Stroke
Speech and communication after a stroke
Initial stroke symptoms
Problems with speech were a common early symptom of a stroke (see 'The event: A stroke or TIA'). People often recalled that their speech had been slurred or occasionally that they could not make sounds that were understandable as speech. This was usually due to weakness of the muscles that are crucial for speech production on one side of the face. Some had resorted to writing to communicate what was happening to them and had initially used writing and simple hand signals to communicate in hospital.
A few people had damage to areas of the brain in the left hemisphere which are chiefly responsible for language production and experienced immediate problems with talking, understanding, reading and writing. Speech was either jumbled, was affected by word finding difficulties, or the person found that they could not speak at all.
Losing the ability to communicate completely could be very frightening. One woman described losing her speech after a stroke in the left hand side of her brain following an operation as like being trapped in a box.
She completely lost her speech after her stroke which she said felt like being trapped in a box....
She completely lost her speech after her stroke which she said felt like being trapped in a box....
I don't really remember him leaving but I was quite groggy after the anaesthetic and obviously I'd had quite a major operation and they in the middle of the night I became aware of something not being quite right.
I just remember it being dark, the lights were all out and I couldn't, I tried to, to speak out and I couldn't and I managed to press the call button for the nurse with my left hand and the nurse came to see me and it was like being in a box that I couldn't speak, I couldn't communicate with her. I couldn't move, and basically I, I could understand what she was saying, she started shouting at me trying to get me to talk and I couldn't. They then called a doctor who came and started shouting at me as well and so there was a bit of commotion and I could, I was only trying.
I just felt like I was inside this box looking out and I was just trying to communicate with my eyes and they didn't understand what I was doing, why I wasn't saying anything it wasn't really until the morning that it had become clear that I'd actually had a stroke in the night.
It was scary I've never, I have never felt as scared in my entire life. You don't appreciate how easy it is for people to talk to you and for you to talk back to them until something like that happens.
The stroke was on the left side of my brain and it was fortunately just a very minor one.
Speech problems following stroke sometimes recover within hours or days, however, some communication problems are more permanent. Some people had help from a Speech and Language Therapist to aid their recovery (see 'Stroke recovery: Communication disorders'). The amount of recovery that can be achieved varies depending on the area of the brain that has been affected and the extent of the damage.
Types of speech and communication problem following stroke
Speech problems due to muscular weakness usually recovers within a few days or weeks, however, a few people we spoke to had ongoing problems known as dysarthria. Speech could continue to be slightly slurred and people sometimes experienced problems regulating the volume and speed of their speech.
His speech was initially very slurred due to muscle weakness. He has ongoing problems regulating...
His speech was initially very slurred due to muscle weakness. He has ongoing problems regulating...
At first, it was. Certainly in the acute hospital, those first 3 weeks but when I got to the rehab ward, it was a bit better. But first off, it was just sort of slurry and a bit difficult to understand but after a while, it, I don't know, I'm not quite sure what, I think I just got used to how it was and adapted to the differences so then I could certainly make myself understood. So I was lucky from that point of view that I could communicate OK.
Would you say that your voice has changed at all?
Yes.
Since the stroke?
Yes, it has.
Can, can you explain that?
Well, people that know me from beforehand will say my voice, I don't sound different but certainly my concentration's not as good as it used to be. Sometimes I will just loose my way in a sentence, I'll just lose my way in a sentence and forget what I was going to say. So I don't think my conversation is as fluent as it used to be and I think sometimes I think I get a bit anxious and I try and rush what I'm saying and speak very quickly and another thing that I found is adjusting how loud, the volume of my voice. I find that difficult to do, to talk louder or quieter. It just tends to be whatever comes out is what it is. And also my singing voice has changed because before the stroke when we were growing we used to quite often go to karaoke evenings. I used to like singing in the karaoke but that's not, I'm not as good a singer any more either. I won't do a demonstration but believe me, I'm not. I think just the vocal range of my voice is much more limited than it used to be. So it has affected it.
One man we spoke to had problems with speech due to difficulty organising and sequencing movement. This is known as dyspraxia.
A few people we spoke to had ongoing problems with speaking and or understanding people because of the damage to the language areas of their brain. These problems are known as aphasia or dysphasia. These included:
- being unable to find the occasional words;
- speaking in jumbled sentences;
- not being able to make proper sentences because of difficulty finding connecting words;
- only being able to use a few words;
- having problems understanding other people.
Reading and writing could also be affected by this kind of damage (see below).
She had previously been a teacher and felt that not being able to talk or understand people and...
She had previously been a teacher and felt that not being able to talk or understand people and...
Her speech therapist explained that she had been left with a communication problem which made it...
