Aphasia: Care and Management of Post-Stroke Receptive Aphasia
Published: 29 February 2016
Published: 29 February 2016
Communication itself is quite a complex neural process. It involves a careful sequence of expression, muscle movements, breathing, speaking, and comprehension. When a person who has had a stroke experiences speech difficulty, word-finding difficulty, or speaks with made-up or inappropriate language, they are highly likely to be experiencing aphasia.
The left cerebral hemisphere of the brain is involved in the process of speech. Damage to these areas often causes communication problems. However, in addition to aphasia, a person’s communication abilities after a stroke can be affected in other ways.
One such example is dyspraxia, a condition that affects the co-ordination of messaging from the brain to the muscles associated with speech. This results in a general lack of co-ordination or poorly sequenced word selection when talking. Similarly, a condition known as dysarthria can weaken and paralyse the muscles involved with speech, causing a more general slurring of words.
Receptive aphasia (also known as Wernicke’s aphasia, fluent aphasia and sensory aphasia), is caused by damage to the posterior left portion of brain in the medial temporal/parietal lobes. Receptive aphasia involves a breakdown in the phonological system, removing the person’s knowledge of the sequence of sounds within words; consequently alternative sounds can be used instead. Core elements of the phonological and semantic systems are affected which significantly impairs the person’s auditory-verbal comprehension (visual comprehension is not as impaired).
There are four language systems used to process, understand and use language.
People with receptive aphasia may experience the following:
The main treatment for aphasia is speech therapy. Speech pathologists are able to assess strengths and weaknesses of the aphasic patient’s language and communication skills. By identifying individual strengths, a base can be established from which communication enhancement, comprehension and expression can be improved.
When caring for a person with aphasia, consider implementing some of the tips below as they will assist the person with aphasia to communicate more easily.
Ask questions requiring yes/no responses – determining comprehension through screening is necessary for nurses to modify communication in response to screen outcome. The process you should follow involves asking a yes/no response question to which the answer is known – e.g. “are the lights on in this room?” and then “are the lights off in this room?”. Being able to consistently respond correctly to yes/no questions allows the patient to express their preferences, wants and needs.
Integrate one – to three-stage commands as per the person’s level of understanding. Being able to determine the person’s level of comprehension and capacity to follow directions is important, particularly in regard to safety instructions. Without giving any visual cues ask the patient to follow a simple one-step command, e.g. “make a fist”. If you give a visual cue to the patient, they may simply be following the cue or imitating your movement, rather than following the command. Increase complexity by progressing from a one-stage command to a two- or three-stage command. “Take this piece of paper in your right hand, fold the piece of paper in half with both hands and place it in your lap” is a good example of a three-stage command. This is part of Folstein’s Mini Mental State Examination (MMSE) tool.
Receptive aphasia is initially difficult to treat and less experienced stroke-clinicians on the multidisciplinary team might believe that the prognosis of speech recovery is limited. Despite this belief, receptive aphasia is more likely to resolve than any other form of aphasia. Treatment is centred on establishing the most appropriate mode of communication, gradually increasing frequency and complexity, introducing other communication modalities and exposing the patient to supported social interaction.
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Annette Horton is a Registered Nurse with over 30 years extensive nursing, rehabilitation and management experience. Since 2004 Annette has held a Nurse Unit Manager position of a regional rehabilitation unit in Queensland. Annette is a member of the Australasian Rehabilitation Nurses Association (ARNA) and has presented several papers at ARNA national conferences. Annette has her own nursing blog entitled Nurseconvo, and more recently has become a contributing writer for Ausmed. Interests include stroke, rehabilitation, continence, leadership and management, coaching and case management.