Case 20- Speech and stroke Flashcards
1
Q
Difficulties faced by patients with language impairement
A
- Difficulty exchanging information accurately with health professionals
- Potential exclusion from shared decision making approaches
- Loss of autonomy- by having to rely on others to communicate
- Increased risk of adverse events in health care
- Being treated as if they have a cognitive impairment when they don’t
2
Q
Patient centred strategies to enhance communication with a patient who has a language impairement
A
- Aim for a quiet, well-lit environment, avoiding distractions (TV, radio etc).
- If the person normally wear glasses, hearing aid or dentures, make sure these are available.
- Make sure the patient’s other needs are met before you begin (e.g. they are not hungry or in pain).
- Choose the time of day when your patient communicates best.
- Assume the person can hear and understand well, in spite of any difficulties responding, unless you learn otherwise.
- Listen carefully as well as speaking – you can gain a lot of additional information from facial expression, gesture and eye contact
- Allow extra time
3
Q
FRAME model- highlights five areas of communication adjustment
A
- F: familiarise yourself with how your patient communicates before starting the medical interaction
- R: reduce rate
- A: assist patient with communication
- M: mix communication methods
- E: engage patient to respect their autonomy
4
Q
FRAME model- F
A
- Ensure the patient has some way to express himself or herself.
- Ask the patient about preferences for communication or existing strategies.
- Assess how well the patient can understand what you say
- Clarify the role of others present (family) and if the patient wishes them to be involved in helping with communication.
5
Q
FRAME model- R (reduce rate)
A
- Allow the patient sufficient time to process information and formulate responses.
- Speak slowly and clearly in a normal tone of voice
- Use short phrases and short chunks of information if patient has comprehension problems.
- Stick to one topic at a time and emphasise key words
- Have an attitude of patience and reassure patient it is ok to “take your time.”
6
Q
FRAME model- A (assist patient with communication)
A
- Be willing to “step forward” to help with communication; do not sit back and wait for the patient to fix communication breakdowns.
- Confirm understanding and that you are communicating successfully with closed checking questions to confirm “yes” and “no”.
- Don’t pretend to understand. If you’re having difficulty, be honest and tell your patient: “I’m sorry, I don’t understand – let’s try again.”
- Be flexible to try different strategies until you find something that works. The same patient may need different strategies at different times.
- Use the “least restrictive” accommodation (do not limit the patient to yes/no responses if they are able to communicate more than that).
6
Q
FRAME model- A (assist patient with communication)
A
- Be willing to “step forward” to help with communication; do not sit back and wait for the patient to fix communication breakdowns.
- Confirm understanding and that you are communicating successfully with closed checking questions to confirm “yes” and “no”.
- Don’t pretend to understand. If you’re having difficulty, be honest and tell your patient: “I’m sorry, I don’t understand – let’s try again.”
- Be flexible to try different strategies until you find something that works. The same patient may need different strategies at different times.
- Use the “least restrictive” accommodation (do not limit the patient to yes/no responses if they are able to communicate more than that).
7
Q
FRAME model- M (mix communication methods)
A
- Do not rely solely on speaking and listening; SHOW, don’t just TELL.
- Use body language, gestures, pictures, writing, drawing to supplement spoken language.
- Have communication aids (picture boards, alphabet boards, white boards, and pens/paper) readily available for patients; customize picture boards for the vocabulary and concepts you use in your setting.
- Use these different modalities to help patients with comprehension problems understand what you are saying.
- Encourage patients who have expressive impairments to use these different modalities to help them convey their messages.
- Allow extra time for patients who use augmentative and alternative communication devices to enter messages into the device.
8
Q
FRAME model- E (engage patients)
A
- Speak directly with the patient; family members should help you communicate WITH the patient, but they should not communicate FOR the patient.
- Do not “talk down” to patients—keep your tone of voice natural, respectful, and appropriate to the age of the patient.
