Strokes and acquired brain injuries can cause speech problems and significantly impact language communication. The change in communication skills is known as aphasia. Aphasia can have devastating consequences on relationships, employment, social functioning, and sense of self. Up to a third of individuals with chronic effects of a stroke will experience depression. Speech pathologists play a critical role in supporting rehabilitation after a stroke or brain injury. We will work with you, your family, your employers to support your speech and language.
Speech Problems After Stroke
How speech pathology treats speech and language problems after a stroke or a brain injury
What is a stroke?
There are several different types of strokes and their impact on communication can be sudden or gradual over time.
A stroke is an ‘event’ that causes a lack of oxygen reaching the brain.
Strokes are broadly categorised into 3 causes:
- Blocked artery – when a blood clot or a plaque (fatty deposit) blocks a blood vessel (Ischaemic stroke)
- Bleed – when a blood vessel leaks or bursts in the brain (Haemorrhagic stroke)
- Temporary blockage – symptoms of the stroke only last for a short time possibly only a few minutes due to a temporary blockage. (Transient Ischaemic Attack- TIA) However, the risk of this being repeated is high.
What is an Acquired Brain Injury (ABI)?
A brain injury may be congenital, meaning it is present at birth.
An acquired brain injury means any damage to the brain after birth. There are a number of causes:
- Physical injury – such as a blow or a fall
- Alcohol or drugs – these can poison the brain
- Disease – such as Alzheimer’s disease, Parkinson’s disease, cancer (tumour)
- Lack of oxygen – such as a near drowning
- Stroke – a brain bleed/ or blockage destroying brain tissue is also an acquired brain injury
How does a stroke or a brain injury affect communication?
A brain injury can cause changes to more than one area of communication:
Aphasia – Difficulties with understanding, talking, reading, writing. Also known as dysphasia.
Apraxia – Difficulties with coordination of the muscles for speech although you know what you want to say. This makes speech sound jerky or hesitant.
Dysarthria – Unclear or slurred speech due to weakness or paralysis in the muscles used for talking.
Dysphonia – Change in voice making it sound whispered, rough, or hoarse due to weakness or paralysis of the muscles used to produce your voice.
Cognitive difficulties – This is where your thinking, judgment and memory is affected. It may be harder to process what is being said, or what is happening, or clearly join ideas or analyse information in the way you used to.
“Damage to the brain can impact how a person understands and use language”
More about aphasia
Damage to the areas of the brain that manage communication impacts how a person understands language and how they can use it. These language changes are called aphasia.
As speech pathologists, we often describe to our clients that the effects of a stroke is much like a tornado whipping in, throwing all the books in a library up into the air. This means that we know the book is there but it’s not categorised correctly or in the right place. Much of speech pathology for aphasia is like trying to reorder language and re-teach how the words are linked to one another. The brain has fantastic neuroplasticity and with strategies to help the re-connections, this can make a huge difference to someone’s life.
What is aphasia and what does it look like?
Aphasia can manifest itself very differently from one person to another. When aphasia impacts language understanding (comprehension), a person can hear what is being said but has difficulty understanding the meanings of some of the words which would previously have been known, or the message as a whole. This difficulty with understanding can also affect reading. This means that they may be able to see what is written, can even decode it, but has difficulty processing what it is they have read. Sometimes reading it aloud means they can hear it. This can additionally support their understanding.
Aphasia can also affect how language is used (expressive language). One of the most common features of aphasia is word-finding difficulties. A ‘tip-of-the-tongue’ phenomenon. Oftentimes a person knows they know the word but can’t quite grasp it. This means that speech can be ‘all around the houses, sometimes a stroke can even affect just one language when a person speaks more than one language.
The severity ranges from mild to severe. Spontaneous improvement is depending on the type of stroke or brain event, the location of its impact, its size and often the pressure in the brain as a result of the bleed. It can take several days to several weeks or longer to see what level of spontaneous natural recovery will be achieved.
How speech pathology can help
Speech pathologists can use comprehensive formal and standardised assessments to understand the nature and depth of the effects on language. This allows us to fully understand which skills have been retained, which areas are strengths and which areas needs the most support.
Research has looked to clearly identify exactly the type of aphasia by examining the varying degrees of understanding of language, fluency of speech, whether it is halting with poor word finding, gasping at sounds, how to the point a message can be conveyed.
Therapy can be directed at the specific linguistic skills that have been damaged. This uses the brain’s neuroplasticity to rehabilitate these skills. This approach is impairment based speech pathology.
A social approach, also known as a functional therapy approach, looks at how we can build the communication skills to allow you to participate in your everyday life. This approach focuses on the activities of everyday living which you wish to regain and scaffolds you to succeed in achieving this. Activities, for example, maybe grocery shopping, catching a bus, going to the bowling club.
At Talkshop Speech Pathology we work with you and your family to prioritise which goals will make the most meaningful change as quickly as possible. This is often a combination of an impairment based approach along with a social approach.
Therapy sessions are typically 45 minutes weekly.
We also assess the muscles of the mouth and throat to look how they affect the various skills needed for clear speech.
- Range of movement
- Speed of movement
This allows us to understand the key areas of weakness affecting clear speech
Therapy for Speech
A therapy program focuses on a range of techniques to increase speech intelligibility. This generally requires a lot of home practice to strengthen the muscles for speech. This involves repeated practice to gradually increase strength and regain dexterity for speech.
“Therapy focuses on the activities of everyday living you wish to regain and scaffolds you to succeed in achieving this.”
Alternative and Augmentative Communication Aids (AAC)
Sometimes communication after a brain injury is so significantly changed that speech is too effortful or unclear to others. In this case, we can look at other technologies that can assist with communication. These may be in the form of Apps for your existing devices, or they may be a stand-alone device.
Communication difficulties affect everyone differently. We will assess your talking, listening, reading, writing and understanding. We will work with you to develop a rehabilitation program to meet your needs and goals. We can suggest ways to communicate more easily, and aids that can help.
If you have aphasia, your rehabilitation program may include practising talking, listening, reading or writing. We will work with you and your family/work place. These may be one to one sessions, or in a group. You may work with the speech pathologist on your own or in a group. You may use a computer to work through exercises. You may practise using gestures or aids to get your message across.
If you have apraxia, treatment will focus on helping your muscles to work together. You may work on making sounds accurately and improving the speed and rhythm of your speech. You may practice using words and sentences that gradually get longer and more complex.
If you have dysarthria, you may do exercises to improve the strength and coordination of your speech muscles. You may practise speaking slowly or loudly and exaggerating your speech. You may use a voice amplifier to make your voice louder.
Communication tips for family and friends
Your family and friends can help you communicate:
- Make sure you are face-to-face when speaking.
- Talk in a quiet place with no distractions.
- Make sure only one person speaks at a time.
- Speak slowly in short, simple sentences.
- Use gestures, writing or pictures.
- Make it clear when the topic has changed.
- Check to make sure you have correctly heard and understood.
- If you are not understood the first time, try a different way.
1 “Depression and anxiety after stroke fact sheet — Stroke Foundation ….”
https://strokefoundation.org.au/About-Stroke/Help-after-stroke/Stroke-resources-and-fact-sheets/Depression-and-anxiety-after-stroke-fact-sheet. Accessed 17 Jan. 2019.
2 “Post-stroke depression: Prevalence and relationship with disability in ….”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924510/. Accessed 17 Jan. 2019.