how to do speech therapy for stroke patients

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Mayo Clinic Q and A: Speech therapy after a stroke

Liza Torborg

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ANSWER: The overall effectiveness of speech therapy for people who have communication difficulties after a stroke  largely depends on the area of the brain the stroke affected and the severity of the brain damage. Generally, speech therapy can help those whose speech is affected by a stroke.

The most common type of stroke is an ischemic stroke, in which the blood supply to part of the brain is reduced significantly or cut off. As a result, brain tissue can’t get the oxygen and nutrients it needs. Within minutes, brain cells start to die. The brain damage caused by a stroke can lead to a variety of disabilities, including problems with speech and language.

The medical term to describe some of the communication problems that happen due to a stroke is " aphasia ." There are several kinds of aphasia. The one you describe in your mother’s situation sounds like nonfluent, or Broca’s, aphasia. It occurs when a stroke damages the language network in the left frontal area of the brain. People with nonfluent aphasia typically can understand what others say, but they have trouble forming complete sentences and putting together the words they want to use.

Nonfluent aphasia, which can be a significant barrier to clear communication, often leads to frustration. Working with a speech-language pathologist can help. The goal of speech and language therapy for aphasia is to improve communication by restoring as much language as possible, teaching how to compensate for lost language skills, and learning other methods of communicating

Speech-language pathologists (sometimes called speech therapists) use a variety of techniques to improve communication. After initial evaluation by a speech-language pathologist, rehabilitation may include working one on one with a speech-language pathologist and participating in groups with others who have aphasia. The group setting can be particularly helpful, because it offers a low-stress environment where people can practice communication skills, such as starting a conversation, speaking in turn and clarifying misunderstandings.

A speech-language pathologist also can direct your mother to resources she can use outside of speech-language therapy sessions, such as computer programs and mobile apps that aid in relearning words and sounds. Props and communication aids, such as pictures, notecards with common phrases, and a small pad of paper and pen, often are encouraged as part of speech-language rehabilitation and can improve a person’s ability to convey his or her thoughts.

You, other family members, and friends also can help your mother rebuild her communication abilities. Consistently include her in conversations. Give her plenty of time to talk. Don’t finish her sentences for her or correct errors. Keep distractions to a minimum by turning off the TV and other electronic devices while you talk. Allow time for relaxed conversation.

Recovering language skills can be a slow process. With patience and persistence, however, most people can make significant progress, even if they don’t completely return to the level of function they had before a stroke. It is important to seek treatment for aphasia, because, if left untreated, communication barriers can lead to embarrassment, relationship problems and, in some cases, depression.

Encourage your mother to make an appointment with her health care provider to discuss speech-language therapy and help her find a speech-language pathologist who has experience working with people who have had a stroke. —  Dr. Robert D. Brown, Jr. , Neurology, and Dr. Heather Clark , Speech Pathology, Mayo Clinic, Rochester, Minnesota

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12 Best Stroke Recovery Speech Therapy Exercises For Adults

Stroke, a medical condition often synonymous with sudden and dramatic changes in one’s life, not only alters physical abilities but also profoundly impacts communication skills. The journey to reclaiming these lost abilities can be arduous, yet it is a path illuminated by the beacon of specialized speech therapy. In this article, we delve into the world of stroke recovery, particularly focusing on adult speech and language rehabilitation. We aim to not just inform but to enlighten our readers – adults grappling with neurogenic speech and language disorders, and their caregivers – about the transformative power of speech therapy exercises.

In the wake of a stroke, many individuals find themselves in a new and challenging world where words may not flow as effortlessly, and understanding language becomes an unexpected hurdle. These communication barriers, often overlooked in the broader narrative of stroke recovery, are critical elements that shape the quality of life post-stroke. Addressing them is not just a matter of medical intervention but a step towards restoring the individual’s identity and social connections.

Unlike the more commonly discussed physical impairments, the nuances of speech and language disorders such as aphasia, dysarthria, or apraxia remain less understood. These conditions do not just represent a loss of words or speech clarity; they symbolize a disruption in the most fundamental human connections – the ability to express thoughts, emotions, and needs. It is here that speech therapy, a field that seamlessly blends science and empathy, steps in to bridge the gap created by a stroke.

Our exploration of “12 Best Stroke Recovery Speech Therapy Exercises for Adults” is not merely a list of techniques. It is an odyssey into understanding how each exercise is a stepping stone towards regaining not just speech but also self-confidence and independence. This journey is accentuated by the innovative approach of online speech therapy, a modality that brings the expertise of speech-language pathologists to the comfort of one’s home, breaking barriers of distance and accessibility.

As we unfold this guide, remember, the path to recovery is not just about regaining what was lost but about embracing new ways to reconnect with oneself and the world. Let’s embark on this journey together, understanding how the right words, exercises, and guidance can turn the tide in stroke recovery.

Table of Contents

Understanding Stroke and Its Impact on Speech and Language

Defining stroke and its types.

A stroke occurs when blood flow to a part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. This event can have a profound impact on various functions, including speech and language. Broadly, strokes can be classified into two types: ischemic and hemorrhagic. Ischemic strokes, the more common variety, are caused by blockages in the blood vessels leading to the brain. Hemorrhagic strokes, on the other hand, occur when a blood vessel in the brain bursts. The type of stroke not only dictates the immediate medical response but also influences the rehabilitation approach, including speech therapy.

Recognizing Stroke Signs and Symptoms

The immediate signs of a stroke are often physical, such as weakness on one side of the body or a sudden, severe headache. However, what is less commonly discussed are the subtler, yet equally debilitating symptoms that affect speech and language. These symptoms can include difficulty in finding the right words, problems in understanding spoken language, slurred speech, or even complete loss of the ability to speak. Interestingly, the specific speech and language problems a person experiences depend largely on the area of the brain affected by the stroke.

In the realm of speech and language pathology, we recognize that the effects of a stroke on communication are more than just clinical symptoms; they represent a profound change in the individual’s ability to interact with the world. For instance, a person who was once a brilliant storyteller may now struggle to string sentences together, profoundly impacting their sense of self and emotional well-being. This aspect of stroke recovery is often overshadowed by the more visible physical impairments but is equally critical.

In fact, the impact of a stroke on communication can extend beyond speech and language. It can affect cognitive aspects such as memory, attention, and problem-solving skills. These cognitive challenges often intersect with language difficulties, creating a complex web of issues that need to be addressed holistically in therapy.

Given the multifaceted nature of speech and language impairments post-stroke, it becomes evident that a one-size-fits-all approach to therapy is inadequate. Instead, a nuanced, personalized approach that caters to the specific needs and strengths of each individual is essential. This is where the expertise of speech-language pathologists comes into play, devising tailored strategies that not only aid in regaining speech and language skills but also help rebuild confidence and identity.

Speech Therapy After Stroke: An Overview

The journey of speech therapy following a stroke is both challenging and transformative. As highlighted in the Mayo Clinic article “Speech therapy after a stroke” by Liza Torborg, the path to regaining speech can be fraught with difficulties, but with the right approach, it can lead to significant improvements. This section explores the nuances of speech therapy post-stroke, revealing facets that are seldom discussed but are crucial for a comprehensive understanding of the process.

The Role of Speech-Language Pathologists

Speech-language pathologists (SLPs) are the architects of the recovery process in post-stroke speech therapy. They conduct thorough assessments to understand the specific nature and extent of speech impairment, which can vary significantly depending on the stroke’s location and severity. An SLP’s role extends beyond just administering exercises; they are often a source of emotional support and guidance, helping patients navigate the complexities of their condition. The relationship between an SLP and their client is not just professional but deeply personal, as they become partners in the journey of reclamation of the client’s voice and identity.

Goals and Benefits of Speech Therapy

The goals of speech therapy after a stroke are multifaceted. Beyond improving communication skills, therapy aims to enhance the patient’s quality of life. For someone with nonfluent or Broca’s aphasia, like the woman in the Mayo Clinic article, the objective is to help her find the right words and form complete sentences, thereby reducing her frustration and elevating her confidence. The benefits of speech therapy extend into social and emotional realms as well; by improving communication abilities, patients are less likely to experience the isolation and depression that can accompany post-stroke aphasia.

Tailoring Therapy to Individual Needs

Every stroke survivor’s journey with speech impairment is unique, necessitating a personalized approach to therapy. SLPs use a variety of techniques tailored to individual needs. These may include traditional speech exercises, engaging in conversation practice, using assistive technology like computer programs and mobile apps, and even participating in group therapy sessions. The choice of technique is not arbitrary; it is a carefully considered decision based on the patient’s specific challenges and strengths.

The Power of Technology in Speech Therapy

In recent years, the field of speech therapy has been revolutionized by the advent of technology. Tools such as speech therapy apps and online platforms have become integral in providing innovative and flexible treatment options. These technologies not only offer new ways to practice and improve language skills but also add an element of convenience and accessibility to the therapy process, especially beneficial for those who may have mobility issues post-stroke.

Involving Family and Friends in the Recovery Process

As the Mayo Clinic article stresses, the role of family and friends in the recovery process is invaluable. A supportive environment where patients can practice communication skills without fear of judgment or impatience can significantly enhance the effectiveness of therapy. Loved ones can also assist by ensuring a distraction-free environment during exercises and therapy sessions, thereby facilitating better focus and progress.

Speech therapy after a stroke is not just a clinical intervention; it’s a journey of rediscovery and adaptation. Through personalized strategies, the use of innovative tools, and the support of family and friends, speech therapy can open doors to improved communication and a better quality of life for stroke survivors.

12 Best Speech Therapy Exercises for Stroke Recovery

Embarking on the journey of speech recovery after a stroke involves a variety of exercises, each tailored to address specific aspects of speech and language impairment. We at American Online Speech Therapy worked together to find our top 12 exercises for stroke recovery. These exercises are not just about regaining lost abilities; they are about re-establishing confidence, identity, and the joy of communication. Here, we explore 12 impactful speech therapy exercises, focusing on their unique contributions to the recovery process.

Aphasia Therapy Techniques

• Picture Description : This exercise involves showing pictures and asking the patient to describe them in detail. It stimulates cognitive processes and encourages the formulation of sentences and narratives.
• Naming Therapy : Patients are shown objects and asked to name them. This helps in rebuilding word retrieval abilities and enhancing vocabulary.
• Responsive Yes/No Questions : Engaging in simple yes/no questions improves understanding and processing of speech, aiding in decision-making and response formulation.

Cognitive and Memory Enhancing Exercises

• Memory Recall Tasks : Activities like remembering lists or story details help in enhancing memory, an essential component often affected by strokes.
• Problem-Solving Activities : Engaging in tasks that require solving puzzles or finding solutions to presented scenarios. This enhances cognitive flexibility and reasoning skills.
• Sequencing Tasks : Arranging events or steps in a logical order aids in cognitive organization and speech planning.

