Dear Speechy;

My grandfather had a massive stroke and could not talk afterwards due to Aphasia. He had 2 weeks of physical, occupational and speech therapy, but they release him because he can walk now. I think he still requires more speech therapy, as he becomes very angry when he tries to sputter words. He appears to understand what is being said to him and he no longer has any weakness. Please help. Recommendations?

– Julie in Scottsdale, AZ.

Dear Julie;

It sounds like your grandfather had a stroke isolated in the left hemisphere where the language functions reside. Aphasia is a language impairment that reduces a person’s ability to speak, (match thoughts to words), and often also reduces a person’s ability to understand language, (hear words and match them to your thoughts). Your grandfather could have a co-occurring motor planning difficulty with speech, as well. Apraxia is the name of a speech disorder that reduces one’s ability to coordinate the muscles used for speech and results in difficulty trying to say words, mixing up sound sequences, especially with multi-syllables and general dysfluent speech patterns. Your grandfather would do well to see a speech pathologist who specializes in neuro-rehab at the outpatient level. Someone who could teach him how to utilize speech/language functions on the opposite side of the brain and to use compensatory strategies to optimize his communication.

Indeed your grandfather was cut off from the insurance because in today’s world, the physical therapist’s goals lead the rehabilitation team and the insurance’s decisions. In general, if one can walk, then the rehab is over! Your grandfather’s speech pathologist may not have even had the opportunity to advocate for her patient.

I suggest you accompany your father to a doctor’s appointment and request an order for outpatient speech therapy. Your insurance should be willing to cover a few visits. If you can afford it, you can find someone in practice, like myself, who you are willing to pay privately. I assure you, your grandfather has a lot of potential for improvement.