Stroke/Brain Injury

After a neurological event like a stroke or other brain injury, people sometimes develop difficulties with speech and/or language. These challenges often fall into one or more of the following categories:

• Aphasia: a difficulty with understanding and/or using language. There are different types and severities of aphasia, as it can manifest in a variety of ways. Research shows that early speech therapy for aphasia following a stroke is recommended to maximize progress.

• Dysarthria: a challenge with moving the muscles for speech, resulting in speech that sounds “slurred” or imprecise. A stroke can result in damage to the nerves that innervate the muscles people use to move the lips/tongue/etc to form speech sounds. This basically means that the muscles have been weakened and/or it is more difficult for the person to move them precisely. Dysarthria can also impact the quality of a person’s voice (see the Voice page for more info).

• Apraxia: like dysarthria, apraxia impacts the production of speech sounds; however, it is a challenge not with the muscles themselves, but with the brain’s signal to the muscles. Our brain directs our muscles to move in a certain sequence in order to produce a given word, and with apraxia, the ability to coordinate these muscle movements is affected. This means that a person with apraxia may say a target word differently each time (e.g. they may say “cat” as “tac” one time, “tat” another time, and “cat” a third time).

Speech therapy can support with all of these areas. Depending on the individual’s specific challenges, this could look like working on anything from object naming and expanding utterances, to improving reading skills, to practicing clear speech strategies for functional, meaningful words.

Communication partner training can also be invaluable, as communication is a 2-way street, and the listener has just as important a role to play as the speaker in order to make sure that there has been a successful exchange of information. I have experience with the Aphasia Institute’s Supported Conversation for Adults with Aphasia (SCA™) approach to communication partner training. 

Frequently Asked Questions about
Post-Stroke Communication Challenges:

• Will I (or my partner/parent) have a complete return to my/their speech-language abilities before the stroke (or other brain injury) happened?

Unfortunately, it’s impossible to predict — I wish I had a crystal ball, but I don’t! When it comes to aphasia specifically, we often see the biggest amount of progress in regaining abilities when a person receives immediate and intensive speech-language intervention after the brain injury event, and we tend to see the most progress occur within the first year following the injury. However, the brain is neuroplastic, which means that change can still happen years afterwards.

• My mother had a stroke a few months ago, and she’s still having a lot of difficulty with swallowing, particularly with liquids. Do you work on that?

My professional areas of focus don’t include challenges with swallowing (dysphagia), so if that is the primary issue, I recommend finding a speech-language pathologist who has concentrated on that area.

• (From partner/adult child) My partner/parent is the one who had the stroke — why do I need to change anything about my communication?

A conversation involves active participation from both people — at various points, one takes on the role of the speaker, and the other the role of the listener. In order for the speaker to communicate their message and for the listener to understand it, they each need to be using certain skills. Sometimes there’s a communication breakdown, when the speaker’s sentence structure is confusing or they can’t remember the word they’re looking for, or the listener has tuned out or isn’t asking the right questions.

When your partner or parent has had a brain injury, you are still responsible for your role as a listener — it’s just that the role may look a little different than it did before their brain injury. Perhaps it now means that you write down key words to help keep the conversation on track, or that you periodically summarize what you’ve talked about and check for understanding from your partner/parent. Maybe you search online for images to clarify their understanding, or ask them questions to help them express their intended meaning.

The bottom line: the onus should not be solely on the brain-injured person to do all the work in trying to ensure the conversation is successful. In fact, if you think about it, as the person who has not sustained a brain injury, it is likely much easier for you to implement these strategies.