Motor Speech Exercises

• Oral Motor Exercises : These exercises, involving the movement of the mouth, tongue, and facial muscles, help in improving articulation and speech clarity.
• Breath Control Exercises : Controlled breathing is vital for speech. These exercises focus on regulating breath to improve speech fluency.
• Sound Repetition and Articulation Practice : Repeating sounds, words, and eventually sentences, helps in regaining speech rhythm and clarity.

Technology-aided Exercises: Apps and Online Tools

• Speech Therapy Apps : Utilizing apps designed for speech therapy provides interactive and engaging ways for patients to practice language skills.
• Video Conferencing for Real-Time Feedback : Using platforms like Zoom for sessions with speech therapists allows for immediate feedback and adjustment in exercises.
• Interactive Online Games and Activities : Engaging in online games that require linguistic skills can be both entertaining and therapeutic, enhancing various aspects of language.

These exercises represent a holistic approach to speech therapy post-stroke, addressing the intricate interplay between language, cognition, and motor skills. They are not just about practicing speech but about re-engaging with the world in meaningful ways. Each exercise offers a unique benefit, and when combined, they create a comprehensive therapy regimen that can significantly enhance recovery outcomes. The inclusion of technology-aided exercises also reflects the evolving landscape of speech therapy, where traditional methods are supported and enhanced by digital innovations, making therapy more accessible and engaging.

The Advantages of Online Speech Therapy

In the ever-evolving landscape of healthcare, online speech therapy has emerged as a beacon of innovation, offering unique advantages that extend beyond the realms of traditional therapy settings. This mode of therapy is not just a response to logistical challenges; it represents a new frontier in personalized, patient-centered care, particularly for stroke survivors grappling with speech and language disorders.

Comparing Online and Traditional Therapy

The most evident advantage of online speech therapy lies in its accessibility. Traditional therapy often requires travel to a clinic, which can be a significant barrier for stroke survivors dealing with mobility issues or those living in remote areas. Online therapy, on the other hand, brings the expertise of qualified speech-language pathologists directly into the homes of patients. This ease of access is not just a matter of convenience; it ensures continuity of care, which is crucial for steady progress in speech recovery.

Personalizing Therapy with Passion-Based Approaches

Another unique aspect of online speech therapy is its capacity for customization. In a virtual setting, therapists can seamlessly integrate a patient’s interests and passions into the therapy sessions. For instance, if a patient is passionate about cooking, the therapist can tailor activities around culinary vocabulary or kitchen-based scenarios. This passion-based approach makes therapy sessions more engaging and relevant to the patient’s life, fostering motivation and active participation.

Embracing Technology for Enhanced Therapy

Online speech therapy also allows for the integration of various technological tools that can enhance the therapeutic experience. From interactive apps that offer practice exercises to software that helps in tracking progress, these tools add a dynamic component to therapy. They not only provide variety but also enable patients to practice independently, empowering them to take an active role in their recovery journey.

Creating a Comfortable and Familiar Environment

Receiving therapy in the comfort of one’s own home creates an environment of familiarity and comfort, which can significantly reduce anxiety and stress often associated with clinical settings. This comfort can lead to more relaxed and productive sessions, as patients feel secure in their surroundings.

Facilitating Family Involvement

Online therapy also offers an unprecedented opportunity for family involvement. Family members can easily join sessions, understand the therapy process, and learn ways to support their loved ones in daily practice. This inclusive approach not only strengthens the support system for the patient but also fosters a deeper understanding among family members about the challenges and triumphs of speech recovery.

Online speech therapy, with its blend of accessibility, personalization, technological integration, comfort, and family involvement, presents a compelling alternative to traditional therapy methods. It aligns with the modern-day needs of stroke survivors, offering them not just a service, but a tailored pathway to regain their voice and confidence.

Integrating Speech Therapy into Daily Life

The true essence of speech therapy for stroke survivors lies not only in structured therapy sessions but also in its integration into the fabric of daily life. Making speech therapy a part of everyday activities not only enhances the effectiveness of the therapy but also empowers individuals to reclaim their independence and confidence in real-world settings. This integration, often overlooked in traditional approaches, is crucial for long-term success and satisfaction.

Practical Tips for Everyday Practice

One of the key strategies for integrating speech therapy into daily life is through the incorporation of simple yet effective exercises into routine activities. For example, reading aloud from a favorite book or newspaper each day can significantly improve reading comprehension and speech fluency. Similarly, practicing naming household objects during daily chores can aid in word retrieval and cognitive association. These activities, though seemingly mundane, provide valuable opportunities for consistent practice and reinforcement of skills learned in therapy sessions.

Incorporating Speech Therapy into Social Interactions

Social interactions provide a rich environment for practicing communication skills. Encouraging stroke survivors to engage in conversations, whether it’s a chat with a neighbor or a video call with a family member, can greatly enhance their speech and language abilities. These interactions not only provide a practical application of therapy exercises but also help in rebuilding social confidence. The key is to create a supportive environment where the individual feels comfortable expressing themselves without fear of judgment or pressure.

Utilizing Technology as a Daily Aid

In our digital age, technology can be a powerful ally in speech therapy. Utilizing speech therapy apps for daily practice can provide stroke survivors with immediate feedback and a fun, interactive way to hone their skills. Setting aside a dedicated time each day to engage with these apps can create a structured routine that fosters consistent progress.

Family and Caregiver Involvement

Involving family members and caregivers in daily therapy practice is invaluable. They can play a role in setting up daily exercises, providing encouragement, and even participating in activities that promote speech and language skills. This collaborative approach not only supports the individual’s therapy goals but also strengthens family bonds and understanding.

Building a Routine

Establishing a routine is essential for integrating speech therapy into daily life. Consistency is key; setting aside specific times each day for therapy exercises can help in forming a habit. This routine should be flexible enough to adapt to the individual’s energy levels and other commitments, ensuring that it is sustainable in the long term.

Integrating speech therapy into daily life is a journey of small steps leading to significant strides in recovery. By weaving therapy exercises into everyday activities, utilizing technology, involving family, and establishing a routine, stroke survivors can make continuous progress towards regaining their communication skills and independence.

Understanding the Long-Term Journey of Stroke Recovery

The path to recovery following a stroke is often long and winding, marked by gradual progress and, sometimes, challenging setbacks. It’s a journey that extends far beyond the physical dimensions of rehabilitation, encompassing emotional, cognitive, and social aspects. Recognizing and embracing the long-term nature of stroke recovery is crucial for setting realistic expectations and cultivating a resilient mindset.

Managing Expectations and Setting Realistic Goals

One of the lesser-discussed aspects of stroke recovery is the importance of managing expectations. The recovery process is typically nonlinear, with improvements happening incrementally. It’s essential for stroke survivors and their caregivers to understand that while significant progress can be made, it may not always align with preconceived timelines. Setting realistic, achievable goals plays a pivotal role in maintaining motivation and a positive outlook. These goals should be tailored to the individual’s specific situation, taking into account the severity of the stroke, the areas of speech and language affected, and the person’s overall health and lifestyle.

Embracing a Holistic Approach to Recovery

A holistic approach to stroke recovery, one that addresses not just physical and linguistic abilities but also emotional and psychological well-being, is vital. Encouraging activities that foster mental health, such as mindfulness practices or engaging in hobbies, can significantly contribute to overall recovery. Moreover, acknowledging and addressing the emotional impact of a stroke – feelings of frustration, loss, or changes in identity – is as important as the physical aspects of rehabilitation.

The Role of Support Systems

The support of family, friends, and healthcare professionals plays a critical role in the long-term journey of stroke recovery. A robust support system provides not just practical help but also emotional encouragement, which can be a significant factor in a patient’s progress. Engaging in support groups or communities of other stroke survivors can offer additional perspectives, shared experiences, and a sense of camaraderie that can be immensely beneficial.

Adapting to a New Normal

For many stroke survivors, recovery also involves adapting to a new normal. This might mean finding new ways to communicate, altering daily routines, or adopting new tools and technologies to aid in daily living. Flexibility and adaptability become key virtues in this journey, helping individuals find new ways to enjoy life and engage with their environment.

Understanding the long-term journey of stroke recovery requires a shift in perspective, from viewing recovery as a destination to embracing it as an ongoing process. It’s a journey characterized by patience, perseverance, and adaptability, with each step forward marking a victory in its own right. By managing expectations, embracing a holistic approach, leveraging support systems, and adapting to new realities, stroke survivors can navigate this path with resilience and hope.

As we draw this exploration of speech therapy for stroke recovery to a close, it’s important to reflect on the journey we’ve navigated. From understanding the impact of a stroke on speech and language to delving into the nuances of online speech therapy, our aim has been to offer insights that are both enlightening and empowering. This journey isn’t just about regaining lost skills; it’s about rediscovering one’s voice and reclaiming a sense of self in the post-stroke world.

The path to recovery following a stroke is as personal as it is challenging. It requires not only the guidance of skilled speech-language pathologists but also the resilience and dedication of the individual. Every exercise, whether it’s a traditional speech drill or an innovative online tool, is a step towards rebuilding communication pathways that were once seamless. The integration of therapy into daily life further ensures that these steps are not just strides in therapy sessions but also leaps in real-world scenarios.

Embracing the long-term nature of this journey is essential. Recovery doesn’t adhere to a strict timeline; it ebbs and flows, presenting both triumphs and trials. This journey is as much about cultivating patience and maintaining a positive outlook as it is about practicing speech exercises. The role of family and friends in providing unwavering support and understanding cannot be overstated. Their involvement often becomes the backbone of sustained progress and emotional well-being.

As we conclude, let us acknowledge that the journey of stroke recovery is not just about overcoming a medical condition. It’s a journey of adaptation, resilience, and reconnection. It’s about finding new ways to express oneself, engage in meaningful conversations, and enjoy the richness of life’s tapestry. In this journey, every word spoken and every sentence formed is not just a display of regained ability but a testament to the indomitable human spirit.

May this guide serve as a beacon of hope and a source of practical knowledge for those navigating the complex waters of stroke recovery. Remember, in the realm of speech and language, every small step counts, and every effort made is a victory in its own right.

Seth Koster M.S. CCC-SLP

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Speech Therapy After Stroke and Tips on What You Can Do at Home

Recovering from a stroke is a dynamic, and often challenging process. While rehabilitation after a stroke can help people get back some or all of their skills over time, numerous factors play a part in that recovery. Repetition, practice, and support from family, friends, and caregivers are all important. Speech therapy for adults at home after a stroke can also aid in that recovery.

Speech therapists specialize in communication, but caregivers play a huge role in helping their loved ones who are trying to regain their skills in speech therapy for adults. Better Speech online speech-language pathologists collaborate with both the patient and the caregivers, from the beginning to the end of the speech therapy for adults, to help recovery happen as quickly as possible.

