Every year in the United States, more than 795,000 people have a stroke, according to the Centers for Disease Control and Prevention. Furthermore, the United Kingdom’s Stroke Association note that 1 in 3 people will experience communication problems after a stroke.
Unfortunately, we often judge people on how well they communicate. From the outside, a person who has difficulty speaking may appear to have difficulty thinking, too, but this is not necessarily true.
For a person who has had a stroke, the ability to think and communicate depends on the part, or parts, of the brain that have been affected.
Having a stroke can be a frightening and frustrating experience. Not being able to tell people what is going on in the aftermath can extend the trauma.
Friends and family members, for their part, can also find themselves tongue-tied. They may feel embarrassed, lost for words, or they may think that this is no longer the person they once knew.
Post-stroke rehabilitation can help people to regain some or all of their skills. Speech therapists specialize in communication, but nonspecialists can also play a key role.
It is important for friends and relatives to understand that what a person expresses on the outside, after a stroke, is not necessarily what is going on in their head. They should also remember that, although a person faces new challenges after experiencing a stroke, they are still the same person.
This article will offer some tips from people who have “been there” that can give us the necessary skills for helping someone get back to communicating after a stroke.
A stroke is a brain injury that results from bleeding or a blockage in the brain. The effects can be sudden or gradual, and the damage may impact various aspects of mental and physical health.
- Motor skills
- The senses, including reactions to pain
- Thinking and memory
A stroke can affect a person’s use of language in a variety of ways.
Not only can the processing of language be impaired, but paralysis or physical weakness in the face, tongue, or throat muscles could make it hard to swallow, control breathing, and form sounds.
The type and extent of communication problems will depend on the form of stroke and what kind of injury has occurred. The damage and resulting levels of ability will also vary.
The Stroke Association describe three conditions that affect communication after a stroke: aphasia, dysarthria, and dyspraxia. A person may experience one or a combination of these.
Aphasia, or dysphasia, results from damage to one of the “language control centers” in the brain. While it influences communication, it does not impact intelligence. It may affect just one type of communication – for example, reading, listening or speaking, or a combination.
Damage to a part of the brain known as Wernicke’s area can lead to receptive aphasia.
This makes it difficult to understand long and complex sentences, especially if there is background noise, or if more than one person is talking. The person may feel as if others are speaking in a foreign language. Their own speech may also become incoherent.
If there is damage to Broca’s area, expressive aphasia can result.
The person can understand others, but they will be unable to explain themselves. They can think the words, but they cannot speak them or put them together in order to make coherent, grammatically correct sentences.
A person with expressive aphasia may be able to make sounds or say short words or parts of sentences, but they may miss out important words or use the wrong word. They might have the word “on the tip of the tongue,” but not be able to get it out.
It may seem to the speaker that they are talking normally, but to a listener, it can sound like nonsense. Listeners may believe that the speaker is confused when they are not. They just cannot get the ideas across.
Damage that affects multiple areas of the brain can lead to mixed, or global, aphasia with challenges in all aspects of communication. The person may no longer use language to convey thought.
Dysarthria and dyspraxia
Dysarthria and dyspraxia relate to the physical production of speech sounds.
A person with dysarthria can find the words, but they cannot form them because of a physical problem, such as muscular weakness. This may cause the words to come out slurred or in short bursts. This slurring does not necessarily reflect the person’s state of mind. It is likely that only their ability to communicate is limited.
Dyspraxia involves difficulty with movement and coordination, so that the muscles needed for speech sounds may not work properly or in the correct order. This, too, can affect speech.
Other changes that can make it hard to contribute to conversations include:
- A loss of voice tone, normally used to express emotions
- Fixed facial expression
- Problems understanding humor
- Inability to take turns in conversation.
These can make the person appear depressed, even if they are not.
Some people are aware that they are experiencing these changes. If so, letting others know what the problem is can help to combat the issue.
However, a person with anosognosia will be unable to recognize that anything is wrong, due to a lack of insight resulting from damage to the brain. This can hinder recovery.
Depending on the damage that has occurred, vision and hearing problems can also affect communication and writing ability.
Tiredness is a common result of stroke. Conversation might also be tiring, because it demands so much effort.
After a stroke, stress and personality changes can occur. Stress can exacerbate communication problems, especially if the person becomes impatient with themselves, or if others become impatient.
