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Health Matters - "Coping with Aphasia Post-Stroke and Speech Therapy for Head, Neck and Oral Cancer Patients"



Coping with Aphasia Post-Stroke and Speech Therapy for Head, Neck and Oral Cancer Patients

By Jean Amodea

Speech-Language Pathologists Nicole Lombillo MS, CCC-SLP* and Karen Moss, MA, CCC-SLP
Nicole Lombillo MS, CCC-SLP* and Karen Moss, MA, CCC-SLP*
NCH speech and language pathologists report noteworthy results in restoring functional speech in patients suffering communications disorders after strokes and head, neck and
oral cancers.

Aphasia, a communication disorder, is an after-effect of stroke that is experienced by one in 250 patients.

Speech-Language Pathologist Nicole Lombillo MS, CCC-SLP* said that while a patient’s cognitive faculties may be intact, receptive or expressive language centers are affected, impacting skills like speaking, understanding, reading, writing and gestural communication, depending on which side of the brain was impacted by the stroke.

However, therapists can work with patients to help the brain learn to communicate in new ways with best results started as soon after the stroke as possible within the first six months. The most improvement can be noted up to a year after the onset of the stroke, and gains can be made beyond one year dependent on the severity of the stroke and a survivor’s commitment to a therapy program.

“After referral by a primary care physician or neurologist, we evaluate for the exact type and severity of aphasia, testing speech fluency, vocal quality, understanding, expression, social communication skills, reading and writing skills, as well as for dysphagia (swallowing difficulties),” Lombillo said. “A treatment plan then can begin as early as admission at the acute care stage if the patient is medically stable, which is the best time to have the greatest
impact on the brain.”

Therapy can run about one hour, three to five times a week, with some patients attending the Briggs day program for the therapeutic sessions and then continuing at home, affording more flexibility.

New technology includes the use of iPads and iPhones with interactive apps that help stroke patients communicate. Patients can type into a device that speaks for them, or they can learn to communicate by pointing to pictures to form sentences.

Outpatient Rehabilitation also provides the NCH Aphasia Language Group, didactic group classes led by Nicole Lombillo, designed to enhance communication skills for individuals who have been discharged from Speech Therapy. Additionally, NCH offers a support group for individuals with Aphasia led by Sara Rodgers, MS, CCC-SLP* that meets the third Wednesday of every month at the Brookdale Center for Health Aging and Rehabilitation at the NCH North Naples Hospital.

Helping patients after head, neck and oral cancer, which represent three percent of all cancers in the U.S. (52,000 last year), Karen Moss, MA, CCC-SLP* also notes exceptional results.

The best time to start therapy is during or right after patients complete a course of chemotherapy and radiation therapy. Patients present with swallowing and voice difficulties and have a feeding tube if the body is not able to distinguish something as simple as water from air when swallowing.

A FEES (fiberoptic endoscopic evaluation of swallowing) study or a modified barium study is used to test and determine a specific, intensive treatment plan, with the goal to help patients eat without the use of assistive means. Treatment runs two to three times weekly foran hour with exercises designed to work throat muscles. Therapy may continue at home where patients practice swallowing ice chips up to 2,000 times per day.

“In 2008, we pioneered the NCH speech therapy program for head and neck cancer and started a support group for these patients—SPOHNC. The group, now numbering 19, is part of a nationally recognized support group. Moss leads this group which meets the first Wednesday of every month.

The group, open to patients and their families, invites physicians, dentists, nutritionists and other related professionals to address not only physical issues but also the emotional component.

“Using motivation and high energy, we help patients reach individual goals. We are invested in every patient’s success—each gain is our gain and each triumph, is our triumph,” she added.

Moss recommends prompt evaluation by an ENT( ear, nose and throat) specialist as key to catching a potential cancer before it spreads and worsens.

*CCC-SLP Certificate of Clinical Competence in Speech- Language Pathology


For more information about NCH Speech
and Language Services, Group Classes and
Support Groups, call (239) 624-1600.




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