In this article we will discuss:

How Speech is Affected by a Stroke?

Aphasia after a stroke may require specialized therapy, helping your loved one at home after a stroke, how do i find speech therapy at home after a stroke.

Every patient is affected by a stroke differently and has needs and requirements that are unique to their own life. The type of language impairment from a stroke depends on which part of the brain has been affected by the stroke. The most common impairments include the three below:

Speech motor skills (apraxia, dysarthria)

Language – the ability to understand or produce language (aphasia)

Thinking and memory

Regain social and communication skills after a stroke

At times, a combination of two, or even all three of these problems, can be evident. We can further breakdown and understand how a stroke can affect these three primary areas of communication in the following way:

1. Speech Motor Skills .

Apraxia of speech. When someone is suffering from Apraxia of Speech, they often report knowing what they want to say, but have trouble getting the words out entirely. They might experience a challenge in making or maintaining all the sounds and syllables in those words. Sometimes a different word comes than what was intended. This can happen when the speaking skills of word retrieval and word finding are impaired.

2. Dysarthria.

If a patient has experienced paralysis or paresis in the face, this can result in a weakness in the facial muscles. This can result in speech often coming out slurry, and unclear, resulting in the need for dysarthria treatment . There are several types of treatments for dysarthria due to there being several different types of dysarthria itself (i.e., ataxic dysarthria treatment , hypokinetic dysarthria treatment, etc.)

2. Language

Aphasia. Those who have aphasia may have trouble organizing thoughts into sentences. Producing a clear and understandable narrative also becomes more challenging. In these cases, patients often require reminders to slow down, and take their time to organize their thoughts . See more on Aphasia below.

A stroke usually affects short-term memory more often than long-term. Patients are able to recall events that took place many years ago but forget more recent events.

Short-term memory loss. A stroke usually affects short-term memory more often than long-term. Patients are able to recall events that took place many years ago but forget more recent events.

Working memory. In this case, it’s not a specific memory of an event that is impacted, but, rather, patients may forget how to problem-solve, organize their environments, or recall important information within their routines.

Damage to the brain due to a stroke is not limited to these areas, but these are common impairments that speech-language pathologists treat.

Stroke survivors often experience Aphasia, which affects a range of skills that are closely related to communication.

As mentioned above, Aphasia is what results when the language component of the brain is affected by the stroke. When someone is diagnosed with Aphasia, their communication, not intelligence , is impacted.

It is very important to remember that even though patients experience Aphasias, their condition does not affect their cognition or intelligence. Patients often report that they have the words in their mind and they know what they want to say but they can’t get the words out the way they used to before the stroke.

“When someone is diagnosed with Aphasia, their communication, not intelligence , is impacted.”

Something that many people are surprised by is that it’s not only speech that can be impacted by a stroke, but all types of language-based communication, including reading, listening, or speaking, or any combination. The ability to read and write may, or may not, be affected. This is part of what makes speech therapy after a stroke so important.

Vocabulary and the meaning of concepts is usually not affected. Aphasia impacts the ability to get specific words out in a clear and concise manner.

After a stroke, the patient’s abilities usually evolve and change rapidly, which may feel exciting but unpredictable. Every step of the way within the treatment process brings great improvements and challenges. In the speech and language therapy process, patience works hand in hand with determination and understanding.

“It’s not only speech that can be impacted by a stroke, but all types of language-based communication, including reading, listening, or speaking.”

Better Speech therapists can provide special therapy specifically tailored to patients experiencing Aphasia after a stroke, to help them be able to express their thoughts and communicate with their loved ones.

Here’s a testimonial from one of our clients:

“[My speech therapist’s] expertise was obvious from the first session, but just as important as her ability to coach me through increasingly difficult exercises was her kindness and sense of humor. She was always patient and pleasant, and has helped me more than I thought possible. Great experience.”

The home environment, and every day routines, can offer an amplitude of opportunities to facilitate speech, language, and memory recovery .

As caregivers, we may have a difficult time understanding what a person who has survived a stroke is feeling and experiencing. Fortunately, many stroke survivors have provided invaluable feedback over the years that can aid therapists and caregivers within the therapy process. Speech therapy for stroke patients is full of diverse approaches for every individual.

Here are some of those suggestions about interacting after a stroke:

Look at the person directly when talking to them.

Speak in a normal tone, slowly, and clearly.

Try communicating by writing. Have a portable white board for you both to use, if they are able to write.

Tell the person you understand that they might be frustrated.

Make sure to minimize noise in the background.

Relate to the person by their hobbies and interests.

Use short sentences that are about 1 topic at a time.

Give the person a chance to communicate. Let them take their time and don’t finish their sentences.

Remember that aphasia doesn’t affect intelligence, so be careful that you are speaking with respect.

As speech therapists, we try to encourage adults who have suffered from a stroke to engage in speech, language, and memory-based activities at home with their caregivers with speech therapy for adults After all, no matter how many hours of speech and language therapy someone attends, it’s never as much time as they spend at home with their loved ones. This is partly why stroke speech therapy is so diverse in its approaches.

“Some clients who can’t speak after a stroke can still belt out their favorite song because singing abilities are located in a different part of the brain than language.”

Here are some of the home activities that we like to recommend for our clients:

Play a favorite card game, or board game – Playing a game with strategy stimulates important cognitive processes. And cognitive treatment is a huge part of speech therapy . Review the names or what is written on the cards. Also review the rules, steps, and problem-solving strategies involved in the game.

Play music and sing songs – Surprisingly, some clients who can’t speak after a stroke can still belt out their favorite song. These people can end up singing with more ease, since the singing abilities are located in a different part of the brain than language. Find out what their favorite music is, and sing along. You can even try “Happy Birthday.” Play games, such as guessing the title of a song that is on the radio, or even your own version of “Name That Tune,” if possible.

Discuss hobbies – Look at pictures or read magazines about the person’s hobbies. Gardening, favorite game shows, sports, or cooking. If someone is passionate about a certain topic, they are more likely to want to make an effort to talk about it.

Look at a family album – Seeing photos of loved ones from the past helps stimulate memory. You can name family members, or talk about events. Remember that some people will become emotional looking at these photos, so be mindful.

Go through documents and memorabilia – Take a look at the important objects and paperwork from the person’s life. Discuss items that carry great significance such as trophies, framed pictures, other awards, souvenirs, and nicknacks from vacations. Review important documents such as bills, letters, and notes.

Recall the sequences to events – Review the steps to daily and other common routines. Also go over events that have happened a few days or weeks prior. Recall the steps and ingredients to favorite recipes and make them together!

Discuss favorite shows – Name the title of favorite shows and discuss them. Review the names of characters, the plot of the show, and the patient’s opinions.

Write thoughts down on white board or journal – Patients who retain their ability to write, benefit greatly from journal writing, or having a mobile white board. They can quickly tell their caregivers their thoughts and needs, which reduces miscommunication and frustration.

Read out loud – Practice reading your favorite books and journals out loud to further practice word pronunciation, organizational skills, and the rhythmic patterns of speech.

Many people who have suffered a stroke and need help with their communication skills due to aphasia end up finishing treatment at a hospital, go home, and don’t do any more work to continue to increase their language skills. This isn’t because they don’t want to work on their ability to understand or produce language.

Often many people have a hard time finding a speech and language therapist that is qualified to treat people with aphasia. Or if they do find one, the therapist is far away and finding someone to drive regularly to visits is very difficult.

But what if you or your loved one could stay home and still get speech therapy? There are some therapists that will travel to you but now there is a new type of service. It’s called teletherapy. That’s when speech therapy is done via a computer video feed. It’s just like Skype or FaceTime, which many people know about since they’ve done it with family members.

Teletherapy can help Adults after stroke

Teletherapy helps connect people with aphasia and therapists for an evaluation or treatment of any kind. There are very little technical requirements. Just a computer or tablet, an internet connection and a quiet space. You can stay sitting in your favorite chair, schedule a session right after breakfast or book a session while on vacation.

People that want to continue treatment can stay in the comfort of their own home rather than traveling, which is sometimes very difficult after a stroke. There is also no travel time and some therapists even have support groups online.

Create Simple Goals and Milestones, then Celebrate Achievements

In our online sessions of speech therapy for adults, we look to establish functional and reasonable goals that suit the client’s needs and values. We organize our goals in terms of priority and gradually expand on the activities as the patient’s skills start to return and recover. We look at what areas will need to be modified temporarily or long-term.

The recovery process is truly a collaborative endeavor that circles around your loved one, involving different therapies, specialists, medical practitioners, friends, and familial caregivers. As speech-language pathologists, we want to provide the path back to communication, and the human interaction that is so important for recovery via online sessions of speech therapy for adults. This can be speech and swallowing therapy following a stroke!

At Better Speech, we offer online speech therapy services convenient for you and tailored to your child's individual needs. Our services are affordable and effective - get Better Speech now.

Frequently Asked Questions

What is stroke speech therapy?

Stroke speech therapy helps individuals with communication and swallowing difficulties during stroke recovery. Stroke speech therapy is dependent on the part of the brain in which the stroke occurred as well as what deficits have followed the stroke. Some individuals might have difficulty producing/understanding language, others may struggle with motor planning or swallowing. Speech therapy for swallowing is one of the most common, next to language.

How does stroke speech therapy work?

What are the benefits of stroke speech therapy?

What should I expect during stroke speech therapy?

How long does stroke speech therapy usually last?

How often should stroke patients have speech therapy?

What are some common goals of speech therapy for stroke patients?

About the Author

Svetlana Atenzon

With over 10 years of professional experience, I have been working with children and adults of all ages throughout my career. I have worked in a variety of settings such as home care, clinics, schools, and now teletherapy. I have worked with clients who had articulation disorders, language disorders, cognitive impairments, developmental delays, Autism, literacy delays, Apraxia, Dyslexia, fluency disorders, Down Syndrome, Traumatic Brain Injury, Cerebral Palsy, Parkinson’s Disease, Multiple Sclerosis, Progressive Degenerative Disorders, Aphasia, and much more. I also work with clients seeking Accent Reduction services.

When I am not helping others through my role as a licensed speech-language pathologist, I enjoy doing Yoga, listening to music, reading stories, and making art, especially when I can later incorporate those elements in my therapy.

• Aphasia Speech Therapy
• Apraxia Speech Therapy

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Most Popular Speech Therapy Exercises for Stroke Patients

Strokes or cerebrovascular accidents (CVA) can affect and damage one or more portions of the brain. Someone who has experienced a left-brain stroke may experience communication problems. Speech therapy exercises for stroke patients help overcome these communication challenges.

Some of the more common communication problems left-brain stroke survivors may face are –

• Difficulties in understanding language (receptive abilities)
• Trouble speaking (expressive abilities)
• The problem of producing spoken language or aphasia is quite common among stroke survivors.
• They may also experience dysarthria or weakness in the muscles of the face and mouth. It can cause slurred and unintelligible speech.

