilot study funded by a $40,000 grant from The Center for Integrative Health, Medicine and Research to study the effectiveness of acupuncture in stroke patients’ rehabilitation.
The official journal of the American Society of Neurorehabilitation published the results, indicating that acupuncture in conjunction with conventional stroke rehabilitation therapy showed “statistically significant” rehabilitative progress as compared to conventional rehabilitation methods alone.
Prior studies on the effectiveness of acupuncture applied to recovering stroke patients proved inconclusive.
Twenty-nine Recent Stroke Patients Tested
The trial took place at the Daniel Freeman Rehabilitation Center in Los Angeles California. Twenty-nine recent stroke patients suffering in hemiparesi, or weakness on one side of the body, were randomly divided into a control group and an acupuncture group.
The control group was administered a traditional regime of physical, occupational, and speech therapy six days per week. The acupuncture group receives 30 minutes of acupuncture 7 days per week for two weeks during in addition to the traditional therapy methods.
Improvement in Lower Extremity Mobility and Pain Level
Analysis of the overall data did not show any significant difference in physical performance between groups. But a more detailed analysis indicated significantly greater motor functionality of the lower extremities in addition to slight improvement in lower extremity joint pain.
Researchers noted that the acupuncture group show significant improvement in ability for tub and shower transfer as well as toilet transfer mobility.
Insurance Considerations
Presently most insurance carriers consider acupuncture treatment for post a stroke rehabilitation to be experimental therapy and therefore excluded from policy coverage.
There are many levels of services provided by inpatient facilities and institutions:
- Building Facilities and Maintenance
- Food Service
- Nursing
- Medical Team
- Rehabilitation Team
- Social Services
- Dietary and food service
The unfortunate reality is that even in the finest institutions there is often a disconnect between these services, and in reality a length inpatient stay is likely to be riddled with a seemingly endless string of battles to obtain an acceptable level of service in each of these areas.
It is crucial to successful rehabilitation that patient’s positive attitude be nurtured and supported, and that they are permitted the liberty to focus on their rehabilitation, as well as the psychological adjustments implicit in coming to terms with their trauma.
A strong patient advocate can alleviate the patient of burden of managing all of those may services, and insure that the deserved quality of service is delivered.
Examples:
- Insure medicines and drug therapies administered by the nursing staff are as prescribed by their corresponding medical team lead.
- Pursue remedy of any cleanliness issues in the patients accommodations.
- Insure that wheelchairs, walkers, and any other patient aids are delivered as prescribed, of the correct size and type, and in good functional order.
- Request remedy for any problems that may arise due to roommates such as disruptive behavior, excessive guests, or any other issue that interferes with the peaceful rest and recovery of the patient.
- Monitor the patients meals to insure that they fit any special dietary needs (mechanical, soft mechanical, etc), low or no salt, suitable to warfarin treatment, etc.
- It is unfortunate to have to say it, but there is also sometimes the need to correct the attitude of nursing staff towards the patient. The patient deserves of the nursing staff a professional if not cheerful demeanor in the performance of their duties. If this is not received, you are well within your rights to bring the situation to the attention of the head nurse, the head of nursing, and ultimately the institutions office of patient advocacy, if all else fails.
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How do I Become a Strong Patient Advocate?
- Become the patients Health Care Proxy (HCP). A Health Care Proxy is a person designated to make medical decisions as surrogate to the patient in instances in which the patient is unable to make the decisions for themselves. While this is of paramount importance in the case of dire medical emergency, there is an important fringe benefit inherent in HCP status, especially for those who are not the closest in functional relationship to the patient (i.e. husband or wife, child or parent). The fringe benefit is authority. Unfortunately it is commonplace in an institutional setting such as a hospital or rehabilitation facility for non-medical situations to arise that require remedy from the loved ones. A wheelchair may be mal-functioning, or a promised walker not delivered in a timely basis. Often the first line of defense from institution staff is to challenge your authority. Rather than receive your complaint, they may respond with “Who are you?”. The most effective response you can give to that challenge is: I am the primary patient advocate and health care proxy. In reality the HCP has absolutely no authority as long as the patient can make there own decisions, but I speak from experience when I tell you that phrase works.
Look for Part 2 in this series: Be There and Be Aware
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There is currently no recommended pharmacological treatment to aid rehabilitation of aphasia symptoms.
Testing on the drug piracetam has shown some promise of benefit to language functionality, but results in comparison to speech and language therapy were inconclusive, and potential benefit was were far outweighed by safety concerns.
