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After Stroke: Recovering Communication Skills

A stroke can cause problems with communication if there is damage to the parts of the brain responsible for speech. It can also cause communication problems if muscles in the face, throat or tongue are affected.

A stroke can also affect how well the person can understand speech, can read or write. The range of communication problems stroke patients may have depend on where in the brain stroke happened and how large an area was damaged. There are three main conditions that affect communication skills after stroke – aphasia, dysarthria and dyspraxia. A stroke patient may experience one or combination of these.

The most common speech disorder due to stroke is aphasia. It affects the person’s ability to speak, to understand what’s said, as well as reading and writing skills. It can affect only one aspect of communication or several of them at the same time. While influencing communication, it doesn’t impact intelligence, although sometimes people think it does.

Aphasia can be of different types and can affect people in different ways:

Damage to the Wernicke’s area of the brain can result in receptive aphasia, in which the patient has problems mainly with understanding what’s being said. Understanding speech may become even more difficult if long, complex sentences are used in conversation or there is background noise. The person may feel as though others are talking in an unknown foreign language. With this the person may be able to read newspaper headlines, but not understand the whole text. They also may be able to write but unable to read back what they’ve written.
Damage to the Broca’s area can result in expressive aphasia, in which the person can understand others but may have difficulties expressing their ideas. The person may communicate by making sounds but not able to form words or put them together to make coherent sentence. With this the person may say only simple words, think of the word they want to say but saying another word instead, answer ‘yes’ or ‘no’ but meaning the opposite or get stuck on a single word and end up repeating it. They may write in a similar way. They can also answer any question with a set of words, usually emotional or swear. At the same time, the stroke patient may think they talk normally, while their speech can sound nonsense to the listener. The listener may believe that the patient is confused, but they are not. They are just not able to get their idea across.
Damage to the multiple areas of the brain can result in global aphasia, in which the person has challenges with all aspects of communication. If the effects are severe, patients may not be able to speak at all.

Other conditions stroke survivors can have are related to physical production of sounds. Thus, dysarthria happens when stroke causes weakness of the articulation muscles, such as muscles that move the tongue, lips, mouth and respiratory system to produce voice and communicate ideas. It is often associated with swallowing problems, which can have an impact on speech production as well. Dysarthria doesn’t affect the ability to find words or to understand others, but may cause difficulty speaking clearly due to the voice that sounds slurred, quiet, slow or strained. Once breath control is affected, words may come out in short bursts rather than in complete sentences. Slurring doesn’t reflect the patient’s state of mind. It only indicates that their ability to speak is limited.

Communication skills after stroke can be affected by coordination disorder or dyspraxia. With dyspraxia of speech the patient cannot move muscles in the correct order and sequence to produce sounds necessary for clear speech. Individual muscles we use to produce clear speech may be working well and the patient may not have weakness or paralysis, but they cannot move them as and when they want to in the right order and in a consistent way. The patient may not be able to pronounce words clearly, especially when asked to. They may need time to repeat them and may try several times to do that. Sometimes, patients may be unable to make any sound at all.

Recovering communication skills

Rehabilitation after stroke should start as soon as possible, usually the day after stroke treatment has been administered or once the patient is well enough. Rehabilitation done during early stages has a greater impact on recovery and is associated with better outcomes.¹

Speech therapy

Anyone with communication problems after stroke should address a speech therapist who will assess the gravity of the condition and help the patient to adapt to and overcome communication difficulties. They will also assess patients with swallowing problems, which, if severely impaired, also have an impact on speech production, and advise on safe ways to eat and drink.

The techniques speech therapist will use to help recover communication skills depend on the particular problems you have.

If you have difficulty understanding, you may be asked to match words to pictures or sort words according to their meaning so as to strengthen the ability to remember word meanings and link them to the spoken and written forms of words.

If you have difficulty finding words, therapy may include practicing naming pictures or repeating words the therapist says.

If you have weak facial muscles, you may need exercises to help improve muscles strength. The therapist will give you advice on where your lips, tongue or jaw should go when producing particular sounds. You will also be taught breathing exercises and how to plan pauses within sentences to help control breathing muscles.

An important part of speech therapy involves finding additional ways of communicating, such as:

Following directions
Gestures
Reading
Writing or
Drawing.

Helping someone to recover

You can also help a stroke survivor to recover communication skills. First of all, you should remember that the patient is essentially the same person they were before the stroke and must be treated as mature, intelligent adult. So,

include them in decision making to the extent possible
don’t talk about the person or their problems in front of them, even if you think they can’t understand
speak to them in a relaxed manner, saying their name first to establish their attention
if there is difficulty understanding, use short simple sentences and show the objects you ask the questions about
repeat or re-word sentences
be alert with the person’s gestures and eye signals so that you can gauge their responses. Once you’ve interpreted their body language, check with the question ‘Do you mean no?’
write things down, if it helps
give the person a chance to communicate their idea, without interrupting or correcting them
encourage the person to use alternative forms of communication, such as pointing
don’t speak for the person unless it is absolutely necessary, because saying something for them can be very frustrating and will set back their language progress
do not respond to swear words and acknowledge that you know that’s not what they meant to say.

Self-help

Stroke survivors in their turn should take time to recover communication skills and when communicating take time to explain and not let themselves feel rushed. Here are some tips for self-help:

Focus on the task and avoid multi-tasks
Keep a pencil and paper handy to write things down before saying them
If not able to write, use gestures, hand signals or picture boards to point at
Use scrabble tiles to spell out words
If you have trouble finding words, find clues form the environment or create a communication book with words, symbols and pictures that are helpful
Rehearse speech sounds or nursery rhymes
Enjoy something comforting you’re familiar with, such as old films or music
Persevere and don’t give up. Things will improve gradually.

Resources:

Horn SD, DeJong G, et.al. “Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better?” Archives of Physical Medicine and Rehabilitation. 86(12 Suppl 2):S101-S114. Published: December, 2005. https://www.ncbi.nlm.nih.gov/pubmed/16373145