Speech Therapy After Stroke

Strokes are one of the most common medical conditions that occur in the United States. Every 40 seconds, someone suffers from what is also known as a brain attack. This amounts to nearly 800,000 people each year. 

As part of National Stroke Awareness Month in May, we explore the wide-ranging impact a stroke can have on the body, from muscular difficulties and visual impairments to speech and sensory changes. As it relates to communication, about one-third of stroke patients suffer speech and language problems that require speech therapy services as part of stroke rehabilitation. This blog will discuss how a stroke impacts speech and how speech therapy plays a key role in recovery.

How does a stroke affect speech?

A stroke occurs when the blood supply to the brain is either blocked or reduced, resulting in damage to brain tissue. Many strokes affect the cerebrum, a part of the brain found in the top and front portions of the skull. The cerebrum controls motor skills, thinking, memory and emotions.

• A stroke can occur on either side of the cerebrum – the left hemisphere or the right hemisphere. The effects of a stroke depend on which area is affected.
• A right-sided stroke primarily involves physical and cognitive symptoms, such as vision problems, memory problems and behavioral changes.
• A left-sided stroke, by comparison, usually causes problems with speech and communication and also affects the ability to read and write.

Types of stroke speech disorders

There are three common speech disorders that can occur after a left-sided stroke: aphasia, apraxia of speech and dysarthria.

• Aphasia: This disorder affects your ability to both express and receive speech. In other words, you may have trouble speaking to others or have issues understanding what people say. This can present as struggling to find a word to express a thought, not understanding sentences or not being able to write words or sentences.
• Apraxia of speech: This disorder makes it difficult to control the lips, tongue and jaw when speaking. Apraxia impacts the ability to produce certain speech sounds and also affects the rhythm and rate when speaking.
• Dysarthria: This disorder occurs from physical damage to the muscles used for speech. Dysarthria makes it harder to form and pronounce words. The exact effects can vary, but dysarthria can impact pronunciation, loudness and issues with pitch variations.

How long does stroke speech impairment last?

The duration in which stroke-related speech impairments last will vary in each person. Proper care and rehabilitation can greatly improve outcomes.

In general, though, you can expect speech to improve anywhere from three to six months following a stroke. For some people, it can take longer – months or years longer.
Stroke patients notice the greatest improvements when receiving speech therapy that targets activity-dependent neuroplasticity, meaning the brain can adapt and restructure when tasked with exercises to improve speech, communication and thinking.

Types of speech therapy

Aphasia speech therapy

Speech therapy for aphasia focuses on restoring the ability to produce and understand speech. In the event permanent damage is sustained, therapy also can focus on using what is left of your language abilities. For example, there are non-verbal ways of communicating by using gestures, pictures or devices. For people who have an easier time writing things down, a speech-language pathologist may tailor therapy to written exercises instead of speech  exercises.

• Some speech-language pathologists use pictures to help patients re-learn how to produce sounds. This could involve showing a picture of animals and asking them to repeat what they see.
• Repetition is key in therapy – the more exposure you receive, the more likely your brain is to adapt to those changes.

Susan Dowell, MS, CCC-SLP, a speech therapist at INTEGRIS Health Jim Thorpe says, "Aphasia is the most common communication diagnosis post-stroke leading to life-long changes and challenges. However, with appropriate supportive conversation training and rehabilitation of skills through skilled speech therapy, you will still be able to lead a fulfilling life."

Apraxia speech therapy

Speech therapy for apraxia focuses on using the mouth correctly to produce sounds. One area of treatment includes prosody in speech, which refers to the patterns of rhythm, intonation and stress when speaking.

• A speech-language pathologist may guide you to repeat sounds over and over with the correct movements. You may also focus on rhythm and rate of speech by using pauses and finger snapping to find a certain tempo.

Dysarthria speech therapy

Speech therapy for dysarthria focuses on improving speech rate and articulation and strengthening the muscles needed to produce speech. Tongue and lip exercises can help improve weak muscles, while improving your breathing can help improve speech clarity. Slowing down your speech may also allow you to produce words and sentences more clearly and easily.

Communication tools for stroke patients

There are many tools speech-language pathologists use for treating stroke patients.

• Picture dictionaries: As the name suggests, these books use images to describe words. Examples include a picture of a car instead of the spelling of the word “car.”
• Book boards: These boards are similar to picture dictionaries in that they use pictures, symbols, images and phrases to help patients answer simple questions.
• Chalkboard or whiteboard: These surfaces allow people recovering from strokes to communicate through written language.
• Microphones: Some people who suffer from a stroke can experience a decrease in vocal fold movement and weakness in muscles that help them vocalize sounds and words. To help with this, microphones increase the volume to produce a louder voice when speaking.
• Smart devices: Thanks to advancements in technology, smartphones and tablets have specific  apps to help them create messages and images to help communicate.
• Speech-generating devices: Also known as SGDs, these devices allow users to play pre- recorded words to communicate. SGDs are usually reserved for people who suffer from severe strokes and have limited ability to communicate.

Since 1985, the INTEGRIS Health Jim Thorpe Rehabilitation Center has been considered one of the top places for both inpatient and outpatient rehabilitation needs. Our inpatient stroke rehab program treats hundreds of patients each year to help improve their speech and communication after a stroke. As patients progress from inpatient to outpatient speech therapy services, our outpatient staff stimulates recovery and encourages patients to regain and recover their speech abilities. For more information, call 405-945-4500.