How to manage a patient with intracerebral hemorrhage?

Question

Hi doctor,

A patient aged 73 years had an intracerebral hemorrhage and a speech problem. He speaks too fast to understand. Any suggestion about exercises on how to solve this? Also sometimes have a swallowing problem. Any suggestion about electrical stimulation therapy or devices like VitalStim that can improve his swallowing and speech condition? Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

Speech and swallowing issues resulting from cerebral hemorrhages are highly complex. Therefore, it would be difficult to advise on a specific treatment without a thorough speech-language evaluation. First, if swallowing and fast speech rates continue, I suggest you ask your primary physician for a referral for a swallow study and speech evaluation.

Regarding exercises to help with speech rate, the evidence does not support oral practices for this purpose. However, I can offer suggestions to perhaps aid in more excellent intelligibility. Have the patient read a short passage and record his voice. Then, playback and see if he can verbally repeat what he hears. Establish a cueing system between the patient and primary conversation partners, including visual, tactile, and verbal cues such as moving a hand down, touching the hand, and "slower, please" lines should be simple and discussed ahead of time. Practice describing pictures or playing using short sentences of four to five words. As rate and intelligibility improve for short sentences, increase the number of words and strings of sentences.

Regarding swallowing, Does the patient have problems with liquid? Solids? Aspiration? Swallow paralysis? I need more information before giving recommendations.

Kind regards.

Answer 2

Hi,

Welcome back to icliniq.com.

That sounds like an appropriate protocol for dysphagia. As the patient tolerates different thicknesses and textures better, gradually decrease the degree of puree and give gradually thinner liquids. Check for aspiration of food, water, and pocketing in cheeks. At this stage, the patient's teeth and the oral cavity must be cleaned thoroughly after each meal to avoid aspiration of old food that can result in pneumonia.

I hope you find it helpful.

Kind regards.