Language Loss After Stroke: Can It Ever Improve?

Aphasia is a language disorder that can be caused by a stroke, resulting in difficulties with communication. Aphasia can affect an individual's ability to express themselves and understand others, and can also impact reading and writing abilities. The condition is typically caused by trauma to the left side of the brain, which controls speech and language. While aphasia can result in a total loss of language, the term dysphasia is used to refer to a partial loss.

The specific effects of aphasia depend on the location and extent of the injury to the brain. Individuals with aphasia may struggle with finding and retrieving words, producing intelligible speech, and understanding what others are saying. In some cases, chunks of language may come out in fluent speech, even when an individual is unable to produce the individual words they contain.

Recovery from aphasia can vary, and it is not always possible to know exactly how much language and communicative ability can be restored. However, the greatest improvements typically occur within the first six weeks following a stroke, as areas of the brain that experienced temporary swelling begin to repair themselves. Recovery may then proceed in smaller bursts, and it is important for individuals with aphasia to have access to regular language and speech therapy, as well as a program of rehabilitation activities that can be worked on at home.

Aphasia: a language disorder that affects your ability to communicate

Aphasia is a language disorder that affects an individual's ability to communicate. It is most often caused by strokes in the left side of the brain, which control speech and language. Aphasia is characterised by difficulties in producing and/or comprehending speech due to an impairment in the cognitive skill of language. While individuals with aphasia have the physical ability to produce speech, they struggle with the cognitive processes of producing or understanding language. Aphasia may also affect one's ability to read and write.

There are many 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 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

Aphasia does not affect intelligence. Stroke survivors remain mentally alert, even though their speech may be jumbled, fragmented, or hard to understand.

The recovery process for aphasia differs from person to person and depends on the initial damage sustained by the brain and the support provided to the individual. While it is not always possible to know how long recovery will take and how much language ability can be restored, the greatest improvements typically occur in the first six weeks following a stroke, as areas of the brain that experienced temporary swelling begin to repair themselves. Recovery may then proceed in smaller bursts, interspersed by periods of little to no change, and it can slow down considerably after six months. However, there are cases in which individuals with aphasia have regained language ability up to two or more years following a stroke.

To aid the recovery process, individuals with aphasia can:

• Establish a system of communication with carers concerning basic needs
• Learn to express wants and desires, which can empower the individual and alleviate feelings of helplessness and/or frustration
• Connect and share with others to combat feelings of isolation, loneliness, and depression
• Return to their daily routine, but with modifications to account for aphasia
• Make a list of words needed for daily activities and keep it on hand for easy reference
• Use mnemonic devices to relearn words
• Inform colleagues about their condition so that they are more patient if communication difficulties arise
• Visit a speech and language therapist for regular sessions to help regain speaking abilities and learn coping strategies
• Use multi-sensory flashcards to practice word recall
• Download English language podcasts to expand vocabulary
• Turn on subtitles and closed captioning when watching TV to increase exposure to a wide range of vocabulary
• Enrol in an online typing course to strengthen vocabulary and practice English words

Dysarthria: a condition that affects the articulation of speech, causing drooling, slurred words and difficulty breathing while speaking

Dysarthria is a motor speech disorder that makes it difficult to form and pronounce words. It occurs when damage to the nervous system prevents full control of the parts of the body that control speech, like the tongue, voice box (larynx) and jaw. This damage may be caused by injuries, illnesses or neuromuscular conditions.

Dysarthria can be developmental or acquired. Developmental dysarthria happens due to brain damage during fetal development or at birth, and children tend to have this form of the condition. Acquired dysarthria happens as a result of brain damage later in life, and adults tend to have this form.

There are six categories of dysarthria, grouped according to the specific part of the nervous system affected:

• Flaccid dysarthria results from damage to the lower motor neurons and may cause speech to sound breathy and nasal.
• Spastic dysarthria results from damage to the upper neurons on one or both sides of the brain, and may cause speech to sound strained or harsh.
• Ataxic dysarthria results from damage to the cerebellum, which helps coordinate muscle movement. Those with this form of the condition may have trouble pronouncing vowels and consonants.
• Hypokinetic dysarthria results from damage to the basal ganglia, which helps muscles move. Speech with this condition is associated with a slow, monotone, rigid-sounding quality.
• Hyperkinetic dysarthria also results from damage to the basal ganglia, and is associated with fast, often unpredictable speech.
• Mixed dysarthria includes a mix of two or more of the other five types, and is the most common form of the condition.

The main sign of dysarthria is difficulty speaking so that others can understand. Other symptoms include slurred speech, speaking too quickly or slowly, and sounding hoarse, harsh or nasal. The lack of muscle control may also cause difficulty swallowing (dysphagia).

Dysarthria can be diagnosed by a speech-language pathologist, who will evaluate the patient's ability to coordinate breathing, voice and voice quality, and to move the lips, tongue and face. The pathologist may ask the patient to stick out their tongue, smile or pucker their lips, count or say the alphabet out loud, and repeat sounds, words and sentences.

Dysarthria often benefits from speech therapy, which can help patients communicate more effectively. During speech therapy, patients may learn exercises to strengthen the tongue, lips and jaw muscles, as well as strategies for speaking louder, such as taking fuller breaths, and speaking more clearly, such as slowing speech and using specific muscles to form sounds and words.

Recovery: the greatest improvements occur in the first six weeks following a stroke, but improvements can be made years later

The brain's ability to create new pathways and strengthen old ones after a stroke is called neuroplasticity, and it is key to recovering language ability. Repetition is crucial to activating neuroplasticity, as it signals to the brain that there is a demand for a certain function. This can result in the brain rewiring itself, allowing a healthy area to take control of an affected function.

