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Communication rehabilitation should include caregivers

Health care professionals should look at the whole family and use an individualized treatment plan for stroke victims with diminished communication abilities, says Barbara Shadden, professor of communication disorders.

“What’s missing in treatment is taking the temperature of the family system on a regular basis,” said Shadden.

Shadden studies aphasia, a brain-generated defect in understanding and using language that often occurs in stroke victims. She runs the university’s program in communication disorders and has led a support group for stroke victims for the past 20 years.

She has noted that the sociological and psychological challenges for aphasic people and their families often take a back seat to other considerations.

“If you have a stroke, the doctor’s trying to help you live. The therapist is trying to help you to walk, to speak,” Shadden said. “No one is saying, ‘Where’s the spouse, where are the kids?'”

Traditionally, speech and language therapists treat the brain-damaged language behavior, but that doesn’t always help aphasic patients learn to re-adjust to life after a stroke or cope with their illness.

“Ideally, for intervention in cases like these, you would like to have a team,” Shadden said.

Unfortunately, health care is headed in the opposite direction — emphasizing efficiency, economy and functionality. That may result in visits that treat patients generically instead of individually.

“The bottom line is that our models of aphasia must be as comprehensive as possible, even if the complexity of the model is uncomfortable,” Shadden concludes. “We must consider all players affected by aphasia, standing back from our mission as patient advocate long enough to recognize that more than one set of needs must be addressed.”

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