Before we go into the speech therapy techniques for stroke patients, let us understand the basics. As a caregiver, guardian, or significant other of someone who has suffered a stroke, you should be –

• Ask fewer open-ended questions
• Ask simpler questions that can be answered with "yes" or "no"
• Speak at a natural pace and normal volume
• Don’t rush the person to respond
• Keep the directions, requests, and commands simple
• Allow them time to process the information you are providing
• Do not answer for them or interrupt them

Most left-brain stroke survivors have problems with speech production along with paralysis of their right side. Studies show that exercises are effective in restoring speech production. The effectiveness of these exercises will depend upon how frequently one is doing them as well as the extent of damage due to the stroke.

Here are the 10 best speech therapy exercises for stroke patients that one can do at home –

1. Breathing Exercises for Stroke Patients

One of the most common signs of speech impairment in stroke patients is the inability to coordinate breathing while speaking. It can cause people to breathe in the middle of sentences. Gasping or pausing for breath in the middle of a sentence is quite common among stroke patients.

Breathing exercises can help you control and coordinate your breathing while talking. Ideally, a stroke patient can practice breathing exercises at least twice a day.

How a stroke patient can practice the breathing exercise:

• Inhale for 4 seconds
• Hold your breath for 4 seconds
• Exhale your breath for 4 seconds
• Hold for 4 seconds

Practice this exercise at least 10 -times in the morning and evening. Breathing exercises will strengthen your diaphragm. It will help you remain calm. Working on your breathing will allow you to automatically regulate breathing and speaking.

2. Tongue In-And-Out Exercises

The tongue-in-and-out exercise is simple and fun!

How to do tongue in-and-out exercise at home:

• Stick your tongue out.
• Hold it in place for 2 seconds.
• Pull it back and hold for 2 seconds.

Keep repeating this 10-times at a go. This exercise for stroke patients can help retrain the tongue to move effectively, as necessary, for speech production.

3. Tongue Up-And-Down Exercises

Treat this as an extension of the tongue in-and-out exercise. You can mix these two up, once you are confident about your tongue movements.

Steps to practice tongue up-and-down exercise:

• Stick your tongue out and try to lick the tip of your nose. We know it’s impossible for the majority of the population, but that’s part of the exercise.
• Hold your tongue stretched upwards for 2 seconds.
• Next, try to lick your chin.
• Hold your tongue there for 2 seconds.
• Bright it back inside and rest for 2 seconds.

Repeat the entire set 10 times, twice a day.

4. Tongue Movement (Side-To-Side) Exercise

Before moving on to more complicated exercises for people who have suffered strokes and are now facing communication challenges, let’s do the final set of tongue movement exercises.

Follow these steps for tongue movement (side-to-side) exercise:

• Stick your tongue out and try to lick your right cheek.
• Hold it there for 2 seconds.
• Bring it back in for 2 seconds.
• Stick your tongue out again and try to lick your left cheek. Hold it for 2 seconds.
• Bring it and rest for 2 seconds.

Now, repeat this set 10 times, twice a day.

5. Practice Smiling

It's better to use a mirror or selfie camera for this exercise. It is a simple speech therapy exercise that helps improve oral motor skills.

How to practice smiling:

• Stand in front of the mirror or camera and smile.
• Stretch the corners of your mouth as much as possible.
• Hold for 2 seconds.
• Then, relax.

Keep doing this for as long as you can. The mirror provides feedback that is important for tracking progress.

6. Practicing Kissy Face

Once you have finished the smiling practice, it’s time to practice your kissy face.

Steps to practice kissy face exercise for stroke patients:

• Pucker your lips like you would, to blow a kiss.

Repeat as many times and as often as you can. This simple exercise strengthens the muscles of your mouth and cheeks. Repeating the “kissy face” exercise will bring coordination to your facial muscles that are needed for speech production.

7. Repeating Consonants and Vowels

Now that you are a master of the simple exercises, let's try doing an exercise that's a bit more complex.

Post stroke, you may have trouble saying particular consonants. Some people find saying the /r/ sounds difficult, while others may find saying the /t/ sounds troublesome.

So, let's pair the /r/ sound with vowel sounds. For example, instead of saying /r/, try saying "ra, re, ri, ro, ru."

It may sound silly, but it will help you overcome the anxiety and blocks that /r/ sounds currently induce. Similarly, pair the vowel sounds of a, e, i, o, and u with other consonants that trouble you.

Stroke patients can repeat this speech therapy exercise 10-times daily..

8. Production of Complete Sentences

If you have apraxia or dysarthria you probably have no trouble understanding language. However, you struggle when it's time for you to talk.

So, begin with small sentences. Pick out a book that was your favorite as a child. Read one or two sentences from the book in the morning and evening. Remember to breathe before and after every punctuation.

It can be incredibly frustrating in the beginning. You may want to talk to a speech therapist or speech-language pathologist (SLP) if you have symptoms of moderate to severe aphasia .

9. Playing Word Association Games

Playing word games is a fun way to connect with people around you and exercise your brain. Simple games like word searches, Pictionary, 20-questions, or word association improve your cognition as well as language processing skills.

If you want to play alone, try games like crossword puzzles online or Words with Friends.

Playing these super fun games daily, will improve your vocabulary, language processing, and speech production.

10. Naming Pictures (Picture Cards)

You can play with your family or simply work with your friend or spouse to name objects on picture cards.

You can turn this exercise into a guessing game, taking turns with your partner to guess the object or name of animals on the picture cards from their descriptions.

Just like word association games, this exercise for stroke patients focuses on cognitive and speech production skills.

Consult a Licensed Speech Therapist for Post-Stroke Speech Recovery

Finally, doing these exercises by yourself every day can become boring. It happens when you are not receiving any progress report or feedback. You may also end up doing them wrong.

You can opt for online speech therapy if you or someone you love has suffered a stroke and is now experiencing mild to severe communication difficulties.

Stamurai matches you with the best speech therapists who have experience in working with stroke patients. A licensed speech therapist with relevant experience can identify the problem areas and create a custom therapy plan for most effective post-stroke speech recovery.

Remember - a stroke or CVA is a serious matter. You should speak to your healthcare provider if you are experiencing a stroke or stroke-like symptoms.

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Stroke rehabilitation: what to expect as you recover.

Stroke rehabilitation is an important part of recovery after stroke. Find out what's involved in stroke rehabilitation.

Stroke rehabilitation is a program of different therapies designed to help you relearn skills lost after a stroke. Rehabilitation methods can depend on the parts of your brain affected by the stroke. Rehabilitation can help with movement, speech, strength and daily living skills. Stroke rehabilitation can help you regain independence and improve your quality of life.

There's a wide range of complications from stroke. There also is a wide range in how well each person recovers afterward. Researchers have found that people who participate in a focused stroke rehabilitation program perform better than most people who don't have stroke rehabilitation. Therefore, stroke rehabilitation is recommended for all people affected by stroke.

What's involved in stroke rehabilitation?

There are many approaches to helping people recover from stroke. But overall, rehabilitation is centered around specifically focused and repetitive actions. This involves practicing the same thing over and over again. Your rehabilitation plan will depend on the part of the body or type of ability affected by your stroke.

Physical activities might include:

• Motor-skill exercises. Exercises can help improve muscle strength and coordination throughout the body. These can include muscles used for balance, walking and even swallowing.
• Mobility training. You might learn to use mobility aids, such as a walker, cane, wheelchair or ankle brace. The ankle brace can stabilize and strengthen your ankle to help support your body's weight while you relearn to walk.
• Constraint-induced therapy. An unaffected limb is restrained while you practice moving the affected limb to help improve its function. This therapy is sometimes called forced-use therapy.
• Range-of-motion therapy. Certain exercises and treatments can ease muscle tension, known as spasticity, and help you regain range of motion.

Technology-assisted physical activities might include:

• Functional electrical stimulation. Electricity is applied to weakened muscles, causing them to contract. The electrical stimulation may help retrain your muscles.
• Robotic technology. Robotic devices can assist impaired limbs with performing repetitive motions. This can help the limbs regain strength and function.
• Wireless technology. An activity monitor might help you increase post-stroke activity.
• Virtual reality. The use of video games and other computer-based therapies involves interacting with a simulated, real-time environment.

Cognitive and emotional activities might include:

• Therapy for cognitive symptoms. Occupational therapy and speech therapy can help you with lost cognitive abilities. These abilities may include memory, processing, problem-solving, social skills, judgment and safety awareness.
• Therapy to help communication. Speech therapy can help you regain lost abilities in speaking, listening, writing and comprehension.
• Psychological evaluation and treatment. Your emotional adjustment might be tested. You also might have counseling or participate in a support group.
• Medicine. Your healthcare professional might recommend an antidepressant or a medicine that affects alertness, agitation or movement.

Therapies that are still being investigated include:

• Noninvasive brain stimulation. Techniques such as transcranial magnetic stimulation have been used with some success in research to help improve a variety of motor skills.
• Biological therapies, such as stem cells, are being investigated, but should only be used as part of a clinical trial.
• Alternative medicine. Treatments such as massage, herbal therapy and acupuncture are being evaluated.

When should stroke rehabilitation begin?

The sooner you begin stroke rehabilitation, the more likely you are to regain lost abilities and skills. It's common for stroke rehabilitation to start as soon as 24 to 48 hours after your stroke, while you're in the hospital.

How long does stroke rehabilitation last?

How long you need stroke rehabilitation depends on the severity of your stroke and related complications. Some stroke survivors recover quickly. But most need some form of long-term stroke rehabilitation. This could last for possibly months or years after a stroke.

Your stroke rehabilitation plan changes during your recovery as you relearn skills and your needs change. With ongoing practice, you can continue to make gains over time.

Where does stroke rehabilitation take place?

You'll probably begin stroke rehabilitation while you're still in the hospital. Before you leave, you and your family will work with hospital social workers and your care team to determine the best rehabilitation setting. Factors to consider include your needs, what insurance will cover, and what is most convenient for you and your family.

The options include:

• Inpatient rehabilitation units. These facilities are either freestanding or part of a larger hospital or clinic. You may stay at the facility for up to 2 to 3 weeks as part of an intensive rehabilitation program.
• Outpatient units. These facilities are often part of a hospital or clinic. You may spend a few hours at the facility a couple of days a week.
• Skilled nursing facilities. The type of care available at a nursing facility varies. Some facilities specialize in rehabilitation, while others offer less-intense therapy options.
• Home-based programs. Having your therapy at home allows greater flexibility than other options. But you likely won't have access to specialized rehabilitation equipment. Insurance coverage for home-based programs varies widely.

Talk to your healthcare team and family about the best option for you.

Who participates in your stroke rehabilitation team?

Stroke rehabilitation involves a variety of specialists.

