Treatment of aphasia following stroke.

THE MEDICAL practitioner often has significant success in managing his patient to physical recovery from a life-threatening, major cerebral infarction. However, the stroke brings in its wake emotional, psychological, vocational, and behavioral problems for the surviving patient and his family. Preparation for coping with these problems is usually lacking, and families and survivors of stroke are often left to their own devices in seeking help. One of the most pernicious post-stroke problems faced by patients and families is the presence of the language disorder, aphasia. Physicians usually recommend physical therapy for their patients' motor problems or occupational therapy for both sensory and motor difficulties; yet they seem to share the helplessness felt by their patients about language difficulties shown by a curious reluctance to recommend evaluation of the aphasia by the speech/ language pathologist. "The value of speech therapy in the adult aphasic patient is questionable; it is a difficult, frustrating task for therapist and patient." This flat dismissal, unsubstantiated by experimental evidence, appears in a recent introductory neurology text and serves as a typical example of the nihilistic attitude toward therapy. The remarks that follow suggest that the outlook for benefit is not necessarily so gloomy and may somewhat dispel this attitude of pessimism regarding return of language function. Four topics will be explored briefly: 1) major aphasic syndromes will be described; 2) treatment for the aphasic patient will be discussed; 3) some recent evidence of the efficacy of treatment will be summarized; and 4) ways to find out what services are available in a given community will be suggested.