Speech Communication Disorder Rehabilitation
Expert guidance◎ Wang Jie, Department of Rehabilitation Medicine, Beijing Xuanwu Hospital
The rehabilitation of speech communication disorders after stroke and traumatic brain injury mainly focuses on aphasia and dysarthria. There are different treatment methods for different disorders.
In the case of aphasia, it is necessary to first evaluate and judge which part of the language processing has a problem and how serious the problem is. Generally speaking, it is impossible to repair the damaged brain tissue, but it is possible to help the patient recover by treating the right half of the brain or the area around the lesion to play a certain compensatory role. The basic tools are computerized system training, transcranial magnetic stimulation, etc. The effect of treatment will vary depending on the location of the patient’s injury and the size of the damaged area, age, medical history, physical condition, and vascular status. Du Jubao, Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University
Dysarthria is a motor dysfunction, caused by damage to the articulatory organs caused by brain injury. The main treatment means is manipulation therapy, strengthening the movement, strength and coordination training of the patient’s articulatory organs, promoting the recovery of motor function through sensory input, and achieving the purpose of alleviating the condition. In general, the recovery process is slow because most of these patients have bilateral lesions in the brain or multiple foci, and the brain tissue available for functional compensation is significantly reduced.
In addition, the speech therapy workup includes swallowing disorders, i.e., difficulty in eating and drinking, except that swallowing disorders cannot be classified as speech communication disorders.
Neuropsychological and cognitive rehabilitation
Guidance expert◎ Zhou Jingsheng, Department of Rehabilitation Medicine, Beijing Xuanwu Hospital
In terms of symptoms, neuropsychological and cognitive rehabilitation can be divided into two parts: psychological and cognitive. Psychologically, anxiety and depression are the most common; cognitively, problems with memory, attention and logical thinking skills are the main focus.
Psychologically, patients are prone to symptoms of anxiety and depression. There are several reasons for this: first, the negative impact of the disease, second, the patient himself may have endogenous depression, and third, it is caused by damage to brain regions. It usually manifests as lack of appetite, crying, and non-cooperation with treatment. Treatment can be divided into two main categories: first, psychological relief, but this is not the same as ordinary psychotherapy because it is triggered by an illness or an unexpected event, so it is necessary to explain to the patient his or her condition and treatment plan, and doctors, family members, and friends form a team to help the patient with psychological counseling; second, medication, which allows the patient’s dysregulated neurotransmitters to return to normal.
Cognition is a holistic concept and is generally most exposed to memory training, which is treated mainly through restorative and compensatory strategies. Restorative strategies refer to intensive memory training by repeatedly counting time, memorizing graphics, etc.; compensatory strategies, which help memory through external aids, such as noting in a book, on electronic devices, etc. In addition, there are more spatial structure disorders, such as hemiplegic neglect, which is mainly manifested by the patient’s inability to notice something on one side. It is common that the right brain lesion causes left side neglect, such as only seeing the right side of the dish when eating it.
Rehabilitation of hemiplegia
Expert guidance – Du Ju Bao, Department of Rehabilitation Medicine, Beijing Xuanwu Hospital
Hemiplegia, generally refers to the movement disorder of one side of the limb after a stroke, and can also be caused by diseases such as craniocerebral trauma or brain tumor.
The main treatment tools are exercise therapy, occupational therapy and physical therapy. Exercise therapy is designed by the exercise therapist according to the patient’s hemiplegia, and consists of passive therapy to maintain the patient’s joint mobility and some means to induce and promote active movement. Occupational therapy, carried out by an occupational therapist, focuses more on the achievement of specific functions of the patient’s limbs, such as the training of hand functions. Exercise therapy and occupational therapy are also often done with the help of rehabilitation equipment. Physiotherapy, on the other hand, uses physical factors such as sound, light, electricity, cold and heat to promote the improvement of hemiplegic patients.
Generally speaking, early intervention is recommended for hemiplegia rehabilitation, and the earlier the intervention is tolerated, the better the results will be, and the patient’s active participation is required. In the past two decades, some new theories have been applied in clinical practice, such as “motor imagination”, which means that the patient is instructed to imagine and try to perform the movement of the limbs in his mind before he resumes his activities. After the patient has initially regained mobility, active activities are emphasized and necessary assistance is given to prevent incorrect movement patterns. During the rehabilitation process, the doctor also closely observes the patient’s progress and plans the rehabilitation treatment according to the patient’s specific condition.
(The full article was published on August 10, 2011 in the Health column of Beijing Evening News, page 52)