‘Sorry, but it’s been too long.
Your wife’s stroke was 10 years ago and you can’t expect her language skills to improve now.”
 
That was the disheartening message given to Peter Hardwick, 81, when he sought help for his wife Sybil, 80, after the couple moved from Sutherland to Inverness-shire two years ago. When Sybil had a stroke at the age of 68, her ability to understand the world was unaffected, but her speech was impaired. It improved with the ­support of a speech and language therapist – but, long after the therapist’s visits had come to an end, it deteriorated again due to the stress of moving house. Peter was told there was little that could be done. “The authorities seem to give up after a ­certain stage,” he says.
He did not accept that, however, and took matters into his own hands, going online in search of speech and language therapy software the couple could use at home. 

Now the Hardwicks have two ­different software packages – one American, one a Scottish-made ­program called React2 – and they spend 15 minutes a day working on the computer. Peter, a former engineer, operates the software while Sybil, a former ward sister, does the exercises. 

Is Sybil making any progress, 12 years after her stroke? “Crikey, yes,” says Peter. “We use it as a stimulus for her brain.” 

Sybil agrees. “It’s important because of my speech,” she says. “I don’t get enough practice, so the software is very important.”

This kind of therapy software is increasingly widely used by people who have problems using or understanding language as a result of a brain injury (a condition broadly known as aphasia). Speech therapists encourage clients to use it alongside other treatments, including paper-based exercises and attending communication support groups – but its great advantages are that people can use it at home and that it tells them how they are doing as they go along. As the Hardwicks’ experience shows, it can help stimulate improvement years after a stroke. 

At the forefront of this important technology is a Borders-based ­company called Propeller Multimedia, which produces React. The software focuses on comprehension, rather than speaking, though it can be used to help stimulate conversation too. It comprises 8000 exercises covering five key areas, including recognising sounds and getting the gist of a conversation; improving memory; and life skills, such as understanding bills. React was developed in the late 1990s at the instigation of Tricia Mitchell, the lead speech and ­language therapist for NHS Borders, and React2 is a newer, improved version.
Although there are around 20 other pieces of speech therapy software available, such as the American ­product Bungalow, Propeller’s development director, Dean Turnbull, believes React2 is unique in the ­English-speaking world in the breadth of exercises it offers. It has been developed from paper-based speech and language rehabilitation exercises, and Propeller hope to put it through a ­formal clinical trial soon. 

The benefit of the software, as ­Turnbull sees it, is in giving people a means to practise after their face-to-face therapy has come to an end. ­Tricia Mitchell, meanwhile, says the time a speech therapist has to spend with each person is never enough. “Software would never replace face-to-face therapy,” she explains, “but it could mean people are getting more therapy without having a therapist there with them.”

It can also take the pressure off family members. “If we didn’t have the software, we would still be giving them the paper exercises, but the beauty of the program is that we have the computer telling them if they are right or wrong,” she says. “I often think that if someone has a very severe language problem – say it’s a husband who’s been a very intelligent person but has been severely handicapped and his wife is saying, ‘Can you show me the pen or the ball?’ – it becomes very difficult for the family dynamics and can be resented.”
Fiona Gardiner, a speech and ­language specialist working with adults in NHS Highland, uses various types of software in addition to other resources. Patients start using it on the rehabilitation ward and, where appropriate, take it home with them afterwards. “It gives them independence,” she explains. “We’re getting to the point where you could tailor-make a lot of an individual’s programme via software resources.”

Computer programs can be particularly useful in a geographical area such as hers, where speech therapists must travel long distances to visit ­clients. In future, she says, if a patient has very good computer skills, their progress might be monitored remotely using software. 

The care organisation Chest, Heart & Stroke Scotland (CHSS) runs communication support groups all over the ­country for people recovering from strokes, using a range of technological aids, paper-based exercises and good old-fashioned conversation. One such group meets at Eyemouth Community Centre in the Borders on Thursday afternoons, run by volunteer service coordinator Sandra Smart. On the day we visit, a dozen men and women who are recovering from strokes are doing a quiz about Rabbie Burns. The one-word answers are written on ­individual pieces of paper in front of them, all jumbled up. Each table of three or four must confer before selecting the right one.
The lightning speed at which they pick up the right answers – Burns’s birthplace, his wife’s name, his best-known works – underlines the ­frustrating reality for many: that their comprehension is razor-sharp while their speech lags behind. But coming to the group helps build confidence when it comes to speaking. “Our aim is to rehabilitate people into the ­normality they enjoyed before,” says Rosi Capper, CHSS regional manager for the east of Scotland. “We work with people who have been with us for a long time after their stroke and we see them improving, not just in skills but in confidence and belief.
She adds: “Technology has a very significant role to play.”

The volunteers build on the work each individual has been doing with their therapist. John Collins, 77, had a stroke three years ago and was in ­hospital for a fortnight. “I never spoke a word initially,” he says. He was assigned a therapist for two years, after which he was able to speak “a bit”, and then started attending the communication support group, where he speaks with other people and uses computer-based aids such as React2. Sometimes he has difficulty finding the right words but the software has helped. He has even written his life story. 

This afternoon, after a long and eventful day, he is tired and some words escape him. No therapy can work miracles, after all. But if the conversation classes and the computer exercises seem like a lot of effort for John to be making so long after his stroke, it’s all made worthwhile by three small words, which he utters with a shy smile: “I’m still improving.”
www.chss.org.uk
www.propeller.net

What is a stroke … and what happens next?
A stroke happens when the blood supply to part of the brain is interrupted. This can be caused by a clot or by other bleeding. Some cells recover, some are damaged or die, and some may take over from the damaged cells.
Strokes vary in severity but can cause difficulties with speaking and understanding, as well as concentration and memory problems, weakness or paralysis, difficulty with swallowing, mood swings, anxiety and depression
Recovery begins immediately and goes on indefinitely, but it depends on many factors. Some people make a complete or near-complete recovery within weeks or months; about half may take months or years to achieve near or complete recovery; less than one-third do not make a full recovery.

The organisation Chest, Heart & Stroke Scotland has a phone line that offers confidential, independent advice: 0845 077 6000.