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Stroke

Stroke recovery: communication disorders

Although many people found that their ability to communicate recovered rapidly after their stroke some were left with on-going problems or had severe communication difficulties which they required help with. 

One woman found that her initial ability to hold a basic conversation came back very quickly but that further recovery had taken a long time - she had required help from a speech therapist and had to do a lot of practice. Another man was told the importance of keeping trying to speak no matter how odd it sounded as this was the only way he would improve.

Speech and Language Therapy

People whose communication (speaking, understanding, reading and writing) had been affected by the stroke usually saw a speech therapist in the hospital and sometimes after they left hospital in the community. Speech and language therapists sometimes also saw people if they were having problems with swallowing or if they had facial weakness (see 'Eating and drinking after a stroke').

The help people received was matched to the problems they were experiencing. 

People with slurred speech due to weakness of the facial muscles (dysarthria) were often asked to practice vowels, consonants and simple words. 

 

The speech therapist gave him speech exercises to help regain the muscle strength in his face...

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Age at interview: 58
Sex: Male
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Did you have any help from speech therapy at all?

Oh I did, I had quite a lot of help from speech therapy. Particularly in the last hospital I was in before going back home. And, I was able to do quite a lot of mouth exercises, speech exercises, with them. At one stage I was asked by one of them to read, read her my favourite poem [laughs]. So, there was, there was quite an incentive in there.

Can you, people might wonder what sort of speech exercises you do after a stroke. Can you describe the sort of things you were doing?

Quiet a lot of, speech exercises you do are quite, some of them quite simple in trying to redevelop your muscles where they seem to have gone flat or flabby. And in my case it appeared to most of the left side of my mouth. But quite a lot of 'ee', 'oh', 'ah,', 'ee', 'oh', 'ah', quite a lot of that to sort of, almost like an orchestral musician warms up to be honest or a brass player anyway 'ee', 'oh', 'ah', 'mm', 'mm', and to get those muscles, relearning their strength, re-acquiring their strength. And in fact even now if I do get a quiet moment, sometimes, I look in the mirror and' see whether I can reinforce some strength, particularly on the left side. And I think the left side went with all the mobility problems that I was initially having in my left leg. Still have to a degree in my left side, but I don't seem any longer to have the same sort of problem now with articulating consonants. 

 

At the start she could not speak at all and had to go back to being like a child and practicing...

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Age at interview: 29
Sex: Female
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The speech therapist gave me some, initially some sounds to start trying to make sort of going ooh and ah you know, very basic noises and having to go ttttt but at that point, that was I guess what I needed.

It sounds a bit kind of silly now but when I couldn't say or communicate really in any way at all, I kind of almost had to go back to re-learning a skill that you really take for granted. You think of a child and how they learn to speak and you've been speaking all this time and you're having to go back to basics is very, very strange, quite unnerving and you just don't realise how much you take for granted.

So I was just given various exercises and saw the speech therapist a couple of times on the ward and then had another appointment with her a couple of weeks afterwards. and in those two weeks I'd made quite a remarkable progress and she was, and then she was trying to give me ideas on how I could work on my, my writing and how I need to start.

Basically she was describing to me how my word dictionary had been muddled up but you have, you have all your zoo animals in one section and all your farm animals like under another little category and it's like a big filing cabinet in your head and basically everything had fallen out of my filing cabinet I would say. And that was why I was struggling so much to find words that I needed.

Others were given limericks and poems to practice the speed and volume of their speech. One man had practiced speaking in time to a metronome but did not find this at all helpful.

 

A speech therapist suggested he practice speaking in time with a metronome but he didn't find...

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Age at interview: 68
Sex: Male
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One of the things that, one thing, it didn't really help me but what, the sort of thing they come out with, we had one therapist, these 3 therapists in the hospital, she said to me once, she said to me, 'Well, you quite quickly don't you, speak quickly, don't you?' I said, 'Well, the trouble is I do think like that. I do think quickly and because I can't explain speak in the, the same way I get problem, a problem with it, so', I said, 'Can, you help me?' and she said, 'Well not really, you see, because short of trying to, trying to speak slower', I said, 'Well, yeah, I can't do that because I, when I'm speaking slowly, I lose my concentration and couldn't, couldn't bleugh, bleugh so I'm, I'm trying to do it that and I'm thinking quicker than, so it didn't work. She said, 'Well, one, you could try to', she said because somebody was had the same problem and he used to sit, this chap, he sat with his hand on the chair, the table or something and he would be speak like that and he kept like a metronome, you know. And that way, so for about a week, I tried that and it didn't work but the sort of thing that, that, that might help somebody clearly somebody, she said that this chap, you know, sat and he got used to it, speaking like the metronome and I think that's a bit strange but that's the sort of thing that they come out with, things like that and I pick those and I think, oh I'll try that. Yeah. No, it doesn't work.

Going right back to basics of learning to speak could feel like being a child again which was frustrating or annoying for some people.

