Can additional progress be made?

  My father had by-pass surgery at Ohio State University Hospital June 4th
  which resulted in a severe stroke and then pneumonia.  The stroke resulted
  in paralyzing his right side and left him unable to speak or swallow.  
  He also has aphasia and apraxia.  After spending time in Intensiva and the
  Columbus Rehabilitation and Sub-Acute Institute, he was sent home several
  weeks ago.  He is now able to eat and move himself in a wheelchair with his
  left foot.  His progress has not been consistent.  One day a transfer may
  be minimal assist, the next day maximum.  He is still getting occupational,
  speech and physical therapy at home.  However, he seems to resist therapy
  at times.  Mainly physical.
  He was visited by some doctors from Dodd Hall at OSU during the first few
  weeks and they said that he had the material to work with to be able to
  walk again.  Unfortunately, we have not had any further indication of this
  from any of the therapists and no one had recommended sending him to Dodd
  Hall.  The aphasia has made it difficult for him to follow commands, which
  I believe he must be able to do to go to Dodd.  Also, I believe his resistance
  in cooperating has limited his progress.  
  He still has no speech.  One of his therapists was able to get him to
  whisper "Hi" after much work and he trys to mouth things sometimes.
  His current therapist is working with pictures to get him to communicate.
  Could his resistance to therapy be a result of depression?  Are there any
  rehabilitation programs that you recommend that may help him?  I am
  aware that there is an aphasia program in Michigan which may be of some
  assistance?  Some therapists say there may have been too much damage to
  his brain for him to ever get better.  Others say to keep trying, that it
  takes time.  What course of action do you recommend?
Dear Sandy,
A left hemispheric stroke, when large, can cause devastating results in a patient functions and recovery.  One study looking at long term changes in aphasia after stroke found that in a moderate size stroke,  recovery of language function stabilized at 6 weeks and in severe strokes it stabilized at 10 weeks.  Beyond this time frame, little change was noted in the patients language function. In summary, initial severity of the stroke was the only clinically relevant predictor of outcome.  Another study looking at stroke rehab found that patients with moderate defecits benefited from focuses rehab.  Predictors of poor outcome included advanced age, severe stroke, and neuropsych defecits (such as depression).   Left hemispheric strokes not only affect speech production but can also affect a patients ability to understand language (poor comprehension).  If  both are present, it makes rehab difficult.  Depression is common after stroke.  This may be a factor in your fathers lack of initiative and motivation.  I would recommengd getting in touch with your neurologist  regarding further therapy and antidepressant medication.  Talking to the physical therapist may help give some additional information regarding your fathers motivation, understanding and further rehab potential.  Good Luck.