Speech Loss After a Stroke
Aphasia, the loss of the ability to articulate or
understand spoken or written words or phrases, is one of the most
common and vexing side effects of stroke. Of the 450,000 people
who survive a stroke each year, about 80,000 are left with some
degree of aphasia. Symptoms can include trouble saying, reading,
or writing single words or phrases; problems only with complex,
lengthy concepts; or an inability to produce any meaningful speech
or writing. The prognosis is excellent for those with mild deficits.
Even when symptoms are severe, a great degree of function can often
be restored. But practice, patience, and professional guidance
A Common Aftereffect
Aphasia results from damage to one or more of the
language centers in the brain, usually when a stroke or transient
ischemic attack ("ministroke") cuts off the brain's blood
supply. The interruption of blood flow deprives the brain of oxygen,
which can lead to tissue damage. Symptoms depend on the area of
the brain that is affected and the extent of the damage.
In most right-handed people, oral and written communication
skills are controlled primarily on the left side of the brain,
in Broca's and Wernicke's areas. Broca's area directs the motor
functions necessary for speaking and writing. If tissue in this
portion of the brain is damaged, people know what they want to
express but have trouble saying or writing the desired word or
phrase. They also often omit small words such as "is," "and," and "the." Broca's
aphasia often accompanies right-sided weakness or paralysis of
the right arm or leg because the frontal lobe of the brain, where
Broca's area is located, also controls voluntary limb movement.
Wernicke's area regulates oral and written comprehension.
When tissue in this part of the brain is damaged, patients may
be able to construct full sentences and emit a fluent, steady stream
of speech but the sentences have little meaning because the wrong
words are chosen or new ones are invented. Reading comprehension
is also often compromised. Because Wernicke's area is not near
regions of the brain that control movement, body weakness and paralysis
are not usually a problem. However, vision may be impaired in the
right portion of the visual field in both eyes.
In global aphasia, the most serious form of the condition, damage to tissue
in many parts of the brain results in loss of nearly all language skills.
Regaining Lost Skills
The symptoms of aphasia become apparent soon after
the onset of a stroke and stabilize by the time the episode resolves.
Some studies suggest that improvement is twice as great in people
who receive early, aggressive speech-language therapy than in those
who receive none.
Treatment should be provided by a speech-language
pathologist, a licensed health professional with special training
in communication disorders. The program usually begins in the hospital
and may continue for weeks, months, or even years. Exercises are
likely to include drills to improve word retrieval and sentence
construction and role-playing to practice real-life conversational
skills and situations.
The greatest improvements occur within the first
few months. After a year, gains tend to accrue more slowly. Although
some lasting impairment may remain, improvements in speech, writing,
and comprehension can continue indefinitelyespecially in
those who actively use and practice the language skills that return.
Communication Strategies for Stroke Survivors
the "tip of the tongue" phenomenon. Searching
for a word is the most frustrating aspect of aphasia for
many stroke survivors. Instead, use an appropriate but
different word that does come to youor give the listener
a clue, such as the first letter of the word you are searching
for or a description of the concept.
frank. Let people know you have had a stroke and
explain its impact. If necessary, carry an index card with
an appropriate description, such as "I had a stroke
and have difficulty speaking, but I will understand what
you say," or "I had a stroke and am having trouble
understanding what youre saying. Please repeat it."
written identification. Include your name, address,
and phone number.
aloud. This is one of the best ways to practice
speaking and reading skills. When you have difficulty,
ask someone to provide helpful prompts.
it or lose it. Talk, read, write, and maintain as
much social contact as possible. Consider joining a stroke
support group. For referral, contact the American
alternative methods of communication. Pointing,
gesturing, touching, and drawing can be useful tools. But
rely on them only if speech or writing becomes too frustrating
or deficits persist despite your best efforts.
distractions. Noise, especially from the television
or radio, can interfere with your attempts to communicate.
mood disorders. Depression, mood swings, irritation,
and frustration frequently accompany stroke and may hamper
the recovery of language skills. These emotional and psychological
problems can all be improved with counseling, medication,
or a combination of both.
Johns Hopkins Medical Letter: Health After 50, November