Piracetam also acts as an anticoagulant and therefore can be extremely dangerous if taken by those undergoing warfarin therapy or other blood thinners.
Though piracetam is unregulated in the United States, it is extremely dangerous to self-prescribe piracetam therapy, especially for those with existing medical complications
Repetitive exercises which challenge the brain’s deficits are the key to rehabilitation.
Repetitive exercise will:
· Let the brain know the damaged areas are needed.
· Build new neural paths around the damaged area.
· Re-learn any lost acquired skills.
The brain is a marvel of resiliency, and perhaps the most awesome of all the world’s masterpieces.
Our brains develop neural networks, or paths, to interconnect all of the functions of our bodies, to store all of our memories, to process and produce intellectual material. When we are young, these networks are being formed: Our brains know how to generate themselves. When we suffer traumatic brain injury, a similar phenomenon takes place, but instead of generation, there is regeneration.
The badly damaged portions of the brain do not themselves regenerate, but instead the neural networks that tie everything together re-route around the damaged areas to reconnect the lost functionality. The secret to facilitating this regeneration is to understand that this process occurs on demand. Conversely, the process does not initiate given lack of demand.
Therapy and repetitive exercise that challenge the physical deficits forces the brain to create new paths to restore lost functionality.
A micro economics professor at Rutgers University began her series of lectures by making two strong points about the medical professions:
- Somebody has to be at the bottom of their class in medical school.
- People seldom perform comparison shopping for Medical services.
The first point speaks for itself. Not all health care providers are created equal. More so for therapists as the threshold for entry into rehabilitation therapy profession is much lower than the medical profession.
People seldom perform comparison shopping for medical services. In the case of accident or medical emergency, we may have little or no choice regarding the provider – it may be a function of the nearest facility, or lack of knowledge and exposure to know what organizations are best equipped handle the emergency. As for comparison shopping the costs, is it even thinkable to ask at emergency room admitting the costs of services?
Without proactive decision making, the course of all future service providers will be guided by the initial treatment center.
As health service providers are in business to make money, they operate in networks. A doctor may own a share of the imaging center he recommends. A hospital probably has an affiliation with rehabilitation providers, if they do not have their own in-house.
Medical and rehabilitation services are big business. Unfortunately the implications of that fact reveal that the primary motivation of providers is to make money.
Two big questions:
- Demonstrated proficiency
- Specific interest and compassion to your case.
Don’t be afraid to switch heath care providers
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A dear loved one of mine had a catastrophic stroke one day towards the end of summer in 2009. There are many stages that people go through; the patient and the family and the loved ones. But after the dust settles a bit there’s a great deal of information from a variety of sources to be filtered through and made sense of. Depending upon the particulars and severity of the incident and resulting deficits to the patient, there are likely to be:
- A neurologist
- A Cardiologist
- A rehabilitation doctor
- A neuro-ophthalmologist
- A physical Therapist
- A speech Therapist
- An occupational therapist
- A general MD
- a psychologist
My loved one received excellent emergency treatment at Tisch Hsopital, a part of NYU Langone Medical Center. The stroke ward was run like a Swiss watch – perfect communication, brilliant and dedicated teams of the finest doctors – all working successfully towards saving the patients life.
She went directly from Tisch Hospital to The Rusk Institute of Rehabilitation Medicine (they are in the same complex in Manhattan, New York). Things were a little bit different there. The nursing staff on the floor was completely disconnected from the rehabilitation staff. The team of Doctors that attended her care in emergency were rightfully attending the next emergency. Ira G Rashbaum M.D., who was her new rehabilitation doctor, played little more role than a brief comment to us, and to supervise the team of interns that visited each morning. The “swiss watch” was gone. We were on our own.
We had requested and received the clinical description of her stroke from her neurologist :
…There are bilateral clusters of diffusion restriction abnormalities of both cerebellar hemispheres, consistent with acute infarctions. Additional small lesions involve the cerebellar vermis, the brainstem at the level of the pons, and both thalami. These infarcts are within the vertebral basilar territory. The rest of the brain shows no signs of infarction. . .
Later an addendum was received:
The basilar artery is decreased in diameter, whish is in part, related to direct origin of the posterior cerebral arteries from the internal carotid arteries. Incomplete segmental visualization of the basilar artery suggests thrombosis or partial occlusion.
So we knew that. We knew she had what the neuro-ophthalmologist diagnosed as elevator palsy – a condition which produced vertically stacked double vision. We knew she couldn’t walk on her own to the bathroom, or feed herself. We saw deficits in her speech and in her ability to follow a minimally complex series of events . . . to be continued