Specialists who can help with physical needs include:

• Doctors. Your primary care doctor, neurologists and specialists in physical medicine and rehabilitation can guide your care and help prevent complications. These doctors also can help you achieve and maintain a healthy lifestyle to avoid another stroke.
• Rehabilitation nurses. Nurses who specialize in caring for people with limitations with activities can help you incorporate the skills you learn into your daily routines. Rehabilitation nurses also can offer options for managing bowel and bladder complications resulting from a stroke.
• Physical therapists. These therapists help you relearn movements such as walking and keeping your balance.
• Occupational therapists. These therapists help you lead a more independent and active life. They can help you relearn skills for dressing, bathing and household chores and return to driving. Occupational therapists also can help improve your ability to swallow and your cognitive ability with home and workplace tasks and overall safety.

Specialists who focus on cognitive, emotional and vocational skills include:

• Speech and language pathologists. These specialists help improve your language skills and ability to swallow. Speech and language pathologists also can work with you to develop tools to address memory, thinking and communication problems.
• Social workers. Social workers help connect you to financial resources, plan for new living arrangements if necessary and identify community resources.
• Psychologists. These specialists assess your thinking skills and help address your mental and emotional health concerns.
• Therapeutic recreation specialists. These specialists help you resume activities and roles you enjoyed before your stroke. Activities may include hobbies and community participation.
• Vocational counselors. These specialists help you address return-to-work issues if that is one of your goals.

What factors affect the outcome of stroke rehabilitation?

Stroke recovery varies from person to person. It's hard to predict how many abilities you might recover and how soon. In general, successful stroke rehabilitation depends on:

• Physical factors, including the severity of your stroke in terms of both cognitive and physical effects.
• Emotional factors, such as your motivation, mood and your ability to stick with rehabilitation activities outside of therapy sessions.
• Social factors, such as the support of friends and family.
• Therapeutic factors, including an early start to your rehabilitation and the skill of your stroke rehabilitation team.

The rate of recovery is generally greatest in the weeks and months after a stroke. However, there is evidence that performance can improve even 12 to 18 months after a stroke.

Stroke rehabilitation takes time

Recovering from a stroke can be a long and frustrating experience with difficulties along the way. Dedication and willingness to work toward improvement will benefit you the most.

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• Jankovic J, et al., eds. Neurological rehabilitation. In: Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed Feb. 26, 2024.
• Kellerman RD, et al. Rehabilitation of the stroke patient. In: Conn's Current Therapy 2024. Elsevier; 2024. https://www.clinicalkey.com. Accessed Feb. 26, 2024.
• AskMayoExpert. Stroke rehabilitation. Mayo Clinic; 2023.
• Choi MJ, et al. Digital therapeutics: Emerging new therapy for neurologic deficits after stroke. Journal of Stroke. 2019; doi:10.5853/jos.2019.01963.
• Cunningham DA, et al. Tailoring brain stimulation to the nature of rehabilitative therapies in stroke. Physical Medicine & Rehabilitation Clinics of North America. 2015; doi: 10.1016/j.pmr.2015.07.001.
• Comparative effectiveness chart for stroke. Natural Medicines. https://naturalmedicines.therapeuticresearch.com/databases/comparative-effectiveness/condition.aspx?condition=Stroke. Accessed Feb. 26, 2024.
• Bellamkonda E (expert opinion). Mayo Clinic. March 21, 2022.
• Post-stroke rehabilitation. National Institute of Neurological Disorders and Stroke. https://catalog.ninds.nih.gov/publications/post-stroke-rehabilitation. Accessed Feb. 26, 2024.
• Hoenig H. Geriatric rehabilitation settings and reimbursement. https://www.uptodate.com/contents/search. Accessed Feb. 26, 2024.
• Hoenig H. Overview of geriatric rehabilitation: Patient assessment and common indications for rehabilitation. https://www.uptodate.com/contents/search. Accessed Feb. 26, 2024.
• Schultz BA (expert opinion). Mayo Clinic. March 21, 2022.
• Edwardson MA, et al. Overview of ischemic stroke prognosis in adults. https://www.uptodate.contents/search. Accessed Feb. 26, 2024.

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Speech Therapy For Stroke Patients: How It Works & Benefits

After a stroke, one of the most frustrating and impactful challenges that many encounter is difficulty with speech and communication. The good news is that speech therapy for stroke patients successfully retrains and restores speech, language, and cognitive skills offering hope, improvement, and a brighter future.

In this comprehensive guide, we will explore how speech therapy works for stroke patients and the numerous benefits it brings. Whether you are a stroke survivor, a family member,  care partner, or simply seeking to understand this essential aspect of stroke recovery, this article is here to educate, inform, and encourage!

Understanding Stroke-Related Speech Challenges

A stroke occurs when there is a disruption of blood flow to the brain, resulting in brain cell damage. Depending on the location and severity of the stroke, individuals can experience a variety of physical and cognitive-linguistic  injuries. Among these challenges, speech and communication difficulties are common.

The effects of stroke on language and communication  can manifest in different ways, including:

• Aphasia: Aphasia is a language disorder that can impact a person’s ability to understand, speak, read, and write. Aphasia can have a profound impact on a person’s well being as it can make it hard to express oneself or comprehend others.
• Dysarthria: Dysarthria is a motor speech disorder that affects the muscles used for speech. It can result in a variety of voice and speech symptoms including difficulties precisely articulating words, regulating vocal loudness, hoarse or strained vocal quality, and using vocal intonation. These changes can make it hard to speak clearly and be easily understood by others.
• Apraxia of Speech: Apraxia is a condition in which the brain has difficulty planning the movements required for speech. Patients know what they want to say, but their brain struggles to send the right signals to the muscles involved in speech production.

The Role of Speech Therapy

Speech therapy for stroke patients is a specialized form of rehabilitation designed to strengthen, retrain, and restore these various  speech, language, and communication challenges. It is an essential component of stroke recovery that aims to improve language and thinking skills, enhance speech clarity and voice quality , and rebuild confidence and wellbeing.

The Assessment Phase

Speech therapy programs begin with a thorough one-to-one individual evaluation conducted by a licensed speech-language pathologist (SLP). This initial evaluation serves several crucial purposes:

• Identifying Challenges: Through a series of tests, the SLP assesses the specific speech and language difficulties the patient is facing. This includes evaluating the precise symptoms and severity of aphasia, dysarthria, apraxia, or cognitive-communication challenges
• Setting Goals : Based on results of the assessment, the SLP collaborates with the patient and their care teams to establish motivating and personalized goals for therapy. These goals may include regaining the ability to have conversations, retraining reading and writing, or achieving clearer speech.
• Creating a Customized Treatment Plan: With the goals in mind, the SLP develops a tailored treatment plan with customized exercises and strategies to help patients experience a successful outcome.

The Treatment Process

Speech therapy for stroke patients involves a combination of exercises, techniques, and compensatory strategies to address a variety of speech, language,  and communication issues. While the specifics of therapy vary from person to person, there are several key components that are often part of the process.

Language Rehabilitation

For stroke survivors living with aphasia, language rehabilitation is a central focus of therapy. SLPs use various exercises to improve comprehension, word retrieval, and overall language expression for enhanced connection and communication. These exercises may involve naming drills, rehearsing personalized functional phrases required for communication in day-to-day activities, and engaging in article reading, conversation, and discussion.

Articulation and Pronunciation Practice

Dysarthria, which affects the physical aspects of speech, is addressed through exercises that improve the  strength and coordination of respiratory-phonatory (voice)- and articulatory systems. The exercises lead to improved  vocal quality, optimized vocal loudness, enhanced rate of speech and expressivity, and better articulatory clarity.

Cognitive-Communication Training

Stroke survivors with cognitive deficits related to communication benefit from cognitive communication training. This aspect of therapy helps improve memory, attention, language organization, and problem-solving skills necessary for effective communication.

Augmentative and Alternative Communication (AAC)

In cases where speech or language is severely impaired, AAC devices may be introduced. These assistive tools can range from communication boards with printed images and phrases to high-tech devices that generate speech based on user input.

Family and Care partner Involvement

Support of family and care partners in sessions is imperative to the success of rehabilitation. It helps ensure therapeutic strategies are carried over by care partners into day-to-day activities. It also helps increase confidence and accuracy performing home exercise programs which allow further opportunity for practice and retention of skills. Family and care partner involvement during speech and swallowing intervention is deemed an essential component of effective treatment so care partners may receive adequate education and training to effectively support communication strategies during the rehabilitation process.

Benefits of Speech Therapy for Stroke Patients

The benefits of   for stroke patients extend far beyond improved communication. It plays a pivotal role in enhancing overall quality of life and fostering hope, connection to oneself and the people and activities most loved, and independence. In the second half of this article, we will delve deeper into these benefits and explore real-life success stories of stroke survivors who have regained their voices and reconnected with the world.

Improved Communication

The most obvious benefit of speech therapy is the improvement in communication skills. For stroke survivors, regaining the ability to express oneself and understand others is often the key to connecting with loved ones and the world around them. Speech therapy helps individuals confidently connect with those people and activities enjoyed most in life which significantly enhances individuals sense of purpose and wellbeing.

Enhanced Quality of Life

Effective communication is at the heart of a fulfilling life. By addressing speech and language difficulties, speech therapy empowers stroke survivors to participate more actively in social activities, engage in meaningful conversations, and regain their sense of independence.

Increased Confidence

Stroke survivors often experience a loss of confidence due to communication challenges. Speech therapy provides the tools and techniques to regain control over various aspects of speech and communication and rebuild that confidence. As patients see progress and witness their ability to communicate improving, their self-esteem and self-assurance grow.

Emotional Well-Being

The emotional impact of stroke-related communication difficulties cannot be underestimated. Speech therapy not only addresses the physical aspects of speech but also provides emotional support. Patients learn coping strategies to manage aspects of stress, tension, and anxiety that accompany communication breakdowns, manage frustration, and find encouragement and compassion through their therapy journey.

Better Cognitive Function

Speech therapy isn’t limited to addressing speech alone; it also benefits cognitive function. Exercises that stimulate memory, attention, and problem-solving skills contribute to overall brain health, which is especially important for stroke survivors.

At Open Lines, we understand the unique challenges that stroke survivors face in their journey towards better communication. We are here to provide compassionate and effective speech therapy tailored to individual needs. Our team consists of licensed and superiorly trained speech-language pathologists who specialize in stroke rehabilitation. With years of clinical experience, we bring expertise, knowledge, and compassion to every therapy session.

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The role of the speech language pathologist in acute stroke

Cindy dilworth.

