Communication Problems after Stroke

Rasangi Weerasekera, B.Sc. (Hons)
Many people face communication problems after a stroke. 

Communication Problems after Stroke

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Impact of communication difficulties

Many people face communication problems after a stroke. Undeniably it can be very challenging and overwhelming for such individuals when sharing thoughts and feelings with loved ones does not come as easily as before. The communication problem then adds to their emotional and social problems.

Types of communication difficulties after stroke

A stroke is an interruption of the blood flow to the brain which starves the brain cells of oxygen. The consequent disturbance and damage in the areas of the brain responsible for communication will result in one or more of the communication difficulties listed below:

o   Dysarthria – Typically described as having slurred speech due to weak, slowed and poor movement coordination of speech muscles including tongue, lips, soft palate and vocal folds. The spoken utterances will often sound unclear to the listener.

o   Dyspraxia of speech – Having difficulty in coordinating speech muscles at times that you want to put speech sounds correctly together. The speech muscles may not essentially be weak. The spoken utterance will not sound meaningful. In fact, the person will often grope in the attempt to produce correct speech sound sequences.

o   Aphasia – Affects the ability to understand and speak language. A person may be able to think clearly, but will have total or partial difficulty with the following skills:

-       Making sense of heard words and sentences

-       Expressing needs, thoughts and feelings through speaking

-       Reading and writing

-       Recalling words

o   Right-hemisphere Cognitive Communication Disorders (RCCD) – RCCD can result from stroke on the right side of the brain. These difficulties may include having difficulty in understanding and expressing intent as opposed to literal expression such as in humour, sarcasm and irony; or a person may also have problems with changing the voice as appropriate to suit the context and emotion. Outwardly these communication problems may appear as psycho-social issues.

Assessment and recovery

A Speech and Language Therapist (SLT) is a certified professional and member of the multidisciplinary stroke team with specialist knowledge in stroke and rehabilitation. The SLT will carry out specific assessments to identify and evaluate communication difficulties, and then help the affected individuals to develop ways to work on improving communication abilities. Moreover, the SLT will educate, and liaise with the family to bridge barriers and enable effective communication. Speech and Language Therapy services are accessible in government and private hospitals.

Recovery following stroke is often slow, but progress will continue with proper intervention and support. Rapid improvements usually happen between six months and a year after stroke. Improvements may however continue for years with ongoing effort.  

Tips for caregivers and family to aid communication

ü  Converse in a place with minimal background distractions.

ü  Keep language simple. Speak short and clear sentences.

ü  Speak slowly and clearly at a normal volume.

ü  Use adult language and do not treat the stroke patient as a child.

ü  Make sure that spectacles, hearing aids and dentures are available whenever necessary. 

ü  Use gestures, facial expressions, pictures, writing, drawing or any other mode to reinforce communication.

ü  Offer choices when asking questions.

ü  Allow adequate time to understand, think and respond.

ü  Ask the person to repeat if the spoken utterance was unclear. Do not pretend to understand.

ü  Keep conversation natural and meaningful. E.g. talk about hobbies, sports, people etc.

ü  Look at photo albums or read newspapers and talk about places, people, events etc.

ü  Be patient and stay positive!

Take home message

One should not forget that stroke’s impact on a person’s communication can be significant and frustrating. Understanding the type and severity of the communication problems and the limitations it poses on a person are crucial. Consequently, proper professional support is important to maximize and strengthen abilities and overcome difficulties while enhancing independence and quality of life.

Rasangi Weerasekera  B.Sc. (Hons)

Speech and Language Therapist

Sri Jayewardenepura General Hospital

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