
A stroke occurs when there is an impaired blood supply to the brain, causing brain cells to die. This can result in a loss of movement, speech, and memory. While a stroke can dramatically impact these abilities, it is also possible for a stroke to affect only certain aspects of speech and memory. Aphasia, a common condition following a stroke, affects one's ability to speak and understand others, as well as their ability to read and write. Additionally, dysphonia, a condition resulting from weakness or paralysis in the muscles around the vocal cords, can cause a person's voice to become weak or hoarse. Memory issues can also arise after a stroke, particularly in the case of silent strokes, which create small areas of damage in the brain that can accumulate over time and lead to cognitive impairment and memory difficulties.
Characteristics | Values |
---|---|
Prevalence of communication difficulties after a stroke | 64% of stroke survivors experience communication problems, including aphasia, dysarthria, and apraxia of speech. One-third of stroke survivors have problems with speaking, reading, writing, and understanding others. |
Aphasia | Difficulty verbalizing thoughts, understanding others, reading, and writing. Caused by impairment in the cognitive skill of language or damage to the left side of the brain that controls speech and language. |
Dysarthria | Weakness or incoordination of muscles involved in speech, leading to slurred or slow speech. |
Apraxia of speech | Difficulty with the brain telling the muscles how to move when speaking. Individuals know what they want to say but have trouble producing the desired sounds. |
Dysphonia | Weakness or paralysis of the muscles around the vocal cords, resulting in a whispered, hoarse, or rough voice. If there is no sound, it is called aphonia. |
Cognitive difficulties | Memory, thinking, and judgment are affected. Difficulty paying attention, understanding complex sentences, and speaking inappropriately. |
Treatment | Speech and language therapy, including exercises and techniques to improve speech, reading, and writing. |
Recovery | Most recovery occurs in the first few months, but improvement can continue for years. Individuals with aphasia show improvement over time, and complete recovery of language skills is possible. |
What You'll Learn
- Aphasia: difficulty verbalising thoughts or understanding others
- Dysarthria: weakness or incoordination of muscles involved with speech
- Apraxia of speech: difficulty with the brain telling the muscles how to move when speaking
- Dysphonia: weakness or paralysis of the muscles around the vocal cords
- Cognitive difficulties: trouble paying attention, understanding complex sentences, and speaking inappropriately
Aphasia: difficulty verbalising thoughts or understanding others
Aphasia is a language disorder that affects one's ability to communicate. It is often caused by strokes in the left hemisphere of the brain, which is where the two primary language centres, Broca's area and Wernicke's area, are located. While Broca's area is associated with producing language, Wernicke's area is associated with comprehending language.
Aphasia affects one's ability to speak and understand what others are saying. It can also affect one's ability to read and write. Individuals with aphasia have the physical ability to produce speech, but they have trouble with cognitively producing or understanding language. Their speech may be jumbled, fragmented, or hard to understand. Aphasia does not affect one's intelligence.
There are several types of aphasia, including:
- Broca's aphasia (expressive aphasia): difficulty with spoken and written expression
- Anomic aphasia: difficulty with word retrieval, may demonstrate slow, halting speech
- Wernicke's aphasia (receptive aphasia or fluent aphasia): difficulty understanding speech and trouble with producing meaningful speech; able to speak long, fluent sentences, but words do not make sense
- Conduction aphasia: difficulty with repeating words or phrases
- Global aphasia: difficulties with both speech production and comprehension
There are also other types of aphasia, such as transcortical sensory aphasia, transcortical motor aphasia, and mixed transcortical aphasia.
Aphasia can be treated with speech and language therapy, which involves regular sessions with specialists. Additionally, the patient's family and friends can play a crucial role in the recovery process by engaging with the person as they did before the stroke. It is important to speak slowly, use short sentences and simple words, and give the person ample time to speak.
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Dysarthria: weakness or incoordination of muscles involved with speech
Dysarthria is a condition that can occur after a stroke, causing weakness or incoordination of the muscles involved with speech. It is characterised by slurred or slow speech, or a quiet voice that is difficult for others to understand. It occurs when there is damage to the brain or nerves, resulting in impaired control of the muscles in the face, mouth and throat. This can lead to difficulties in producing clear and intelligible speech.
