Communication Problems

The aphasia/dysphasia present in 20-30% and anar-thria/dysarthria in 40% of acute stroke patients result in difficulty in expressing thoughts in language or a total inability to do so (expressive motor aphasia/ dysphasia) as well as difficulty in comprehending language (receptive aphasia/dysphasia) or producing speech (anarthria/dysarthria). Expressive aphasia, also known as Broca's aphasia, results from strokes affecting the prefrontal gyrus, while Wernicke's receptive aphasia results from lesions of the central sulcus. In contrast, dysarthria results from neurological damage affecting the neuromuscular systems that control the mechanisms of speech production. Since these systems are also concerned with swallowing, it is common to find difficulty with swallowing (dys-phagia) present in dysarthric individuals.

The communication problems result in inabilities/ difficulties in expressing meal preferences (aphasia/ dysarthria), reading a menu, or writing preferences down (aphasia can occur in conjunction with dyslexia and dysgraphia). In contrast, receptive aphasia can impair the ability to comprehend instructions at mealtimes and thus affects compliance with rehabilitative advice. If paralysis and visual field and perceptual deficits are combined with expressive dysphasia and dysarthria, then nonverbal communication can also be limited, resulting in an inability to denote assent or dissent by nodding the head or to use gestures to convey meaning or point to food items/utensils. Early involvement of speech therapists is vital to enable individuals to regain lost functions in speech and language. In selected patients use of visual material, i.e., charts or pictures of food items and symbols, can he helpful. Use of short sentences, normal volume speech, avoidance of jargon, and patience in allowing individuals to respond to questions are also helpful in general communication.

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