Royal Brisbane and Women's Hospital, Rural Stroke Outreach Service and Speech Pathology Department, Royal Brisbane and Women's Hospital, Queensland, Australia

Dysphagia and communication impairment are common consequences of stroke. Stroke survivors with either or both of these impairments are likely to have poorer long-term outcomes than those who do not have them. Speech-language pathologists (SLP) play a significant role in the screening, formal assessment, management, and rehabilitation of stroke survivors who present with dysphagia and/or communication impairment. Early diagnosis and referral is critical, as is intensive intervention as soon as the patient is able to participate. The SLP is also responsible for educating carers and staff in strategies that can support the patient and for making appropriate environmental modifications (e.g. altering diet consistencies or providing information in an aphasia-friendly format) to optimize the stroke survivor's participation, initially, in the rehabilitation program and, subsequently, within the community.

Stroke unit care is internationally recognized as the gold standard for the acute management and early rehabilitation of stroke patients.[ 1 ] A key element of comprehensive stroke unit care is the involvement of a multidisciplinary team. Speech-language pathologists (SLPs), along with medical, nursing, occupational therapy, physiotherapy, and social work staff are considered as core members of the multidisciplinary stroke team as defined in the Australian,[ 2 ] New Zealand,[ 3 ] United Kingdom,[ 4 ] United States,[ 5 ] and European[ 6 ] guidelines. SLPs working with stroke survivors have particular skills in the assessment and management of dysphagia and will be directly involved in the assessment and management of communication disorders associated with stroke, including aphasia, motor speech disorders, and cognitive communication disorders.

There are three levels of care for stroke survivors with dysphagia. Stroke patients should receive a swallow screening test within 24 h of admission; those patients with evidence of dysphagia should have a formal clinical and/or instrumental assessment, which is generally undertaken by the SLP; and following this, a swallowing management and/or rehabilitation program should be developed with the involvement of the multidisciplinary team, the patient, and their significant others.

Dysphagia Screening

Up to 50% of acute stroke patients are likely to experience dysphagia.[ 7 , 8 ] If it is not recognized early, dysphagia may be responsible for aspiration, aspiration pneumonia, and/or undernutrition and dehydration.[ 9 ] Stroke patients with dysphagia are likely to have poorer outcomes.[ 9 ] Therefore, dysphagia screening should be undertaken as soon as possible after the patient has been admitted to hospital and before starting oral intake of food, fluids, or medication.

A number of dysphagia screening tools exist,[ 10 ] many of which combine an evaluation of the clinical predictors of dysphagia (i.e., dysphonia, dysarthria, abnormal volitional cough, abnormal gag reflex, cough after swallow, and voice change after swallow)[ 11 ] with a water swallowing test. While this combination appears comprehensive, it may prove time consuming, both because of the amount of education required to train nursing or emergency department staff and because of the actual time taken to screen. A combination of the water swallow test with pulse oximetry has also been advocated,[ 12 ] and this may prove to be an equally effective and more efficient tool. SLPs may or may not be responsible for the dysphagia screening; however, in countries where they are the lead dysphagia clinician, they should be involved in the selection of a suitable screening tool for their hospital and in providing training to the staff responsible for screening.

Dysphagia Assessment

If the patient fails dysphagia screening, referral to an SLP should occur for more comprehensive assessment. Alternative means for hydration and nutrition should be considered and implemented if a full assessment is not available within 24 h and if such intervention is deemed medically appropriate. [ 2 , 3 , 4 , 5 , 6 ] Formal dysphagia assessment includes an initial clinical bedside evaluation. If the clinical examination is inconclusive, the patient develops signs consistent with aspiration despite adherence to a dysphagia management plan, or dysphagia continues without improvement for longer than 7 days, instrumental evaluation such as a videofluoroscopic modified barium swallow (VMBS) or fiberendoscopic examination of swallowing (FEES) is indicated. Either of these tests (or both) can be used in conjunction with clinical examination to inform the swallowing management plan or to develop a swallowing rehabilitation plan.

Clinical Bedside Evaluation

Prior to undertaking the clinical bedside evaluation of swallowing, the SLP should review the patient's medical chart regarding the admission and make a note of comorbidities and medications which may impact on swallowing. The first part of the bedside swallowing evaluation involves screening for communication involvement, particularly with regard to the presence of dysarthria and dysphonia, the patient's ability to understand instructions (aphasia), and whether or not they are able to perform simple motor tasks in response to commands (apraxia). An oral examination is undertaken to note issues such as poor dentition, mucosal lesions, oral thrush, excessive or inadequate saliva, and halitosis. In addition, the SLP looks for facial (in particular, cheek and lip), tongue, soft palate, jaw, and laryngeal weakness. The SLP will examine for asymmetry at rest and in movement and, where possible, use resistance techniques to determine weakness. Subsequently, the patient's ability to perform a voluntary cough and saliva swallow will be checked. In combination, this provides information about the risk factors associated with oral health[ 13 ] and the motor function of the key cranial nerves for swallowing (i.e., V, VII, IX [small motor component to stylopharyngeus], X, XI, and XII). The SLP may also screen for oropharyngeal sensory involvement by testing taste recognition and perception (VII, IX, and X),[ 14 ] light and deep touch, and perception of hot and cold (V).[ 15 ] In some countries, dysphagia assessment and management is undertaken by other suitably trained health professionals; however, the SLP has particular skill in undertaking the above aspects of the bedside evaluation.

Subsequently, food and fluid trials may be undertaken to determine which, if any, food or fluid consistency can be swallowed safely. Trials are likely to include a range of fluids from very thick or pudding-like fluids to thin watery fluids, with the trial sequence determined by the preceding clinical examination. The SLP will check for oral residue, voice quality, and breathing rate after each trial. Cervical auscultation may be used to provide additional information about changes in breathing sounds or breathing patterns during or after each trial.[ 16 ] If no fluid consistency proves safe, the SLP should advise the multidisciplinary team and consider other sensory stimulation pathways that can be used to promote swallowing activity (eg, tactile, temperature, or taste). If a given consistency appears to enable oral intake without apparent risk to the patient, a diet can be commenced incorporating food and fluids of that consistency. Generally, vitaminised foods are introduced first, as the bedside clinical examination is seldom long enough to detect fatigue either in the swallowing act itself or in the muscles involved in bolus preparation. The final part of a bedside clinical evaluation should be the observation of the patient consuming a full meal of the recommended consistency of food and fluid. At this point, a swallowing management plan has to be developed. This plan should include:

• Positioning for oral intake or sensory stimulation (determined after consultation with the physiotherapist and occupational therapist)
• A sensory stimulation program to encourage swallowing activity if no level of oral intake appears 'safe'
• Texture specification for all oral intake
• Recommendations for oral medications
• Requirements for meal-time monitoring, including indicators of poor swallow function
• Review schedule

A formal review should include evaluation trials of food and fluid consistencies that have previously been considered 'unsafe.' It is important for the patient to move toward normal consistency food and fluids as soon as it is clinically safe. The Consumption of normal food and fluids encourage adequate oral intake,[ 17 ] increases saliva flow and therefore taste acuity, increases activity in a range of speech and swallowing muscles, and enhances social interactions and quality of life.[ 18 ]

Instrumental Assessment

A thorough bedside clinical examination is a sensitive, but not always specific, tool.[ 19 ] The bedside clinical examination may fail to identify some patients at risk of aspiration and may predict aspiration in patients where an instrumental study demonstrates safe swallowing. Nevertheless, routine use of an instrumental examination such as VMBS is unlikely to add significantly to functional outcome for people with post-stroke dysphagia.[ 9 ] For many stroke patients, dysphagia will resolve quickly. Instrumental examination should however be considered when:

• The clinical examination is inconclusive.
• The patient fails to improve in the first week, and additional information is required to inform swallowing management or rehabilitation.
• The patient develops clinical signs consistent with aspiration, even though there had been no clinical evidence of dysphagia during screening or despite adherence to the swallowing management plan.

Two instrumental techniques are available for the evaluation of swallowing: FEES and VMBS. Both examinations have similar sensitivity and specificity.[ 20 ] The SLP must be present for either of these assessments.

During the FEES examination, a flexible endoscope is passed transnasally to enable direct viewing of the velopharynx, pharynx, base of tongue, epiglottis, pyriforms, laryngeal vestibule, and vocal cords; the subglottic space may also be viewed. These structures can be examined both at rest and during speech and swallowing, providing information about structural and functional asymmetries and integrity of the swallowing mechanism. Although the movement of the tongue base and epiglottis block the endoscopic view once the involuntary swallow has been initiated, the information provided just prior to this and immediately after swallowing is invaluable.

The VMBS is considered the 'gold standard' for the evaluation of swallowing. During the test, the patient swallows a range of fluids and/or foods impregnated with barium and the actual swallow is filmed. The test allows clear identification of laryngeal penetration and aspiration; the timing of that aspiration (before, during, or after the swallow); the function of the velopharyngeal, pharyngeal, and base-of-tongue muscles; excursion of the hyo-laryngeal complex; protection of the airway; pooling in the valleculae or pyriform sinuses; opening of cricopharyngeus; and any pharyngeal residue post swallow.

As well as providing a direct view of swallowing function for food/fluid of different textures, temperatures, or taste, both procedures can be used to test the effectiveness of different postures/positions (eg, head turn, head tilt, chin tuck) and swallowing strategies (eg, supraglottic swallow, Mendelsohn maneuver) and so can inform the swallowing management plan. In conjunction with a thorough clinical examination, either of these tests can be used to develop a swallowing rehabilitation plan.

Swallowing Rehabilitation

Information supporting swallowing rehabilitation is circumstantial rather than evidence based. Carnaby[ 21 ] found that stroke patients who received daily swallowing intervention (management and/or rehabilitation) demonstrated better swallowing outcomes at 6 months than those who received less intensive treatment or no treatment. Exercise physiology principles indicate that swallowing rehabilitation is likely to be more effective when coupled with actual swallowing activity. Published exercises which meet this criterion are the Masako maneuver (also known as the tongue-holding swallow) and effortful swallow, both of which promote activity in the base of tongue and pharyngeal wall muscles; effortful swallow supported by sEMG biofeedback; voluntary laryngeal elevation plus suck;[ 22 ] sEMG-supported electrical stimulation to support involuntary saliva swallows;[ 23 ] faucal arch stimulation and, potentially, taste stimulation. In the majority of patients, these exercises would be used to support saliva swallows. Swallowing maneuvers such as the Mendelsohn maneuver and supraglottic swallow would also meet this criterion if they were employed as an exercise for supporting saliva swallows. Other exercises may also be of benefit; two examples are the Shaker (head-lift) exercise[ 24 ] and the Lee Silverman Voice Treatment (LSVT).[ 25 ] Exercises that are not accompanied by swallowing activity need to be employed for a minimum of 3 weeks before any decision is made about their effectiveness.

