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Your Questions Answered: STROKE

Hillis, Argye Beth M.D.

Department: Ask the Experts

Answers on stroke, epilepsy, neuropathy, and dystonia

Argye Beth Hillis, M.D., is professor of neurology and an aphasia expert at Johns Hopkins University School of Medicine.

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Q My father recently had a stroke. What's the best form of therapy to help get him started talking again?

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A The first step in getting your father talking again is to have him evaluated by a speech-language pathologist who will determine what your father can do on his own and what he will need assistance with.

The speech pathologist will help design a plan to treat his aphasia. The therapy doesn't all have to be done with a speech therapist. If your father is willing and able to work on his own at home, there are computer programs and workbooks that he can use to work on his language skills.

One thing to keep in mind: The most important thing about the therapy is that it should be intense. This means the person should be working on language skills at least two hours a day, five days a week.

There was a fairly large randomized trial that showed that it didn't matter whether the aphasic person worked with a trained family member or a speech therapist-both were effective in improving language skills.

Exercises for people who have trouble speaking after a stroke are designed to help with word retrieval, sentence production, comprehension, reading, or spelling. The idea is to elicit successful language production or comprehension as frequently as possible, by any means. There are a lot of tricks for helping people elicit words with assistance. For example, you might make the initial sound of the word to help them retrieve it. You might teach the person to think of the first letter of the word and then write it down. Sometimes seeing the first letter of the word can help with retrieval of the whole word.

The computer programs work in much the same way. For instance, to prompt for a word, they might show a picture and then the first sound of the word. The cues are gradually withdrawn, to help the person say the word independently.

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