Communication problems after stroke

Why can’t I communicate properly?

Communication problems happen after a stroke because of the damage to your brain.

When we communicate, our brain has to complete a series of tasks. So when someone asks you a question, your brain has to understand what you are being asked, decide on your answer and put the words together, before you can give them a reply.

Different parts of your brain carry out these tasks. Depending on the area of your brain that is damaged, you could have problems with any part of this process. Communication isn’t just about speaking and understanding speech, however. Many people also have problems with reading, writing and using numbers.

What kinds of problems can this cause?

Aphasia

Aphasia affects your ability to speak and understand what others say. It can also affect your ability to read and write. Aphasia is sometimes called dysphasia.

It happens when the parts of your brain that control language is damaged. It does not affect your intelligence, although some people may treat you as if it has. Aphasia is a common problem after stroke. Around a third of stroke survivors have it.

There are different types of aphasia:

• Broca’s aphasia or expressive aphasia is when it’s very difficult to find the right words and say them, although you probably know exactly what you want to say. You may only be able to say single words or very short sentences, although it’s usually possible for other people to understand what you mean. This can be very frustrating.

• Wernicke’s aphasia or fluent aphasia is when you’re able to speak well and use long sentences, but what you say may not make sense. You may not know that what you’re saying is wrong, so you may get frustrated when people don’t understand you.

• Global aphasia is when you have serious communication problems and you may not be able to speak, read or write at all.

Dysarthria

To speak clearly, we need to control the muscles in our face, mouth and throat as well as our breathing. Dysarthria happens when you’re not able to do this.

Dysarthria is a physical speech difficulty. It doesn’t affect your ability to understand other people or to find words and put them together unless you have other communication problems at the same time. Dysarthria is a common problem after stroke.

Apraxia of speech

Apraxia of speech is when you can’t move the muscles in your face, mouth or throat in the right order. This can make it difficult for you to speak, and other people may struggle to understand you.

You may not have any weakness in these muscles and you may be able to control them individually without any problem. However, you can’t move them in the way you want to when you try to speak.

This is because apraxia is a problem with planning movements, rather than the movements themselves. So even though you may not be able to say goodbye if someone asks you to, you may be able to say it when you go to leave, because you’re doing it without thinking.

Will it get better?

Most communication problems do improve. However, how much they’ll improve or how long it will take is very difficult to predict, as it’s different for everyone.

Problems tend to improve quite quickly within the first three to six months, but you can continue to recover for months and even years after this. While some improvement will happen naturally, having speech and language therapy can help. Your speech and language therapist can help you work on your problems. Try to communicate with others as much as you can.

For most people, getting better is about returning to the way they were before their stroke. However, this isn’t always possible. Even if you get close, you may still have problems from time to time, especially when you’re tired, stressed or under the weather.

But even if you don’t recover completely, there are many ways to communicate that don’t rely only on speaking. Many stroke survivors continue to live full and happy lives, even though they still have problems with communication. With support, you can become more confident about communicating.

Are there treatments that can help?

Speech and language therapy

Speech and language therapy aims to help you improve your ability to communicate. But speech and language therapy isn’t just about ‘fixing’ your problems so that you can speak as well as you did before. It’s not always possible to recover your speech completely, but you can develop your confidence and ability to communicate in new ways.

When you work with a speech and language therapist, what you do in your sessions will depend on the problems that you have and what’s important for you to work on. You may also have therapy sessions with a rehabilitation assistant.

Information guides

• Download Communication problems after stroke guide (PDF)

• Download Communication Licence guide (PDF)

Where to get help and information from the Stroke Association

Helpline
Call us on 0303 3033 100,from a textphone 1800 0303 3033 100
Email: helpline@stroke.org.uk
Our Helpline offers information and support for anyone affected by stroke, including family, friends and carers.

Read our information
Call the Helpline to ask for printed copies of our guides.

Other sources of help and information

Aphasia Alliance
Phone: 01525 290 002
Lists organisations that people with aphasia and their carers might find useful.

Chest Heart & Stroke Scotland
Advice Line: 0808 801 0899
Email: adviceline@chss.org.uk
A charity for people affected by chest and heart conditions as well as stroke. They offer communication support in Scotland, including groups and one-to-one support. They also have information on their website that has been written for people with communication problems.

Communication Matters
Phone: 0845 456 8211
Email: admin@communicationmatters.org.uk
Has information about methods of communication you can use instead of writing or speaking, known as augmentative and alternative communication (AAC). Their website lists all the communication aid centres and AAC assessment services across the UK. These services can tell you about aids that can help you communicate and show you how to use them. Some also lend out equipment.

Apps from MyTherappy
App recommendations from the NHS for survivors and carers ranging from communication, eating and drinking, healthy lifestyle, vision and more.

Disclaimer: The Stroke Association provides the details of other organisations and apps for information only. Inclusion on My Stroke Guide does not constitute a recommendation or endorsement.