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Aphasia: treatment options

Aphasia: treatment options


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Therapy options for a central language disorder

In the case of aphasia, which is medically defined as a central speech disorder due to brain injury and occurs particularly as a result of a stroke, professional and individually tailored speech therapy treatment should be initiated as early as possible. In addition to needs-based language exercises, this also includes comprehensive information for those affected and their relatives on how to deal with the communication disorder. The symptoms often improve to a certain extent in the first few weeks through the body's self-healing powers. These can be further stimulated by natural healing methods and alternative methods.

A brief overview

In addition to the actual treatment measures, aphasia therapy always includes a precise diagnosis in order to determine individually required therapy methods. The most important facts about the diagnosis and therapy of aphasia are briefly summarized below. The further article provides detailed information in this regard.

  • Diagnosis: The precise assessment of existing aphasia and its individual expression (see: Aphasia: Forms and Symptoms) can usually be done better using a careful and personal approach during professional speech therapy than with the available standardized test procedures. Existing difficulties in the assessment must be taken into account in every situation in order to avoid incorrect conclusions. The diagnosis should be continuously checked and adjusted during the therapy period in order to achieve the best results.
  • Treatment using speech therapy: The central form of therapy is professional speech therapy, which should begin shortly after the event. Gradually, the language skills are slowly stimulated again and later restored as much as possible via intensive exercise units. At the same time, communication with relatives and the environment is of great importance and can achieve good improvements. The duration of therapy is very different and can be limited to a few weeks or extend over years.
  • Alternative forms of therapy: Various alternative treatments can be used to support the body's own healing powers and to create the most relaxed possible situation for the life of those affected and for learning. In addition to other methods, acupuncture or various relaxation methods can be used.

Diagnostics: preparation and monitoring of therapy

If there is aphasia as a central language disorder and communication disorder, it is important to make an exact diagnosis in order to plan the required therapy individually and to adapt it later. Established standard procedures, such as the Aachen Aphasia Test (AAT), can provide a sample and a snapshot of the possible form of the language deficits. However, such tests cannot claim general validity and can only be carried out and interpreted with great care.

In expert circles, it is recommended that such a test is only carried out if a relationship of trust has already been established with the person concerned and this apparent test situation does not represent an unreasonable burden. A poorly prepared test situation, for example due to excitement, poor daily health or unfavorable query constellations, can result in the actual language ability not being recorded. The following misinterpretations can have a negative impact on decisions regarding the necessity and form of therapy. Bad results can also reduce the motivation of those affected and the associated therapeutic success.

The AAT is often carried out repeatedly at different times, the results often being used as a follow-up. The difficulties mentioned, as well as other problems of assessing people with cerebral language disorders, must be taken into account in any type of test procedure or assessment of language and communication skills.

Especially at the beginning of treatment, other methods are often chosen that enable precise diagnostics and needs-based therapy planning and that support those affected with care and trust. First of all, it is very helpful if the treating person has all the necessary background information to be able to precisely assess the personal situation. These include all available medical and neurological examination results, the family situation and the social environment as well as the current status of communication skills with the environment. In the first therapy sessions, attempts are then made to find out through targeted conversations and other means of communication how much those affected can understand and communicate and to what extent they can write and read.

Since the disturbance patterns vary greatly, are subject to various individual factors and can change over time, so-called thermagnostics is also proposed. This is a diagnostic system that integrates the therapy at the same time. An initial diagnosis of language skills should be continuously supplemented and adjusted.

Professional speech therapy as a central form of therapy

A professional speech therapy as a central and indispensable therapeutic element is already derived from the diagnosis, which is carried out with speech therapy expertise. Aphasia therapy should start as early as possible, but even at a later point in time - even after years - it definitely makes sense and can make considerable progress under certain conditions.

The therapy goal should always be determined individually in order to find and develop the right forms of communication. Nevertheless, the first priority is always to achieve the best possible communication skills as quickly and carefully as possible. The aim is to get those affected out of their initial isolation. The path is usually less important than a good and trusting relationship between the sick and the therapist.

It should be borne in mind that although speech therapy makes a significant contribution to regaining communication skills, it is only possible to find one's way back into one's own language and to communicate independently through the support of other contact persons in everyday life. This includes other treatment providers, but above all close relatives, friends, acquaintances and the wider social environment. Through a constant and intensive exchange with the aphasic person, the closest contact persons have great influence on language development.

The methodology depends not only on the respective situation and personality of the person concerned, but also on the individual approach of the person treating the patient. In addition to the necessary individual therapies, speech therapy groups or other group meetings (e.g. self-help groups, psychotherapeutic groups) can also provide support.

