Case Study: A 67- year old with Broca's Aphasia

Summary:

A 67-year-old woman recovering from a stroke reached out to our clinic for online speech therapy services. We developed and implemented a plan to

(a) Help the woman communicate her basic needs and

(b) Improve her ability to communicate by using an augmentative and alternative communication (AAC) board.

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Patient Info:

Name: Mrs. Helen Smith

Age: 67 years old

Gender: Female

Diagnosis: Broca's aphasia 

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Background

Mrs. Smith reported not feeling well during the first week of April. On, April 10th, she fell in her home, was found unconscious by her husband, and was admitted to a hospital. She went to the emergency department with an acute infarct to the left middle cerebral artery. Initially, Mrs. Smith’s prognosis was poor. However, Mrs. Smith’s condition improved, and she became awake and alert. Mrs. Smith had right hemiplegia, dysphagia, and aphasia, as well as suspected apraxia of speech. She was a retired teacher who was living independently with her husband. She had two children. Mrs. Smith had been completely independent, but after the stroke, she needed assistance with all Activities of daily living. 

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Team:

Speech-language pathologist, Physiotherapist, Patient, Neurologist, Social worker, Nurse, Family, Occupational therapist, and Counsellor.

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Treatment Plan:

Mrs. Smith reached out to us one year after the stroke. At that time, her speech and language assessment reported Broca's Aphasia with Apraxia of speech. Her attention and memory were limited.

She had limited speech- she could say the names of a few colours and family members.

Her attention span was limited. She had difficulty finding words, naming pictures/objects, and provided unreliable answers to “yes/no” questions, had difficulty writing or copying letters, words, and sentences.

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Goals:

• We worked on restoring her lost-language skills and improving speech production and fluency.

• We worked on strengthening intact communication skills and enhancing ability to form complete sentences.

• We also worked on educating and training the family members to communicate more effectively.

• We worked on increasing her confidence in verbal communication.

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Intervention:

We made a treatment plan tailored to her needs. She was started off with sessions thrice a week and then reduced to twice a week.

 

• With aphasia post-stroke, recovery of language function peaks within two to six months, after which time further progress is limited. However, patients are encouraged to work on speech production, because cases of improvement have been seen long after a stroke. Family and social support are extremely important to keep patients with language deficits engaged in social and leisure activities which can greatly influence the aphasic patient’s quality of life.

• When speaking to a patient with aphasia, it is important to maintain a normal rate and volume. Questions should be simple. It is preferable to ask yes or no questions rather than open-ended questions that require a lengthy answer. have problems with retrieving words or names quickly, as well as saying and understanding numbers and the alphabet.

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Outcomes:

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After 6 months of regular online speech therapy sessions, Mrs. S has shown a lot of improvement in her speech. The structured and personalized therapy sessions have led to substantial improvements in speech production, language comprehension, and overall communication ability. The patient’s confidence and quality of life have significantly improved.

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• She has shown noticeable improvement in word retrieval and speech initiation. She is able to form simple sentences with less effort. Her speech is more spontaneous and less labored.

• She had heavy reliance on gestures to communicate and had limited verbal output. Now she communicates in small sentences, participates in short conversations and has reduced dependence on non-verbal method

• She has shown improved ability to understand and respond to more complex sentences.
  She engages in conversation with better understanding and response accuracy.

• Earlier she had high levels of frustration and anxiety. She showed gradual improvement in confidence. She is more willing to engage in social interactions now.

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Recommendations:

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• Continue with online speech therapy sessions to further enhance speech fluency and prevent regression.

• Questions should be simple. It is preferable to ask yes or no questions rather than open-ended questions that require a lengthy answer.

• Encourage participation in social activities to practice communication skills. 

• Periodic re-evaluation to monitor progress and adjust therapy goals as needed.

• It is recommended to family and friends that when speaking to a patient with aphasia, it is important to maintain a normal rate and volume.

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