Her speech therapist explained that she had been left with a communication problem which made it...
Okay, I went to, as I said when I was in hospital, I was seen by the speech therapist on the ward but I live quite a way from the hospital and I wanted to see somebody who was more local to me. Unfortunately she only has one adult clinic a week in my local town and we had to I had to wait about six months from the day of the stroke until I got a, an appointment with her.
So the first time that I saw her I'd already come on a huge amount in my speech and when she first met me she really didn't see anything that was wrong in my speech but I know myself, that I was struggling with certain things.
She described it as quite high level the things that I was still struggling with. But if she was to say, name me five emotions I would probably come up with happy and sad and wouldn't be able to give her another meaning or another word you know, she would say, 'Name me five zoo animals or pieces of fruit', and I would really struggle to name five of those things still because my word dictionary was still quite muddled.
She would ask me to give her an alternative word for, 'Give me another word for beautiful', and I would struggle to find another word that would mean that. So when I'm trying to help my child with his homework I am, you know, learning myself with his English and his literacy it was really helping me, helping him.
Damage to speech and communication areas of the brain is sometimes very selective meaning that aspects of language are preserved. The wife of one man whose first language was Tamil explained that he was more able to speak Tamil than English. He found this very frustrating because he wanted to speak in English so he could become more independent. He was also still able to sing and pray because these long-established functions of language are controlled by a different part of the brain.
His wife explains that he can still speak Tamil and uses this when he talks with the family but...
His wife explains that he can still speak Tamil and uses this when he talks with the family but...
Husband' Yes. Yeah. Tamil go-good
Wife' English is hard. Second language is always hard. But he, now he's more anxious to know, he wanted to talk English more than Tamil because he thinks he's OK with Tamil, communicate with me and the child. Then he go out or he want to be more independent, he wanted to go out and do the shopping or he wanted to go himself anywhere, he wanted to talk to other people but he need English. So he's thinking if someone could help me or some, or somehow I have to talk English, and he's, very anxious nowadays. It's really hard for him.
Between the family, do you mainly talk in Tamil?
Husband' Yes.
Wife' Tamil, yes.
Husband' Hmm.
Wife' Mm hmm.
He was still able to sing and pray as these long established functions of language are controlled...
He was still able to sing and pray as these long established functions of language are controlled...
So with the prayers, can you still speak the, the prayers?
Husband' Yes.Yes.
Wife' Clearly.
And you can still sing?
Husband' Yes.
Wife' Yes.
Coping with speech problems in social and family life
Coping with communication problems in daily life was often difficult. A woman initially found it difficult to talk to people on the phone and in shops and asked others to speak for her instead.
She initially found it difficult to talk to people particularly strangers. Her mum stayed around...
She initially found it difficult to talk to people particularly strangers. Her mum stayed around...
So I would, if a friend had called they, all my friends knew that I was going for an operation so you know a few weeks later when they were phoning to see how I was, my mum who had come down the week before I went into surgery and ended up staying for about six weeks I think to help look after me and the children.
She would explain what had happened and then I would then speak to, to people. But I couldn't, I couldn't make any plans for going back to work or anything that was very, very difficult.
People could learn ways of getting around their problems by using notebooks to write in (although often the ability to write is affected too). Understanding could be helped by asking other people to speak more slowly, to write things down or draw. Some made a point of explaining to others that they had a problem.
He had been given a card to show to people explaining that he had a stroke and has communication...
He had been given a card to show to people explaining that he had a stroke and has communication...
Well' difficult.
Mmm
But it's alright.
Do you have something that tells people?
Yes. Yes the' is in. (Showing card).
Hmm. So it says, 'I've had a stroke''
Yes.
''And find it difficult to speak read or write''
Mmm. Mmm.
''I usually understand what is said but please could you speak clearly?'
Yeah.
''Thank you'. And' that was from the, the Stroke Association.
Yeah.Yeah.
That's good. How did you get that? When you were in hospital?
Yes.
Yeah.
Mmm.
Have you' Have you been a member of the Stroke Association since the stroke?
No.
No. This was given to you in the hospital?
Yeah.
Yeah. That's very useful. I think people would find that useful to'
Oh yes. Yes.
' to know about.
Yes. Yes.
Yes. Because other people might not be get, given it.
Yes. I'
In Philadelphia.
Yes. And I can't speak and they
And you gave that to them.
Yes.
You gave that to the police.
Yes. And said alright.
And, and helped you.
Yes.
That's really helpful. That's good.
She found it helped to use facial expressions and gestures. It helped her to understand other...
She found it helped to use facial expressions and gestures. It helped her to understand other...