Individual therapy is intended to help those affected to relearn the underlying language processes in order to communicate independently. This means that words, sentences and grammar are not practiced, as is known, for example, from learning a foreign language, but the rules and regulations leading to it are dealt with.

With all available methods and programs, care should be taken to stimulate and activate the existing skills of the person concerned and to unblock "blocked channels". The entire language behavior should be specifically and holistically stimulated. An important aspect for the success of therapy is a relaxed and relaxed learning atmosphere.

Learning elements for aphasias with different degrees of severity and different deficits can be selected and used individually from a large repertoire of different exercises. This can include, for example, completing a series of numbers, viewing and describing images, putting together individual words to form a sentence, writing and reading aloud on your own, or linking sounds and movements. In addition to targeted exercises, each therapy unit should also include free conversations and relaxation times.

The recognized therapist and aphasia specialist Dr. According to Luise Lutz, there are a number of principles that provide crucial building blocks for successful therapy:

  • Step-by-step practice and learning,
  • Use of different exercise forms and materials,
  • Addressing and linking all language modalities (speaking, writing, reading, understanding),
  • Communication success comes before a perfect language form,
  • Promotion of active participation, independent actions and decisions,
  • Practice with content and meaning
  • Creation of a relaxed and learning-promoting concentration.

Furthermore, a distinction is made between three therapy phases, which can accompany and support those affected from the first day over a very long period:

  • Activation phase: In the first weeks after the onset of aphasia, those affected are positively strengthened in their communication skills and encouraged to speak, but only slightly challenged.
  • Disorder-specific exercise phase: After a few weeks and when the rehab clinic switches to outpatient therapy, the vast majority of those affected are more resilient than at the beginning and the therapy hours are slowly becoming more intensive and complex. How long this phase lasts depends on self-motivation and other external circumstances. In principle, progress can be made over the years.
  • Consolidation phase: If speech therapy stops after a certain period of time, every communication and occupation with language in everyday life further promotes personal skills.

These therapy phases correspond approximately to the course of an aphasia. The acute phase lasts for four to six weeks, followed by the post-acute phase, which lasts up to a year. After about a year, one speaks of the chronic phase.

According to the guidelines for the rehabilitation of aphasic disorders after a stroke of the German Society of Neurology (DGN), speech therapy should take place as daily as possible with an intensity of not less than five to ten hours a week. Intensive interval treatments may still be promising after more than a year. In this context, a study on the efficacy of intensive speech therapy for aphasia after a stroke that was already half a year or longer ago was recently published in The Lancet. The results of the studies led by the University of Münster show significant improvements in communication after at least three weeks of treatment for ten hours a week in chronic aphasia.

Education and advice for those affected and their relatives

Speech therapy professions that conduct aphasia therapy include speech therapy, breathing, speech and voice teaching, clinical linguistics and speech therapy. If, in addition to the linguistic expertise, other knowledge from the field of social and special education as well as psychology is available, this can have a very positive effect on treatment.

It can be important to intervene and help them to deal with the major changes in life and mental stress. Since the entire communicative competence is more or less severely limited, misunderstandings and frustration experiences often occur on both sides in everyday interaction. This can be improved through competent education, advice and support and lead to fewer problems in everyday life.

For relatives it is important to know, for example, that a disturbance in speech comprehension is by no means to be equated with hearing loss and therefore noisy communication does not remedy the situation. Quietly waiting for long pauses in conversation or patiently listening to an aphasic person's accelerated speech is essential so as not to create even more stress and time pressure. For the contact persons, this often means learning in a long process, not interrupting those affected. Because with this mostly well-intentioned help, you usually only create more confusion and blockages. To support and help people with a language disorder, a great deal of understanding and thinking is required.

Depending on the needs and possibilities, suitable communication aids can also be used, for example in the form of certain conversation techniques, letter boards, picture portfolios or special computers, in order to facilitate the expression and understanding of needs.

Supportive alternative treatment options

Aphasia is usually based on a lesion of the brain as part of the central nervous system (CNS), often caused by a cerebral infarction or a traumatic brain injury. Alternative treatments can promote the natural healing process of this type of injury (especially in the early stages). Alternative healing methods can also be helpful for those affected when dealing with the new life situation, which often leads to stress and psychological stress and which may then result in fears, depression or other mental disorders.

Naturopathy

The most common naturopathic treatments are primarily detoxifying, regulating and rebuilding measures. This can be achieved, for example, by means of phytotherapy, a classic drainage procedure or a regulating milieu therapy. There are limits to detoxification of the body, including through elimination therapy and activation of detoxification organs (liver and kidneys), through continuous medication with blood-thinning and blood pressure-regulating medicines. These drugs are indispensable in many sufferers because of an increased risk of stroke.

