Flashcards for Stroke Rehabilitation – picture my picture

Flashcards for Stroke Rehabilitation

What is Stroke?

A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain either bursts or is blocked by a clot. As a consequence, a portion of the brain does not get the blood (and oxygen) it needs, so some of the brain cells die.

The types of stroke
A haemorrhagic stroke occurs when a blood vessel ruptures and prevents blood flow to the brain. In comparison, an ischemic stroke is one that involves a clot obstructing the flow of blood to the brain. The other type of stroke is a transient ischemic attack (or TIA), which is often known as a mini stroke, and is caused by a temporary clot.

The effects of stroke 

The effects of stroke depend primarily on the location of the obstruction in the brain and the extent of the brain tissue affected. If the stroke occurs in the left side of the brain, the right side of the body will be affected. This might result in speech and language problems, memory loss and/or paralysis on the right side of the body.

In comparison, if the stroke occurs in the right side of the brain, the left side of the body will be affected. This outcome of this might be vision problems, memory loss and/or paralysis on the left side of the body.

Stroke rehabilitation
Stroke rehabilitation is an important part of recovery from stroke. The goal is to help a person who has suffered a stroke relearn skills that have been lost. The severity of stroke complications and each person’s ability to recover vary widely. There are many approaches to stroke rehabilitation - the ones that are most suitable are determined by the part of the body and type of ability affected by the stroke.

Image of a brain affected by a stroke

Physical activities(show +)

Cognitive activities(show +)

Flashcards for Stroke Rehabilitation

Flashcards can be a great resource for stroke rehabilitation. A flashcard (or flash card) is a card that contains information on the front and reverse sides. The front of the flashcard has the concept to be learned (such as an image of an apple) and the reverse side provides the answer (the word ‘apple’).

Their history and use today (show +)

Speech and language problems 
There is a range of speech and language problems that may occur after stroke which include aphasia, dysarthria and apraxia. Flashcards may prove to be a helpful resource for each of these conditions.

Aphasia
Aphasia is an impaired ability to understand or produce speech as a result of brain damage. There are three types – receptive, expressive and global. People with receptive aphasia have trouble understanding words other people speak. They may not understand the order of the words or the relationship between the words. In comparison, those with expressive aphasia know what they want to say but have trouble saying it. They may use the wrong words or omit words without realising they’ve done so. When a person experiences both receptive and expressive aphasia, this is known as global aphasia. People with global aphasia may be unable follow commands, name objects or repeat phrases.

For a person struggling to name objects after a stroke a set of flashcards that consists of images from a range of categories (such as food, transport and clothing) may prove helpful. The flashcards can be shown to the person affected and then time given for them to name the image. This process can be repeated many times over and assists with forming the connections between the image and the word.

Dysarthria
Dysarthria can occur after stroke and is a speech disorder caused by muscle weakness in the face, tongue and/or mouth. People with dysarthria may speak slowly and their speech may sound slurred, muffled, hoarse or nasal.Flashcards may be helpful for treating dysarthria in a variety of ways. For example, a series of verbs flashcards may be used to focus on articulation, with the person affected by the stroke naming the action images shown to them (eg “running”, “sleeping” and “eating”) and re-attempting words if at first they are unclear to the listener.

Apraxia
People with apraxia of speech have difficulty connecting speech messages from the brain to mouth. It relates to difficulty initiating and executing voluntary movement patterns when there is no paralysis or weakness of the speech muscles. When a person has apraxia of speech they may find it difficult to produce the right speech sound and use the correct rhythm and rate of speaking. It is a loss of prior speech ability that results in limited and difficult speech.

Flashcards are often used to assist people with apraxia of speech. For example, they might be used for speech drills, which encourage a person to say words and phrases repeatedly, such as the prepositions “on top”, “next to” and “between”. Alternatively, flashcards may be used for vowel practise. If the focus were on ‘a’ then the images of an acorn, apron, lady and baby would be ideal.

Memory and cognitive challenges  
Another potential effect of stroke relates to difficulties with memory and cognition, such as planning, organizing ideas and making decisions. Not all memory problems are the same. It may relate to the ability to absorb new information, transfer learning from one setting to another or remember information for a significant period of time.

Flashcards are an ideal resource for assisting with memory challenges because they are an application of the testing effect – the finding that long term memory improves when time is dedicated to (a) testing a person’s understanding of information through having them retrieve it, and (b) providing feedback on their accuracy. For example, a set of association flashcards might be used to consolidate the concept of items that inherently go together, such as sock and shoe or bowl and spoon. The person with memory challenges might be asked to match the card they are holding (such as the toothpaste) with the associated card on the table (ie the toothbrush) which is in the midst of a number of cards.

Variety of uses
Whilst the image on a flashcard may be simple, its use may be for a range of speech, language, memory and cognitive challenges after stroke. For example, the image of a bus may be used to assist with treating receptive aphasia (eg by touching the image of the bus among a series of images), expressive aphasia (eg saying the word “bus”) and dysarthria (eg pronouncing the word “bus” clearly). The same image may also be used to assist with treating memory challenges (eg by identifying this object as a transport rather than a food or a piece of clothing). As a result of their broad application, flashcards are useful for a range of challenges potentially experienced by a person after a stroke. Whilst their potential application is broad, their success lies in being specific to the particular needs of the person affected.