The greatest improvements in language ability typically occur in the first six weeks following a stroke. This is because the areas of the brain that experienced temporary swelling start to repair themselves. However, improvements can be made for years after a stroke, particularly if the individual continues to receive speech therapy to strengthen and reinforce communication skills and confidence.

According to one study, by the time a survivor was discharged from the hospital, over half of those with aphasia experienced improved language skills, with many experiencing a complete recovery of language. By six months post-stroke, nearly 90% of survivors had improved, with 74% fully recovering their language skills.

While it may not be possible to know exactly how long the recovery process will take and how much language ability can be restored, there are steps that can be taken to aid recovery. These include:

• Working with a speech-language pathologist to evaluate speech, language, and communication skills, and develop a customized treatment plan
• Practicing tongue and lip exercises to improve strength, coordination, muscle tone, and motor planning
• Undergoing naming therapy, including verbally labeling pictures or matching words to pictures
• Learning to compensate for speech and language difficulties by using non-verbal techniques or augmentative and alternative communication
• Using multi-sensory flashcards to practice word recall
• Turning on subtitles and closed captioning when watching TV
• Enrolling in an online typing course

Treatment: speech therapy targets the redevelopment of the muscles of the face, mouth and throat to improve articulation and render speech more intelligible

Speech therapy is a crucial part of stroke recovery, helping individuals regain their speaking abilities and learn coping strategies. The therapy focuses on the redevelopment of the muscles in the face, mouth, and throat, improving articulation and making speech more intelligible.

Tongue and Lip Exercises

One of the most common exercises for stroke patients is tongue strengthening. This involves sticking the tongue out as far as possible, holding for a couple of seconds, and then pulling it back in. Another exercise is moving the tongue from side to side, touching the corners of the mouth. These exercises help train the tongue to move in coordinated patterns, improving speech production.

Smiling

Smiling is a simple yet effective speech therapy exercise. The act of smiling engages many facial muscles, improving oral motor skills. Patients are encouraged to practice smiling in front of a mirror, focusing on creating a symmetrical smile. This is especially beneficial for those who have trouble moving one side of their face due to the stroke.

Puckering

Puckering the lips together as if kissing is another exercise that helps strengthen the lips. Patients hold this position for a couple of seconds, relax, and repeat. For an extra challenge, they can try puckering slowly, practicing motor precision and control.

Consonant and Vowel Pairing

This exercise involves pairing difficult-to-speak consonants with each of the five vowels (a, e, i, o, u). For example, those who struggle with the "r" sound can practice saying "ra, re, ri, ro, ru" repeatedly. This helps with pronunciation and speech production.

Sentence Production

Reading aloud is an excellent exercise for individuals with apraxia of speech, a speech disorder caused by damage to the cerebellum or other areas of the brain involved in motor coordination. While it may be frustrating for those with aphasia, starting with a sentence or two and gradually increasing the difficulty can be beneficial.

Phonological Processing

In this exercise, patients guess the number of syllables in words stated by a family member or caregiver. The feedback provided by the family member or caregiver is an essential part of this exercise, helping to reinforce learning.

Singing Therapy

Singing therapy is effective for individuals who are unable to speak after a stroke, particularly those with aphasia. Singing words instead of speaking them can help with verbal expression because singing is a right-brain function, while speech is a left-brain function.

Exercises: tongue and lip exercises, naming therapy, singing therapy and learning to compensate for speech and language difficulties by using non-verbal techniques

Speech and language difficulties can arise from damage to many different areas of the brain. Aphasia, a language disorder caused by damage to the brain, can lead to difficulties in speaking, understanding, reading, and writing. Treatment for aphasia includes speech therapy, which can help individuals improve their language abilities.

Tongue and Lip Exercises

Lip exercises help strengthen the muscles around the mouth, improving oral motor skills and articulation abilities. Specific speech sounds, such as bilabial sounds (/p/, /b/, /m/), require synchronized lip movements, and lip exercises can enhance the accuracy and clarity of producing these sounds.

Some techniques that improve lip movements include:

• Lip rounding
• Lip retraction
• Lip protrusion
• Lip closure exercises
• Lip massage
• Pressing with lips
• Resistance and holding exercises

Naming Therapy

Naming therapy is a treatment for aphasia, a language disorder caused by brain damage. Aphasia often results in anomia, or difficulty naming objects. Naming therapy can help improve a person's ability to name objects and enhance their language skills.

There are several types of naming therapy:

• Confrontational naming: Naming the object you are looking at.
• Responsive naming: Naming based on hearing or reading its definition.
• Convergent naming: Naming the category that a group of objects belongs to.
• Divergent naming: Naming a list of things that belong to a certain category.
• Cued naming: Providing a cue, such as a phonological or semantic cue, to help the person correctly name the object.
• Sentence formation: Naming an object and then using it in a sentence.

Singing Therapy

Singing is a form of self-expression and can bring joy and pleasure to individuals. Voice therapy, which is similar to speech therapy, can help individuals with vocal difficulties improve their vocal technique, expand their vocal range, and overcome vocal injuries. It involves various techniques and exercises, such as breath control exercises, vocal warm-ups, and pitch control exercises.

Non-Verbal Techniques

Non-verbal communication can be a bridge to language development. Hand gestures and eye contact, for example, are building blocks for language. Exaggerating hand gestures and using universally recognized gestures like clapping and nodding can help encourage a child to communicate non-verbally.

Imitation is another effective strategy, where the parent or caregiver imitates the child's sounds and actions to encourage more communication. Allowing the child to choose the topic and set the pace can also help maintain their focus.

Additionally, using single words initially and gradually building up to phrases and sentences can make it easier for the child to understand and imitate. It is important to give the child time and space to respond and not to complete sentences or answer questions on their behalf.

Frequently asked questions