Speech therapy after stroke: Communication, aphasia and swallowing recovery

Speech therapy plays a key role in stroke rehabilitation by providing help to patients with speech, communication or swallowing difficulties after stroke.

A stroke can affect communication in many ways. Patients may have trouble speaking, forming complete sentences, reading, writing, comprehending written words or recalling words or thoughts. Stroke can also impact muscles and coordination patients need to swallow safely.

Not all stroke patients will experience communication or swallowing difficulties and challenges may affect them differently. Physical and cognitive deficits are unique for stroke patients. Read more on stroke, its causes, symptoms, risk factors and treatment.

Stroke rehabilitation may include physical, occupational and vision therapy alongside speech therapy, depending on the stroke’s impact. Speech-language pathologists, also referred to as SLPs or speech therapists, help patients address communication and swallowing challenges after stroke.

In this article, you will learn how speech therapy supports stroke rehabilitation by helping patients with communication or swallowing challenges restore abilities or adapt to lasting changes. You will also learn more about how a stroke can affect communication and swallowing.

How can a stroke affect communication and swallowing?

When a stroke occurs in areas that control functions like language, speech, cognition and swallowing, patients can experience functional effects based on the exact location and severity of the stroke.

Patients may encounter challenges related to speech, communication and swallowing after their stroke.

• Aphasia is difficulty speaking, expressing oneself, reading or writing.
• Dysarthria is weakness or lack of control in the muscles used for speech that can cause slurred speech after a stroke or a lack of speech clarity.[1]
• Apraxia is difficulty performing voluntary movement patterns needed to speak that does not involve muscle weakness or paralysis.[2]
• Patients may experience cognitive-communication disorder related to memory or thought recall, focus or problem-solving abilities.
• Dysphagia is difficulty swallowing due to an impairment in the oral and/or pharyngeal stage of the swallow.

Some patients may experience no deficits in these areas while others may experience more severe deficits.

What is aphasia after a stroke?

Aphasia is a disorder of the brain that affects the language centers, impeding communication. A stroke on the left side of the brain is the most common cause of aphasia, but other injuries can also cause it.

While aphasia may impact the way a person communicates involving language, it does not affect their intelligence or cognition.

A person with aphasia may:

• Speak in short or incomplete sentences
• Speak in sentences that do not make sense
• Substitute one word for another or one sound for another
• Speak words you do not recognize
• Have difficulty finding words
• Write sentences that do not make sense[3]

While aphasia can appear similar to apraxia, dysarthria and other cognitive and communication challenges, they each represent different diagnoses.

Aphasia is a language disorder that affects someone’s speaking, writing, reading or language skills, while apraxia is a motor planning condition that affects the ability to produce speech.[4]

Dysarthria also differs slightly from both aphasia and apraxia. Like apraxia, dysarthria affects someone’s motor skills. In this way, it is different from aphasia. However, patients with dysarthria have weakness or lack of control in the muscles used for speech. Muscle weakness is not present in apraxia.

Aphasia also differs from cognitive-communication disorder. People may appear to struggle to find words or communicate thoughts because of challenges with memory, reasoning or problem-solving. While it may appear that they are struggling to speak, the underlying challenge is not knowing what to say, not an inability to say it. Learn more about cognitive and emotional changes after a stroke.

Symptoms will vary in nature and severity among patients depending on how stroke impacted their brain. To fully understand your diagnosis, you should consult a physician.

How does speech therapy help with communication after a stroke?

Speech therapy helps stroke patients regain communication skills and find alternative means of communication to adapt to lasting changes.

First, a speech-language pathologist (SLP) will evaluate patients to determine the impact of the stroke on their cognitive and communicative abilities.

During an evaluation, an SLP may ask patients about their background and history, conduct a cognitive and language screening, evaluate their vocal quality and endurance and assess voice volume. The evaluation will also consider the side of the brain affected by stroke.

Following the evaluation, the SLP will work with stroke patients to develop goals that consider the areas of the brain damaged, amount of impairment, exact nature of communication challenges, age and other factors.

A speech therapy plan will focus on restoring communication skills to the extent possible and, if necessary, introducing alternate means of communication to adapt to lasting communication deficits.

The plan may differ from inpatient to outpatient rehabilitation. Inpatient speech therapy often focuses on ensuring patients have the necessary communication and cognitive skills to return home after their stroke with an appropriate support level. Outpatient speech therapy often helps patients further improve communication and cognitive abilities to increase their independence.

Speech therapy may use both impairment-based therapies and communication-based therapies.

An SLP will use impairment-based therapies to repair what a patient lost in the stroke by focusing on basic structures and functions of language. Exercises focus on helping patients comprehend language and improve speech while minimizing frustration. These therapies may include practicing at home between sessions with computer programs or apps that support word-finding and comprehension.

Speech therapy can also go beyond exercises to help patients regain comfort communicating in social settings. These communication-based therapies emphasize natural interactions and real-life communication challenges and focus on improving communication success rather than simply reducing deficits. It may introduce patients to social situations and teach them ways to compensate in real time for any deficits.

