How to communicate after a stroke

What can happen to communication, and why

A stroke damages part of the brain. Depending on the area, it can affect the speech muscles, the planning of speech movements, or language itself. These difficulties can appear alone or together.

• DysarthriaThe muscles we use to speak become weak or hard to control. Speech may sound slow, slurred, very quiet or hard to understand.
• Apraxia of speechThe muscles are not weak, but the brain has trouble planning and coordinating the movements for speech. The person knows what they want to say, but it doesn't come out. Errors change from one try to the next, and automatic phrases may come out more easily.
• AphasiaIt affects language itself: speaking, understanding, reading and writing. It does not affect intelligence or how a person thinks. Stroke is its most common cause, and about one third of people who have a stroke have aphasia.

Who assesses which difficulty it is

The speech-language pathologist checks how the mouth, lips and tongue move, and how the person understands, speaks, reads and writes. That shows which difficulty it is, and they propose a therapy plan that often includes the family.

Many people improve, especially in the first months, and improvement can continue for years. The pace is different for everyone.

How to communicate now

While therapy moves forward, any method that works is fine. People often combine several.

• Yes-or-no questionsAsk questions that can be answered with a gesture, or offer a few clear choices.
• Writing, drawing and pointingA notepad, a whiteboard or a phone can be used to write words, draw, or point to letters, pictures or words.
• A book of photos or wordsYou can put one together with people, places and everyday topics, so the person can point to what they mean.
• Apps that speakText-to-speech apps on a phone or tablet are another way to communicate. The speech-language pathologist can advise on which support fits best.

Tips for conversations at home

• Give timeWait until they finish; don't complete their sentences.
• Less noiseTurn off the TV or radio and talk face to face, in good light.
• Short sentencesSpeak calmly, in simple sentences, as you would to any adult. There's no need to shout.
• Say when you don't understandDon't pretend you understood. Repeat the part you did understand, so they don't have to start over.
• Accept every way of communicatingGestures, drawings or single words count too. Don't correct the way they speak.
• Include themMake them part of conversations and value their opinion.

Where Tocavox helps

Tocavox is a free social project. The person picks or types a phrase and the phone says it out loud, in a natural voice. It's an option the person or their family can set up on their own, and one more support alongside therapy.

It usually fits best when the problem is with speech (dysarthria or apraxia) and the person can read. With aphasia, reading and choosing phrases can be hard. In that case it may help only with a few simple phrases prepared by the family. The speech-language pathologist can advise on other supports, for example picture-based ones.

Frequently asked questions

Other guides

• After a laryngectomy
• With ALS (MND)
• With a tracheostomy or in the ICU
• During voice rest
• After tongue or mouth surgery
• See all →