Stroke Survivors: Regaining Speech And Communication

how people who suffered strokes can talk

Strokes are a life-threatening medical emergency that occurs when there is an interruption in blood flow to the brain, causing brain cells to die due to oxygen deprivation. This can lead to severe and debilitating consequences, including difficulties with speech and communication. About one in three stroke survivors experience communication problems, including aphasia, apraxia, dysarthria, and dysphonia, which can manifest as impaired speech, reading, writing, or comprehension abilities. Rehabilitation and speech therapy play a crucial role in helping stroke patients regain their communication skills, and early intervention is essential for optimal recovery.

Characteristics Values
Difficulty speaking Slurred speech, trouble choosing the right words, jumbled sentences, inability to speak
Difficulty understanding speech Trouble understanding what others are saying
Reading and writing difficulties Trouble reading and writing
Aphasia Difficulty talking, reading, writing, or understanding speech; may happen even if memory, judgement, and thinking are unaffected
Apraxia Difficulty coordinating the muscles for speech; the brain struggles to plan the movements
Dysarthria Weakness or paralysis of the muscles used for speaking, causing slurred speech
Dysphonia Weakness or paralysis of the muscles in and around the vocal cords, resulting in a whispered, hoarse, or rough voice; if there is no sound, it is called aphonia
Cognitive difficulties Difficulty paying attention, understanding or speaking complex sentences, memory issues, impaired judgement

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Aphasia: Difficulty speaking, reading, writing or understanding others

Aphasia is a language problem that affects how people process language in their brains. A person who has suffered a stroke may think clearly but struggle to use or understand language. Aphasia can also affect a person's ability to read or write.

There are many types of aphasia with different symptoms. Some people with aphasia can understand language but can't speak. Others can talk but don't make sense—their sentences are jumbles of random or made-up words.

Aphasia can happen even if your thinking, memory, and judgment are unaffected by your stroke. This is also called dysphasia.

If you have aphasia, your rehabilitation program may include practising talking, listening, reading, or writing. You may work with a speech pathologist on your own or in a group. You may use a computer to work through exercises. You may practice using gestures or aids to get your message across.

Communication difficulties after a stroke can make it hard to connect with people. It can be difficult to provide information to your treating team and to ask questions. It can be frustrating and isolating, and people with communication difficulties are at an even greater risk of depression than other stroke survivors.

While most recovery takes place in the first few months, you can continue to improve for years. After leaving the hospital, you can join an aphasia group to practice your communication. The more you practice, the more you will improve.

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Apraxia: Difficulty coordinating muscles for speech

Apraxia is a motor speech disorder that occurs when the brain struggles to send the right signals to the mouth to produce speech. It is not due to muscle weakness or paralysis, but rather a disconnect between the brain's intent and the body's ability to execute. The brain knows what it wants to say, but the message gets lost on the way to the lips, tongue, and jaw. This can put a barrier between thoughts and their expression, leading to frustration and isolation due to ineffective communication.

Apraxia of speech is caused by damage to the parts of the brain responsible for speaking. This can happen suddenly due to a stroke or head injury, or it can develop gradually due to progressive neurological conditions such as dementia. A stroke can interrupt blood flow to the brain, damaging areas crucial for speech planning and execution. The left hemisphere of the brain, which is responsible for language in most people, is often affected by strokes, leading to aphasia or apraxia.

People with apraxia may have inconsistent speech sounds, knowing exactly what they want to say but struggling to organise their lips, tongue, and jaw to form the words. They might visibly struggle, trying to position their mouths correctly. Their speech might sound slurred or robotic, even when the correct speech sounds are made. Some people with apraxia cannot speak at all, while others have difficulty moving their tongue and/or lips to form specific sounds.

Treatment for apraxia involves speech therapy, with a focus on improving sound sequencing and coordination. People with apraxia can benefit from sensory treatments aimed at improving awareness of how it looks and feels to produce different sounds. Treatment is more beneficial when started early and can include motor speech therapy, sensory cueing, rate control, and the use of augmentative and alternative communication (AAC) devices in severe cases.

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Dysarthria: Weakness or paralysis of muscles used for speaking

Dysarthria is a motor speech disorder that affects a person's ability to speak clearly. It is caused by damage to the nervous system, which can occur during a stroke, resulting in paralysis or weakness in the muscles used for speaking. This includes the tongue, lips, jaw, and vocal cords. People with dysarthria may have slurred speech, speak too quickly or slowly, or have difficulty producing certain sounds. They understand language and know what they want to say, but their bodies don't cooperate due to muscle weakness.

Dysarthria can be developmental, resulting from brain damage during fetal development or at birth, or acquired later in life due to conditions such as stroke, brain tumours, or Parkinson's disease. It is characterised by slow, weak, and/or imprecise muscle control, affecting the intelligibility of speech.

