Stroke's Impact: Losing Voice And Regaining It

Strokes are a medical emergency and can cause a range of communication problems, including aphasia, apraxia, dysarthria, and dysphonia. Aphasia is a common problem after a stroke, affecting around one-third of survivors. It impacts the ability to speak, read, write, and understand others. Apraxia is a condition where the brain struggles to plan the movements needed to produce speech, while dysarthria causes weakness or paralysis in the muscles used for speaking, resulting in slurred speech. Dysphonia, on the other hand, affects the vocal cords, causing a hoarse, rough, or whispered voice. These conditions can make it challenging for stroke survivors to connect with others and express their thoughts and needs.

Aphasia: the inability to speak or understand speech

Aphasia is a common problem after a stroke, affecting around one-third of survivors. It occurs when one or more of the regions of the brain that control language and speech are injured or damaged. Aphasia can manifest as an inability to speak or understand speech, but it can also affect a person's ability to read and write.

A person with aphasia may not be able to translate their thoughts into coherent speech, and they may not understand what is being said when others are speaking. This is because 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 capacity for speech, they struggle with the cognitive processes of producing or understanding language.

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 be demonstrated through slow, halting speech.
• Wernicke’s aphasia (receptive aphasia or fluent aphasia): difficulty understanding speech and trouble producing meaningful speech; the person is able to speak long, fluent sentences, but the words do not make sense.
• Conduction aphasia: difficulty with repeating words or phrases.
• Global aphasia: difficulties with both speech production and comprehension.

Aphasia is often the result of a left-hemisphere stroke, as the two primary language centres of the brain typically reside in this hemisphere. These language centres include Broca’s area, associated with producing language, and Wernicke’s area, associated with comprehending language.

Speech and language therapy is important for individuals with aphasia, as some degree of the condition often remains after the initial period of recovery. Treatment involves regular sessions with specialists, and patients can also benefit from support from their family and friends. The patient’s loved ones can help by engaging with the person as they did before the stroke, speaking slowly, giving them plenty of time to speak, and using short sentences and easy words.

Dysarthria: weakness or paralysis of the muscles used for speaking

A stroke can cause a person to lose their voice, or at least impair their ability to speak. This condition is called dysarthria, a motor speech disorder where damage to the nervous system causes the muscles used for speaking to become paralysed or weakened. The damage may make it difficult to control the tongue or voice box, resulting in slurred words or garbled speech.

Dysarthria is characterised by difficulty in forming and pronouncing words. It is a motor speech disorder that occurs when damage to the nervous system prevents full control of the parts of the body that control speech, such as the tongue, voice box (larynx), and jaw. People with dysarthria understand language and know what they want to say and how to say it, but muscle weakness makes speaking difficult. The muscles may be weak or completely paralysed, or they may struggle to work together.

There are six categories of dysarthria, grouped according to the specific part of the nervous system affected. Flaccid dysarthria, for example, results from damage to the lower motor neurons in the peripheral nervous system, and speech may sound breathy and nasal. In contrast, spastic dysarthria results from damage to the upper neurons in the central nervous system, and speech may sound strained or harsh. Ataxic dysarthria, meanwhile, is caused by damage to the cerebellum, the part of the brain responsible for coordinating muscle movement. This can cause trouble pronouncing vowels and consonants and placing emphasis on the right parts of a word.

Dysarthria can be developmental or acquired. Developmental dysarthria occurs due to brain damage during fetal development or at birth and tends to affect children. Acquired dysarthria, on the other hand, occurs as a result of brain damage later in life and is more common in adults. Acquired dysarthria can be caused by a stroke, brain tumour, or Parkinson's disease.

Dysarthria can cause several symptoms, including slurred speech or mumbling, speaking too quickly or slowly, speaking louder or quieter than intended, and sounding hoarse, harsh, strained, breathy, nasal, robotic, or monotone. The lack of muscle control may also lead to dysphagia, or difficulty swallowing.

Dysphonia: weakness or paralysis of the muscles in and around the vocal cords

Dysphonia, or hoarseness, is a common problem that affects the voice, causing it to sound raspy, strained, rough, or breathy. It can also lead to changes in volume and pitch. While there are many causes of dysphonia, it is rarely indicative of a serious underlying condition. However, in some cases, it can be a symptom of a stroke.