I don't find it socially difficult' I mean, I love to go out and to talk to people and to just talk about things for just odd words to help people. Sometimes I suppose, because I have my own power through using my hands, using my mouth, using my eyes, and I use expression sometimes if I find that other people are 100% difficult, I have to say, 'Can you just get a pen, I haven't got a clue what you're saying?' Right. Sometimes people become frustrated or angry. Very, very rarely. Very rarely. But, to be perfectly honest, I would say I think women are much easier than men. Yeah, they are. Women will listen.
Did you find that sometimes it's helpful if people write things down?
Or draw things, yes. Drawing things. Yes. Yeah. Yeah.
One man had been initially been reluctant to tell people that he had a problem but others encouraged him to and he found that people were sympathetic.
He wouldn't tell people that he had problems with speech and would struggle. Others from a...
He wouldn't tell people that he had problems with speech and would struggle. Others from a...
After 2 years, I've realised now, this is the best it's going to get, you know, and I, and I think you say to yourself, 'Well, I've got to get on with it, get on with it and battle on, you know and don't worry about it' and I got to a point where I wouldn't tell anybody I'd had a stroke at all. I go into a shop and I'll, I would just bash away, you know. Other people have said to me, 'Well, why, why do you do that?' because we all had a card, we're all given a card. I said, 'I can't say that I've had a stroke, please be careful with me' or something. I thought, 'I wouldn't do that' I'd bash on, 'Oh no', they all said, 'No, no, you, we found that if you tell people that you've had a stroke, people are quite set have you ever thought of that' and I thought, 'Well right yeah' so I did say that and people did. And when I was on the telephone and got myself in trouble and I wouldn't try to tell them that I'd had one I'd just bash on with it and, you know, I'd come away perhaps thinking, 'Well that's a mess' but when I found people now, everybody's kind and I think, 'Well that's good' so that's something that I've learnt you know, I was a bit proud or pride, proud I suppose, I was you think, 'Well why do you do that?' and they all say that.
So if I go in now and I get in real trouble, I'll say, 'I'm sorry, if you bear with me I've just had a bit of a stroke'. 'Right, oh yeah, what is it?' 'Great' and you feel your confidence gets a lot better but all the time it is a funny thing.
Family members reacted differently to people with communication problems and most were very sympathetic and helpful. Family and friends were often the ones to notice that the person's speech or ability to write had changed. Whilst some people preferred not to be told that there had been a change in their speech or writing others were grateful that their friends had been honest. One woman spoke regularly to her father on the phone to practice her speech.
Clare spoke regularly to her father which helped her recover her speech.
Clare spoke regularly to her father which helped her recover her speech.
Children were often very open about a person's communication problems, which one man found refreshing but others found hard to deal with sometimes. One man said that his grandson did not want him to read to him. However, he had been able to involve his grandchildren in word games to help him with his speech.
His grandson will often pick him up on things he says and he does not like him reading to him....
His grandson will often pick him up on things he says and he does not like him reading to him....
I can't do that, I'm going to do it, so I'll bash it away and, but it's, it, I think with me, it's mainly the confidence you think and once you get, feel you can better, and my grandson here from [town] he's quite sharp and he'll say to me, 'Grandpa, you, you keep saying this' you know or 'Why did you say that?' and I, 'Oh, I'm sorry, [Grandson's name] I don't know.' So we started words I could do and I couldn't understand why because we, I think it was it, Mary Poppins, the supercalifragilisticexpialidocious. Now, that was the one. Now I can say that. When we first tried it, [my grandson] said, 'You say it, you say it grandpa, supercalifragilisticexpialidocious and I had no idea. And what I can't understand about the stroke is that once you've practised it, I can do it, I can get it right, I can get it right every time I think now.
A few people found it frustrating that they could not engage in conversations about current affairs or other meaningful subjects with their friends and families. One man commented that although he could now have simple exchanges in shops he found anything deeper difficult. He found that his family did not always give him enough time to respond which made it difficult to enter into conversation. Sometimes other people would help out by finishing a word or sentence for people. Whilst some found this helpful others found it annoying and preferred people to be patient.
Reading and writing
Reading and writing could also be affected by stroke. Some people were unable to write because of weakness or paralysis in the upper limbs. Reading and writing could also be affected by damage to the language areas of the brain. Those who had previously read a lot or regularly read a newspaper found it difficult to be reduced to struggling to read even simple children's books. Others found using children's books a helpful way to re-learn reading and writing skills (see 'Stroke recovery: Communication disorders'). One woman wrote letters to her aunt which helped her practice writing with her non-dominant hand.
Clare wrote letters to her aunt with her non-dominant hand as a form of therapy.
Clare wrote letters to her aunt with her non-dominant hand as a form of therapy.
Last reviewed June 2017.
Last updated August 2011
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