7/7/23, 3:32 PM Aphasia patients can improve with therapy long after stroke

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HEALTH

Aphasia patients can improve

with therapy long after stroke

Charlie Middlebrook of Texas talks with Lori Bartels-Tobin, a speech-language pathologist at the Aphasia Center in
St. Petersburg. He paid for intensive speech therapy after a stroke.

By Irene Maher | Times correspondent

Published Feb. 29, 2012

ST. PETERSBURG
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7/7/23, 3:32 PM Aphasia patients can improve with therapy long after stroke

Nearly 800,000 Americans have strokes each year and about 100,000 are left with
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serious problems communicating, a condition known as aphasia. Research has
demonstrated that with therapy, many of these patients can talk and understand
language again. But the process can be slow and expensive.

A new study from the Medical University of South Carolina tallies at least part of
that expense by examining Medicare payments to thousands of stroke patients.
The study found that people with aphasia tend to be older and sicker than other
stroke patients, requiring hospital stays that are on average 6.5 percent longer and
Medicare payments that are 8.5 percent higher.

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But despite their greater needs, Medicare caps payments for speech and physical
therapy after a stroke at less than $1,900. Most private insurance also has strict
limits for such rehabilitation.

In light of growing evidence that recovery can continue for some time after the
stroke, that philosophy should be reconsidered, says the lead author of the new
study, published recently in Stroke: Journal of the American Heart Association.

Without adequate treatment, patients and families suffer "substantial limitations

in life participation," said Charles Ellis Jr., associate professor at Medical
University of South Carolina.

Lisa Edmonds, an aphasia researcher at the University of Florida, says some

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patients continue to make gains for years. "The improvement may not be as steep

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7/7/23, 3:32 PM Aphasia patients can improve with therapy long after stroke

as it is in the first year but there is the capacity to continue improving. Some for
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three, five years after," she said.

But the insurance limits also mean that fewer health facilities offer the kind of
intensive therapy these patients need, so it may not be available even to those
willing to pay cash for it.

Mollie Middlebrook scoured the country looking for additional speech therapy for
her husband Charlie, 66, after he suffered a stroke just over a year ago.

"After three or four months of therapy at home, they said he had plateaued," she
said. But she read research reports suggesting more therapy could help. "I wanted
intensive therapy before his first year was up, so he could get the most out of it."

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Their search brought the Houston couple to the Aphasia Center in St. Petersburg.
Mrs. Middlebrook chose the program in part because treatment would be tailored
to her husband's specific needs "and because of the weather," she said. Similar
programs she found are in Michigan and Illinois.
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7/7/23, 3:32 PM Aphasia patients can improve with therapy long after stroke

The Middlebrooks paid $15,000 for four weeks of intensive therapy—five hours of
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daily sessions, Monday through Friday, including one-on-one time with therapists,
group and computer work.

"We were blown away with the success of it," said Mrs. Middlebrook during a
January visit to the center. "He is speaking in fuller, more accurate sentences,
using more words than before, he can string together four or five sentences. He
couldn't do that before we came."

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But Mr. Middlebrook's frustration that he wasn't progressing even more was
palpable.

The retired pastor, educator and author holds a doctoral degree in biblical studies,
yet his wife says that since the stroke sometimes he can't recall the names of his
grandchildren. On the last day of his January visit to the Aphasia Center, he
couldn't recall certain words or answer a reporter's questions fully.
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"I just can't say it. I'm not dumb about it," he said.

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7/7/23, 3:32 PM Aphasia patients can improve with therapy long after stroke

But he had no difficulty finding the words to say grace before lunch.
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How much can patients expect to recover by undergoing additional therapy when
insurance coverage runs out? It varies, but Edmonds said if you still have
symptoms a year after a stroke, you likely won't return to your pre-stroke ability to
communicate — though smaller improvements are possible.

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Mrs. Middlebrook said the time and money spent were worthwhile. Although Mr.
Middlebrook has been in treatment for cancer, he sounded strong in a brief phone
conversation on Wednesday.

Edmonds said that most patients and their families are grateful for even
incremental improvements. Returning to a high stress, complicated job may not
be in the cards, but a satisfying life is still within reach — if they can adjust
expectations.

"People can live normal lives with aphasia," said Edmonds, "But the way they live
might change."

Irene Maher may be reached at imaher@tampabay.com.

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