The Silent Aftermath: Stroke's Impact On Speech

Strokes can have a severe impact on a person's ability to communicate, with around a third of survivors experiencing problems with speaking, reading, writing, and understanding others. This condition is called aphasia, a language disorder that affects your ability to communicate. It is caused by damage to the regions of the brain that control language and speech, which can result in garbled speech, an inability to translate thoughts into coherent speech, and difficulty in reading and writing. Other speech disorders that can occur after a stroke include dysarthria and apraxia, which affect a person's ability to control the muscles used for speech and produce slurred or slow speech. While these conditions can be distressing for both survivors and their loved ones, there is hope for recovery through speech therapy and other treatments.

Aphasia: a language disorder that affects your ability to communicate

Aphasia is a language disorder that affects your ability to communicate. It impacts your speech, as well as the way you write and understand both spoken and written language. Aphasia usually happens suddenly after a stroke or a head injury, but it can also develop gradually due to a slow-growing brain tumour or a disease that causes progressive, permanent damage.

Aphasia occurs when the language centre of your brain sustains damage, typically in the left hemisphere, where the language centres of the brain reside. The severity of aphasia depends on factors such as the cause and the extent of the brain damage.

There are several types of aphasia, including:

• Expressive aphasia, where individuals can understand what is being said but struggle to form the words to communicate.
• Fluent aphasia, where individuals can speak without issue but struggle to comprehend speech, often stringing words together in an incomprehensible way.
• Transcortical aphasia, which describes how well an individual can understand what others are saying and how easy it is for them to speak or repeat what they hear.
• Broca aphasia, where individuals may omit small words like "and" and "the" from their language and tend to speak in short, meaningful sentences.
• Wernicke aphasia, where individuals may speak in long, confusing sentences, adding unnecessary words or creating new ones, and they often struggle to understand the speech of others.
• Global aphasia, where individuals have significant trouble speaking or understanding language.

Treatment for aphasia involves addressing the underlying condition, as well as speech and language therapy. The goal is to improve communication skills and find alternative ways to convey messages. Some people with aphasia fully recover without treatment, but most individuals will have some residual speech or language difficulties. Speech therapy can help improve communication abilities over time, and nonverbal communication methods, such as computers or pictures, can also be utilised.

Dysarthria: a motor speech disorder that causes difficulty controlling the muscles used for speech

A stroke can cause aphasia, a language disorder that affects a person's ability to communicate, or dysarthria, a motor speech disorder. Dysarthria is a speech disorder caused by muscle problems. It can make it hard to talk, and people may have trouble understanding what the person with dysarthria is saying.

Dysarthria is a motor speech disorder that causes difficulty controlling the muscles used for speech. This can result in speech that is slurred, slow, or difficult to understand. The muscles in the tongue, lips, and other parts may be too weak for speech. Or the brain may be unable to send the correct messages to get those muscles to work in sync. Dysarthria can also cause changes in the tone, volume, and speed of speech.

Dysarthria is caused by brain or nerve damage that changes the way muscles work. It can be mild or severe and can affect both children and adults. It is often the result of a stroke, severe head injury, brain tumours, Parkinson's disease, multiple sclerosis, cerebral palsy, or certain medications.

Speech and language therapy can help improve dysarthria. Treatment may include exercises to strengthen the muscles used for speech, strategies to make speech easier to understand (such as slowing down), and the use of communication aids such as alphabet boards or voice amplifiers.

Those with dysarthria can also try the following:

• Tell new listeners that you have trouble talking before starting a conversation.
• Say one word or phrase before starting to talk in sentences to give context to the listener.
• Check with listeners to ensure they are paying attention and understanding.
• Focus on changing one thing about the way you talk, such as speaking more slowly or loudly.
• Pause to allow the listener to process what you have said.
• Rest before and after talking a lot, as speech may be harder to understand when tired.
• Add visual information to what you are saying, such as pointing to things, using gestures, or writing down important words.

Apraxia of speech: a motor speech disorder that causes difficulty coordinating the oral muscles to form words

Apraxia of speech (AOS) is a motor speech disorder that causes difficulty coordinating the oral muscles to form words. It is a neurological disorder that affects the brain pathways involved in planning the sequence of movements required to produce speech. While the brain knows what it wants to say, it cannot properly plan and sequence the required speech sound movements.