Mood changes, due to the stroke’s effect on the brain, can further add to the strain.
Speech therapy is a key part of rehabilitation after a stroke.
A speech therapist will help people with swallowing; this can be severely impaired, and it has an impact on language production.
Language practice activities that speech therapists may use include intensive exercises in:
- Repeating words
- Following directions
- Reading and writing.
Examples of more extensive practice are:
- Conversational coaching
- Rehearsing speech
- Developing prompts to help people remember specific words
- Working out ways to get around language disabilities, such as using symbols and sign language.
Communication technology has expanded the range of ways to practice and improve communication. An example of this is pressing a key to activate a voice simulator.
Medical News Today asked two men, Peter Cline and Geoff, about their experience in regaining communication skills after a stroke. Peter, an engineer, had a stroke at the age of 59 when he was just starting a holiday in Tasmania. Geoff, who ran his own business until his retirement, was living in Spain when he became ill.
Both men have worked hard to regain their communication skills.
We asked what advice they would give people in order to help them communicate with someone following a stroke.
They gave us this list of dos:
- Do look directly at the person when you are speaking to them
- Do speak slowly and clearly, but use a normal tone of voice
- Do use short sentences and stick to one topic at a time
- Do ensure there is no background noise
- Do reassure the person that you understand their frustration
- Do write things down, if it will help
- Do find out about the person’s employment, interests and passions – now and before the stroke – and try to relate to these
- Do give people a chance to say what they want to say, without jumping in or correcting them.
They also gave us some don’ts:
- Don’t finish the person’s sentences for them
- Don’t speak too fast
- Don’t push them too much
- Don’t speak to the person while they are driving, for example, because they cannot concentrate
- Don’t assume that because the person is having difficulty understanding, they must be stupid
- Don’t “talk down” to the person, or speak to them as if they are a child
- Don’t keep “rabbiting.”
Geoff told MNT that he feels his communication skills “go up and down.” It becomes harder for him to communicate when he is tired, and when there are more than two people in the conversation.
Both Geoff and Peter have made remarkable progress in their communication skills, and they each offered some words of encouragement for people who have had a stroke.
Geoff’s advice is:
“Take time to recover, and, when communicating, take time to explain, and don’t let yourself feel rushed.”
- Persevere and don’t give up. Things will gradually improve but not as quickly as you want them to
- Expect peaks and troughs in your recovery
- Enjoy relaxing with something you are familiar with, for example, old films, music, or whatever your “comforter” is.
Peter explains that after a stroke, an individual can feel as if they are inside a bubble. “It helps if you can get someone to understand that,” he says.
Friends and family can engage in regular practice activities to help someone recover their communication skills after a stroke.
It may be helpful to arrange regular slots for communication practice, at a time when the person will not be tired.
Here are some activities for sharing, depending on individual styles and taste:
- Songs, especially if the person was a keen singer before. Some people can sing after a stroke, even if they cannot speak, because singing and speaking use different parts of the brain
- Card games that involve the person saying the name of the card
- A photo album, to share and discuss the people and events in the pictures
- A personal file, with information about the person’s life, jobs, and family, in order to provide topics of conversation and nonverbal clues when access to key words is difficult
- A diary, with records of visits, events, and conversations. Friends and family can be encouraged to write in it, to help the person track their progress
- News stories to read in advance and discuss during the session.
If an important conversation is coming up – with the insurance company or hospital, for example – these slots can be a good place to prepare.
Other tips for self-help
If a person has difficulty expressing a word or idea, encouraging them to write or draw what they mean can help. Some people can spell a word, even if they cannot say it.
Strategies that people have used to practice alone include:
- Rehearsing speech sounds, such as vowels and consonants
- Using children’s books to practicing reading and writing
- Reciting poems or nursery rhymes
- Saying the names of famous sports personalities
- Watching the news, and copying how the newsreader speaks
- Persevering in conversation with friends or family, however difficult it is
It is important for friends and family to continue to treat the person as an intelligent adult, and to be aware that while their ability to communicate has changed, their identity has not. They are still who they are, with interests, skills, and a past.
In addition, everyone is different, and the effects of stroke vary. For this reason, there will not be a “one-size-fits-all” solution.
Full recovery is not always possible, but patience, help, support, and practice can go a long way in helping people to regain their communication skills after a stroke.