Symptoms of dysarthria include unnatural-sounding speech, which may be described as robotic or choppy, as well as speaking too loudly or quietly, or at an abnormal pace. Speech may also sound breathy, hoarse, or nasal. Individuals with dysarthria may experience difficulty moving their lips, jaw, and tongue, affecting their ability to articulate words clearly.
Dysarthria is considered a motor speech disorder, distinct from aphasia, which primarily affects language comprehension and production. Unlike aphasia, dysarthria does not impact a person's intelligence or cognitive abilities. It is purely a physical impairment that affects the articulation of speech.
Treatment for dysarthria typically involves working with a speech pathologist or speech-language therapist to improve muscle strength and coordination in the speech muscles. This may include tongue and lip exercises, as well as practising speaking slowly and loudly, and exaggerating speech. The use of a voice amplifier can also be beneficial in making the individual's voice louder and more intelligible.
While recovery from dysarthria can vary, most improvements occur within the first few months after a stroke. However, it is important to continue practising speech exercises, as consistent practice is key to regaining speech and language skills.
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Apraxia of speech: difficulty with the brain telling the muscles how to move when speaking
Apraxia of speech (AOS) is a motor speech disorder that makes it difficult for the brain to send messages to the mouth, specifically the muscles involved in speech. These messages tell the muscles how and when to move to make sounds. When a person has apraxia of speech, these messages are disrupted and do not get through correctly due to brain damage. This means that the person may not be able to move their lips or tongue in the right way to say sounds, or they may not be able to speak at all.
AOS is a neurological disorder that affects the brain pathways involved in planning the sequence of movements required for speech production. While the brain knows what it wants to say, it cannot properly plan and sequence the required speech sound movements. This is not caused by weakness or paralysis of the speech muscles, which would be a separate disorder called dysarthria. However, some people have both dysarthria and AOS.
The severity of AOS varies from person to person. In mild cases, it may cause trouble with a few speech sounds or with pronouncing long words. In more severe cases, a person with AOS might not be able to communicate effectively through speaking and may need alternative methods of communication.
There are two main types of AOS: acquired apraxia of speech and childhood apraxia of speech. Acquired AOS can occur at any age but is most common in adults. It is caused by damage to the parts of the brain involved in speaking and results in the loss or impairment of existing speech abilities. Childhood AOS is present from birth and is also known as developmental apraxia of speech or developmental verbal apraxia. The causes of this type are not well understood, and imaging studies have not found evidence of brain damage or differences in brain structure in children with AOS.
Symptoms of AOS include distorting sounds, making inconsistent errors in speech, groping for sounds, and making errors in tone, stress, or rhythm. People with AOS often appear to be searching for the right sound or word and may try saying a word several times before getting it right. Treatment for AOS involves working with a speech-language pathologist to improve how sounds are said and put into words. Treatment focuses on getting the muscles to move correctly and may involve teaching the muscles to make sounds again through repetition and correct mouth movements.
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Dysphonia: weakness or paralysis of the muscles around the vocal cords
A stroke can affect a person's ability to speak and communicate, and in some cases, it can also impact memory. While it is possible for a stroke to affect only voice and memory, this is not common. Communication problems are very common after a stroke, with around one-third of stroke survivors experiencing difficulties with speaking, reading, writing, and understanding others.
Dysphonia is a condition that can result from a stroke, and it involves weakness or paralysis of the muscles in and around the vocal cords. This can cause a person's voice to sound like a whisper, or it may sound hoarse or rough. In some cases, the person may not be able to make any sound at all, a condition known as aphonia.
Dysphonia occurs when there is damage to the brain or nerves that control the vocal cords, resulting in weakness or paralysis of the muscles. This can include damage to the pons, corona radiata, cerebellum, or areas within or surrounding the motor cortex.
Treatment for dysphonia typically involves working with a speech pathologist or speech therapist to improve voice strength and coordination. This may include exercises to improve the strength and coordination of the vocal cords and improve muscle tone. In some cases, a voice amplifier may be used to make the voice louder and improve communication.
In addition to dysphonia, a stroke can also cause other communication disorders such as aphasia, dysarthria, and apraxia of speech. These conditions can affect a person's ability to speak, read, write, and understand others. Aphasia, in particular, is a common language disorder that affects the ability to communicate and is often caused by strokes in the left side of the brain, which controls speech and language.
While a stroke can have a significant impact on communication and memory, it is important to note that it does not affect a person's intelligence. Stroke survivors remain mentally alert, and their difficulties with communication are due to the specific areas of the brain affected by the stroke.