Treatment for dysarthria often involves speech therapy, which can help individuals improve their communication skills. Speech-language pathologists may recommend exercises to strengthen the tongue, lips, and jaw muscles and provide strategies for speaking louder and more clearly. Non-verbal communication techniques, such as gestures or writing, may also be taught. In severe cases, individuals may need devices to aid communication, such as letter or picture boards or special computers.

While dysarthria can improve with treatment, the recovery process may be gradual, and some individuals may experience long-term communication difficulties.

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Dysphonia: Weakness or paralysis of vocal chords

Dysphonia is a condition that can occur after a stroke, causing weakness or paralysis of the vocal cords. This can lead to significant communication difficulties, affecting an individual's ability to speak, and connect with others.

The vocal cords are bands of muscle inside the voice box (larynx) that sit atop the windpipe (trachea). When we speak, the vocal cords touch, and air from the lungs passes through them, causing them to vibrate and produce sound. Dysphonia occurs when these vocal cords become weak or paralysed, resulting in impaired movement and, consequently, a diminished ability to speak.

The voice of an individual with dysphonia may sound like a whisper, or it might be hoarse or rough. In some cases, the person may experience aphonia, resulting in the complete inability to produce any sound. Dysphonia can also cause changes in vocal pitch and volume, leading to a voice that sounds weak, scratchy, or breathy.

Dysphonia is often a result of nerve damage caused by the stroke. This nerve damage can prevent the muscles inside the vocal cords from opening and closing properly, leading to the aforementioned symptoms. It is important to note that dysphonia can affect one or both vocal cords, with unilateral dysphonia being more common than bilateral dysphonia.

Treatment for dysphonia typically involves voice therapy and, in some cases, surgery. Voice therapy, administered by a speech-language pathologist, focuses on strengthening the vocal cords, improving muscle control, and enhancing breathing techniques during speech. More severe cases may require surgical interventions such as vocal cord injections, voice box implants, or nerve reinnervation surgery.

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Cognitive difficulties: Memory, thinking and judgement are affected

Cognitive difficulties are common after a stroke, with more than half of survivors developing cognitive impairment within a year. This can affect memory, thinking and judgement, and may manifest as difficulty paying attention when people talk to you, or understanding or speaking complex sentences. Your conversation may seem inappropriate to others.

These difficulties can make it hard to connect with people around you, provide information to your treating team, ask questions, or communicate how you are feeling. They can be frustrating and isolating, and people with communication difficulties are at an even greater risk of depression than other stroke survivors.

If you think you may be experiencing some of these problems, the first thing to do is to speak to your GP. They will check if there is anything else that could be causing the problems, such as an infection or side effects of medication. Depression, anxiety and sleep problems are common after a stroke, and can make it harder to perform cognitive tasks, so it is important to seek help if you are experiencing these issues.

There is no gold standard for cognitive screening after a stroke, but some brief screening tests (30 minutes or less) are widely used to identify cognitive impairment, including the Mini-Mental State Examination and the Montreal Cognitive Assessment.

Treatments for cognitive problems focus on ways to cope with the issues, rather than 'fix' them. An occupational therapist can assess you and help you learn coping strategies, which may involve using aids such as writing in a diary or using labels and reminders. If your problems are quite specific or severe, you may be referred to a clinical neuropsychologist or clinical psychologist, who specialise in how the brain works.

Tips for family and friends

  • Make sure you are face-to-face when speaking.
  • Talk in a quiet place with no distractions.
  • Make sure only one person speaks at a time.
  • Speak slowly in short, simple sentences.
  • Use gestures, writing or pictures.
  • Make it clear when the topic has changed.
  • Check to make sure you have correctly heard and understood.
  • If you are not understood the first time, try a different way.

Frequently asked questions

A stroke occurs when there is an issue with blood flow to the brain, often due to blocked blood vessels or bleeding in the brain. The cerebral cortex, the largest part of the brain, houses functions like movement, sensation, language, memory, thinking skills, and emotional responses. When a stroke occurs in this area, it can cause difficulty in speaking and understanding others.

Two common issues are aphasia and dysarthria. Aphasia is when a person struggles to use or understand language, either spoken or written. Dysarthria is a speech problem where the person's tongue, lips, and other parts are too weak to form words clearly, often resulting in slurred speech.

It is important to be patient and clear when communicating with someone who has had a stroke. Speak slowly and use simple sentences. Ensure you are face-to-face in a quiet place without distractions. Use gestures, writing, or pictures to support your speech.

Speech and language therapy can help address communication issues. Therapists can teach individuals and their families how to use communication tools and devices. Exercises can also be taught to improve muscle strength and coordination for speech. Additionally, group therapy and support groups can be beneficial.

Family and friends can assist by creating a supportive and calm environment for communication. They should ensure that conversations are clear and unrushed, using gestures, writing, or visual aids if needed. It is also important to be patient and understanding, as the person may need more time to express themselves.

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