What are the chances that my wife will recover her speech after her stroke?
My wife Suzanne 61 years old, had her first major brain haemorrhage involving the right temporal and parietal lobes in March 2010 and after 5 weeks in hospital, after an urgent craniotomy to remove the blood, she went to the rehab unit where after another 5 weeks I took her home. An angiogram was done when she was at the rehab hospital which indicated that all the veins in her brain were normal. The professor diagnosed Amyoloid Angiopathy.
She had the use of her speech, could eat by herself and the use of her right arm and leg. Her spatio visual improved well and she was even starting to do cross word puzzles As the next few months progressed, Suzanne got better with neuro physio and occupational therapy and was getting to the point, where she started to take a few assisted steps and she was hugely positive that she would walk unaided within a few months.
Unfortunately, she had another massive brain haemorrhage in the same area of the brain on the 23 September 2010 and went through the normal trauma of this insult to the brain, surgical intensive care unit with ventilator, venticular drain etc. After 4 weeks, she was admitted to the general ward but this time, she has no movement in ANY of her limbs and is unable to speak. She is able to move her head only. We started neuro physio and occup therapy and speech therapy already by the second week. After 2 months Suzanne had another haemorrhage which was unknown to us and was picked up on an MRI which was done to try to understand why her right side and speech was affected when the MRI indicated that the structure of the left brain was intact but a right frontal haematoma had developed.
What was interesting is that with the previous bleeds, if Suzanne had not been admitted to hospital immediately, she would have died of the brain bleed yet we were unaware of this frontal lobe bleed. There was no indiction of this last bleed in any of her vital signs. Remember, she could not speak and tell us anything.
She has now been admitted to a care facility from 1 December 2010 because she requires 24 hour nursing. She still has neuro physio daily and occupational and speech therapy 2 to 3 times a week. Suzanne is in a wheelchair twice a day and is taken for a 1 to 2 hour walk in the care centre to stimulate her brain, see the gardens and experience the fresh air. Suzanne has a complete understanding of what we are saying to her and she vocalises this through a crying response which really is traumatic for the family. Remeber, she also experiences emotions and has emotional lobility as a result of the frontal lobe bleed.
We needed to remove the NG tube and get a PEG inserted to make her feeding more practical and when she went back to hospital for the small procedure, we had a CAT scan done of the brain just to ensure that the injuries were healing. The report dated 28/12/2010 reads as follows:
" extensive old infarcts/ evacuated haemorrhages involves the right temporal and parietal lobes associated with focal atrophy. No recent bleed. Old infarcts are also noted in the right frontal lobe inferiorly and left frontal lobe superiorly. Compensatory dilation of the right lateral ventricular system is present. Previous craniotomies noted"
My question to this long background particularly over the last 4 months since the September bleed, is what is the chance of Suzanne being able to recover her speech and being able to move her right side again. Remember, the MRI scan indicates that the left brian is structurally sound and the speech area is clear. Also there is no stroke indicated on the brain stem.
We wait every day for the small steps we have been told to expect but my question is has anyone experienced this type of event and what has the prognosis been? I know that each person is different but there are so many recovery stories which take place over the first 12 months and seem to continue afterwards and this has to be my hope and continue to pray for God's help. She understands what has happenned to her and I cannot imagine what she must be experiencing in trying to tell us what she feels or whatever and this is just not possible to comprehend.
Any comments please.
I am truly sorry to hear of these chain of events. I have a few thoughts:
First, given the number of hemorrhages that have occurred, I would make sure that the treating physicians are absolutely certain that the diagnosis is amyloid angiopathy. As the strokes were on the same side of the brain on several occasions, I would want the reassurance of either a Neurosurgeon or a Stroke specialist that further testing does not need to be done to completely rule out an abnormal blood vessel. If amyloid angiopathy is the cause, the best treatment is to very tightly control her blood pressure and avoid giving any blood thinners. Unfortunately, the long term prognosis of amyloid angiopathy is fairly grim as there is no cure for this disease.
Second, recovery after several strokes is hard to predict. In general, the best therapy is to 1) try and maintain a positive outlook for possible recovery, 2) get her up an out of bed, working with therapy, etc. as much as possible, 3) treat any confounding depression (extremely common after several strokes) with an anti-depressant and a healthy dose of a positive attitude.
