Dear Doc | Help! I’m recovering from a stroke and cannot speak

Dear Doc:

Q I am recovering from a stroke and I cannot speak. I need some advice on acupuncture and herbal medicine. I am 68 years old.

A What you are describing is aphasia, which is a communication disorder that impairs a person’s ability to process language. It affects the ability to speak and understand others, and most people with aphasia also experience difficulty with reading and writing. Although aphasia affects a person’s ability to communicate, it doesn’t affect their intelligence.

The most common cause of aphasia is stroke. About 25-40 per cent of stroke survivors acquire aphasia, caused by damage to the parts of the brain responsible for understanding and producing language.

Not all persons with aphasia require treatment. If the brain damage is mild, a person may recover their language skills without treatment. However, if the symptoms of aphasia last longer than two or three months after a stroke, a complete recovery is unlikely.

It is important to note that some people may continue to improve over a period of years, and even decades. Improvement is a slow process.

The recommended treatment for aphasia is speech and language therapy. This treatment is carried out by a trained practitioner called a speech and language therapist.

Most people with aphasia need many hours of speech and language therapy to recover to their full potential.

Speech and language therapy aims to:

- Help restore as much of your speech and language as possible.

- Help you communicate to the best of your ability.

- Find alternative ways of communicating.

- Provide information to patients and their relatives about aphasia.

How the therapy is carried out will depend on your circumstances. The treatment you receive will depend on your general health and the difficulties you have with your speech, language, or social skills.

An intensive course of speech and language therapy may be recommended for some people. This involves a number of sessions given in a shorter period of time.

But speech and language therapy can be exhausting, and an intensive course of treatment won’t be suitable for everyone.

For some people, shorter and less intensive sessions may be recommended.

Using Technology

Therapy may be individual sessions, in groups, or using technology, such as computer programmes or apps. An increasing number of computer-based programmes and apps are available to help people with aphasia improve their language abilities. But it’s important to start using these with the supervision of a speech therapist.

For many people with aphasia caused by stroke, the most rapid changes are early on in the weeks and months after their stroke. One factor that significantly determines whether or not recovery from aphasia is possible is the ability for the brain’s capillaries to repair.

Currently, there are several treatment methods being researched to study whether other treatments can benefit people with aphasia.

These include:

- Hyperbaric oxygen behavioural therapies or practice – for example, apps to help people gain large amounts of repetitive practice on certain language tasks.

- Electrical brain stimulation techniques – for example, transcranial direct current stimulation, where a small electrical current is passed through the scalp into the brain to help boost performance on language tasks.

- Medications – for example, to help the brain recover or replace damaged neurotransmitters.

Although some studies have suggested these treatments may benefit some people with aphasia, further research is necessary. Several medications, such as donepezfil, memantine (Namenda) and piracetam, have shown promise.

- Traditional Chinese medicine – acupuncture and moxibustion therapies.

Research and clinical observations have long shown that acupuncture has the ability to directly dilate the brain’s capillaries, as well as improve blood and oxygen supply to areas of the brain that have been oxygen-deprived. Scalp acupuncture, in particular, has proven to be effective for the treatment of aphasia after a stroke. Acupuncture patients regained the ability to communicate through speech and written language at a similar rate as patients receiving drug therapy. A combination of acupuncture with drug therapy produced optimal positive patient outcomes. Acupuncture alone produced a 46 per cent improvement rate, and drug therapy (donepezfil) produced a 50 per cent improvement rate. The combination of acupuncture and donepezfil produced a 77 per cent improvement rate.

Scalp acupuncture is done by inserting acupuncture needles into the loose tissue layer of the scalp to stimulate the brain neurons of the underlying area. Since the skull protects the brain, there are no organs to injure, making it a safe treatment. The speed and amount of recovery will vary with patients and will depend on the recency and severity of the damage. A treatment takes one hour. Two to three treatments a week is usually recommended. Frequency of treatment may change depending on the progress. Ten treatments constitute one course. Evaluation is continuous, but a more overall consideration is done at each five-treatment interval to determine the future course.

There and no proven herbal remedies. However, the following are known to improve brain health:

- Omega-3 fatty acids: These are known to improve brain health and help improve the eyes and nerves. Supplementing omega-3 fatty acids in the form of capsules or through increased dietary intake is recommended.

Vitamin B12: Can be taken by those aphasia patients that suffer from digestive tract problems.

Primrose oil: This is another natural supplement that improves brain function. It improves alertness and helps the brain to work efficiently.

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