Communication after a stroke
Communication is often impacted after someone has a stroke. This is either due to damage to language centers in the brain, physical weakness or paralysis of muscles used for speech, or a combination. Below are some common communication impairments that can occur after a stroke, tips for effective communication, and alternative communication options.
Communication impairments
Aphasia
Aphasia is an acquired language disorder that impacts communication receptively and/or expressively. An individual may have difficulty comprehending spoken or written language and/or with expression of spoken or written language. Aphasia occurs as a result of damage to the brain, typically to the left hemisphere. It can be caused by a stroke, a traumatic brain injury, and neurodegenerative diseases. One of the key characteristics is anomia, or difficulty naming/word finding. There are many types of aphasia, but they are typically broken down by fluent and nonfluent aphasia types. Roughly 25-50% of strokes result in aphasia.
Fluent/receptive aphasia
This type of aphasia is characterized by someone being able to express themselves fluently, but has difficulty comprehending spoken or written language. A type of fluent aphasia that is commonly heard is Wernicke’s aphasia. Someone with this aphasia will speak fluently but it will often not make sense to the listener, and sentences include lexical-semantic disruptions. This language may include word or sound substitutions and a “roundabout” way of talking about things. People with this type of aphasia typically have little to no awareness that their language does not make sense to the listener, making therapy difficult.
Nonfluent/expressive aphasia
This type of aphasia is typically characterized by having difficulty with written and/or spoken language, with relatively intact comprehension. A type of nonfluent aphasia that is often talked about is called Broca’s aphasia. People with this type of aphasia will often have agrammatical and dysfluent speech. Speech often sounds halted, effortful, and stilted. The individual knows what they want to say, but has difficulty expressing it.
Global/severe aphasia
Someone with global aphasia will have impaired receptive and expressive language.
Motor speech disorders
A motor speech disorder is a disorder characterized by an impairment in the motor production or planning of speech, or an impairment in the neuromuscular execution of speech. The most common cause of motor speech disorders is vascular accidents, or strokes. They can also be caused by traumatic brain injuries, infections, and degenerative diseases.
Dysarthria
Dysarthria is a type of neuromotor motor speech disorder that can be congenital or acquired. Dysarthria is a motor speech disorder that is caused by an impairment in the neuromuscular execution of speech, meaning there is an impairment in the musculature required for spoken language, caused by an impairment in the central or peripheral nervous system. There are various types of dysarthrias that are characterized by impairments such as weakness or paralysis, incoordination, variable muscle tone, and poor range of motion. Common dysarthria types caused by a stroke include flaccid dysarthria, spastic dysarthria, ataxic dysarthria, and mixed dysarthria. The type of dysarthria will depend on where the stroke occurs in the brain. It is estimated that 22-58% of people who have experienced an acute stroke present with dysarthria. An individual with dysarthria may have speech that sounds slurred, dysfluent, breathy, hypernasal, slow, strained, monopitch, rapid, irregular, and imprecise. The speech characteristics will depend on the type of dysarthria the individual has. Certain dysarthria types often have accompanying features. For example, someone who has weakness/paralysis may have facial drooping, contributing to their flaccid dysarthria.
Apraxia of speech
Apraxia of speech is a neuromotor motor speech disorder that is caused by an impairment of programming or planning the motor movements and positioning for speech. The individual has difficulty sequencing their motor movements. Unlike dysarthria, there is no weakness or incoordination of the speech musculature, there is a higher level impairment in the ability to plan the muscle movements required for speaking. Apraxia is most frequently caused by strokes, but can also be caused by traumatic brain injury, tumors, seizure disorder, and degenerative diseases. Speech will be characterized by inconsistent productions of words, slowed speech, speech sound errors and sound substitutions, difficulty at the beginning of words/sentences, monotone speech, difficulty initiating speech, and frequent revisions/restarts. Individuals may display articulatory groping where you can see the individual physically trying to make the sound.
Communication tips
- Acknowledge your communication partner. Recognize that their communication difficulties are not due to a lack of cognition and support them in contributing to the conversation, regardless of if it is verbal communication or not.
- Use clarifications: make sure they are understanding you and that you’re understanding what they are communicating.
- When working with individuals with aphasia, it can be helpful to use a slow rate and add in natural pauses.
Communication tools
Click on photos and links below to print communication tools for use.
- Accommodate by using communication tools. Communication aids can help improve communication, especially in the acute phase of a stroke before intensive speech therapy has been implemented.
- White boards: White boards can be useful, especially immediately after the stroke while the person is still recovering. If they can physically write and are able to express a meaningful written message, this can be a good short-term means of communication.
- Alphabet boards: Alphabet boards are helpful for someone who is not able to expressively speak or write.
- Symbol sets: Symbol sets can be helpful to get a larger message across with less effort.
- written/verbal choices: if someone is severely impacted immediately following their stroke, writing down or saying a few choices and having them choose by pointing or blinking can be a way to allow them to express wants and needs.
- Customized communication flipbook: If the individual has a need, they can signal it and communicate using this homemade flipbook. Commonly used words and phrases can be written in the flipbook. The individual can signal if their communication partner is on the right page by blinking, saying “yes,” nodding, pointing, etc. The communication partner can then go through the rows and the columns of words until the correct word/phrase is selected.
- Communication passport: This document has information for medical staff or people that the individual may come across in their everyday life.
- Apps: There are many apps that can aid in communication.
- More downloadable handouts to aid in communication for healthcare
DON’T
- Treat them like they are not cognitively aware.
- Finish their sentences or cut them off.
- Start talking to someone else or change the topic while they are communicating.