Speech disorders and rehabilitation after Stroke

One of the most common symptoms of a stroke is slurred speech. Speech impairment coupled with numbness of the face or the extremities, visual impairment, dizziness and loss of coordination, and severe headache, calls for immediate medical attention.

Stroke and speech impairments
A stroke is the interruption of blood flow to the brain, depriving brain cells from oxygen. These cells die after a few minutes, causing a loss of the neurological functions controlled by those cells. Strokes affecting the parietal lobe, Broca’s center or Wernicke’s center are likely to affect speech.

There are several types of speech difficulties which may arise after a stroke:

- Aphasia is an acquired language disorder affecting the ability to produce and understand language, as well as reading and writing.
- Dysarthria is a motor disorder affecting the control of speech muscles. Information transmitted to the tongue, throat or lips is disrupted, resulting in poor articulation.
- Apraxia of speech (or verbal apraxia) is the inability to produce information commanding speech muscles.

1. Aphasia
In the case of aphasia, speech impairment results when the damage occurs in the left hemisphere of the brain, which contains the person’s language centers. These centers are responsible for the processes of speaking, listening, reading and writing.

2. Dysarthria and apraxia
Dysarthria and apraxia are speech problems which involve the physical act of speaking.

Apraxia is often regarded as a result of the speech muscles re-learning their ability to move and produce specific and accurate sounds, which were affected by the stroke.
Dysarthria, on the other hand, refers to weakness (or tightness) in the muscles affecting speech production.

Thus, speech impairment does not only refer to the inability to move the mouth and lips in speech, but also in the decreased ability to use and comprehend words. It is recognized as one of the more pressing problems for stroke survivors as it makes it difficult to communicate with other people.

Treating language disorders
The goal of rehabilitation of speech impairments, therefore, is to restore a person’s confidence in communicating with others. This may prove to be a difficult task, but people giving assistance should realize that the ordeal a stroke patient endures because of speech difficulties can be frustrating and should be met with a greater deal of patience and understanding.

1. Aphasia
Since aphasia affects use and comprehension of words, the effective goal for therapy is restoration of language ability. Focus should also be set on improving the patient’s ability to communicate by helping him use his remaining language abilities and compensate for language problems. It must be recalled that the brain damage caused by the stroke may erase some abilities, which must be re-learned during the rehabilitation process.

Most patients with aphasia will have difficulty understanding words or expressing thoughts to words. Rehabilitation should be trained on understanding spoken language, making use of additional aids, if necessary. For example, one can use pictures which the patient can try to identify. This will help in recognition of several objects and translation of thoughts into words. Another exercise recommended is to give multiple clues leading to a word, stimulating the patient to think.

Patients may also be allowed, at first, to use hand gestures or signals to compensate for lack of appropriate words or just to help in carrying out a train of thought during a conversation. But, this should not let the patient and his therapist deviate from the ultimate goal of reestablishing the language capabilities. The hand gestures should only be used as an initial tool, so as not to contribute to the patient’s frustrations. It is important to keep in mind that together with rehabilitating the language capabilities, the patient’s confidence needs nurturing as well.

2. Verbal apraxia
In verbal apraxia, the patient knows what words to say, but the brain has trouble coordinating the necessary muscles for speaking. This impairment manifests as difficulty in producing or imitating desired speech sounds and incorrect rhythm and rate of speaking.

Patients suffering from apraxia may utter illogical words and phrases arising from this. Simple words such as “kitchen” may come out as “biden” or “chicken”. Another notable symptom is struggling to say words that have more than two syllables, for example, “institution” or “rehabilitation”.

The difference with this impairment is that the speaker is well aware of his mistakes, but still has difficulty in correcting them. Common therapy approaches for apraxia include teaching sound production, rhythm and rate. Again, the exercises entailed in the therapy are aimed at practicing speech patterns, such that the brain sends out the necessary impulses to coordinate facial muscles for generating speech. Tasks may involve repetition of syllables and words to train the lips, mouth and tongue into making these sounds once again. Providing tips on proper placement of the tongue or shape of lips and mouth while producing sounds also helps in this therapy.

3. Dysarthria
Dysarthria, on the other hand, leaves a patient struggling to move the speech muscles because they become too weak or too tight as a result of the stroke. Additional medical help from healthcare personnel should be heeded to identify the specific type of dysarthria, since it is crucial for the treatment. For example, strengthening exercises are appropriate when the muscles are weak, but may be harmful when the muscles have too much tone. A speech language pathologist should be able to aid in the identification and consequently recommend the proper therapy.

Usually, dysarthria rarely requires therapy and often disappears a few months after the stroke. But, in the event that the impairment persists, a more rigid therapy program may be suggested by the speech language pathologist.

Ultimately, the goal in the rehabilitation of stroke patients with speech difficulties should be to try and bring the patient to his normal, usual speaking self. This can only be achieved with providing the patient not just the therapeutic exercises but also with the environment that minimizes their frustration in having to re-learn common, everyday activities such as speech. This is very important in the recovery process, because speech does much in enabling the patient, making him a more independent and confident individual.


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18 thoughts on “Speech disorders and rehabilitation after Stroke

    • Dear Wendy,

      One of the exercises you can do is to have an object identified in front of the patient – a label or repeating the name would help. Trying approving the patients effort in communicating be it gesture or little sounds. Encouragement is really helpful.

