How speech therapy helps stroke survivors learn to communicate again

Many people refer to a stroke as the brain’s equivalent of a heart attack. A stroke occurs when there’s an interruption or issue with blood flow to part of the brain. This life-threatening event is most commonly due to a blocked artery, but could also be the result of bleeding in the brain.

“Having a stroke can have a significant impact on the survivor’s ability to communicate clearly,” says Elana Kahn Thompson, MS, SLP, senior medical speech-language pathologist (SLP) at Mount Nittany Health. “The part of the brain impacted by the stroke and the size of the stroke will determine the type of communication problems that will be experienced.”

Struggling to communicate can feel hopeless. Speech-language pathologists can offer people with aphasia a path to recovery.

How stroke affects communication

Communication is about forming a thought and then being able to make the thought known. You put it into words and those words are made of sounds. Those sounds need to be in the correct order and the muscles of the mouth need to be able to produce the sounds. Communication also includes being able to understand what is being said in return.

“This process of rehabilitating communication abilities can be difficult after a stroke, but there are interventions, based in evidence, that can help make it happen. That is why, when a person has aphasia after a stroke, speech therapy is an important part of their recovery,” says Elana.

There are three primary ways having a stroke can affect communication. These are aphasia, dysarthria and dyspraxia.

Aphasia

Aphasia is the most common communication disorder caused by stroke, affecting about 20% of stroke survivors. It means a person can’t use language when they speak, listen, read or write. When a person has a stroke on the left side of their brain, it is more likely they could have aphasia.

The different types of aphasia are expressive aphasia, receptive aphasia and mixed (global) aphasia:

• Expressive aphasia: Expressive aphasia is a condition that makes it hard for people to share their thoughts clearly. Someone with this type of aphasia may struggle to find the right words. They might know what they want to say but can’t say it. They might use words and sounds that don’t fit their message. They may pause before answering questions, leave thoughts unfinished or repeat the same word or phrase multiple times. Often, they may not realize that their speech is unclear to others. Writing their thoughts can also be challenging for individuals with expressive aphasia.
• Receptive aphasia: This type of aphasia presents as difficulty understanding what is being said. This is different from physical hearing loss. In the case of receptive aphasia the person hears what is said, but is unable to recognize and make sense of the word(s). People with receptive aphasia might also struggle to understand what they read.
• Mixed (global) aphasia: This type combines expressive and receptive aphasia. It can affect nearly all of a person’s communication skills.

Dysarthria

Unlike aphasia, dysarthria doesn’t affect the ability to use language. It impacts a speaker’s ability to produce speech clearly. A stroke can damage the brain area that activates speech muscles. It also affects the nerves that help you feel those muscles move. The muscles used to move the face, lips, tongue and palate can be affected. Often the person’s speech is described as slurred or slushy and is more difficult to understand.

Dyspraxia

Dyspraxia also impacts a speaker’s ability to produce speech clearly. Dyspraxia interrupts the signals from the brain to the muscles, affecting movement. The person is then unable to start and coordinate the motions necessary to form words. This can happen even if the person has no muscle weakness.

The role of speech therapy in recovery of communication abilities after stroke

After a stroke, a patient has a team of rehabilitation (rehab) professionals to help them recover and a SLP is part of that team.

If a patient has aphasia, a SLP will do an initial evaluation. This includes:

• Reviewing medical history
• Checking the motor and sensory function of the mouth and face
• Assessing how well the person can express themselves
• Evaluating the person’s understanding of spoken language

After the evaluation, the SLP will work with the stroke survivor and caregivers. They will discuss the evaluation results, set recovery goals and create a treatment plan to help reach those goals.

“Recovering the ability to communicate after stroke can include strengthening and retraining muscles and helping the brain rewire itself around the areas damaged by the stroke so that new pathways are formed to perform the tasks necessary for expressing and understanding language,” says Elana. “The brain is an organ that is believed to be able to reconfigure itself after injury to form new pathways to do a task. This ability, known as neuroplasticity, is what rehabilitation is meant to stimulate.”

Speech therapy offers various methods to help people regain communication skills after a stroke. Physical exercises help improve the motor and sensory functions of the facial and mouth muscles. Language-based activities include computer applications, workbooks and conversations tailored to meet individual therapy goals.

Speech-language pathologists use various cues to help people improve their communication skills. The main goal is for individuals to communicate independently without needing these cues. For instance, an SLP might show how to position the mouth for the first sound in a word. This gives the person a hint to say the word they want. Alternatively, the SLP may encourage the individual to think of a word that is close to the word they are struggling to find. Figuring out which cue works best usually starts during the initial evaluation. The goal is to slowly remove the cues and have the person communicating well without them.

The importance of early and consistent speech therapy

Early intervention is helpful to patients having better results from therapy. To achieve the best results, rehab should start once the patient is stable enough. During hospitalization or recovery in a rehab center, patients can have speech therapy sessions five to seven times a week.

When a person continues therapy outside the hospital, like at a clinic or home, they will see the SLP one to two times a week. It’s crucial to practice the SLP’s prescribed activities outside of these sessions. Daily practice is vital for meaningful improvement.

“It’s important to manage expectations. Recovery is almost never a linear process. It’s more of a zigzag with ups and downs,” says Elana. “Patients with no other medical conditions or complications may have a more direct route to recovery. Those with multiple medical issues may have a more challenging route. Success in therapy should not be defined as the complete return of function as it was prior to the stroke, but rather as the individual regaining the ability to communicate in order to be understood and to understand, in return. Redefining success in that way opens the door to the stroke survivor having many more opportunities to feel proud of achieving their goals.”

Family members and caregivers play a vital role in supporting stroke survivors. Including them in therapy is key. They can learn how to help their loved ones communicate better. Stroke survivors will practice what they learn in therapy with family and caregivers. This practice is vital for improvement outside of formal therapy sessions.

The best way to rehabilitate communication is simply to communicate. Family members and caregivers should involve stroke survivors in everyday conversations, even if they are not therapeutic. While strategies may vary for each person, it’s usually best to keep the environment calm and free from distractions. Also, avoid finishing the survivor’s thoughts unless they ask for help.

People diagnosed with aphasia can improve their communication skills with help from licensed speech-language pathologists and support from loved ones. It can be challenging, but there is hope.