A healthy living blog from Marshfield Clinic

Speech recovery after stroke focuses on function

Communication Disorders Evergreen Inside

Communication problems after a stroke may include difficulties with verbal expression and language comprehension or motor impairments that affect speech.

Sudden difficulties speaking, including slurred speech or use of garbled words, are a few signs of a possible stroke. Speech problems that last after a stroke can make it hard to communicate.

“Suffering a stroke and experiencing communication deficits can be scary,” said Lisa Bast, a Marshfield Clinic speech pathologist. “We tend to take for granted our ability to let people know what we’re thinking, how we feel and what we need.”

Communication problems may involve language impairments, motor impairments or both. The extent of impairment depends on the size, location and severity of the stroke.

Speech pathologists like Bast work with people who have had strokes to improve functional communication.

Language impairments common after left-brain stroke

Most language impairments are caused by strokes in the left side of the brain, Bast said. It’s less common for strokes in the right side of the brain to affect language.

Someone who had a stroke may have trouble with verbal expression or comprehending language. These impairments are called aphasia.

Examples of problems with verbal expression include:

  • Problems repeating words or sentences
  • Word finding difficulties
  • Disorganized speech

People who have comprehension problems may not be able to understand questions or follow directions. They may need more time to process information.

Language impairments also take the form of reading and writing difficulties. Reading impairments, called alexia, range from problems matching words with pictures to trouble comprehending paragraphs. Sometimes vision problems caused by a stroke also make reading difficult.

Writing impairments, called agraphia, can include problems copying letters and numbers or writing sentences and paragraphs. A stroke on the left side of the brain can affect the right hand’s motor functioning, making handwriting hard.

Motor impairments can affect speech

A stroke can affect muscles of the face, mouth, and throat. Dysarthria is a condition that affects how clearly a person produces speech. It can affect ability to produce certain sounds, pitch, volume and rhythm of speech.

Another motor impairment, called apraxia, involves difficulty with motor planning needed to speak. The patient may know what he or she wants to say, but can’t organize the sequence of movements needed to produce the desired words.

“Apraxia is one of the more frustrating conditions for patients to work through,” Bast said.

Therapy focuses on functional goals

“Recovery is focused on restoring functional abilities,” Bast said. “Some people may need to read their mail, medication labels and menus. Others may need to perform more complex tasks, like reading and discussing a textbook or research paper.”

A speech pathologist evaluates the patient’s strengths and weaknesses and builds on what the patient already can do. Therapy may include exercises to strengthen muscles used for speech, drills to help patients coordinate sounds, and reading or writing exercises.

Some people need as little as one week of therapy. Others may receive aggressive therapy for several months in order to accomplish realistic goals. In addition to the severity and location of the stroke, age, health status and cognitive function before the stroke are a few of the factors that affect how well patients recover and how long recovery takes.

Sometimes therapy involves learning alternate forms of communication to reach functional goals, like using a computer with special communication software.

“It may take a lot of work from the patient to overcome communication difficulties, but the results are very rewarding,” Bast said.

Families can help

The speech pathologist will educate family caregivers about what to expect in terms of communication and cognition impairments. Family members may be involved in setting functional goals for the patient’s recovery.

Bast provided these tips to make communication easier:

  • Speak naturally and in an adult tone.
  • Don’t avoid conversations.
  • Be patient. Speak slowly and use shorter sentences if needed. Give your loved one extra time to respond.
  • Ask “yes/no” type questions or multiple-choice questions instead of open-ended questions.
  • Support communication with pictures, printed words or gestures to clarify meaning.
  • Confirm messages with phrases like, “Am I hearing you correctly?”
  • Take some ownership for the communication breakdown.
  • Avoid being the therapist. Be a partner or loved one first.

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