Communication and Swallowing changes
after a stroke
A stroke affects the crucial blood and oxygen supply to the brain. The resulting lack of blood and oxygen can reduce the brain’s ability to perform properly. Depending on which area of the brain is affected, various daily functions such as movement, bladder and bowel control, thinking and sensation can be affected. Speech, language and swallowing can also be impaired following a stroke.
Changes to communication
The muscles needed for speech may be affected due to damage to the specific nerve signals.
This can result in ‘slurred’ speech, as the lips and tongue move less swiftly or accurately after the stroke.
Several areas of the brain are involved in our ability to use and understand language.
When these areas are damaged by a stroke, language impairment – also known as Aphasia –
may result. The person may have difficulty understanding what is being said, or experience difficulty expressing what they wish to say. Reading, writing and working with numbers can also be affected.
A person’s cognition/ thinking – such as attention span and memory, can also be affected by a stroke. This can also reduce the success of communication, due to reduced concentration, or memory of what is said.
Aphasia (also called Dysphasia) is a condition which affects a person’s language after damage to the brain. It can happen after a stroke, but also after other trauma to the head,
or changes within the brain such as in Parkinson’s or dementia.
A person with Aphasia may have problems understanding the language around them.
They may not understand what particular words mean, or take a long-time processing what others say. Aphasia may also affect the ability to read, as the ability to relate written words to meaning is impaired.
People with Aphasia may have difficulty expressing themselves or finding the word they want to use, even though they often feel they know what the word is.
Some people make errors where the wrong word comes out. The word may sound similar to the intended word (such as bark instead of park), or be a related word (such as radio instead of telephone). Sometimes, a totally unrelated word is said (such as cabinet instead of trousers), or a ‘nonsense’ word occurs. It is not uncommon for a person to repeat words, whereby a word is used over and over despite it not being correct in the context.
In the condition ‘Fluent Aphasia’, the person may speak in apparent sentences, but make little actual sense, possibly using nonsense or unrelated words. The person is often not aware of this.
- Keep spoken sentences brief, emphasising the key words.
- Repeat what you say if this helps.
- Give the person plenty of time to understand what you have said.
- Write down the key word if that helps.
- Use gesture or point to objects to illustrate what you are talking about. You can use familiar items such as the clock, diary page, calendar, family photos or everyday objects to illustrate what you mean. For example, ‘Sally is coming at 4 o’clock for tea’ can involve pointing to a photo, the clock, tea bags / cake and gesture).
- Reduce distractions (e.g. get the person to look at you, turn the TV off, avoid overcrowding and stick to one person talking at a time).
- Confirm that they have understood (e.g. say, “So it’s the red sweater you want”).
- Give the person plenty of time.
- Prompt the person to describe the word they can’t find, such as what it looks like / who uses it / where you find it / what colour it is etc.
- Offer choices such as, ‘Do you want tea, or do you want coffee?’
- Use ‘Yes/No’ questions such as ‘Are you talking about Sheila?’
‘Is it about what the doctor said?’
- If you think you know what the word is, such as a person’s name, give the first sound of the word (for example, ‘You want to say Ka…’ for Katherine, or ‘You’re talking about the drink. The drink is co..’ ). You can also let the person finish a phrase such as.
‘David is married to K…’ or ‘It’s a cup of co…’
- Prompt the person to write the word down, or draw what they are trying to say,
or use gesture to demonstrate the word.
- Agree to come back to the topic later if it is really difficult.
A stroke can cause Dysarthria, which is difficulty in forming speech sounds because the muscles of the lips or tongue can be slow or weak. The person with dysarthria may sound ‘slurred’ or like they are ‘mumbling’. It can also affect the voice and the person may have quiet speech. Dysarthria is likely to be worse when the person is tired.
How Can I Help?
- Give the person plenty of time to get their words out, and avoid completing their words for them.
- Ask them to talk with a slow pace and with increased volume, and make sure you can see their mouth as they speak.
- Encourage them to exaggerate (over-articulate) the speech sounds they are using.
- Prompt them to speak in single words at a time.
- Avoid interference from other sounds (e.g. other people speaking / TV)
- The person may find it difficult to make themselves understood on the telephone,
so you may want to limit these times to when the person is not too tired.
Apraxia of Speech (also called Dyspraxia) happens when the signals from the brain for speech movements are not fully coordinated and this results in speech sound errors.
Words may be off target (e.g. ‘crisps’ comes out as ‘sclipse’ or ‘bus’ sounds like ‘boss’).
Some may have only mild difficulties, but the condition may be severe, affecting everything the person tries to say. It is not uncommon for the person with apraxia of speech to try and correct their speech, but it may actually get worse the more they try, which is frustrating.
How Can I Help?
- Give the person with apraxia of speech plenty of time.
- Looking at the written word can sometimes prompt a more accurate spoken version of the word.
- The support of picture or alphabet charts may help if the person can point to the letters / pictures to help express themselves.
- Offer pen and paper for writing or drawing a picture if the person can’t get the word out.
A stroke can affect a person’s cognitive ability. This means that a person’s usual ability to take in and respond to information around them is affected.
It may affect a person’s attention or memory. This can mean that they can’t concentrate on all of what is being said to them, or they may not be able to remember information they are given. It can also affect what they are trying to say, as they may not be able to keep on-topic, or remember what they wanted to say when they first started speaking.
A person’s appreciation of how things work can be affected, and this can relate to communication as well. The person may not follow usual ‘social norms’ in conversation for example, so may not realise that they are interrupting others, or that it is somebody else’s turn to speak.
How can I help?
- You may want to remind the person of the main points of what has been said.
- You can use their name and eye contact to get their attention, to help direct them back to the topic.
- Write important things down.
- Fill in the person’s calendar / diary to help with reminders.
Swallowing difficulties (dysphagia)
A stroke can affect the muscles involved in chewing and swallowing such as the lips, cheeks, tongue and jaw, and also the muscles of the throat. It is often the case that the muscles on one side of the face are affected more than the other.
When muscles are affected, food or drink can spill out of the front of the mouth. It may also be difficult to chew properly, or to control what food or fluid is in the mouth to get it to the throat ready to swallow.
If the muscles of the throat are affected, the person may find that they cough or start to choke when they swallow. This may be due to lack of co-ordination, lack of strength of muscle movement, or reduced sensation.
The Speech and Language therapy team are best placed to assess and give advice and suggestions for changing types of food or drink.