- Resist the urge to interrupt, finish sentences or offer words; ask the patient if it is OK to guess at what they are trying to communicate
- Interact with the patient as you would other patients including social banter to build rapport, soliciting patient viewpoints, and providing full information and education.
9
Q
Aphasia
A
A language disorder that results from damage to those areas of the brain that are responsible for language. It can affect understanding of spoken communication of written communication (reading), spoken production of language and written expression (writing) leaving other cognitive abilities and intellect intact. Incidence:
1) Stroke- one third are left with a communication disability
10
Q
Types of aphasia- the Classical approach
A
- Injury to the left hemisphere
- Type of aphasia
- Syndrome defined by characteristic features- fluency of speech, level of understanding, ability to repeat
11
Q
Wernicke-Lichtheim-Geschwind model
A
- Word meaning- distributed across cortex
- Broca’s area- centre of motor world image
- Output from Broca’s area to motor nuclei
- Wernicke’s area- centre of acoustic word image
- Input to Wernicke’s area from sub cortical regions
12
Q
Types of aphasia
A
- Broca’s aphasia
- Wernicke’s aphasia
- Damage to the arcuate fasciculus- conductive aphasia
- Damage to Broca’s and Wernicke’s area- Global aphasia
- Damage to the anterior superior frontal lobe of the language dominant hemisphere- transcortical motor aphasia
- Damage to specific area of the temporal lobe- Transcortical sensory aphasia
- Anomic aphasia
13
Q
Symptoms of the different types of aphasia
A
- Anomic aphasia- good repetition, good comprehension, fluent
- Conduction aphasia- impaired repetition, good comprehension, fluent
- Transcortical sensory aphasia- good repetition, impaired comprehension, fluent
- Wernicke’s aphasia- impaired repetition, impaired comprehension, fluent
- Transcortical motor aphasia- good repetition, good comprehension, non-fluent
- Broca’s aphasia- impaired repetition, good comprehension, non-fluent
- Mixed transcortical aphasia- good repetition, impaired comprehension, non-fluent
- Global aphasia- impaired repetition, impaired comprehension
14
Q
Broca’s aphasia
A
- Non fluent agrammatic speech= simplified sentence, nouns>verbs
- Halting, effortful, dysprosodic production
- Impaired non-fluent repetition
- Good functional comprehension but asyntactic comprehension on testing
15
Q
Wernicke’s aphasia
A
- Fluent pragmatic speech- normal sentence structure, empty content, either English jargon and/or neologisms
- Repetition as spontaneous speech
- Prominent comprehension difficulties
16
Q
Anomic aphasia
A
- Fluent grammatical speech
- Poor word retrieval- impaired spoken naming, naming to definition and verbal fluency. Evidence of word finding difficulties in connected speech. ‘Tip of the Tongue’ feeling.
- Production of words with similar meaning i.e. cat instead of dog. Or production of words with similar sounds like ‘cap’ instead of ‘cat.
- Intact repetition
- Intact comprehension
17
Q
Importance of aphasia
A
Language and communication is essential for participating in everyday tasks. It is the foundation of our relationship with other people. People with aphasia: • Loss of communicative competence • Loss of family roles • Loss of employment and societal roles • Report a ‘loss of self’ • Isolation • Loss of self-confidence and self esteem • Depression and reduced quality of life
18
Q
Speech- helping the person to understand
A
- Reduce background noise/distractions
- Keeping your language clear and simple
- Using short phrases and sentences to communicate
- Using all forms of communication to reinforce what you are saying
- Give the person time to take in what you say and to respond
19
Q
Speech- helping the person to communicate
A
- Don’t interrupt- ask if the person wants help
- Look as well as listen- you will get information from natural gestures, facial expression and body language
- Encourage and accept all forms of communication
- Asking careful questions- yes or no, forced alternatives
- If your having difficulty understanding their communication, be honest and tell them to repeat