People who had damage to the language areas of the brain (aphasia or dysphasia) often needed help with speech, understanding, reading and writing. They were helped to find the best way of communicating. 

One man explained that he had been given help with reading, comprehension and writing cheques and letters. Another woman was given exercises to help with her problems with word finding.

 

He was given help with reading and comprehension and writing cheques and letters.

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Age at interview: 68
Sex: Male
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Can I ask you to tell me in a bit more detail about the sort of things that you did with the speech therapy?

Oh yeah. They she used to, she did things like sentences mixed up and she'd write them down and she'd say, 'This today, this today Romsey going shop with until Tuesday' or something like that and maybe something, oh, I've not been to, I'm not, I'm not going there until Tuesday but when I'm going to shop in Romsey.' Something with, and that was quite useful because all, some of those I couldn't work, you know, some of them are quite straightforward like 'You birthday have at year last year' some, something like that and 'My birthday was in April last year', something like that, you know, and she's very good, very good [laughter] but at first that was useful and she'd give me tests like that, you know numbers as well. Sometimes numbers. And you know, quite straightforward and I think I think, I think at first, she was trying to find out what I could do and what I couldn't do. I think she was trying to work where, where I was. But as I say, she was very good for around 6 or 7 weeks. She'd come with different ones like the cheque book, the cheque book, she realised I couldn't do that and then when she realised, when I realised or when I was told that I couldn't work, work simple arithmetic things, she did give me those, you know, so things like that. 

What else? Oh and a bit of comprehension where she'd give me a story and then questions at the end and make notes, we used to have at school and that was quite useful and what else did we do? And a bit of writing because that's something that I still can't do. I can't do writing and the, I know what I'm trying to say, to write a letter I'm better, I'm getting better now but a low, I had to wrote, I had to write to somebody what was it? About 2 months ago, I wrote something about a complaint I had. What was it about? I don't know. And I battled away at it and I, I couldn't, I couldn't do it right, I wrote it again and I did it, I did, I get, I think in the end it was alright and [my wife] said it was it was alright but.

One man who had great difficulty finding words was given a card to explain to people that he had had a stroke (see 'Speech and communication'). Another man who could only speak a few words of English was given sheets of cartoon drawings to help him communicate. 

 

He was given sheets of cartoon drawing to help him communicate.

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Age at interview: 44
Sex: Male
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Husband' Uh huh. Cartoons, car.

Wife' Car

Husband' Yeah. 

Wife' Yeah. This is really helpful.

Husband' TV. TV' cassette, CD.

Can you hold it up to show the camera? 

Wife' Do you want to show it to the camera?

So you can use the, the cartoons to'

Husband' Yeah. 

'to point out?

Husband' Mmm. Floppy. Floppy'

Wife' For the disk.

Husband' Disk. 

Wife' CD.

Husband' C mmm computer'

And where did you get the cartoons?

Wife' From? Where did you get it from?

Husband' [The local hospital] speech therapy. 

From the speech therapy?

Husband' Yeah. Uh huh. 

People's experiences of speech therapy had varied dramatically. Some were very complimentary about speech therapists who they felt had been dedicated and sympathetic to their problems. Others felt that speech therapists had been discouraging and depressed them, or had given up on them too quickly, either because of lack of funding or because they did not take time to understand them. 

 

They felt the speech therapy had been excellent are encouraging their daughter to train as speech...

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Age at interview: 44
Sex: Male
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Wife' He had a, yes, the therapy, you know, he had a speech therapy, is wonderful, you know, the lady was so, so nice with him and then, you know, they tried their best, you know. I know it's really hard with stroke people, you know, they get angry quickly, you know, they very patient with [my husband] and it was, yeah, it was, you know, they start from 1, the numbers and little, first they start with signing, you know, he signed, you know, he forgot the signs so they said start from the beginning, so they started the sign, how to sign [my husband], so he started slowly and after that numbers slowly one by one. It was wonderful. Respect the speech therapy more than the doctors, you know. I was sitting with him and I will see how they, you know, bring the words out from the people, you know, who cannot speak, you know, very patiently, so this, is not, this is not, because we try and help him but they are trying to bring the words from, you know, them first, you know. It was wonderful, this is really. I respect them and that, you know. Really amazing job speech therapy I told my daughter one day if you could, you could become a speech therapist. Yes. 

 

He would have liked more help from speech therapy and felt it stopped because of lack of funding.

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Age at interview: 59
Sex: Male
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Have you had any help to try and improve your communication?

No. 

No.

The' is' he, he's

Speech.

Yes. Alright not very good. 

Did you have any more speech therapy'

Yes.

'since you left hospital?

Yes. 

Yeah. Was that better than in hospital?

'Yes.

You said that wasn't very good. 

Yes but'

After one year'

Yes.

'after leaving hospital?

Yes. He said finished. 

No. He finished.

You, you get bet, not very good.

Hmm. 

That's, I wanted and they said no. [laughs]

You wanted more?

Yes. 

And they said no.

Yes. 