      If the pronunciation is wrong, accept it. The patient was able to associate objects and names and this is part of the recovery process. Baby steps.

      Try avoiding set drills and exercise. Repetition has nothing to do with communicating. Vary each days exercises from time to time – like what food they want to eat, like clothes to wear.

      After names, it would be good to to introduce verbs. Studies show that aphasic patients learn best if nouns such as names of objects, people was set first before verb. Though note that try to avoid “to be” and “to have” verbs as this comes out a bit difficult on their end. Use simple verbs as “open”, “read”, etc.

      I hope this helps.

  1. My father has aphasia, but its not too severe. He had about 95% of his speaking abilities and 80% of his understanding abilities back in less than 24-36 hours. Any idea what kind of progress we could hope for in the the following days, weeks, months?

    • Dear Rod,
      Thank you for your inquiry regarding NeuroAiD™.
      Response time and the extent of progress on speech varies from patient to patient. You may consult your father’s neurologist on this matter to know his potential of recovery.

  2. I had a micro-vascular thrombosis on June 23, 2011 with the chief residual effect being a mild case of dysarthria. I began physical mouth exercises about June 30, and added speech therapy from August 3 through November 30.
    I would say that my speech is about 90% normal. But I still notice a difference. If I slow down somewhat, every word is pronounced. Speaking at my normal speed does produce an occasional mispronounciation. Hyperbaric chamber therapy, I am told, will not help. I have started taking 2 types of neuro pills. Would taking Neuroaid in addition help?

    • Dear Eric, NeuroAiD could help you improve your speech. I have forwarded your question to a product specialist that can look into your case with more details. Thanks for your comment.

      /Fran

  3. I HAVE SPEECH DIFFICULTY THR EE YEARS AFTER A STROKE AND AFTER SPEECH THERAPY FOR ABOUT TEN WEEKS. Most people can understand me but it is a very stressful condition. I am able to go anywhere in the nation for best treatment but dont know where to go. Any suggestions?

    • Dear Billy,

      Thanks for your comment, I have forwarded your concern to a product specialist who will be in touch with you shortly. all the best.

      /Fran

  4. my husband who is a writer had a minor stroke last week and from the reading in this website, he has verbal apraxia. He has full understanding of his condition and comprehension of what people say. Subconsciously, he can say certain words but struggles when trying to express himself. Forming a simple word is very trying; does he need a professional speech therapist, can he fully recover and how long does it take to full recovery? By the way,he has made great progress in this one week and can even do Sudoku…

  5. My dad had a stroke a week ago which has affected his left side,the doctor also said, due to blood clotting in the brain his speech have been affected and right now he cannot utter a word. The doctor have told us to give him time though he is not sure whether he will recover his speech. It’s so sad and devastating to see my father not able to speak, wish he can even utter one word, ooh lord have mercy on him and perform just one miracle, restore his speech almighty father as with you nothing is impossible.

    Anybody with a similar case kindly share.

    Thanks and be blessed.

    • Hi Mary,

      Unfortunatly this is very heartbreaking. My mother had a severe stroke 4th of Jan. Has been having speech Therapy since then.
      At first like in your case she was unable to utter a word, spontaneous speech did work though.
      After almost 7 months of Therapy she is finaly able to say a few words, she understands everything but speaking is still problematic. Its not only learing for her but also for us to interpret what she needs.
      The important thing is never to loose hope, it does get better and it will with time and therapy, how fast the recovery and to what extent is dependent on damage. No one can tell you how long it will take. Two things that me and my family has made up mind on is never to loose hope and secondly keep on trying every day is a bit better then earlier and this keeps the hope alive.
      I hope you find a good therapist, and dont give up on your father Im sure he along with the complete family will pull through.
      Wish you all the best.

  6. hi Mary,
    My husband had a severe stroke two and a half years ago; like your dad, there was nil speech. Thanks to injections that can be administered a year down the line, which help in getting the vocal cords to come together to produce sound, he can now speak quite clearly. It’s a long journey, but faith and determination works wonders.
    Good Luck and positive healing….

    • Hi Mona,

      My Mum has the same problem as your father and still not able to talk. can you please tell me what type of injection helped him?
      Thanks

    • Hi,

      My father had stroke in July and left with no speech. Helps, if you let us know what those injections that you mentioned helped vocal chords.

      thanks
      ashok

  7. If someone had a stoke and left their speech slurred how could the person communicate like someone who is deaf a little they have hearing aids and a loop system is there anything like that in place for slurred speech?

  8. My best friend of 53 years old was operated on a month ago of a brain tumour in the base of the brain and this has left her with paralysis of the left side of her body. The skills of swallowing and her speech are totally affected and although she can make the necessary movements with her mouth, there is no expulsion of noise. This is causing her distress, and the medical team do no seem to give the issue much importance. Is this normal? Should she not be in the hands of a therapist immediately to start treatment on learning to swallow and vocalise even the smallest of words??

  9. I sustained a massive AVM stroke and had my malformation removed in 1987; then, in 2003, I discovered voice recognition software and used it to assist me in graduate school. My memory deficit has been diminished, substantially, even though such a long expanse of time elapsed between my deficit’s onset and my commencing to use the software. I recommend it, wholeheartedly. Matt Ramsey http://www.facebook.com/mattramzzz1971

  10. my father is in india pune and is paraplegic,visual handicapped and suffered a stroke last auguest,pls help as to how i can get back his speech

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