Dysphagia is a common consequence of stroke, and stroke survivors with dysphagia are likely to have a much poorer outcome than those who do not have dysphagia. Stroke patients should be screened for dysphagia prior to commencing any oral intake. Once dysphagia has been identified, a swallowing management plan should be developed based on the results of the bedside clinical assessment with or without evidence from FEES or VMBS. Often dysphagia will resolve quickly; however, for some patients, a swallowing rehabilitation plan will be required. The SLP plays a major role in all aspects of dysphagia management. The evidence suggests that intensive swallowing exercises will result in optimal swallowing outcomes for patients.

Communication

The communication deficits associated with stroke are diverse; they can be described as affecting one of three main areas: language, motor speech, and/or cognitive communication. The evidence base for the management of post-stroke communication disorders is at best weak.[ 26 , 27 , 28 ] This is partly because of the diversity of the communication deficits associated with stroke and also reflects the long history of communication intervention. Nevertheless, there is overall agreement in the international evidence-based guidelines regarding intervention for communication impairments associated with acute stroke. These take the form of: communication screening[ 2 , 3 , 4 , 5 , 6 ]; full assessment of those identified with communication impairment by a SLP[ 2 , 3 , 4 , 5 , 6 ]; intensive intervention, which should be initiated as soon as the patient is able to cooperate [ 2 , 3 , 4 , 5 , 6 ]; and education of patient, family and significant others, and involved staff regarding the nature of the communication disorder, strategies to maximize communication, and activities that may support communication recovery. [ 2 , 3 , 4 , 5 ] In addition, the SLP should work with the multidisciplinary team to ensure that written information given to stroke patients is provided in a way which maximizes their understanding.[ 2 , 14 ] This holistic approach is supported by the International Classification of Functioning, Disability, and Health (ICF) as it seeks to address issues about the communication environment and the stroke survivor's ability to communicate effectively within that environment, as well as providing direct intervention at the level of impairment.[ 29 ]

Communication Screening

Among stroke survivors, 30-60% are likely to experience a communication deficit.[ 30 , 31 ] Communication deficits have been demonstrated to be associated with depression[ 32 , 33 ] and therefore, by inference, with quality of life (QOL); however, any direct relationship between communication involvement and QOL remains unestablished. Many researchers have examined QOL in stroke survivors but have not been able to demonstrate a direct relationship; however, standard QOL measures do not routinely score items that are communication dependent. Results are beginning to emerge from the SAQOL-39 (Stroke and Aphasia Quality of Life Scale-39)[ 34 ] which may clarify this. Overall, stroke survivors with acquired communication disorders have poorer outcomes than those who do not have such disorders, and this highlights the need for early diagnosis. The first step in this process is for all stroke survivors to undergo a communication screening test within 48 h of admission. This screening test should, if possible, be done using a validated tool and should be performed by the SLP or suitably trained nursing/other staff.

An effective communication screen needs to check whether the person is able to understand spoken and written material as well as gestures, facial expressions, and prosody; whether they can communicate their ideas effectively through speech, writing, facial expressions, and gestures; and whether or not their speech is easily understood or demands extra effort from the communication partner to decode. Currently, the most commonly used screening test is the Frenchay Aphasia Screening Test (FAST), which is designed to be used by any member of the multidisciplinary team to promote early referral to the SLP.[ 35 ] This test however, only examines receptive and expressive language in the domains of speaking, listening, reading, and writing and therefore may fail to identify patients who demonstrate cognitive communication disorders or mild motor speech disorders.

Communication screening could also be seen as part of a more comprehensive cognitive screen. Cognitive screening of all stroke survivors is recommended in some of the clinical guidelines.[ 2 , 4 , 5 , 6 ] The Functional Impairment Battery, which includes screening of memory, neglect, aphasia, anomia, hearing, visual acuity, and depression,[ 31 ] identifies cognitive deficits in many more stroke survivors than informal screening or a standardized broad instrument such as the National Institutes of Health Stroke Scale (NIHSS).[ 36 ] The administration of the Boston Naming Test in addition to FAST in this battery proved effective in identifying a greater number of patients with probable communication involvement than FAST alone. Given the strong relationship between language and memory,[ 37 ] and the association between visual neglect and communication disorders associated with right hemisphere involvement,[ 38 ] a comprehensive cognitive screen such as this would be more likely to identify stroke survivors with communication deficits.

For any screening tool to be effective, however, it needs to be both linguistically and culturally appropriate. The SLP must therefore be involved in the selection of an appropriate screening tool and in training other staff as required in the administration of that tool. Stroke survivors identified as having communication disorders (including those with memory problems, poor repetition skills, and/or neglect on cognitive screen) should be referred to an SLP for more comprehensive communication assessment. In addition, all stroke survivors who premorbidly used an alternate means of communication, including gesture, sign language, or augmentative device, should be referred for formal communication assessment.

Communication Assessment

Using the ICF as a framework, three areas emerge for comprehensive communication assessment. These are the assessment of the communication impairment experienced by the stroke survivor, the impact that this has on their activity and participation within specific contexts, and the way in which their communication environment influences that activity and participation. Assessment in each of these areas should be both quantitative as well as qualitative so that outcomes of the rehabilitation program can be measured objectively.

Assessment of Communication Impairment

The assessment of the communication impairment should be informed by the cognitive or communication screening test and formal cognitive assessments undertaken by the occupational therapist, psychologist, and neuropsychologist. In addition communication assessments must be linguistically and culturally appropriate. Where possible, the assessment should provide clear direction for intervention strategies. Table 1 summarizes the areas identified by the ICF[ 29 ] under the heading of 'Body Functions' that may be affected by stroke and which are likely to have a direct or indirect impact on communication. Areas indicated in bold type demand formal assessment by the SLP, while the other areas demand integrated assessment with other members of the team regarding their impact on communication.

Body functions (ICF framework) likely to be affected by stroke. The SLP provides primary assessment for areas indicated in bold type and supportive assessment for other areas listed.

Activity and participation

All formal communication assessment should be undertaken to inform the intensive rehabilitation program which needs to address real goals identified by the stroke survivor. In some circumstances, however, the communication involvement is so severe that early assessment and intensive therapy must be directed toward the receptive and expressive language disorder to help provide the patient with basic communication skills so that they can be involved in goal setting. In other cases, the stroke survivor may have a range of communication impairments but each of these may not have the same impact on their ability to participate within their communication environment. The rehabilitation program is best directed toward those areas which will have maximum impact on the patient's ability to participate: initially within the hospital environment and subsequently within the home and community. Again the ICF[ 29 ] provides a framework for helping the clinicians and the patient evaluate those areas which are most significant [ Table 2 ]. For example, a patient with mild language impairment may have lost the ability to interpret body language and facial expression and this will have a negative impact on activities involving interpersonal interactions and relationships; major life areas; and community, social, and civic life. Rehabilitation directed toward this impairment should be practiced in the context that is most limited by the impairment. For some patients that may be at the level of family relationships, while for others the impact may be most significant in their work life or career.

Activity and participation (ICF framework).

Communication environment

The final part of the communication assessment undertaken by the SLP is to examine the communication environment which impacts on the stroke survivor. During the acute post-stroke stage, this is most likely to be a hospital. The SLP needs to determine:

• What communication devices, if any, can support the stroke survivor in their efforts to communicate
• What communication strategies can be employed by communication partners to enhance communication with the stroke survivor
• What education is required by communication partners (including family, significant others, and staff) to employ the identified strategies
• What support the stroke survivor requires to access written information relevant to their care
• What support the stroke survivor requires to access leisure time activities in the hospital environment.

Intervention strategies for the patient during the initial acute post-stroke period and the early rehabilitative phase need to address the areas identified by these assessments.

Communication interventions and early rehabilitation

Communication assessment will be an ongoing process throughout rehabilitation; however, once initial assessment is complete, an intervention and rehabilitation plan should be initiated. In the immediate post-stroke period, communication interventions are likely to take precedence over communication rehabilitation. Some strategies for both intervention and rehabilitation are described below; however, the SLP will have access to many other rehabilitation strategies which are accepted practice supported by expert opinion but have not been evaluated in appropriate controlled studies. It is therefore important that the assessment procedures allow adequate measure of outcomes to ensure that the rehabilitation program is effective.

Communication interventions

Communication interventions include strategies that can be employed by the stroke survivor to enhance their communication; strategies used by family, significant others, and staff to promote effective communication with the stroke survivor; and environmental adaptations to enhance communication effectiveness. The aim of these interventions is to maximize communication opportunities and participation for the stroke survivor and also to promote optimal involvement in the rehabilitation and recovery process.

Strategies for the stroke survivor

Where the major communication impairment is in the area of speech rather than language, the patient can be encouraged to use a range of communication supports such as:

• Pen and paper (using the non-dominant hand if necessary)
• Letter pointing board (either for first letter or whole word)*[ 39 ]
• Electronic communication devices[ 40 ]
• Amplification[ 41 ]
• Reducing speed of speech*
• Introducing the topic first*[ 39 ]
• Using iconic gestures*[ 42 ]
• Talking one-to-one where possible

*There is emerging evidence from the literature on dysarthria (including that related to etiologies other than stroke) that using letter pointing for initial phoneme in combination with topic nomination or the trained use of gesture is likely to decrease the speed of speech, increase pause times, and improve the intelligibility of the dysarthric speaker.[ 39 , 42 ]

For the patient with aphasia, useful strategies may include:

• Writing/drawing with either dominant or non-dominant hand[ 43 ]
• Gesturing and pointing[ 44 ]
• Introducing the topic first
• Using any communication chart/device that has been developed for them[ 45 , 46 ]
• Encouraging visitors to complete the communication diary (see below)

Strategies for family, significant others, and staff

For all stroke survivors who have communication impairment it is important to:

• Reduce distractions
• Talk one-to-one where possible
• Check that they have understood the message correctly by paraphrasing or reiteration
• Seek clarification if you have not understood
• Allow sufficient time
• Ensure that the area is well lit
• Encourage the patient to use any communication device/strategy developed for them
• Provide props such as photographs, magazines, or sports results that are important to the patient
• Fill in the communication diary at the completion of each visit (see below)

If the patient has aphasia it may also be important to reduce the complexity of sentences, write down key words, use pictures of gesture cues, and ensure that your face is well lit.

Environmental adaptations

A range of environmental adaptations may be considered; for example:

• Providing a nurse call button that is more easily recognized
• Changing ward rounds such that one team member remains with the patient to reiterate information after the team has moved on.
• Developing a communication diary that stays with the patient. Staff, family, and significant others should be encouraged to complete the diary with information about the time/date of the communication, the people involved, and the main elements that were discussed.

The patient with aphasia may require additional adaptations such as:

• Development of aphasia-friendly menus
• Provision of all essential information in an aphasia-friendly format (information about stroke and its consequences; the rehabilitation team and process; essential tests and medical management routinely used post stroke).[ 47 ]
• Development of specific information sheets in an aphasia-friendly format where the patient's management varies from the standard protocols.[ 47 ]

The SLP is responsible for choosing the optimal strategies and environmental adaptations for each patient; training family, significant others, and staff in the use of those strategies and adaptations; and for providing input for the development of all aphasia-friendly materials.

