How to help stroke patients with speech?

EFFECTS OF AN AFFECTED BASAL GANGLIA IN A NON-HEMMORAGIC STROKE

• JANUARY 23, 2004 MY 62 YEAR OLD HUSBAND WOKE ME, BY HAVING WHAT RESEMBLED A SIEZURE. HIS MOVEMENTS WERE VERY STIFF, AND JERKY. NOT THE TREMOR TYPE. HIS FACE WAS DISTORTED AND I COULD NOT GET RESPONSE FROM HIM ON THE COMMAND TO OPEN HIS EYES. HE WAS RUSHED TO THE HOSPITAL, THEY DETERMINED THAT HE HAD "PROBABLY HAD A MINOR STROKE,TIA, BROUGHT ON BY THE SIEZURE. AFTER SEVERAL HOURS OF OBSERVATION, HE WAS ADMITTED. MY HUSBAND HAS A HISTORY OF BLOOD CLOTS, AND HAS BEEN ON COUMADIN THERAPY FOR OVER 30 YEARS. 10 DAYS PRIOR TO THIS "EVENT" HIS "INR" WAS 1.7 (TARGET NUMBERS FOR HIS CONDITION ARE 2.5 TO 3.0) SO ALTHOUGH HIS INR WAS MARKEDLY LOW ON AN UNRELATED HOSPITAL VISIT, NOTHING OF CONSEQUENCE WAS DONE ABOUT THE LOW INR. [NOW I KEEP A SUPPLY OF DALTEPARIN SODIUM (INJECTABLE) TO BRIDGE THE PERIODS OF LOW INR UNTIL THE COUMADIN CAN STABALIZE THE NUMBERS] ANYWAY, THE NEXT DAY, (SATURDAY) BILL WAS UP AND WALKING, AND TALKING, ALTHOUGH STRENGTH WAS INTERMITTENT AND INCONSISTENT. SUNDAY MORNING, HE HAD LOST ALL ABILITY AND MOTOR SKILLS ON THE RIGHT SIDE. SPEECH WAS LOST AS WELL AS THE MOTOR SKILL OF SWALLOWING. RESULTING TESTS, MRI, MRA, ANGIOGRAM, ULTRASOUND, ETC, ETC. DETERMINED THAT HE HAD SUFFERED A STROKE AFFECTING THE BASAL GANGLIA. TPA, WAS NOT USED SINCE THE TIME OF ONSET WAS UNSURE, AND THE CHANCE OF THE CLOT BECOMMING A HEMMORAGIC STROKE, AND AFFECTING LARGER AND MORE PARTS OF THE BRAIN WAS CRITICAL IN THIS DECISION. AFTER THREE DAYS I CONVINCED DR'S TO HANG HEPARIN TO RAISE HIS INR. THIS NUMBER I CONTINULY MONITORED DAILY WITH THE NURSE ON DUTY. NOW FOR THE QUESTION: ASIDE FROM THE MOTOR CONTROL LOSSES ASSOCIATED WITH THE BASAL GANGLIA STROKE VICTIM, WHAT IS THE CHANCE THAT THE "MENTAL AGE" OF THE PATIENT WOULD REGRESS/ IE: LOSS OF CONTROL OF IMPULSE ACTIONS, REFUSAL TO COMPLY WITH HOME THERAPY, BY SPOUSE, BUT WILLING TO COMPLY WITH PROFESSIONALS, WHO "DOTE" ON HIS EVERY MOVEMENT. THE BLOOD CLOT WAS LOCATED IN THE LEFT CAROTID ATRERY, TOO FAR UP IN THE BRAIN TO PROVE SURGICAL. MY FEARS ARE THAT THE ADULT I MARRIED, MAY HAVE BECOME THE CHILD I NOW HAVE TO RAISE, WITHOUT TREATING HIM OPENLY LIKE A CHILD, SO THAT SELF RESPECT CAN BE MAINTAINED. HE PUTS ON A FRONT FOR FAMILY AND FRIENDS, BUT BECOMES SULKY AND SULLEN WHEN ALONE. UNWILLING TO PARTICIPATE IN LENGTHY CONVERSATIONS WITH LOVED ONES, FOR FEAR HE WILL FAIL TO FIND THE WORDS. I AM FRIGHTENED, AS THE SOLE CARE GIVER, AND HIS CHILDREN ALL BELIEVE HE IS OKAY. WE JUST RETURNED FROM A 6,00 MILE 6 WEEK TRAVEL TRAILER VACATION,[I DID ALL THE DRIVING, AND 'TRAILER WORK'] BOTH WITH FAMILY AND TO SEE FAMILY. MY HUSBAND, WHO USED TO HOOK THE TRAILER, AND HANDLE THE "SET-UP" DID ABSOLUTELY NOTHING, CLAIMING NOT TO REMEMBER HAVING DONE IT. HE IS NOT ALLOWED TO DRIVE, UNDERSTANDABLY TO MOST, BUT AFTER A 20 YEAR CAREER AS A PROFESSIONAL DRIVER, A SLAP IN THE FACE OF HIS VARILITY, I'M SURE. WELL I'V HIT THE HIGH SPOTS OF THE FACTS.... WHAT MENTAL AND SOCIAL SKILL REVERSALS SHOULD BE WATCHED FOR IN THIS TYPE OF STROKE? IS THIS COMMON, OR PERHAPS A PASSING EMOTIONAL STAGE THAT SHOULD BE ADDRESSED BEFORE IT BECOMES, PERMANENT? ALL HELP APPRECIATED. THANKS, GLORIA

