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Prof. Dr. Cengiz BAHADIR


Post-Stroke Speech Disorders – Aphasia

Unilateral paralysis (stroke, hemiplegia) occurs due to the damage of the brain cells in the relevant region as a result of obstruction or bleeding of the arteries feeding the brain. In this case, the opposite half of the body of the damaged brain is paralyzed. The degree of this paralysis is generally proportional to the size of the damaged part of the brain. When left part of the brain is affected, in addition to right-sided paralysis, the speech is also often impaired as the speech center is also in this part. This deterioration can occur in varying degrees, from the inability to talk to a slightly distorted speech. Often, when the patient wants to talk, he/she cannot choose the right words, he also has difficulty in naming objects. This situation, called as aphasia, may cause psychological problems because not only paralyzed patient cannot use the right part of the body properly but also they have difficulties in verbalizing what they want. During the recovery period of the paralysis, the movements on the affected side gradually normalize and the speech gradually begins to recover. Mild cases are usually recovered completely, but in moderate and severe cases, speech impairment may remain more or less.

Speech therapy has been used for the treatment of such patients for years. Speech therapy conducted by a medical personnel trained in this area can lead to an additional improvement in the recovery period of paralysis to some extent. Speech therapy is compelling for both the patient and practitioner and also it requires long hour sessions.
In recent years, in addition to this traditional method, transcranial magnetic stimulation (TMS) therapy has been used in post-stroke speech disorders, which makes it possible to treat brain from outside. Although it is not approved as a regular treatment method, hundred of studies carried out in this subject have revealed it’s efficiency. When it is provided in combination with speech therapy, it is possible to get better results in paralyzed patients.
TMS treatment can increase or suppress the activity of the brain cells in the affected region. With this method, speech center of brain is stimulated in a painless and harmless way. This treatment is provided through stimulating speech center in the left part of brain with high frequency or suppressing the other part with low frequency. With suppressing the opposite side, it becomes easier for patient to recover his/her speech ability lost after stroke.
In treatment of aphasia through TMS, lowest magnetic current intensity that stimulates the brain is determined and then the treatment that is most suitable for the patient’s condition is performed accordingly. Typically 1000-1200 stimulation is given to speech center of right hemisphere of brain. The duration of treatment usually ranges from 10 to 30 minutes depending on the patient’s condition and lasts between 10-15 sessions. TMS treatment, which has nearly no side effects and is very painless, has been a promising treatment in the treatment of post-stroke speech disorders.