Stroke can lead to ongoing communication problems, but recovery is often possible.
For a person who has had a stroke, the ability to think and communicate depends on the part, or parts, of the brain that have been affected.
Having a stroke can be a frightening and frustrating experience. Not being able to tell people what is going on in the aftermath can extend the trauma.
It is important for friends and relatives to understand that what a person expresses on the outside, after a stroke, is not necessarily what is going on in their head. They should also remember that, although a person faces new challenges after experiencing a stroke, they are still the same person.
This article will offer some tips from people who have "been there" that can give us the necessary skills for helping someone get back to communicating after a stroke.
How does a stroke affect communication?A stroke is a brain injury that results from bleeding or a blockage in the brain. The effects can be sudden or gradual, and the damage may impact various aspects of mental and physical health.
- Motor skills
- The senses, including reactions to pain
- Thinking and memory
The type and extent of communication problems will depend on the form of stroke and what kind of injury has occurred. The damage and resulting levels of ability will also vary.
The Stroke Association describe three conditions that affect communication after a stroke: aphasia, dysarthria, and dyspraxia. A person may experience one or a combination of these.
AphasiaAphasia, or dysphasia, results from damage to one of the "language control centers" in the brain. While it influences communication, it does not impact intelligence. It may affect just one type of communication - for example, reading, listening or speaking, or a combination.
- Stroke can lead to paralysis or weakness on one side of the body
- There may be difficulty with thinking, awareness, attention, learning, judgment, and memory
- It can be hard to understand or form speech
- Mood and emotions can be affected.
This makes it difficult to understand long and complex sentences, especially if there is background noise, or if more than one person is talking. The person may feel as if others are speaking in a foreign language. Their own speech may also become incoherent.
A person with expressive aphasia may be able to make sounds or say short words or parts of sentences, but they may miss out important words or use the wrong word. They might have the word "on the tip of the tongue," but not be able to get it out.
It may seem to the speaker that they are talking normally, but to a listener, it can sound like nonsense. Listeners may believe that the speaker is confused when they are not. They just cannot get the ideas across.
Damage that affects multiple areas of the brain can lead to mixed, or global, aphasia with challenges in all aspects of communication. The person may no longer use language to convey thought.
Dysarthria and dyspraxiaDysarthria and dyspraxia relate to the physical production of speech sounds.
Other changesOther changes that can make it hard to contribute to conversations include:
- A loss of voice tone, normally used to express emotions
- Fixed facial expression
- Problems understanding humor
- Inability to take turns in conversation.
Some people are aware that they are experiencing these changes. If so, letting others know what the problem is can help to combat the issue.
However, a person with anosognosia will be unable to recognize that anything is wrong, due to a lack of insight resulting from damage to the brain. This can hinder recovery.
After a stroke, stress and personality changes can occur. Stress can exacerbate communication problems, especially if the person becomes impatient with themselves, or if others become impatient.
Mood changes, due to the stroke's effect on the brain, can further add to the strain.
What does a speech therapist do?Speech therapy is a key part of rehabilitation after a stroke.
A speech therapist will help people with swallowing; this can be severely impaired, and it has an impact on language production.
Speech therapy can involve practicing forming words.
- Repeating words
- Following directions
- Reading and writing.
- Conversational coaching
- Rehearsing speech
- Developing prompts to help people remember specific words
- Working out ways to get around language disabilities, such as using symbols and sign language.
Some tips from people with first-hand experienceMedical News Today asked two men, Peter Cline and Geoff, about their experience in regaining communication skills after a stroke. Peter, an engineer, had a stroke at the age of 59 when he was just starting a holiday in Tasmania. Geoff, who ran his own business until his retirement, was living in Spain when he became ill.
Both men have worked hard to regain their communication skills.
We asked what advice they would give people in order to help them communicate with someone following a stroke.
Songs help some people to relax and communicate.
- Do look directly at the person when you are speaking to them
- Do speak slowly and clearly, but use a normal tone of voice
- Do use short sentences and stick to one topic at a time
- Do ensure there is no background noise
- Do reassure the person that you understand their frustration
- Do write things down, if it will help
- Do find out about the person's employment, interests and passions - now and before the stroke - and try to relate to these
- Do give people a chance to say what they want to say, without jumping in or correcting them.
- Don't finish the person's sentences for them
- Don't speak too fast
- Don't push them too much
- Don't speak to the person while they are driving, for example, because they cannot concentrate
- Don't assume that because the person is having difficulty understanding, they must be stupid
- Don't "talk down" to the person, or speak to them as if they are a child
- Don't keep "rabbiting."
Geoff's advice is:
"Take time to recover, and, when communicating, take time to explain, and don't let yourself feel rushed."Peter says:
- Persevere and don't give up. Things will gradually improve but not as quickly as you want them to
- Expect peaks and troughs in your recovery
- Enjoy relaxing with something you are familiar with, for example, old films, music, or whatever your "comforter" is.
Activities that can help
Here are some activities for sharing, depending on individual styles and taste:
A photo album can be useful for prompting conversation.
- Songs, especially if the person was a keen singer before. Some people can sing after a stroke, even if they cannot speak, because singing and speaking use different parts of the brain
- Card games that involve the person saying the name of the card
- A photo album, to share and discuss the people and events in the pictures
- A personal file, with information about the person's life, jobs, and family, in order to provide topics of conversation and nonverbal clues when access to key words is difficult
- A diary, with records of visits, events, and conversations. Friends and family can be encouraged to write in it, to help the person track their progress
- News stories to read in advance and discuss during the session.