• Answer:

  Hello gloriaval-ga, First of all, I'm sorry to hear of your situation and with you the best of luck. It takes a lot of strength and patience to care for a loved one at home. I did so for my grandmother, with her lung cancer many years ago and it's hard on both the ill person and the caregiver. I've been doing some research into the basil ganglia strokes and the symptoms you've mentioned and I believe I have an idea about what is going on with your husband and how you can help him. Let me give you a brief outline of how I'd like to cover this information. I'm going to give you some information on how the stroke affected your husband, how it ties into his behaviors and what you can expect from him in the future regarding behavior, and what are some things you can do to lessen the stress of this for all involved parties. Let's start with the information. The basil ganglia are groups of structures (large collections of nuclei) inside the brain that help with movement and also play a role in thinking and emotions. Unfortunately, this is one of those things that while it has been studied, it's not extensive, so there's not a massive amount of information out there about how it affects people, unlike with AIDS or cancer. However, we do know this much. The motor cortex sends information to both the basil ganglia and cerebellum, and both structures send information right back to the cortex via the thalamus. The output of the cerebellum is excitatory, while the basal ganglia are inhibitory. The balance between these two systems allows for smooth, coordinated movement, and a disturbance in either system will show up as movement disorders. Therefore, that in a nutshell, explains the movement issues your husband is facing. Now, let's move on to the mental issues that are going on. There has been research into how basil ganglia strokes and anything affecting the basil ganglia can cause depression and other psychiatric problems. Some of the emotional and psychiatric systems that occur when the basil ganglia gets affected are emotional and/or personality problems, such as depression, apathy, inappropriate behavior, or paranoia. In addition, an inability to think clearly, concentrate, or recall. This seems to apply very well to your situation as you mentioned him not being able to recall hooking up your travel trailer. You also mentioned his unwillingness to work with people and his sullen mood. Those all fall into place with the depression, apathy, and inappropriate behavior symptoms. I found a great research study and presentation called "Post-stroke depression and emotional incontinence: correlation with the lesion location" They define emotional incontinence as "inappropriate or excessive laughing and/or crying.? It determined that there was a higher of PSD (Post Stroke Depression) and PSEI (Emotional Incontinence) with people with basil ganglia lesions. However, the size of the lesions really did not have a lot to do with how strong the PSD and PSEI affected the patient. Therefore, this once again explains the behaviors your husband is going through. It's not really a "mental age" thing as you put it. It's more than likely he's suffering from PSD, PSEI, and the frustration that happens with this type of medical problem. It has to be very hard emotionally and physically to deal with this and the behaviors your seeing are a manifestation of the stroke and the emotions surrounding it. The PSD can fall into one of two categories Major depression or minor depression. Here are the differences between the two. Major depression has symptoms and behaviors such as sadness, anxiety, tension, loss of interest and concentration, sleep disturbances with early morning awakening, loss of appetite with weight loss, difficulty in concentrating and thinking, and thoughts of death. Minor depression is a lesser form of depression and is characterized by anhedonia (the inability to gain pleasure from normally pleasurable experiences) and up to three additional symptoms of major depression. The DSM IV (Diagnosis Criteria for Mental Disorders) classifies depression like this. Table 1: Criteria for a major depressive episode. I. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. A. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation B. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) C. significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day D. insomnia or hypersomnia nearly every day E. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) F. fatigue or loss of energy nearly every day G. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) H. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) I. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide You may be able to treat these behavioral symptoms with an anti-depressant or some other medication. I recommend talking to your physician or making a psychiatric appointment for your husband. The biggest thing he needs, in addition to those is a strong support system. This can't be easy for him either, and the more people who understand and can offer sympathy and empathy the better. Here are some links with more information for you. http://health.discovery.com/encyclopedias/3037.html http://www.healthandage.com/PHome/135!gid2=629 http://plaza.snu.ac.kr/~nurse21/csm/smi-abs1.html http://www.neuro-net.net/diseases/journals/acutestroke/depress.html http://thalamus.wustl.edu/course/cerebell.html http://www.netdoctor.co.uk/special_reports/depression/anhedonia.htm http://mysite.verizon.net/res7oqx1/index.html I found all of this information for you with a google search. BASAL GANGLIA STROKE ://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-8&q=BASAL%20GANGLIA%20STROKE&btnG=Google+Search If this answer requires further explanation, please request clarification before rating it, and I'll be happy to look into this further. Nenna-GA Google Answers Researcher