For the most part, at this point, suffice to say that she seems to have suffered some very devastating brain injuries, and that love, support, and optimizing medical and rehabilitative care is the best therapy she can get.
I wish you good luck with her recovery.
Thanks Dr. Castle. What you have suggested is exactly what we are doing. Suzanne has a great team around her of neuro physios, an occupational therapist and a speech therapist. She also has a physician who handles the medical macro management as she really is now out of the hands of the neurosurgeon and neurologist. As you have suggested, she is on Cilift the anti-depressent and Epilim which apart from the control of potential seizures, it is also a mood enhancer and she is only on a maintenance dose.
She is now going to have Botox treatment by a neurologist to her left arm and left neck area to try and release the tight muscles and to preserve the muscle groups in those areas. This nerologist is of the view that she had a bi-lateral stroke although the left side of the brain is clear on the MRI as per report above and he referred to it as a diffusive stroke which he said is in a way "good news" because recovery for this type of stoke can continue up to 24 months.
As far as the Amaloyd Angiopathy is concerned, they suspect it is so and apparently the only real way to determine this is with a brain biopsy which is not going to happen to Suzanne. I did refer in my original report that after the first stroke, an angiogram was done of her brain and all the arteries and blood vessels were completely normal and there were no abnormalities present.
Suzanne in fact also has low blood pressure so that is not a problem but in 2 of the 3 strokes ( which were in the same right temporal parietal area), she had been on anti-coagulents but on the 3rd stoke 2 months after the last stroke she off the blood thinners and in fact we did not even know that she had had the stroke which was in the right frontal lobe area. Refer to the report in my original post.
We are very positive about her recovery although it will take time and as you say, it is difficult to predict as each person is different but her doctor says she will not walk or speak again which diagnosis I have got to disagree with. In her "communication" with me she has indicated that she will continue to pull with us to get herself recovered.
We also give her daily huge doses of love, she is an incredible brave and courageous lady and we have lots of faith in God to Whom nothing is impossible!!
Thank you for your positive reply.
Strokes have hit my family more than once. My sister, when she was 31, had one which took her speach and her right side. It's been 35 years and she has managed to learn to speak well enough to communicate. She sure can sing with no problem. Have you tried having her sing? My 87 year old mother just had a stoke 10 months ago which affected her the same way. We did therapy but her brain doesn't respond the same in a given day so she hasn't been able to communicate. I consider her age and other medical issues to be the reason she is not improving. She also can sing familiar songs. I hear what you say about how difficult it must be to not say what you feel or think. Like being in a type of prison. This is why I moved 800 miles away, left my teens with their father, and am caring for my mom full time. It's very hard to have a loved one stricken in this manner and that's why we use forums such as this to get support and understanding. It helps when we know that God is in control even when we don't understand the why.
The area of the brain that controls speech is separate from the area that controls singing. If you can help your wife to sing - familiar songs, or even as ways to communicate her needs and thoughts - you can actually rewire her speech capacities. Here's a BBC article from last February that discuses this: http://news.bbc.co.uk/2/hi/8526699.stm
In addition, stroke victims that have difficulty walking may find that it is much easier to dance, whether it's across a room or as part of an exercise program.
It's obvious that your wife is still a young, vibrant, determined personality in spite of her physical difficulties. I am a stroke survivor myself, and can assure you that what she wants most is hope. She doesn't want hope based on mere desire, but hope based on facts.
The more you learn about the rapid developments in neurobiology and neurogenesis, the more certain you will both become that brain regrowth and regeneration is possible at any age. Moreover, if a person believes and envisions that their brain can heal - and in what ways it will do so - then the physical brain will respond to those "thoughts" - that is, the neuronal activity - by actually reorganizing themselves. Help her to visualize her recovery. Practice putting her in a mentally receptive, positive, even hypnotized state so that she deeply believes her recovery is occurring.
It sounds like New Age clap-trap, but the most recent neuroscience shows that this is the way the brain heals: visualization, belief, and practice. As the patient physically practices improving their skills, their belief in recovery grows even stronger - so they improve more rapidly.