A person with AOS may have trouble pronouncing words correctly, as the speaker may not place the speech structures (e.g. tongue, jaw) in the right place, resulting in distorted sounds, especially vowels. Longer or more complex words are usually harder to say than shorter or simpler words. People with AOS may also make inconsistent errors in speech, such as saying a word correctly and then struggling to repeat it, or being able to say a sound one day but having trouble with it the next. They may also appear to be groping for the right sound or word, trying a word several times before saying it correctly.

AOS is not caused by weakness or paralysis of the speech muscles. Instead, it is the result of damage to the parts of the brain involved in speaking and can occur alongside other conditions, such as dysarthria and aphasia. Dysarthria is a similar speech disorder that results in consistent speech errors, whereas AOS results in inconsistent errors. Aphasia, on the other hand, is a language disorder that affects one's ability to understand and use language.

AOS can range from mild to severe. In mild cases, AOS may only cause trouble with a few speech sounds or the pronunciation of long words. In more severe cases, individuals with AOS may not be able to communicate effectively through speech and may require alternative communication methods, such as sign language, picture boards, or electronic devices.

Treatment for AOS typically involves speech-language therapy, with frequent, intensive, one-on-one sessions being the most effective. Therapy aims to help individuals improve their speech sounds, words, and sentences, as well as plan and execute the required movements to produce speech.

Melodic intonation therapy: a treatment method where people learn to sing words they can't say

A stroke can cause severe language impairment, affecting a person's ability to speak, read, write, and understand what others say. This condition is called aphasia, and it occurs in about 1 in 3 stroke survivors. A less common condition is dysarthria, which causes difficulty controlling the muscles used for speech, resulting in slurred or slow speech.

Melodic intonation therapy (MIT) is a treatment method that uses singing to help people with aphasia improve their expressive language. The therapy takes advantage of the fact that singing uses a different part of the brain from speaking. While the left hemisphere of the brain is typically responsible for language, singing is a creative skill that involves the right hemisphere. So, even if someone has lost their ability to speak after a stroke, they may still be able to sing.

During MIT, a trained specialist guides patients through "singing" exercises that activate the right hemisphere of the brain. These exercises involve slowing down the pace, lengthening syllables, emphasizing intonation, and tapping the left hand to further engage the right hemisphere and improve fluency. Over time, patients develop the ability to sing the words they want to say and eventually transition into speaking them.

MIT is particularly effective for people with severe Broca's aphasia, a type of non-fluent aphasia where individuals struggle to produce language. To benefit from MIT, patients must have damage only to the left hemisphere of the brain, demonstrate moderately good auditory comprehension, and be alert, motivated, emotionally stable, and have a good attention span.

While MIT has been studied for several decades, there is still some controversy surrounding its effects and mechanisms. Some challenges include frequent deviations from the original protocol, inconsistent findings of right hemisphere activation, and uncertainty about whether it treats aphasia, apraxia, or both.

Speech and language therapy: a treatment method to improve speech, reading, and writing

Speech and language therapy is a treatment method that can help improve speech, reading, and writing for those who have suffered a stroke. It is a common treatment, with around one-third of stroke survivors experiencing problems with speaking, reading, writing, and understanding others.

Speech and language therapy can help with a range of communication issues, including expressive aphasia, where the patient can understand speech but struggles to form words, and dysarthria, where the muscles in the face, mouth, and throat are difficult to control, resulting in slurred or slow speech.

Therapists will work with patients to improve their communication skills through various exercises. These may include breathing exercises to help regulate breathing while speaking, tongue strengthening exercises to improve the formation of words, and sentence practice to help with forming complete and correct sentences.

In addition to improving speech, reading, and writing, speech and language therapy can also help patients learn alternative methods of communication, such as gestures, pictures, or electronic devices. This can be particularly useful for those with severe expressive aphasia who may not be able to speak at all.

The effectiveness of speech therapy depends on the area of the brain affected by the stroke and the severity of the brain damage. However, with patience and persistence, most people can make significant progress in their communication skills, even if they don't return to their pre-stroke level of function.

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