A stroke may impair the abilities of survivors in many different ways. Some of the impairments may be mild or severe. Rehabilitation and recovery are determined on an individual basis but many stroke survivors, with rehabilitation and medical treatment are able to regain some or all of their abilities. As they recover, it is impossible to estimate how much each person will improve or how long a full recovery will take. The road to recovery can be a long, challenging journey. Below, there is more information about some of the speech-language effects of a stroke.
Aphasia
Aphasia is a language disorder that is usually caused by a stroke. It can affect peoples' ability to speak, read, write, and understand what they hear. Aphasia does not change their intelligence or their memory, but impacts their ability to communicate with others. Individuals with aphasia know what they want to say, but cannot find the words to express their thoughts. Aphasia can vary significantly in severity.
- Wernicke's aphasia
Individuals with aphasia may be able to say a lot of words but what they are saying does not make sense. Sometimes people with aphasia also use the wrong words or nonsense words. These speech impairments are evident in the fluent form of aphasia.
- Broca's aphasia
Sometimes individuals with aphasia have trouble talking because they cannot think of the right words. This type of speech impairment is the non-fluent type of aphasia.
- Difficulty with auditory comprehension or auditory processing
Aphasia can change individuals' ability to communicate in all ways. Having aphasia means that some individuals may have trouble understanding what other people are saying to them. They can still hear what is being said, but cannot understand what they are saying. They may have difficulty following conversations, particularly when the information is complicated or when many people are talking at once.
- Trouble telling time and understanding time concepts
Aphasia can also change the way that people understand and use numbers. They may have trouble understanding phone numbers, paying bills, or making change.
Alexia
Individuals with aphasia may experience some difficulty when reading. They can still see the text, but may not be able to understand what they are reading. The severity of this impairment can range from not being able to read any words, to having trouble understanding the details of complicated material.
Agraphia
People with aphasia often have trouble writing, too. Some people may prefer not to write their thoughts but rather to say them. They may have trouble thinking of the words that they want to write, or trouble with spelling, as well as organizing their thoughts, or writing complete sentences.
Apraxia
Apraxia is a problem with the muscles of the body doing what they are told by the brain. This happens when the part of the brain that coordinates the muscle movements has been damaged. This is often referred to as a problem with motor planning. Individuals with apraxia may have trouble making their muscles move the right way to get dressed, eat, or talk.
When there is a problem with the coordination of the speech muscles (face, lips, tongue, etc.) it is called apraxia of speech. These muscles are not paralyzed or weak, but are not moving the way that they should to create clear speech. Individuals with apraxia of speech may struggle to make the sounds of speech, or have trouble sequencing the sounds in syllables and words. The severity of apraxia can vary from very mild to severe.
Dysarthria
If the speech muscles (face, lips, tongue, etc.) are weakened or paralyzed, the speech can become slurred or unclear. This is called dysarthria. There are many types of dysarthria depending on the part of the brain that was injured. This can range from a very mild muscle weakness to severe muscle paralysis. Sometimes a person might have minor changes to their speech, while others have great difficulty being understood. People with dysarthria may also have aphasia.
Dysphagia
After an injury to the brain (such as a stroke), some people have difficulty swallowing food or beverage. Dysphagia is caused by weakness of the muscles of the mouth and throat that controls swallowing. Also, dysphagia may occur when these muscles become uncoordinated. People who have dysphagia may cough or choke, when food or liquids to "go down the wrong way". This condition can be dangerous, as it can lead to pneumonia.
A swallowing study (often a Modified Barium Swallow Study/Videofluorographic Swallow Study) can be done by a radiologist and a speech-language pathologist to determine exactly what kind of foods and liquids are causing the problem. Sometimes, changing the position in which a person is eating, or changing the type of food a person eats, or adding thickeners to liquids to make them easier to swallow may help to manage or mitigate dysphagia.
In more severe cases of dysphagia, stroke survivors may not be able to swallow anything without it going into their lungs. In these cases, a feeding tube is necessary. The tube may go through their nose and into their stomach (naso-gastric tube, NGT). The NGT is usually used for shorter periods of time. If a feeding tube will have to be used for a longer period of time, the tube goes directly into their stomach (percutaneous endoscopic gastronomy, PEG).
Just like other changes from a stroke or brain injury, it is difficult to say how long it will take for dysphagia to improve. It is important to keep the individual with dysphagia well nourished, so that the body has the fuel it needs to heal and recover. It is also important to be sure that the risk for pneumonia is minimized.
