Understanding the Communication Challenges Facing Stroke Survivors

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Katherine stares intently into the mirror, applying lip liner and lipstick with the meticulousness of a portrait painter.

The control and attention to detail seem at odds with the setting, the restroom of a community arena.

“I had a stroke a few years ago,” Katherine says. “My smile is still a little crooked, but I can make it less obvious this way.”

You would never guess she’s a stroke survivor.

“I’m lucky,” she says. “The stroke was minor, and they got to the clot quickly. It could have been a lot worse.”

Katherine’s crooked smile is all that remains of her paralysis, having received extensive rehabilitation to regain control of her arm, walking, and speech.

Paralysis, or the inability of a muscle to move, is one of the most common disabilities resulting from stroke, according to the National Stroke Association. As many as 9 out of 10 stroke survivors have some degree of paralysis immediately following a stroke.

What is a Stroke?

A stroke occurs when blood flow to the brain is interrupted by a clogged or burst artery. This interruption deprives the brain of oxygen, starving and killing some of the brain cells. The body parts and mental functions controlled by those brain cells no longer function properly after that.

In addition to the kind of muscle weakness Katherine has suffered, a stroke can cause the following issues:

  • Speech and language problems
  • Cognitive challenges
  • Swallowing difficulties
  • Sensory impairments
  • Emotional complications.

More than 7 million Americans and 33 million people around the world have survived a stroke. They may be living with some or all of these conditions. According to the American Heart & Stroke Association, stroke is the fifth most common cause of death and the leading cause of adult disability in the United States. That’s why Katherine feels lucky.

Learn more about stroke types, causes, prevention, and rehab by reading What is a Stroke?

Have you ever seen someone and wondered why she can’t get her words out, why his speech is so choppy, why she’s slurring her words, or why he keeps jumping from topic to topic? They may have one of the four types of acquired communication disorders that are common after a stroke.

How you engage with a stroke survivor can make a big difference in how successfully they communicate.

Why Can’t She Get Her Words Out?

Someone who’s had a stroke may be left with aphasia, which is the inability to produce or to comprehend language (or both).

Aphasia affects different people in different ways. Someone with aphasia may be unable to do some or all of the following:

  • Understand what other people say
  • Use the right words to express a thought
  • Read
  • Write
  • Use gestures
  • Draw pictures
  • Use numbers or do math

Aphasia varies in severity. Someone with a mild form called anomia usually just has trouble finding certain words during conversation. Someone whose language abilities are severely impaired, however, is said to have global aphasia.

Aphasia has nothing to do with intelligence. A person with aphasia is just as smart after the brain injury as before. He or she usually has coherent thoughts and meaningful ideas to share, but has trouble getting the words out.

According to the National Aphasia Association, 25 to 40 percent of stroke survivors have aphasia. Other common causes of aphasia include head injuries, brain tumors, and other neurological conditions.

Aphasia affects about 1 million Americans, or 1 in 250 people. It’s more common than Parkinson’s disease, cerebral palsy, and muscular dystrophy. Even though more than 200,000 Americans acquire the disorder each year, most people have never heard of it.

Why is His Speech So Choppy?

Someone who’s had a stroke may also have apraxia of speech, which is an impaired ability to control the muscles used to form words. This makes it hard to initiate and sequence the sounds that make up speech.

Someone with apraxia of speech has trouble coordinating movements of the tongue, lips, and/or jaw. You may see groping movements in the mouth as the person tries to speak.

Someone with this type of impairment may speak slowly and haltingly, if at all. They may have trouble starting to talk, making multiple attempts to articulate a word.

Errors are often inconsistent. The person may be able to say something once, then not be able to say it again, or it might come out differently next time.

According to the American Speech-Language-Hearing Association, apraxia of speech often occurs together with other communication disorders, such as aphasia. The exact number of people with apraxia of speech, however, is poorly understood since diagnosis can be difficult.

Why is She Slurring Her Words?

Someone who’s had a stroke may also have dysarthria. This is difficulty speaking clearly because of weakness, slowness, or lack of coordination in the muscles of the mouth, face, voice, and lungs.

Dysarthria affects different people in different ways. Some people sound like they’re mumbling or slurring their words. Some sound like they’re talking through their noses, while others sound stuffed up.

Some speak in a monotone, while others make extreme pitch changes. Some speak slowly, some speak very quickly, and some fluctuate their rate. Some speak loudly, some speak softly, and some are irregular in volume. Their voices may sound unusually hoarse, breathy, or strained.

There are several types of dysarthria. The area of the nervous system that’s damaged determines the type of dysarthria the person has. Someone with dysarthria may look like his or her face is drooping. He or she may have difficulty swallowing, or get food caught in the cheeks. Due to limited movement of the tongue, lips, or jaw, the person may drool or have trouble keeping dentures in place.

According to the American Speech-Language Hearing Association, because of the broad variety of possible causes, there are no data about the incidence of dysarthria in the general population.

Dysarthria can be a mild annoyance, or it can have a devastating effect on a person’s ability to make him or herself understood.

Why Does He Jump From Topic to Topic?

Stroke survivors may be left with a cognitive disorder that affects how they communicate. This is referred to as a cognitive-communication disorder.

It’s not a single condition, but rather a group of disorders that result when communication is impaired because of problems with cognition. This makes it different from primary speech and language deficits.

A cognitive-communication disorder results from impaired functioning of one or more cognitive processes, including the following:

  • Attention
  • Memory
  • Perception
  • Insight and judgment
  • Organization
  • Orientation
  • Processing speed
  • Problem solving
  • Reasoning
  • Executive functioning
  • Metacognition.

A person with a cognitive-communication disorder may have difficulty paying attention to a conversation, staying on topic, remembering information, responding accurately, understanding jokes or metaphors, or following directions.

Cognitive-communication disorders vary in severity. Someone with a mild deficit may simply have difficulty concentrating in a loud environment, while someone with a more severe impairment may be unable to communicate at all.

Thirty-five to 44 percent of stroke survivors find themselves with cognitive impairments about three months after their strokes. About a third of these people experience impairments for a long time.

Stroke is just one cause. A cognitive-communication disorder can also result from a traumatic brain injury, a brain infection, a brain tumor, or a degenerative disease such as multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, or some other form of dementia.

Cognitive-communication disorders can occur alone or in combination with other conditions, such as dysarthria, apraxia, and aphasia.

Communication Problems after Stroke

If you have one of these communication disorders, or if you are a professional who works with people with these disorders, you’ll want to stay tuned for upcoming blog articles on the definitions, causes, symptoms, treatments, and tips to share with others. Topics include:

  • What is Aphasia?
  • What is Apraxia?
  • What is Dysarthria?
  • What is a Cognitive-Communication Disorder?

Megan Sutton, MS RSLP, CCC-SLP (C) is a speech-language pathologist in Vancouver, Canada and co-founder of Tactus Therapy, a company that develops evidence-based speech therapy apps for adult communication, cognitive, and swallowing disorders. Megan earned a Master of Science degree in Speech-Language Pathology from Boston University after earning a B.A. in Linguistics from Rutgers University. She has worked passionately with adults with acquired communication and swallowing disorders for over 13 years in inpatient and outpatient settings, specializing in the assessment and treatment of aphasia. Visit her website for additional resources.