Speech Therapy Key to Stroke Rehab, But Many Miss Out

Lack of coverage can keep patients from services even though help is out there, experts say

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THURSDAY, Oct. 27 (HealthDay News) -- Like many stroke survivors, Casey Gwinn received only rudimentary speech therapy after suffering a massive stroke at the age of 37.

Gwinn had no insurance and spent a year-and-a-half completely isolated, unable to communicate, socialize or work until he fell into the lap of Austin Speech Labs in Texas, one of a handful of organizations cropping up around the country to help people like him regain their communication skills and rejoin the world.

"When he came to us, literally the only word he had was 'Hi,'" recalls Shilpa Shamapant, founder of Austin Speech Labs.

It's taken two-and-a-half years of intensive work, but Gwinn can now speak for himself.

"I talk a lot better than I used to partly because, before, I had no talk at all so that's great news," said Gwinn, now 41. "I can talk to you a little bit. It's a struggle but I can."

The need for speech therapy is "huge," said Darlene Williamson, vice president of programs for the National Aphasia Association. (Aphasia refers to the communication impairment that can occur after a stroke or head injury.)

Even people with health insurance often don't get the care they need, she said.

Medicare, for example, pays a maximum of $1,870 for speech and physical therapy combined.

And most insurance companies take their cue from Medicare, said Williamson, who is also director of The Stroke Comeback Center in Vienna, Va., a nonprofit organization providing affordable communication services to stroke survivors.

"That doesn't take you very far," she said.

"It's very, very difficult to get the reimbursement long-term [for speech therapy] and many people out there need it for a year or two," agreed Karen Riedel, director of speech-language pathology at the Rusk Institute of Rehabilitation Medicine at NYU Langone Medical Center. "Somehow or other, we've gotten into something about communication -- that it is not medically necessary, whereas it is medically necessary to walk."

NYU has four aphasia programs available to patients after they complete formal speech therapy.
The programs are free and operate more as support groups for individuals with communication impairments, not only giving them a place to practice their speech but also to combat the terrible isolation which so often accompanies a language impairment.

Last year, 1,000 people visited the groups, Riedel said.

"Individuals need a place to be with other people and be a part of the world," Riedel said. "They consider the groups almost their lifeline to connecting with the world." She said that get-togethers like these go a long way to help "the reintegration of people into society."

Lynn Stiles, 73, a retired social worker and copywriter, can attest to that.

She found Austin Speech Labs not long after suffering a stroke in February. She now speaks fluidly and eloquently after participating in the organization's eight-week "boot camp."

But she keeps coming back anyway.

"It's a community and everybody is in this boat more or less," Stiles said easily. "One of us makes a little progress, everybody congratulates them. Being able to come here every day for six weeks convinced me that I needed the people."

SOURCES: Darlene S. Williamson, vice president, programs, National Aphasia Foundation, and executive director, The Stroke Comeback Center, Vienna, Va.; Shilpa Shamapant, founder, Austin Speech Labs, Texas; Casey Allen Gwinn, 41, Austin, Texas; Lynn Stiles, 73, Austin, Texas; Karen Riedel, Ph.D., assistant clinical professor and director, speech-language pathology, Rusk Institute of Rehabilitation Medicine at NYU Langone Medical Center, New York City

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