Finally, reassure you wife every day, every time you see her, of just how precious she is to you. Help her to believe that, more than anything, you want her with you. Despair is very common among stroke patients. The idea that one's loved one world be "better off" without the burden of care is especially pernicious and tempting. While you are concentrating on helping her regain her powers, also reassure her that you love her spirit, her soul - and even if she doesn't regain her capabilities, you will always love her. You want her to get well for her own sake, because you know how happy and proud she will be.
You believe in her. You have the faith that she can do it. Don't ever listen to anyone - no matter how "expert" - that tells you that she can't improve.
Take care of yourself, as well. She wants you to.
Blessings on you, your wife, your family and your marriage.
Thank you to LouiseinNJ and 4mymother for your wonderful messages of hope. I found both your comments about singing to be very interesting. I was not aware that the singing area of the brain is different from the speech area and the issues of love and belonging and the fact that Suzanne is so precious to me, and I tell her so every day, are so important and the fact of reassuring her that I will never leave her and that I will always be there for her come what may.
I have been expecting big increases in recovery as per the first stroke. These 2 subsequent strokes have completely changed the rules from the first time around. What I am having to learn is patience and set small goals e.g. just to open her mouth more on command, to relax her jaw, etc. rather than expecting her to move her limbs or start speaking tomorrow.....just keep to the baby steps I am told.
I recently read the interview of Jill Bolte the lady who wrote the book "my stroke of insight" and what makes me keep faith and hope is that she said that doctors that pronounce a prognosis after the 3 and 6 month periods make her angry. She said the problem with such a prognosis is that you get into the mindset that "this is as good as it gets" and that the recovery actions for the stroke patient is one of 'maintenance" rather than a continual positive programme of therapy. After all, her mother looked after her and Jill said it took her a full 8 years for a 'full' recovery. There is always hope!!
I hope to record Suzanne's progress and on the 23rd of February 2011 it will be 5 months since the 2nd major stroke and 3 months since the 3rd minor stroke. I am still happy to say that it amazes me that she is still with us after the unbelievable suffering that she been through. As I said in a previous post, she is one incredibly brave and courageous lady. God Bless her and bring her healing in His time.
zanne1, Jill Bolte Taylor's book is extremely important in a number of ways:
1.) She demonstrates that recovery can take a decade - or more. The three- and six-month "recovery periods" are actually what *insurance companies * use, so that they are off the hook paying for years of expensive therapy. Bolte Taylor's mother continued Jill's therapy at home, after the insurance agencies stopped financing it.
2.) Bolte Taylor worked hard physically. She pushed herself to walk to run, to even return to rock-climbing. The more physical activity she undertook, the faster he general cognitive performance improved. The physical exercise perfused her brain with the blood vessels that her neurons needed to rebuild. Of course, in your wife's case, you'll have to work closely with her doctors to protect her cerebral venous system.
3.) Bolte Taylor had been an agnostic before she "hit the ground." Her stroke essentially destroyed all of her linguistic and logical capabilities. She even lost a recognition of Time as an arrow. What she did find was a mystical certainty that there is a God, outside of Ego, the World, and religions.
It's a great book. Maybe your library has a copy.
God's blessings on you both. (Although it sounds like He blessed you by helping you find each other.)
My husband who is 74 years old suffered a stroke in November of 08. He still is unable to use his right side or talk, however, like other people have mentioned, he can sing songs. He does once in awhile get a word out here and there, for instance when we are driving if he sees a deer he can say that. He can also, unfortunately, gets out a lot of swear words. Which I understand he must be very frustrated. In the past 2 1/2 years I have seen little improvement with his speech. He also did not cooperate with physical therapy so he can not use his right arm but he is able to stand on his right leg and if holding on to me can walk a little bit. It is very difficult to try and understand what he has to say and he is very impatient when I ask him questions to try and figure out what he is talking about. I doubt, despite everything that I do for him that he will improve, however, I will keep trying to do the best that I can. I hope for the best for everyone that takes care of someone who has suffered a stroke or any kind of illness. I know that it has taken a toll on myself, health wise and I am 25 years younger then my husband! May there be brighter days ahead for everyone.
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