Communicating after a stroke: understanding aphasia

Each year, 800,000 people in the United States will experience a stroke. Stroke survivors can experience a wide range of challenges including muscle weakness, temporary or permanent paralysis, difficulty with balance, memory, speech, cognition and vision.

A common issue for stroke survivors is a speech language disorder. According to the American Stroke Association, around a third of stroke survivors will experience some kind of speech language disorder. People may have difficulty finding words to communicate, understanding what others are saying or even have difficulty with reading and writing. A person may exhibit cognitive linguistic deficits in areas of auditory memory, problem solving, organization, social skills, judgement and executive functioning (multitasking).

This sudden barrier in communicating with the people around them can be especially frustrating for stroke survivors as they navigate life with new challenges.

Communication recovery is a big step towards independence and speech language pathologists are here to assist.

Common Speech Language Disorders

Post-stroke communication disorders can be divided into main categories:

• Aphasia is defined as an acquired neurogenic language disorder (usually left hemisphere of the brain) which can affect speech, comprehension, writing, reading, and general communication.
• Dysarthria occurs when a stroke causes weakness of the muscles you use to speak. Dysarthria may affect the muscles you use to move your tongue, lips, breath control and support, as well as vocal quality.
• Apraxia/Dyspraxia is a motor speech disorder. Apraxia/Dyspraxia of speech happens when you cannot move muscles in the correct order and sequence to make the sounds needed for speech production due to a faulty innervation in the brain for motor planning. The individual muscles you use to produce clear speech may be working well and you may have no weakness or paralysis, but you cannot move them as and when you want to in the right order due to decreased motor planning.
• Cognitive Linguistic Deficits/Higher Level Language Deficits- may affect right hemisphere of the brain with deficits in short term memory, making decisions/providing solutions to everyday situations, social skills, reasoning skills, organization, insight, and multitasking in all settings.

Focus on Aphasia

Aphasia is the most common type of speech language disorder in stroke patients. There are different types of aphasia you may have:

• difficulty to understand what is being said (receptive aphasia)
• have difficulty expressing what you want to say (expressive aphasia)
• difficulty with communication in multiple areas (mixed or global aphasia)

Aphasia can affect communication in varying degrees (Mild, Moderate or Severe) of impairment. Aphasia may affect a single aspect of language use, such as the ability to retrieve the names of objects, or the ability to put words together into sentences. Multiple aspects of communication in the areas of comprehension (auditory and reading), verbal expression, and written expression can be impaired as well.

An important thing to remember is that aphasia is a speech and language disorder. The diagnosis refers to the person’s ability to communicate, it doesn’t define intelligence.

Treating Aphasia: Speech Therapy

A speech language pathologist will assess the following areas to determine if treatment is warranted:

• Auditory Comprehension-Does the person understand what is being said by others?
• Reading Comprehension- Does the person understand information that is written and can they orally read aloud correctly?
• Verbal Expression- Does the person verbally express basic wants and needs clearly? Does the person present with word finding difficulty?
• Written/Graphic Expression- Does the person express basic wants and needs in written form for activities of daily living?

Hierarchy of Aphasia Treatment

A speech language pathologist will evaluate these areas and determine the level at which to begin treatment:

• Word Level
• Phrase Level
• Sentence Level
• Paragraph Level
• Conversation

Alternative/Augmentative Communication (AAC) is also a treatment tool used for a person exhibiting moderate to severe aphasia and apraxia. Communication devices (complex computer devices, IPads, communication applications(for IPads, phones, etc.) assist in communicating wants and needs to others when unable to use verbal expression in daily activities.

Supporting Someone with Aphasia

A person with aphasia can experience isolation, frustration and depression secondary to these communication deficits. Activities of daily living may seem overwhelming to a person who has aphasia along with difficulty communicating wants/ needs to family and peers.

There are steps that family members and friends can take to support someone with aphasia. You can help someone with aphasia communicate by:

• Keeping your language clear and simple. Speak slowly
• Giving the person time to speak and formulate thoughts – give the person time to take in what you say and to respond
• Using short phrases and sentences to communicate
• Reduce background noise/distractions
• Using all forms of communication to reinforce what you are saying – use clear gestures, drawing and communication aids if needed

You can also help someone with aphasia to express themselves by:

• Not interrupting and ask if your help is needed before giving it
• Using alternative communication systems if appropriate (ex. Keyboard, written expression, communication applications on devices, etc.)
• Asking careful questions that only require a ‘Yes’ or ‘No’ answer instead of open ended questions. Give them plenty of time to respond. Don’t ask too many questions too quickly, as they may feel overwhelmed and become frustrated.
• Look as well as listen – you will get information from natural gestures, facial expressions and body language.
• Communicate to understand. If you’re having difficulty understanding their communication, be honest and tell them: “I’m sorry, I don’t understand – let’s try again.”

The goal of the speech language pathologist is to achieve the best level of communication for a person with aphasia to participate in all activities of daily living.

Learn more about speech therapy, learn more about stroke rehab or call 570.348.1360.

About the Author: Danielle Burrier, MS, CCC/SLP is a speech language pathologist at Allied Services Luger Scranton Rehab Center. Danielle has more than 24 years of experience in speech language therapy, serving both pediatric and adult patients. She specializes in the treatment of adult neurological disorders (CVA, TBI), pediatrics, and dysphagia/swallowing disorders.