Home Health Care Where to Start When Treating Clients Post-Stroke

Where to Start When Treating Clients Post-Stroke

by Jordyn Sims

So, let’s say your receptionist tells you your new patient recently had a stroke. And you immediately think, “the last time I saw someone post-stroke was grad school!” Fret not! Instead, I hope my evidence-based insights into treating clients who experienced a stroke will help you brush up on treatment approaches.

First, see what patient information you can access before the patient even steps foot in your office; what can any previous evaluations or medical documents tell you? Do you know the location of the injury? In general, a left hemisphere injury brings about more speech and language challenges, while a right hemisphere injury likely results in more cognitive challenges—such as issues with attention, executive function, memory, or judgment. Can you find out if they have any muscle or nerve damage potentially affecting speech or voice?

Do you have any previous speech, language or cognitive testing results? If not—or what you receive is insufficient—you’ll want some assessments on hand. I like the Cognitive Linguistic Quick Test (CLQT), the Boston Naming Test (BNT) or the Western Aphasia Battery (WAB) for evaluating stroke patients. Although these assessments will give you valuable, concrete information about cognition and language, your primary goal should be to assess how your patient’s unique stroke symptoms affect their day-to-day life.

A tool like ASHA’s Quality of Community Life Scale can shed light on how this stroke has affected your patient, as caninterviewing your patient’s caregiver to evaluate the impact on your patient and those closest to them. You want to come away from assessments knowing how the stroke affected a person’s speech, voice, language, cognition and—probably most importantly—life. Also, think about how long post-stroke your patient is. If it’s been a considerable amount of time, ask about treatment approaches they’ve tried in the past. These issues will guide your goal setting.

When you set goals, make sure your client finds them relevant and motivating. Create measurable goals and a timeline for reasonably achieving them. Think about long-term versus short-term goals. Short-term goals can build toward longer-term goals, such as guiding your patient to make their regular coffee shop order independently again. So short-term goals include navigating to the coffee shop, using cash or a credit card, finding the words to order their style of coffee and demonstrating appropriate pragmatic judgment while waiting for their coffee.

Is it possible to teach executive-function skills to people who have brain injuries? Absolutely, says cognitive rehab clinical researcher McKay Sohlberg. 

Okay, so you set goals. Now, how do you and your client meet them? Research evidence-based treatments to best fit your case. Often, I find a combination of approaches especially effective for patients. Consider your individual patient and their specific situation and needs. When I think about treatment approaches, I like to use the Life Participation Approach to Aphasia (LPAA) as a guiding structure.

Within the LPAA framework, I can select a variety of evidence-based programs to address treatment goals, all while keeping in mind the LPAA mission – to help my patient re-engage in their life. I often use traditional, paper-based treatment approaches, such as Semantic Feature Analysis (SFA). I find them handy, because they require minimal materials—for SFA I only need paper for drawing a diagram, plus some photos of objects. You also may already have some paper-based materials, like the Workbook of Activities for Language and Cognition. Also, try a real-life activity, such as writing a practice check or balancing a hypothetical checkbook.

Technology continues to become an increasingly popular and is now a common approach in treatment. Use a tablet, computer or even a cell phone to help teach a patient compensatory strategies, including using their calendar reminders. In terms of apps, I like Constant Therapy, because I can choose from more than 60 different speech, language and cognitive tasks, which I can easily assign for homework. The app can advance difficulty-level of tasks, so it’s also an option for continued practice when SLP services are no longer covered. Various apps also exist to collate data for us to analyze and track, so we can continue to evaluate the most effective approaches and activities for patients.

Jordyn Sims, MS, CCC-SLP, is a speech-language pathologist working in the Baltimore area. She is an affiliate of ASHA Special Interest Groups 1, Language Learning and Education; 2, Neurophysiology and Neurogenic Speech and Language Disorders; and 15, Gerontology. Sims has experience with adults and children and is a clinical consultant for Constant Therapy. jordyn.sims@gmail.com


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1 comment

Marilee Dunn June 8, 2017 - 10:29 pm

Good article that had some definitive ideas. Most of all stressing the functional use of language as the treatment basis is so important. I still see clinicians everywhere doing the same old stuff that we did before the WHO came out with its new delineation of how we should approach rehabilitating someone for interacting in their daily lives. That was years ago and still there are clinicians using workbooks instead of real life tasks.

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