In February we talked about aphasia, a loss of the ability to produce and/or comprehend language due to injury to brain areas specialized in these functions. In 1989, two scientists showed in their survey that stroke with aphasia have a greater negative impact on the patient’s spouse than stroke without aphasia does. This was explained by the fact that aphasic partners had more difficulty communicating about details concerned with role adjustments.

Already in 1987, two Canadian Scientists, Friedland and McColl studied patients during the first two years after a stroke and identified four aspects of social support which could provide positive and useful help. These were:

1. satisfaction with social support
2. satisfaction with social support
3. the single most significant relationship in the individual’s life
4. close friends and family
5. the community

It is suggested that other approaches to helping the stroke patients could be developed. One way of looking at an aphasic sufferer’s difficult situation is to use the psychological model, Personal Construct Theory (PCT). This method, developed by Kelly in 1955, is a way of describing how we understand ourselves and other people. That is, in Kelly’s terms, the way in which an individual understands the reality of his world, based upon the past he learnt and the future he estimates. PCT can offer a theoretical perspective on the individual’s situation which can enhance our understanding and thus empower us therapeutically.

Used in therapy, it is helpful to view adapting to a stroke as a process of transition, a change of patient’s initial role (spouse, parents etc). That is, the individual comes to understand and make sense of the situation by moving through phases of researching and understanding.

Personal Construct Theory was devised primarily for people with intact language systems – even there was no such mention in Kelly’s original work about this application. However, in case of acquired brain damage, a “grid technique” is widely used today, which is originally from Kelly’s sub-theory: the Role Construct Repertory Test. It aims to elicit constructs from a person by asking them to consider groups of role titles which have been selected from their social context. The role titles are written along the top, and the bipolar constructs are written down the side. Each role title is considered in relation to each pair of constructs.

An example of the procedure would be that three elements are considered:

• Self before illness
• Self now
• Self I would like to be

And put the following words below in the grid:

• very good – very bad
• can move – can’t move
• happy – sad
• angry – not angry
• Calm – more excitable

The grid allows to understand one’s behavior in relation to the aphasic (patient or impatient) and to acknowledge one’s pain because of the loss of abilities. Past-self and present-self may be shown to be significantly far apart which would then form a basis for therapeutic intervention. It helps to set a therapy focus around achievement and being fulfilled. It is possible to distinguish a theme about communication and the ability to socialize.

In a case, Mr. X talks about his distress at his changed ability in talking: “I know I talk slower than what I could do before the stroke, but, it was a shock, because round here people talk quick and I talked quicker than them and I miss the words out, the little words and that. I think it was a shock.”

Note the use of the contrast between before his stroke and afterwards, the pain caused by the loss of his abilities of speech is clear.

Along with PCT, while talking to a stroke survivor with communication disabilities, try to grab adjectives with which he/she describes him/herself, and compare those to the language he/she used before the stroke. Help them with the right and appropriate strategy and give them a positive strength. Personal characterization can also offer a basic starting point.

The application of PCT to our understanding of the reactions to stroke and acquired communication problems can offer theoretical insights which make it easier to understand the meaning of the problem to the individual. It offers a structure to the recovery process.

In the end, here are several communication tips for daily life:

• Personalize the conversation, including using the person’s name to get attention, making eye contact or a gentle touch
• Use short, simple sentences and speak clearly and slowly.
• Repeat sentences exactly, if the person does not seem to understand a word, try substituting it with another one.
• Be specific

Offer simple choices such as “Yes” or “No”.

Sources:
Stroke rehabilitation Journal