Homeopathy

In classic or process-oriented homeopathy, homeopathic constitutional products are determined individually according to the respective physical and psychological symptoms and can be clearly assigned to certain diseases. This is also referred to by Dr. med. Karl-Heinz Friese, author of the book "Homeopathy in Otolaryngology".

According to Dr. However, Friese, who combines conventional medicine and complementary medicine in his medical practice, can generally have a positive effect on treatment with arnica for aphasia after a stroke. Real arnica (Arnica montana), also known as mountain wellness rental, is a proven wound healing agent that is used for physical injuries and bruises as well as for injury shocks and psychological trauma. The latter can, for example, be mental stress conditions that can also arise from a sudden loss (here: loss of speech).

It is recommended to start therapy with arnica D12 and continue later with a high potency. Self-medication with high potencies is, however, strongly discouraged; expert medical or homeopathic advice and support should always take place with this form of therapy.

Acupuncture

The use of acupuncture, an old form of therapy in the area of ​​traditional Chinese medicine (TCM), aims to harmonize the flow of energy. The activation of nerve fibers, which in turn also affect the spinal cord, midbrain and cerebral areas, releases neurohormones with stimulating effects.

Prof. Dr. M. Ptok, head of the clinic for phoniatrics and pediatric audiology in Hanover, reported in the magazine "Sprach-Sprach-Hearing" (issue 31 (3) / 2007) of the results of Chinese scientists on a positive effect of acupuncture on the ability to speak with existing aphasia . Most acupuncture treatments have shown improvements in certain sounds after acupuncture treatments. In motor aphasia in particular, this seems to be an effective additional treatment.

In the case of speech comprehension disorders (sensory aphasia), on the other hand, according to scientific knowledge, biofeedback procedures are more suitable, whereby the affected people get feedback from their own physiological processes (such as brain activity and heart rate) to improve their impaired self-perception.

Relaxation procedures and hypnosis

For speech therapy it is important to create the most relaxed atmosphere possible for good learning success. The general relaxation effect and the reduction of stress reactions in those affected mean that they have better access to their own language. To this end, home remedies for stress relief can be used as additional supportive measures, including a variety of relaxation methods such as progressive muscle relaxation (PMR), autogenic training (AT), meditation and breathing exercises.

In hypnotherapy, which also creates a state of relaxation, the flow of speech can also be stimulated symbolically and figuratively, for example with the idea of ​​a flowing water that encounters obstacles and overcomes them "fluently". Because hypnosis works with unconscious processes, people with severe intellectual losses and reduced ability to concentrate and remember can also benefit from this type of treatment (Revenstorf and Burkhard, 2001).

Other alternative therapeutic approaches

A number of other, in particular pedagogically and psychologically oriented, alternatives are also used successfully in aphasia treatment. These include, for example, animal-assisted therapies and garden therapy. The relaxation effect and the healing effects of nature support you on your way back to language.

A healthy, wholesome and as natural as possible diet with a sufficient intake of water promotes the general state of health and supports the necessary performance and regeneration of the body. Certain vitamins and minerals can also be used as a dietary supplement to optimize metabolism. (jvs, cs)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. rer. nat. Corinna Schultheis

Swell:

  • Luise Lutz: Understanding the silence: About aphasia, Springer, 4th revised. Edition, 2011
  • Prof. h.c. Ptok: relaxation therapy and acupuncture for communication disorders, language voice hearing, Thieme, 2007, DOI: 10.1055 / s-2007-985385
  • Revenstorf, Dirk (ed.), Peter, Burkhard (ed.): Hypnosis in Psychotherapy, Psychosomatics and Medicine: Manual für Praxis, Springer, 3rd and act. Edition, 2015
  • German Society for Neurology (DGN): S1 guideline for the rehabilitation of aphasic disorders after a stroke, as of September 2012 (accessed: June 24, 2019), dgn.org
  • Federal Association for the Rehabilitation of Aphasicians e. V .: Aphasia (call: June 24, 2019), aphasiker.de
  • German Stroke Aid Foundation: Forms and Effects of Aphasia (Call: June 24, 2019), schlaganfall-hilfe.de
  • Merck & Co., Inc.,: Aphasie (accessed: June 24, 2019), msdmanuals.com
  • Mayo Clinic: Aphasia (call: June 24, 2019), mayoclinic.org

ICD codes for this disease: F80, R47ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


Video: Curing Aphasia: Part 1. The Social Cure, Linda Worrall (June 2022).


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