Most treatment for aphasia is focused on behavioral techniques, such as speech and language therapy (SLT) and constraint-induced language therapy (CILT). However, some pair the behavioral rehabilitation with medications like piracetam or bromocriptine. Piracetam has been seen to improve learning and memory, by targeting cognitive, language, and memory functions. Bromocriptine targets the dopamine system, improving mood and motor abilities. 

Treatment Process

Speech and language therapy, otherwise known as SLT, is a form of behavioral therapy which combines two approaches: the impairment-based approach and the functional communication approach. While the impairment approach targets the foundation of language (breaking speech down into phonology, syntax, etc.) to decrease one’s level of linguistic impairment, the functional communication approach teaches the patient how to communicate in order to get their needs met. 

Speech and Language Therapy (SLT)

Constraint-induced language therapy is a form of treatment which forces the patient to only use verbal communication. Involving intense games and language cues, the main purpose is to avoid the reliance of the patient on gestures or body language to communicate. Generally, this is seen to significantly improve an individual’s expressive speech and verbal communication, but does not seem to improve writing abilities. It can be beneficial for both short and intense sessions, or slower, distributed sessions. 

Constraint-Induced Language Therapy (CILT)

Aphasia is a language disorder which is typically acquired after stroke. It is characterized by impairment of language-based processes, such as auditory comprehension, reading, oral expression, and writing. The level of impairment depends upon the type of aphasia, which also depends upon the damaged brain region. There are two levels of intensity: acute and chronic. While those with acute post-stroke aphasia may reach some level of normalcy in their linguistic centers of the brain, many with chronic aphasia struggle to receive sufficient treatment, whether due to the required time and intensity of treatment or financial restrictions — there are very few recovery stories in those with chronic aphasia.  

Rutgers University

Stroke can be clinically recognized through a sudden or rapid onset of symptoms which reflect global or focal deficit of neurological function, lasting around 24 hours or yielding death. Due to infarction or hemorrhage of the central nervous system, it is classified as both a neurological disorder and vascular injury. There are associations between stroke development and hypertension, diabetes, history of smoking, and more. Despite the wide range of severity in symptoms, strokes are generally characterized by difficulties with motor function, visual deficits, speech and language deficits, pain, and other difficulties with daily life activities which yield a strong dependence on a caregiver or nursing facility. Combinations of pharmacological- and rehabilitation-based treatments are the most common strategies to help a patient improve their overall function. 

Stroke

A very common post-stroke diagnosis is homonymous hemianopia, a visual disorder characterized by partial or complete blindness in the same visual field of both eyes. While some may spontaneously recover their vision (within the first few months) others endure permanent damage to their visual fields. Those who endure the permanent damage have a few different treatment options: optical therapy, eye movement therapy, and visual restitution therapy. Damage to the visual fields in this manner results in blindness on the same side of both eyes — a person with left-sided homonymous hemianopia might compensate for their blindness by turning their head to the left to see things with their right-sided visual fields.

Homonymous Hemianopia

There are a variety of rehabilitation approaches and goals with regards to stroke, depending on the severity of the patient’s symptoms. There are three main approaches to any form of rehabilitation for stroke patients: restoration, compensation, and modification. The restoration approach looks to retrain parts of the central nervous system in order to restore functions of damaged brain tissue; the compensation approach hopes to adapt the individual’s behavior to their loss of functionality; the modification approach alters the patient’s environment to promote daily function. Altogether, these three approaches can improve brain and daily life function after this major medical event.

Rehabilitation Approaches

Outpatient, home-health, and inpatient rehabilitation therapies are all common options for the patient, again depending on their severity. In general, a team-based therapy approach should be employed for the patient to get the most well-rounded care and improvement — this would include a mix of physical, occupational, and speech therapy. Alongside therapeutic opportunities, pharmacologic treatments are common for stroke patients as well. In general, the impact of stroke can lead to a wide range of possible diagnoses and additional treatments. For example, someone who acquires visual deficits with stroke may require the addition of optical therapy; someone who begins feeling depressed may require mental health treatment or SSRIs, which can also improve motor function.

Treatment Options

Aphasia

Based on the information provided in the scenario below, what is the most likely medical event occurring? Justify your answer by explaining how the pattern and onset of the symptoms support your conclusion.

Clinical Symptom Analysis

Based on the sudden onset and specific combination of symptoms presented in the case study below, what is the most likely medical event that has occurred? Justify your answer by linking the patient's history and symptoms to the characteristics of this event.

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