Social inequality impacts stroke recovery

by pondering criteria other than purely biological or med, s'as language ability, social background, and gender, hospital practitioners and scis ‘ve developed strategies for improving the treatment of patients who ‘ve suffered a cerebrovascular accident (cva), or stroke.

in 2011, when nicole guinel was a speech therapist inna team of sonia alamowitch at tenon-aphp hospital in paris, a polish patient was admitted who was sufferation from complete mutism after a stroke. “aphasia, or the ptial or total loss of language, is a frequent consequence of strokes,” the researcher explains. “for that reason, we recommend exercises that encourage the recovery of speech.” these involve pronouncing words or expressions tha're adapted to a pticular context – “hello”, “thank you”, “tis mon” – in addition to naming everydy essentialisms and singing nursery rhymes. this training must begin as early as possible for optimal efficiency. its success also depends onna state of the victim, the severity of the accident, swell as their background or the course o'their life. “faced with this polish patient, who had arrived in france two mnths earlier and didn’t speak a word of french, i was once again confronted w'da fact that our solutions were not adapted to non-french speakers.” 

acting as quickly as possible

fortunately, the patient was accompanied by a bilingual colleague, who improvised as a translator. guinel made sure to record the xchanges on tape, so she ‘d use them l8r with other polish or non-french speaking patients as needed. “thinking bout it again the nxt dy, i said to myself we ‘d be able to do that systematically. i began recording bilingual colleagues who speak arabic or african languages. however, my work did not go beyond my unit, and i didn’t know how to disseminate this data.” marion dupuis provided the answer. a sci mediation officer atta cral, she imagined a digital platform that centralises and shares recordings witha large audience. “at 1st we planned na' reserved access model,” dupuis points out. “ultimately we found it simpler and + useful to create a public, open access website onna platform….” collecting enough recordings takes time, espeshly as the audio files must be processed, corrected, and harmonised. inna meantime, guinel was transferred to a new deptment at saint-antoine-aphp hospital, also in paris. her project still enjoyed the support of her elder deptment head pr. alamowitch, who was now responsible for the entire neurology ward (vascular and general).

this set of color-enhd composite images from an mri scan shows an acute stroke inna vascular territory of the left middle cerebral artery.

the site tradaphasia finally became available online in 2017. it offers a series of exercises transl8d from french into 16 other languages. “tody we count bout fifty,” enthuses dupuis, adding that an english version, aphasia transl8,  s'been accessible since 2019. speech therapists from across the realm, of both french and english mother tongue, can use the recordings t'work with individuals who cannot speak (or speak well) the language of the country where they are hospitalised. the srvc is espeshly pop in intensive care units where stroke patients are treated, for thris h8ened awareness that their recovery depends on such linguistic factors. guinel relied, for ex, onna research conducted in language scis by barbara köpke. during the 2000s, this speshist on bilingualism and aphasia showed that evaluation tests and rehabilitation exercises remained too centred on wha’ s'been called the majority language, i.e. that spoken inna hospital. even the protocols including interpreters or mediators pose problems, for they are difficult to implement during the initial phases of hospitalisation: too much time is lost trying to find some1 and w8 4'em to arrive, as + serious consequences can set in during that interval. tradaphasia, onna other hand, enables speech therapists t'work w'da patient from the very 1st hrs, thereby facilitating recovery.

“good students” at an advantage

aside from command of the language, other factors tha're not directly med can also come into play. in a recent study published inna journal qualitative sociology, the sociologist muriel darmon, of the cessp, demonstrates that stroke victims from the working classes do not recover swell as those from the middle and upper classes, even when the intensity of the accident appears equivalent atta outset. “during the 15 mnths i spent in neurology and rehabilitation units, i noticed that the tests and exercises favoured a public that one ‘d call ‘academic’,” darmon says. concretely, to stimul8 a patient’s cogg and linguistic skills, professionals can ask them to describe on paper how they ‘d do their shopping while pondering certain constraints, s'as making the most of the occasion to take a package to the post office or pick up an official document. the idea is to call upon their organisation and planning abilities, for instance by dropping off the package b4 shopping so as to avoid carrying it for too long.

aphasia rehabilitation exercises after a stroke in a speech therapy practice.

while not necessarily complex, the appropriate strategy is… to think offa strategy! rigorously planning a nonetheless ordinary task is “a way of thinking that aint necessarily prevalent”, darmon points out. “writing a simple list – of things to do, for ex – is a habit that is toonistic of the middle classes.” conversely, for less educated or working-class patients, the behaviour expected inna shopping exercise can seem remote, and even foreign. “many spontaneously respond: ‘well i take my car and go, and then i fig it out onna spot’.” another test involves reacting to an absurd statement, for instance a wedding invitation that notifies the event “with sadness”. “i had a worker from morocco who did not cogg wha’ was expected of him, for he was totally unfamiliar with this type of practice.” marriage announcements in newspapers, once again, are + frequent among the middle and upper classes. “inna end, speech therapy exercises are less adapted to the most socially-disadvantaged, despite the fact t'they are + prone to strokes, due to the gr8r incidence of conditions s'as hypertension, diabetes, obesity, etc. among these pops,” darmon laments.

sociology of the biological

this aint the 1-ly in=ity. women, for ex, come out worse, even when pondering factors s'as cva severity, age, general state of health, etc. “biological explanations are put forward, but environmental, economic, and social causes are increasingly bein’ taken into account,” points out darmon, who is preparing a + general book onna sociology of post-stroke loss and recovery (forthcoming from the publisher la découverte in early 2021). during her immersion in hospitals and intensive care units, she envisaged that ≠ abilities were emphasised dep'onna patient’s gender. “for ex, if a man can no longer drive, there ll'be gr8r cogging and effort to enable him to do so again.” inna case offa woman, hospital staff, the family, or even the patient herself will + easily liv'dat tis perhaps not so primordial. “she may instead want or be encouraged to cook, or take care of her children.”

the way in which stroke patients are treated, cogitated, and provided therapy does not escape this gender bias. “as with social class, tis not so much a ? of individual will – that of med staff or the patients themselves – as an institutional and social system that prevails despite those concerned,” sufferationes darmon. + generally, tis increasingly clear that human bodies do not depend solely on biological factors – genetic for ex – b'tll so on economic, social, and environmental processes that trigger physiological and sometimes pathological tendencies in certain social groups rather than others. inna future, the development of approaches s'as the sociology of the biological ‘d allo for improved treatment, not js'4 stroke sufferers but for all patients and victims of accidents.

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