Learn the 4 Speech-Language Skill Areas   

Understand the 4 types of impairement so you can help your stroke survivor

Imagine waking up one day with the worst headache you’ve ever had, in a strange room with a needle stuck in your arm. You’re scared and in pain. To make matters worse, the people around you are speaking some foreign language and they can’t understand you. So you don’t even understand why you’re here, what has happened to your or what is going to happen next. Oh, and you desperately need to visit the bathroom.

Then you remember your stroke.

That gives you a brief taste of what it’s like have a stroke. If you’re a caregiver it helps immensely to empathize with the survivor. It provides important insights into what will frustrate them, and motivate them. In addition to empathy, you’ll also need a better understanding of what language skills are impaired and which are still largely intact, so that you’ll know what skills to work on and what skills can be used to compensate for the impaired ones. E.g., if they can’t speak but they can still read, they can point to what they want on the menu at a restaurant or on a communication board you can make for them (I'll cover that in a future article). Also, when we provide exercises for the patient to work on, we need to know what sorts of instructions they can understand. If they can’t speak or understand what is said them, then asking them to point to picture will be difficult for them.

We don't appreciate how language works until it doesn't

Language can be like a car.  It's a tool we use without understanding it.  Language is all in our head, where we can’t see it. It just works. Until it doesn’t. That’s when we realize how complicated language is. It’s like driving a car without needing to know how the transmission works. Until it stops working.  Then it’s helpful to have a rough idea of how it works. Maybe 2^nd Gear doesn't work.  But if you understand what the gears are, you know you can shift from 1^st to 3^rd. So, you use working gears to work around the damaged gears. 

When the brain is damaged, perhaps due to to stroke, we suddenly have to start thinking about things that “just worked” in order to help someone recover those skills. You need to know what those language skills are, and which are impaired, so that you know what skills to work on. This is not meant to replace a proper assessment from a speech & language pathologist (SLP), just to help caregivers appreciate and understand what aspects of language are impaired. If you have a written assessment from an SLP (or speech therapist) please review that. If you do not have one, I highly recommend having a therapist do a proper assessment of the patient’s skills and needs. You can ask your doctor for a referral to a speech therapist. If you can not afford a speech therapist, I’ll be covering (in a future article) where to find affordable (paying what you are able) treatment from the most enthusiastic speech therapists.

Using the remaining language skills makes life easier

Most caregivers tell me that the patient has some areas still unaffected. And you can use those skills to compensate for the impaired one(s) and provide hints and cues during the treatment of the impaired skills. e.g., if we know the survivor can read but has difficulty with written word retrieval then we can cue them with sentence-completion tasks. Likewise, at a restaurant, they can point to the menu item they want. They can also point to words or pictures on a  Communication Board. I'm working on an article on how to make your own Communication Board, or you can ask your speech therapist for one.

 I spoke with one caregiver over a decade ago who had to physically bring her husband (who outweighed her significantly) to the bathroom of their small mobile home every hour or so just in case he had “to go”. Eventually he learned a few words using speech therapy software.  But in the meantime, she could have shown him a few pictures (bathroom, kitchen, empty page) and let him point to the one he needed. Or, better yet, he could ring a bell to get her attention and then point to the picture. Speech therapists often create custom communication boards for this purpose. Or you can make one yourself (I’ll cover that in a future article) But, you have to start by understanding what communication is impaired.

Language skill-areas

• Expressive: Expressing our wishes to others by:
  • speaking
  • writing (or typing or spelling)
    Both of the above can be affected by Expressive Aphasia, which impairs the recall of words (in either speech or writing, often both)
• Receptive: Comprehending what others say or write to us, so, it's what we:
  • Hear
  • Read
    Both of these can be affected by Receptive Aphasia, which impairs the ability to comprehend what we read or hear.

Most people don't fully understand language because there's no need. It's all inside your head where you can't see it. But having a rough framework of the types of language can help you to better understand what the survivor can and cannot do.  It'll also help you understand the diagnosis from their speech therapist.  In the upcoming issues of this newsletter, I'll be diving into each of the skill areas and explaining (in plain-English) simple ways to grasp how severe their impairments are.

Coming up in your next issues....

You'll get free treatment exercises and and explanation of the levels of ability within each of these communication skills:

1. Reading Comprehension
2. Auditory Comprehension
3. Writing
4. Speaking