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When Stroke Affects Speech: How to Overcome Aphasia or Apraxia of Speech

friendly speech language pathologist talking with stroke patient about recovery

Has a stroke affected your speech? It could be a sign of aphasia or apraxia of speech. Both conditions can inhibit a stroke survivor’s speech and communication.

To help you understand how to recover speech after stroke, this article will outline how stroke can affect speech. Then we will discuss available treatment options.

Types of Speech Problems After Stroke

When stroke affects speech, it’s often the result of a left hemisphere stroke. This is because the language center of the brain resides in the left hemisphere.

There are two main areas of the brain associated with language: Broca’s area, which is associated with producing language, and Wernicke’s area, which is associated with comprehending language.

Generally speaking, there are 2 main types of speech problems that occur after stroke: aphasia and apraxia of speech.

Aphasia involves difficulty producing and/or interpreting language, caused by damage to a specific area of the brain. Aphasia can generally be broken down into the following types:

  • Expressive aphasia (also known as Broca’s aphasia): difficulty with spoken and written expression
  • Anomic aphasia: difficulty with word retrieval, where the person may demonstrate slow, halting speech
  • Fluent aphasia (also known as receptive aphasia or Wernicke’s aphasia): difficulty producing meaningful sentences. The person generally has no issues with speaking, but the words they say do not make sense. They may also have difficulties with comprehension.
  • Conduction aphasia: difficulty with repeating words or phrases
  • Global aphasia: difficulty with speech production, expression, and comprehension

While these are the main types of aphasia, that’s not all. There’s also transcortical sensory aphasia, transcortical motor aphasia, and mixed transcortical aphasia. The list is quite long! Therefore, it’s important to work with a specialist called a Speech-Language Pathologist for a formal diagnosis and treatment plan.

Finally, apraxia of speech involves difficulty with voluntary muscle control for speech. In other words, patients cannot properly control their lips and tongue enough to produce clear speech. This is a motor issue, not a cognitive issue.

Every type of language difficulty is treated with different rehabilitation techniques. This, again, is why it’s important to work with a specialist that can help diagnose your type(s) of language difficulties and create a unique treatment plan for you.

Next, we’ll discuss the treatments and timeline.

Rehabilitation for Speech Problems After Stroke

Recovering speech after stroke requires neuroplasticity: the brain’s ability to create new pathways and strengthen old ones. Skills lost after stroke, like language and communication, can be restored by creating new neural networks in the brain.

The key to activating neuroplasticity is repetition. The more you practice a skill, the better you get.

For this reason, Speech-Language Pathologists greatly rely on speech therapy exercises to help stroke patients regain their speech. By practicing the skill of speaking, patients can get better.

Speech therapy is not usually easy. Many stroke patients compare speech rehabilitation to learning how to talk for the first time. This isn’t far from the truth.

After a stroke has damaged the language center of the brain, the brain must use new, healthy areas to regain control of the function of language. This often feels like learning how to speak as if for the first time.

But even if you’re mentally prepared for difficult the road ahead, how do you know which speech exercises to use?

Exercises Used to Improve Speech After Stroke

There is no one-exercise-fits-all regimen for speech therapy. The speech therapy exercises that help one person may not help another.

For instance, some stroke patients might speak with clarity but struggle with comprehension. Others might comprehend speech correctly but struggle with word formation.

This is where SLPs really help. Through a thorough evaluation, they can make a clear diagnosis in order to focus your therapy on exercises targeting difficulties specific to you.

For example, exercises for aphasia may involve reading comprehension and naming therapy. Whereas exercises for apraxia of speech, which focus on motor control, may involve tongue and lip exercises. These are just a few examples out of hundreds of possibilities.

Therefore, one set of speech therapy exercises will not benefit all stroke patients with affected speech. Rather, every patient needs a highly individualized plan.

Usually, it works best to work with an SLP one-on-one initially, and then to continue with your therapy through the use of speech therapy apps at home. We recommend the CT Speech & Cognitive Therapy App, created by SLPs, because it assigns specific exercises based on your needs.

How to Recover Speech When You Can’t Talk At All

Now that you understand the best stroke treatment for speech and language difficulties, we’d like to discuss a very important caveat: What if you can’t talk at all?

Surprisingly, even when a stroke patient can’t talk at all, they can usually sing. That’s because language is a left-brain function, but singing is a creative right-brain function.

When a stroke occurs, it usually only happens on one side of the brain (bilateral strokes are the rare exception). This means when the language center in the left hemisphere is damaged, the right hemisphere is undamaged. This preserves “right-brained” artistic skills like singing.

Therefore, patients who can’t talk at all often begin aphasia treatment with singing therapy. It does not come easy, and progress takes time. But over the course of many weeks, patients can begin to recover speech. Speech therapists are also able to recommend non-verbal communication options to utilize while you are working on recovering your verbal communication skills.

How Long Does Speech Recovery Take?

Speech recovery after stroke is highly individualized. The rate of recovery depends upon the severity of the stroke and how consistently the patient participates in speech therapy.

Over 33% of stroke patients have some form of speech problem immediately after stroke.

Many recover within a few months, but 60% continue to have speech problems over 6 months post-stroke.

However, slow recovery is likely due to low volume of treatment. When insurance stops covering therapy sessions with an SLP, many patients stop speech therapy altogether, which stops or greatly slows recovery as a result. (See: what to expect 5 years after stroke for more info.)

That’s why it’s important to continue speech therapy at home with speech therapy apps. This provides the brain with the stimulation needed to keep recovery going well past the 6 month mark.

Overcoming Speech Problems After Stroke

Speech problems after stroke are often diagnosed as aphasia or, less commonly, apraxia of speech. These conditions are common in left hemisphere stroke patients.

It’s best to work with a trained Speech-Language Pathologist for a diagnosis. They can create an individualized exercise plan and even help you use speech therapy apps with success.

To achieve your highest recovery, it’s important to be consistent. The more you practice your exercises, the more your speech will improve.

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