Causes of Dysphonia

Dysphonia can be caused by a variety of factors, including:

• Laryngitis: Allergies, upper respiratory infections, or sinus infections can cause the vocal cords to swell, resulting in hoarseness.
• Vocal Cord Hemorrhage: This occurs when a blood vessel on the vocal cord ruptures, filling the muscle tissues with blood.
• Vocal Nodules, Cysts, and Polyps: Noncancerous growths on the vocal cords can cause dysphonia.
• Vocal Cord Paralysis: This condition affects the ability of the vocal cords to open and close properly.
• Neurological Diseases: Conditions such as stroke or Parkinson's disease can impact the brain's control of the muscles in the larynx, leading to dysphonia.

Dysphonia and Stroke

Dysphonia can be a symptom of a stroke, particularly when the brainstem is involved. The brainstem plays a crucial role in controlling the vocal cords, and a stroke in this region can lead to paralysis of the vocal fold muscles on one side, resulting in a hoarse, breathy voice.

Additionally, when a stroke affects the cerebral cortex (the brain), it can result in articulation disorders like slurred speech or dysarthria. This is different from the hoarseness typically associated with dysphonia.

Treatment and Rehabilitation

The treatment for dysphonia depends on the underlying cause. In the context of a stroke, speech and language therapy play a vital role in rehabilitation. Speech-language pathologists work with patients to improve their speech, reading, and writing abilities. They also help patients learn alternative communication methods, such as gestures or electronic devices, to support their expression.

Dysphonia, or hoarseness, can be a symptom of a stroke, particularly when the brainstem is involved. It is characterized by weakness or paralysis of the muscles in and around the vocal cords, resulting in changes to the quality and volume of the voice. Treatment and rehabilitation focus on speech and language therapy, aiding patients in regaining their communication skills and finding alternative means of expression when necessary.

Apraxia: difficulty coordinating the muscles for speech

A stroke occurs when there is an impaired blood supply to the brain, which can be caused by a partial or complete blockage of a blood vessel. This disruption in the delivery of oxygen and nutrients to brain cells causes them to quickly begin to die. Strokes can also be caused when a vessel in the brain leaks or bursts, causing blood to spill into the space around the brain cells and resulting in cell damage and death.

One consequence of a stroke is the loss of speech, known as aphasia. This occurs when one or more regions of the brain that control language and speech are injured or damaged. A person experiencing aphasia may not be able to translate their thoughts into coherent speech and may struggle to understand others. Aphasia can also affect the ability to read and write.

A related condition is apraxia, a neurological condition that makes it difficult or impossible to make certain movements, despite the muscles being normal and the person having the understanding and desire to make these movements. Apraxia is caused by damage to the brain that prevents it from forming and giving instructions to the body.

Apraxia of speech, also known as verbal apraxia or oral apraxia, makes it hard or impossible to move the mouth and tongue to form words, despite the person having the desire to speak and the physical ability to do so. People with apraxia may sometimes form words correctly and then later struggle to form those same words. Speech may sound slurred or robotic, and there are different levels of severity. Some people with apraxia cannot speak at all, while others have difficulty moving their tongue and/or lips to form specific sounds.

Apraxia can be treated with physical, speech, and/or occupational therapy. These therapies can improve symptoms and make the condition easier to live with. Speech therapy for apraxia focuses on improving sound sequencing and coordination, as well as sensory treatments aimed at improving awareness of how it feels to produce different sounds.

Cognitive difficulties: problems with memory, thinking, and judgment

A stroke can affect the brain's ability to understand, organise and store information, which can lead to cognitive difficulties. These difficulties can manifest in various ways, including problems with memory, thinking, judgment, and other cognitive functions.

Cognitive problems after a stroke are common, and they can significantly impact a person's life. These issues can affect a person's ability to plan, solve problems, recognise things, control their body movements, and find their way around. The severity of these problems can vary, and they may not always be immediately apparent.

The risk of cognitive impairment after a stroke is influenced by both demographic factors, such as age, education, and occupation, as well as vascular factors like hypertension, diabetes, and smoking. The prevalence of post-stroke cognitive impairment ranges from 20% to 80%, depending on various factors, including country and race.

Cognitive problems are typically most severe during the first few months after a stroke. While they can improve over time, the rate of improvement tends to slow down after the first three months. Treatments for cognitive problems often focus on helping individuals develop coping strategies rather than curing the underlying issue. Occupational therapy and, in some cases, clinical neuropsychology or psychology, can be beneficial.

It is important to monitor cognitive problems and seek support as needed. While these issues do not necessarily indicate dementia, they can still have a significant impact on a person's life and well-being.

Frequently asked questions