Having a stroke can be devastating. Most people associate a stroke with physical changes: leg weakness that makes it difficult to walk or hand weakness that can make it difficult to hold a utensil. A less often considered but just as life-altering change is a stroke that leaves one with a communication disorder. Imagine waking in a hospital bed to find you don’t have the words to ask how you got there, does your family know where you are, or worse being unable to say to the nurse “I’m in pain.”
There are several ways that a stroke can negatively affect communication.
Slurred speech caused by a stroke, or any other medical condition, is referred to as dysarthria. This is when the speech sounds lose precision. This can be caused by weakness in the muscles of the mouth and/or loss of coordination of the muscles for sequencing the rapid movements required for speech. If there is unilateral weakness (weakness on one side) of the face it becomes difficult to coordinate the lips and tongue muscles that may now be moving at different rates and degrees. That weakness may be visible with what is called a “facial droop.” But because not all of the muscles used for speech are visible, dysarthria is not always visibly obvious. Sometimes it is only evident in complicated sound complications. Sometimes there’s a change in one’s voice. The severity of dysarthria can range from a barely perceptible problem speaking to barely intelligible speech. With speech therapy, dysarthria can improve with strategies and concerted practice.
Another type of communication impairment caused by a stroke is aphasia. This is when the part of the brain that interprets and produces words and sentences is affected. When the ability to comprehend and decode language is impaired, it is called receptive aphasia. When the ability to express oneself with words and sentences is impaired, it is called expressive aphasia. These impairments also occur on a continuum from mild to severe and one can experience varying levels of both simultaneously. In its most severe form, both expressive and receptive language are severely impaired, and communication can be extremely difficult, and frustrating. A speech pathologist can help guide a patient and family in finding a reliable method for communicating using alternative means, while simultaneously working to rehabilitate language. How much recovery can be expected varies from individual to individual and can depend on severity, age of the patient, motivation, any pre-existing or new cognitive changes that the stroke may have caused, and of course the support of family, caregivers, and the medical team.
To learn more about receptive and expressive aphasia, be sure the check out my previous blog devoted to aphasia.
o Verbal Apraxia
A lesser known and less frequently occurring type of communication impairment caused by strokes is called verbal apraxia or acquired apraxia of speech (AOS). This is when the portion of the brain that controls movement is affected. The best way to explain verbal apraxia is the message for a word or sound that is sent from the brain to the muscles goes haywire. What one intends to say does not come out as planned. In its very severe form, even turning on your voice to sigh or hum or clear your throat is extremely difficult. As you can imagine, this is a very frustrating condition. Many individuals with apraxia, have normal cognition and language skills and know exactly what they want to say but the sounds or words don’t come out as intended. Verbal apraxia is rehabilitative but depending on severity, can take a lot of work. It is helpful, in the meantime, to have an alternative method of communicating, such as writing or a speech generating device (SGD). [learn more about verbal apraxia in another blog entry.]
The American Stroke Association has successfully communicated F.A.S.T to help the public identify the most common symptoms of stroke so they can get timely medical assistance. The acronym helps us remember the most obvious and visible signs of stroke, with the S standing for “speech difficulty.” Now you know exactly what that can look like: Slurred speech, trouble finding the words, nonsensical speech, not seeming to understand what others are saying, or struggling to speak.
Navigating care during and after a stroke can be overwhelming. Even if it is a small stroke, it is still a frightening and complicated experience. Having worked in hospitals for over 15 years, I can attest to the tendency to focus on the physical abilities affected by a stroke—are the arms and legs working well? Can he walk 50 feet? Can she stand safely at the sink to brush her teeth? What about the less obvious complications that might not show up if a 2-minute conversation? For example, with verbal apraxia, many patients can still have routine social interactions such as “Hi. I’m fine” and sound completely normal. But if you ask, they couldn’t tell you their name or what city they grew up in. No one should have to struggle to communicate.