Hmm. That's difficult. Did they think that you, you wouldn't improve more or was it'

No.

'financial?

Yes.

Financial?

Yeah. 

 

She would have liked more help with reading because she wanted to be able to read more than...

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Age at interview: 34
Sex: Female
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Have you had any help with the reading at all?

'No but speech' yes.

Can you tell me about that?

The' in Australia' see, I can't' yeah, I can't, this is too hard this book, this, yeah, but' I could read that one or the, like, like that or this, this one. But in the'

So you can read words but you can't read sentences, is that the problem?

Sentences. Read. Yes. Read. Yeah. 

But have you had any help specifically for your reading?

Yeah. Yeah. 

Would you like to get more help with that?

Yes [laughs] please' but on the waiting list, you know, the, because' you know. And books, baby books, I don't like that' The.

Is that what you were given?

Yeah. 

And you didn't like that.

Yeah. 

What would you like instead? What would be helpful?

Like normal books' Like, you know, newspapers, Herald or' Yeah. 

See the Stroke Association leaflet ‘communication problems after stroke' for more information.

Self help for communication

Practicing communication was seen as very important and some people decided that they would do things to help themselves. These included: 

  • Using children's books to practice reading and writing;
  • Reciting nursery rhymes and passages of Shakespeare;
  • Saying the names of famous sports personalities;
  • Carefully watching the news to copy how the news reader was speaking;
  • Persevering talking with friends or family no matter how difficult it was.
 

She bought children's books and practiced speaking by copying the news readers on the television...

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Age at interview: 54
Sex: Female
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When you first had the stroke, your speech was very badly affected?

Right. Right.

What sort of things helped that get better?

To speak?

Yes.

Right, OK. To speak. At the beginning, I had no idea about how to speak and I didn't have anyone to really help me. I used to sit with oh, in front of the TV and I would listen to the news and I would watch people's move here (mouth) and if anyone spoke slowly into some of the programmes, that might help me. And occasionally I tried to pick up books written for children and that helped me a little bit and sometimes I would get a children's book with a picture on and I would have say A to Z or something that helped me as well a little bit, very, very slowly. I became very, very frustrated and hurt at one point if people spoke to me, particularly if I made a nice dinner and if a couple came with my husband and I and I made a nice dinner and I watched with people and we talked, I couldn't understand what they were speaking. But if they very kindly looked at me and spoke things, then I could say the odd words, particularly if they were very, very kind caring people, then I could say the odd word. So that would help it got a little bit better. Yes, it was very, very slow. Very, very slow. Particularly during the first, hmm, 3 or 4 years. I couldn't do a thing really. Horrific. Yeah. But I wasn't, I wasn't even angry or anything.

Several people had joined a support group for people with communication problems following stroke and found it good to meet other people with similar problems and practice communicating in a supportive environment. Connect is a voluntary group in London for people with a communication disability following stroke.

 

Likes meeting other people with aphasia at Connect meetings and found lots of people she meets...

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Age at interview: 34
Sex: Female
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Tell me what you do when you go to the meetings?

A coffee' Well the, I had juice because I, I can't Fanta and lemonade, ugghh, a stroke is strange, I don't know but anyway. Chatting and conversation. 'Ah hello, hello' and, because [one of the men] is a lively one' so upstairs and the group divide' and talk about, you know, books or film or, you know, literature, you know. You know, the Queen, you know. So, and all of us in the circle is and then' and coming altogether and' running up, you know, the' I can't say it, you know the but, anyway.

Is it helpful to meet other people that have the same experience as you?

Yes. Exactly the same as me. Aphasia. One side of my body, well, the different other side of the body but I didn't know because Australia only 2 or 3 got it but' lots of people had a, aphasia on the right side, yeah. 

So it was helpful to meet other people?

Yes. Finally, finally. And numbers, you know, I can't add up, you know. Different. Yes. Finally. This is it. Connect [laughs].

 

Finds it helpful to go to Connect meetings to discuss news and other issues and to share...

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Age at interview: 44
Sex: Male
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And how about Connect? Can you talk about Connect?

Husband' Yes. 

Wife' Yes.

Husband' Speech. English speech'

Wife' Mainly he want to know the paper, newspaper, what's going on, he want to know all the newspaper, what they say and I think he likes the communication group or news.

Husband' Uh huh.

Wife' And I think they sit together and the tea speech therapy explain about one topic in the paper, you know. He's quite, quite interest in sports. He loves cricket and sports or anything they pick about some time with medical, about stroke or something or, yes, he's quite, he said it's worth it to go there. 

And is it helpful to meet other people with communication problems'

Husband' Yeah.

'at Connect?

Husband' Mm hmm. 

Good to share your experiences?

Husband' Mm hmm.

Wife' I think after the stroke he likes to be mingle with the people who have the same problem I think so. He likes to go these.

Husband' Register.

Wife' OK. He used to register the people who attend the class [laughs].


 

Last reviewed June 2017.
Last updated June 2017.

 

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