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Cognitive difficulties: trouble paying attention, understanding complex sentences, and speaking inappropriately
Cognitive difficulties after a stroke
Cognitive difficulties are common after a stroke and can affect a person's memory, thinking and judgement. This may manifest as trouble paying attention when people are talking to them, difficulty understanding or speaking complex sentences, and inappropriate conversation.
Communication is a complex process that involves many aspects of thinking and social skills. If a stroke impairs any of these skills, it can affect the ability to communicate successfully. 'Cognitive communication difficulties' is the term most often used for the resulting problems.
The frontal lobes are particularly important for cognitive communication skills because of their role in the brain's 'executive functions', including planning, organisation, flexible thinking and social behaviour. However, many other parts of the brain interact to perform these skills and are also important, such as areas of the temporal and parietal lobes.
Attention and concentration difficulties
People with attention and concentration difficulties may:
- Be unable to concentrate on watching a TV programme or following a conversation.
- Need to end conversations abruptly or avoid them altogether.
- Miss important information and say inappropriate or embarrassing things.
- Ignore what someone says when carrying out another activity at the same time.
Literal interpretation
Damage to the right side of the brain may lead to the person interpreting verbal information very concretely and taking things literally. They may:
- Have a reduced ability to grasp humour or sarcasm and may miss the subtle nuances of conversation.
- Take things the wrong way, such as interpreting a joke as a serious comment.
- Struggle to understand common expressions, such as "I'll just be a minute".
Reduced reasoning and problem-solving skills
People with altered problem-solving abilities may:
- Be unable to use language to think through and resolve a problem.
- Make poor judgments or decisions.
- Fail to understand the logic of someone's point of view and be inflexible in their own opinions.
Cognitive fatigue
Cognitive fatigue is a common long-term consequence of brain injury. A person experiencing cognitive fatigue may:
- Manage less well with their cognitive communication skills.
- Have reduced attention and concentration.
- Be less able to think clearly and become irritable and agitated.
- Find that other communication impairments, e.g. aphasia, dysarthria and dyspraxia of speech, worsen.
Slowed speed of information processing
People with a slowed speed of information processing may:
- Struggle to keep up with a rapidly flowing conversation, especially in busy settings or when talking with more than one person.
- Become 'overloaded' with information, leading to feelings of being overwhelmed or frustrated and angry.
Impaired social communication skills
Social communication difficulties are particularly associated with injury to the frontal lobes of the brain. People with these difficulties may:
- Not recognise everyday social cues, both verbal and non-verbal.
- Say the wrong thing at the wrong time and come across as rude or aggressive.
- Struggle with turn-taking in conversation, either by 'hogging' the conversation or not realising when it is their turn to speak.
- Interrupt because they are afraid they will forget what they want to say.
- Flit from topic to topic or have a reduced range of topics.
- Only talk about themselves and fixate on certain subjects.
- Speak in a sexually explicit way or swear at inappropriate times.
- Perseverate (get stuck) on a favoured topic.
- Struggle to give information in an orderly and organised way.
- Not 'read' non-verbal cues accurately, such as facial expressions and body language.
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Frequently asked questions
A stroke occurs when the blood supply to the brain is impaired, resulting in the disruption of oxygen and nutrient delivery to brain cells, causing them to malfunction or die. This can lead to the loss of abilities such as speech, movement, and memory.
There are three main types of strokes: ischemic stroke, hemorrhagic stroke, and transient ischemic attack (TIA). Ischemic strokes are caused by a partial or complete blockage of a blood vessel, while hemorrhagic strokes occur when a vessel in the brain leaks or bursts. TIA, also known as a "mini-stroke," is a temporary interruption in blood flow that does not cause lasting damage but should still be treated seriously.
A stroke can cause aphasia, a condition that affects one's ability to speak, read, write, and understand others. It can also lead to dysarthria, which is characterized by weakness or paralysis in the muscles used for speaking, resulting in slurred speech. Additionally, apraxia, or dyspraxia, can occur, making it difficult to coordinate the muscles for speech.
Treatment options include speech and language therapy, where specialists work with individuals to improve their speech, reading, and writing abilities. This may involve practicing talking, listening, reading, or writing, and using gestures or aids to enhance communication. Family members and friends can also help by engaging in conversations, speaking slowly, using short sentences, and including the person in group discussions.