To address ongoing deficits following stroke, augmentative and alternative communication (AAC) devices can assist patients communicate functionally in their daily lives by using alternative devices or methods to augment their current communication ability.

AAC devices can range from low-tech communication boards to sophisticated eye-tracking, speech-generating devices. During speech therapy, an SLP will help patients determine devices that meet their abilities and needs, train them on the device and ensure it works properly. Speech therapists can also help patients and families implement other communication strategies as needed.

Speech therapy approaches can vary among patients. At Good Shepherd, your SLP will work alongside the rest of your rehabilitation team to incorporate speech therapy into a multidisciplinary stroke rehabilitation plan.

What is dysphagia (difficulty swallowing) after a stroke?

Dysphagia is difficulty swallowing. A stroke can damage nerves that control a person’s ability to swallow or cause muscle weakness or coordination deficits, making swallowing difficult or impossible. Patients with dysphagia following stroke may experience a range of symptoms, including:

• Choking
• Food or liquid entering the airway when swallowing, causing coughing or throat clearing
• Evidence or signs of food or liquid remaining in various areas of the mouth or on the tongue
• Difficulty transferring food or liquid from the front to the back of the mouth
• A feeling that something is stuck in the throat or chest after a swallow
• Regurgitation or food coming back up after it is swallowed
• Reflux or heartburn sensations

Swallowing issues can present in the mouth, throat and/or esophagus following a stroke. These changes may be due to strength, sensation and/or coordination changes. An SLP will work with patients to identify any specific issues and how to address them.

Patients with dysphagia can have difficulty receiving proper nutrition and/or hydration. It can also affect their respiratory health.

If you or someone you know experiences these symptoms, you should obtain an evaluation to determine the best course of treatment. If you’re unsure, contact Good Shepherd.

How does speech therapy help with swallowing after a stroke?

Along with addressing communication deficits after stroke, speech-language pathologists work with patients that have eating or swallowing difficulties.

An SLP’s dysphagia evaluation may assess the types of foods and liquids patients consume, evaluate their range of motion, examine facial muscle and nerve strength and review case history. The SLP may also evaluate how safely and effectively patients swallow to determine if patients need further assessment.

In an acute-care or inpatient setting, patients may receive a modified barium swallow test with an X-ray to evaluate patients’ swallowing ability. At Good Shepherd, outpatient dysphagia evaluations may include the use of Flexible Endoscopic Evaluation of Swallowing (FEES).

After evaluating and speaking with patients, the SLP will work with physicians and the rehabilitation team to develop an individualized dysphagia treatment plan.

Speech therapy exercises for dysphagia may focus on stimulating and strengthening muscles and nerves in the head and neck associated with swallowing, supporting tongue and lip pressure, and mobilizing soft tissue in the head and face area. At Good Shepherd, patients can work with Neuromuscular Electrical Stimulation (NMES). Patients, families and caregivers may also receive education and training on strategies for adapting to lasting swallowing changes. This could include learning to prepare modified diets or increasing awareness of how patients chew and swallow.

Speech therapists also collaborate closely with other members of a patient’s medical team to address swallowing, hydration and nutrition needs. Together, that team will assess whether patients need changes in their diet or additional treatment to address their dysphagia.

As your abilities change through therapy, your treatment and rehabilitation also can change. An SLP will conduct further evaluations and update therapies, treatments and recommendations as your needs and abilities change.

Speech therapy and stroke rehabilitation at Good Shepherd

Speech therapy represents just one component of stroke rehabilitation.

During inpatient stroke rehabilitation at Good Shepherd Rehabilitation Hospital, our speech therapists work directly with physical medicine and rehabilitation physicians, certified rehabilitation registered nurses and other therapists to address your swallowing and communication challenges alongside other physical, cognitive and functional effects.

In outpatient rehabilitation, our SLPs coordinate with your other therapists and medical team to help continue progress you made during inpatient rehabilitation or address any new challenges.

To support speech and language therapy, we offer a Cognitive Communication Skills Group for adults to maintain and improve social communication skills through activities and group interaction. We further assist patients with communication challenges through our providing AAC solutions.

Meanwhile, our Flexible Endoscopic Evaluation of Swallowing (FEES) service provides an effective and minimally invasive way to assess swallowing function and diagnose dysphagia. In addition, our therapists can support traditional swallowing exercises to further help strengthen and retrain the swallowing mechanism through Neuromuscular Electrical Stimulation (NMES) such as the FDA-approved, VitalStim® electrical stimulation technology in swallowing therapy.

Whether at Good Shepherd Rehabilitation Hospital or at one of our 20 outpatient locations in eight counties across eastern Pennsylvania, stroke rehabilitation focuses on your abilities, needs and goals.

Visit our stroke rehabilitation page to take the next step in your journey.

You can also call us at 1-888-447-3422 (44-REHAB) or contact us online.

[1] Dysarthria – Symptoms and causes – Mayo Clinic

[2] Aphasia vs Apraxia | American Stroke Association

[3] Mayo Clinic, Aphasia Symptoms & Causes

[4] What’s the difference between Aphasia and Apraxia? | The Aphasia Center