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Speech Therapy After Stroke: Understanding Your Treatment Options

working with your medical team for speech therapy after stroke

There are many different types of communication and speech difficulties that can emerge after stroke. Furthermore, there are just as many options for speech therapy after stroke, too.

To help you navigate this new terrain, we’ll show you what to look for in the right speech therapy to rehabilitate your communication needs. Let’s get straight to it!

Purpose of Speech Therapy After Stroke

When a stroke occurs, it compromises the supply of blood to an area of the brain. This leads to brain damage in the areas deprived of oxygen-rich blood.

Once the stroke has been treated and normal blood flow has been restored, stroke patients begin rehabilitation to recover the side effects of this damage.

When speech and communication impairments have been sustained, it implies that the stroke damaged the language center of the brain.

Since the language center resides in the left hemisphere, communication disorders after stroke are most common in left-hemisphere stroke patients.

This is why it’s important to ask your neurologist about the location of your stroke, so that you are prepared to deal with common side effects.

Types of Communication Disorders After Stroke

The most common type of communication disorder after stroke is aphasia, which impairs the patient’s ability to use or comprehend words.

However, aphasia does not cover all communication disorders, and there are many types of aphasia to be aware of, too.

Therefore, it’s important to work with your medical team for a proper diagnosis of your communication problems.

Before we dig into the methods for speech therapy after stroke, it’s helpful to have an idea of what type of speech problem you have.

Here are the different types of aphasia and other communication disorders that may occur after stroke:

  • Expressive aphasia (non-fluent): Knowing what you want to say but cannot communicate it to others. In severe cases, the patient cannot speak at all.
  • Receptive aphasia (fluent): The patient can often speak just fine but the meaning of language is lost because they do not understand it.
  • Anomic aphasia: Difficulty with finding words. It can manifest as taking large amounts of time to say a few words.
  • Global aphasia: This chronic type of aphasia impairs both the ability to speak and understand words along with reading and writing.
  • Primary progressive aphasia: A rare condition when stroke patients slowly lose their ability to talk, read, and write. Speech therapy may help improve or slow down this condition, but there is no cure that reverses it.
  • Speech apraxia: Involves difficulty making voluntary movements patterns to produce speech when there is no paralysis or weakness of the speech muscles.
  • Dysarthria: Involves weakness of paralysis of the speech muscles from the neurological impact of stroke, making it difficult to produce speech

The types of communication disorders are intricate, making self-diagnosis nearly impossible. It’s highly recommended to work with a speech-language pathologist to diagnose, assess, and treat your language condition after stroke.

Your medical team can get you started, and then you can take speech therapy into your own hands once outpatient therapy has stopped or slowed down.

Methods for Speech Therapy After Stroke

Fortunately, most communication disorders can improve with the help of a speech-language pathologist and regular participation in speech therapy.

Here are the most common methods used for speech therapy after stroke:

1. Speech Therapy Exercises

speech language pathologist running stroke patient through therapy exercises

Practicing various speech therapy exercises can help improve language processing skills and/or oral motor skills. This is useful for most types of mild/moderate aphasia and speech apraxia.

Some examples of speech therapy exercises include tongue strengthening exercises, speech sounds, and sentence practice. Your speech-language pathologist will likely run you through some of these exercises during your time together.

When you’re on at home, you can use mobile apps like the CT Speech & Cognitive Therapy App to keep practicing speech therapy exercises away from the clinic.

Speech therapy exercises should be practiced frequently and consistently for the best results. Repetition helps activate neuroplasticity so that healthy parts of the brain can take over the function of language.

When impairments are severe, intense repetition is required.

2. Melodic Intonation Therapy (Neurologic Music Therapy)

If speech impairments are too severe to start with speech therapy exercises, then you can try singing therapy, also known as melodic intonation therapy or neurologic music therapy.

This method of speech therapy is particularly useful for non-fluent aphasia where stroke patients cannot speak at all.

For over 100 years, we have known that stroke patients with severely limited speech are better at singing lyrics than speaking the same words. Now, we have clinical studies to back that up.

But how can non-fluent stroke patients manage to sing their words when they cannot even say them?

That’s because music crosses the hemispheres of the brain. Language is a left-hemisphere task while music and melody are right-hemisphere tasks.

Stroke patients with language disorders often have not sustained damage in the right hemisphere, giving them access to right-brained skills like music.

By working with a speech-language pathologist trained in singing therapy, you can overcome severe aphasia.

Watch this video to see what melodic intonation therapy looks like:

3. Constraint Induced Language Therapy

Constraint induced language therapy is an aggressive type of speech therapy after stroke that can benefit mild to moderate communication disorders.

You might already know about constraint induced movement therapy (CIMT), which involves intense rehabilitation of motor skills. Specifically, it involves constraint of the non-affected limb, forced use of the affected limb, and massed practice.

These same principles can be applied to speech therapy after stroke to create constraint induced language therapy (CILT). Instead of constraining the affected limb, stroke patients are constraining the use of communication compensation techniques like gestures. It only allows talking.

CILT also focuses on massed practice, which means using speech-only communication for many hours every day.

As you can see, CILT is an aggressive form of speech therapy that is often best for stroke patients that have some speech to work with.

Those with severe aphasia will find greater benefit from starting with melodic intonation therapy first.

4. Visual Speech Perception Therapy

Another type of speech therapy that’s particularly useful for non-fluent aphasia – but all stroke patients can benefit from – is visual speech perception therapy.

This type of speech therapy involves naming pictures and associating words with images. It’s particularly useful with a visual of the speaker’s mouth moving while saying the words.

This explains why the speech-language pathologist in the video above is pointing to his mouth while the stroke patient tries to repeat after him.

Working with a speech-language pathologist for this therapy is best, because it’s a great fit for severe types of aphasia.

However, you can work on this speech therapy at home using the picture naming exercises in the CT Speech and Cognitive Therapy App.

Tips for Coping with Speech Problems After Stroke

If you or a loved one are struggling with speech and communication after stroke, those speech therapy methods can help.

In the meantime, while therapy is underway, here are some tips to help with communication during everyday activities.

Tips for stroke patients:

  • Use props and gestures. When you’re not doing constraint-induced language therapy, it’s perfectly fine and helpful to use props to communicate.
  • Say one idea at a time. Sometimes your brain will work faster than your mouth, and attempting to say everything all at once will result in garbled speech. Try your best to slow down and present one idea at a time.
  • Communicate your condition. It can be helpful to start a conversation with a stranger by explaining that you have aphasia and that it’s difficult for you to speak. Often, this will help the listener slow down and be patient as you work to find the right words.

Tips for caregivers:

  • Draw or writing things down. This can be helpful if your loved one is better at reading than processing verbal language.
  • Speak clearly and slowly. Give your loved one time to process and understand you.
  • Do not speak more loudly! Language conditions are a result of the brain struggling to heal itself after stroke. The ears have not been affected, and the patient can likely hear you just fine.
  • Act with respect and empathy. Again, language disorders are not a loss of intelligence. It’s a loss of the ability to speak and find the right words. This can be frustrating for the patient, so be kind and respectful when communicating.

By using these tips, you can enhance communication throughout the day.

And if stroke patients are participating in speech therapy daily, their communication skills will continue to improve.

We hope this guide helped you understand all your options for speech therapy after stroke!

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