Rehabilitation

Where rehabilitation principles are included in the clinical stroke guidelines, the consensus is that rehabilitation for communication impairments should be initiated as soon as possible post stroke and as intensively as possible (approximately 3-8 h/week).[ 48 ] In the early rehabilitative phase, rehabilitation is likely to be one-to-one. The actual nature of that intervention is determined by the SLP in response to the assessments described above. However, a number of methodologies have evidence base either within the stroke literature or in the broader neurological literature for those patients who demonstrate particular communication impairments.

Motor speech

Dysarthria is underpinned by possible impairment in the respiratory, phonatory, resonance, and/or articulatory systems. This impairment may include weakness, tonicity changes, or incoordination and therefore intervention strategies are inferred by careful assessment. Although evidence from randomized trials is lacking,[ 27 ] evidence-based clinical practice guidelines are emerging for the management of dysarthria.[ 49 , 50 ] These guidelines address issues in the areas of respiratory, phonatory and resonance strength, control and coordination.

Apraxia of speech frequently coexists with aphasia and therefore the most appropriate intervention will depend on the functional consequences observed in the individual patient. While there is no clear evidence, intervention strategies such as modeling, visual cueing, integral stimulation,[ 51 ] and cueing for articulatory placement Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) [ 52 , 53 , 54 ] have proved effective for some patients.

Respiratory/phonatory

Exercises to improve the respiratory/phonatory parameters underpinning speech may include non-speech, postural, and speech activities. Resistance training techniques can target respiratory and/or phonatory muscles directly when reduced strength is hypothesized, while coordination of respiration and phonation should work toward the fast inspiration and controlled exhalation pattern suitable for supporting speech. Programs need to incorporate motor learning principles with strength and coordination exercises modified quickly to incorporate speech tasks.[ 50 ] Patients may initially benefit from blocked practice to develop appropriate motor patterns but may require distributed and randomized practice sessions to promote motor recall.[ 53 , 54 ] Biofeedback will also be an important element to promote effective motor learning across the respiratory/phonatory systems.

Little evidence is available to identify effective programs for patients who demonstrate hyperadduction syndromes. Relaxation with biofeedback may be of benefit, but the SLP should use careful assessment to ensure that the hyperactivity is not a functional adaptation to an underlying weakness.[ 50 ]

Velopharyngeal

Increased nasal resonance is common across all types of dysarthria[ 51 ] and indicates either velopharyngeal insufficiency or incoordination or a combination of these. A secondary consequence of this is reduced air flow via the oral cavity and therefore reduced resistance during oral articulation. Yorkston[ 49 ] provides clinical practice guidelines for the management of velopharyngeal involvement based on a review of the literature and concludes that velopharyngeal prostheses are effective in some instances. Other therapies which directly affect air flow are LSVT[ 25 ] and continuous positive airway pressure (CPAP) therapy.[ 55 , 56 ]

Early aphasia rehabilitation should target the areas identified during assessment. It should be initiated as soon as the patient is able to participate in rehabilitative activities and be offered intensively (3-8 h/week).[ 48 ] Case study evidence has demonstrated the effectiveness of phonological and semantic interventions,[ 57 ] which provide the patient with language models that are systematically made more complex, constraining the patient to produce utterances at the level they have reached.[ 58 ]

Cognitive language

Stroke survivors who demonstrate impairment in the areas of attention and memory will frequently have concomitant communication involvement. The speech pathologist should work with the occupational therapist and the neuropsychologist to minimize the impact of these impairments on communication. In particular, areas such as verbal attention, divided attention, sustained attention, auditory memory, verbal memory, and visual neglect are likely to have a direct impact on communication. As yet, there is little evidence on the efficacy of clinical interventions in this area.

Summary: Communication

Communication impairment occurs in 30-60% of stroke survivors. Despite the potential for improvement and recovery being high, communication impairment in stroke survivors is often related to poorer outcomes. Screening for cognitive and communication impairments is therefore critical to ensure that all patients with a communication impairment are referred to the SLP for comprehensive assessment and management.

The SLP plays a significant role in the multidisciplinary team managing patients with acute stroke. Screening for dysphagia (within 24 h) and communication impairment (within 48 h) is critical in working toward optimal outcomes for stroke survivors. The SLP is involved in choosing appropriate screening tools and providing training in the use of those tools. In addition the SLP must provide comprehensive dysphagia and/or communication assessment that takes into account the impairment, the impact that impairment has on the patient's life, and any environmental modifications which may minimize the impact of that impairment. Assessments chosen must be culturally appropriate and provide quantitative as well as qualitative information. The SLP is responsible for developing appropriate management and rehabilitation programs based on the assessments undertaken as well as the goals identified by the patient and the multidisciplinary team and for monitoring the functional gains associated with those programs through careful reassessment.

Acknowledgment

I would like to acknowledge the support of Angie Dobbrick, Senior Speech Pathologist, Royal Brisbane and Women's Hospital, for her suggestions and comments with regard to this manuscript

Source of Support: Angie Dobbrick, Senior Speech Pathologist, Royal Brisbane and Women's Hospital,

Conflict of Interest: Nil.

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Speech therapy and the benefits for stroke patients

• Category: Speech Therapy , Stroke Recovery
• Posted On: May 9, 2022
• Written By: Allied Services Integrated Health

Speech-language pathologists (SLP) play an integral role in stroke recovery. Our work can be transformative, helping stroke patients recover their speech and with it, freedom of communication. Aphasia, dysarthria, apraxia of speech, and cognition impairments are commonly seen in people recovering from stroke, and can be assessed and treated by SLPs. Additionally, strokes can cause swallowing disorders that negatively impact quality of life. Here again, SLPs play an important role in assessing and treating stroke patients.

Restoring speech following stroke

Aphasia is a language impairment that can impact reading, writing, comprehension, and expression. Dysarthria and apraxia of speech are motor speech disorders: the result of a disconnect between the brain and speech mechanism. With dysarthria, the “plan” from the brain is correct, but the muscles can’t follow it due to weakness or incoordination, resulting in slurred or sluggish sounding speech. Apraxia of speech is the result of the brain's inability to create the “plan” to tell the muscles how to produce correct speech sounds. The muscles can follow the plan, but the plan is incorrect, resulting in difficulty producing the desired speech sounds to form the words they know they want to say. Every stroke patient presents differently, some experiencing one or more of these impairments while some may not experience any impairments requiring speech intervention.

Assessing and treating dysphagia

Dysphagia is a symptom of a medical condition, such as stroke, and refers to difficulty swallowing. The prevalence of dysphagia ranges from 50% to 80% in stroke patients. Addressing dysphagia is critical as it can lead to medical complications, nutrition and/or hydration issues, and a decrease in quality of life. The SLP is responsible for determining which diet texture a patient can safely tolerate considering the swallowing impairment and rehabilitating the swallow while minimizing risk of aspiration. Aspiration refers to food or liquid “going down the wrong pipe,” which we have all experienced at some point; however, repetitive occurrences are a concern for aspiration pneumonia, especially for those not in full health.

Gold standard in swallowing assessment

We cannot visualize the swallow after the food leaves the patient’s mouth; therefore, if a patient exhibits coughing or other signs of a pharyngeal impairment then a speech-language pathologist may conduct a videofluoroscopic swallow study. This is an an x-ray of the swallow. It is the gold standard for swallowing assessment and allows the SLP to evaluate the anatomy and physiology of the swallow to determine what is happening that is causing the patient to cough while eating or drinking, and create an individualized treatment plan.

Often, patients present with weakness within the region of the pharynx or delayed initiation of the swallow, where the food or liquid is propelled back into the pharynx before the swallow is triggered, causing that material to go “down the wrong pipe,” meaning into the airway rather than down the esophagus. Sometimes in these instances, a patient may temporarily be prescribed thickened liquids, as these travel slower than regular liquids and give the swallow a moment longer to trigger, decreasing aspiration risk, keeping the lungs clear and the patient safe. Dysphagia treatment can include diet modification, swallowing maneuvers to increase safety, and strength and coordination-based exercises to restore function.

Stimulating muscles for better swallowing

Today, many speech-language pathologists are certified in VitalStim, a neuromuscular electrical stimulation device that is FDA approved, non-invasive, and uses a controlled electrical current to help stimulate specific muscles responsible for swallowing. A dysphagia treatment session with application of VitalStim is ideally 60 minutes and includes various therapeutic exercises to target strengthening of specific musculature based on the swallowing impairments identified during the x-ray of the swallow. Surface electrodes are placed over specific swallowing muscles on the patient’s larynx and provide small electrical impulses to assist in contraction of the muscles, and over time, re-education of those muscles to restore the swallow.

About the Author: Amanda Petrosky, M.S., CCC-SLP , works with patients at Allied Services Scranton Rehab Hospital.

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Top 5 Speech Therapy Exercises for Patients Who Have Suffered a Stroke

Have you or a loved one recently suffered from a stroke? Are you having difficulty speaking with the people you care about most?

Having a hard time communicating can be frustrating for everyone involved, but when you’re the one struggling to say even the simplest things, it can feel infuriating.

That’s where having the right tools (or, in this case, speech therapy exercises) comes in.

In this post, we’ll give you the rundown on speech therapy for stroke patients and review 5 of the most popular speech exercises to help you get your groove back.

Let’s get to it, shall we?

1. Sticking Your Tongue Out

For this exercise, all you need to do is stick your tongue out, hold it for as little as 2 seconds, pull it back, and then repeat.

When you’re working to overcome a post-stroke condition like aphasia , it can sometimes feel like you’re never going to be able to do even the smallest things like sticking your tongue out again. But really, all you need to do is practice.

2. Moving Your Tongue from Side-To-Side

Before you move on to more advanced tongue strengthening exercises , you’ll want to ensure that you can do some basic movements with your tongue.

Here, you will open your mouth and touch the right side of your mouth with your tongue. Hold it for a few seconds, reach the left side of your mouth, and then repeat the exercise.

3. Moving Your Tongue Up and Down

This is an extension of the in-and-out tongue exercise.

Once you’ve mastered the in-and-out, you can take things to the next level by reaching your tongue up to your nose, holding, and then reaching down to your chin.

4. Practice Smiling

We’ve covered a few tongue exercises already, but what about if you want to improve the control of your lips, too?

An easy exercise to do just that is to practice smiling. It goes like this:

Smile. Relax. Smile. Relax. Repeat the exercise until your cheeks hurt.

Practicing in front of a mirror is ideal because the mirror will give you a visual representation of how you’re doing – and this can help motivate you even further.

5. Make a Kissy Face

You might not think that making a kissy face would be considered one of the top speech therapy exercises, but it is.

When you’re all smiled out, you can practice making kissy faces.

Pucker your lips for a few seconds and then relax. It’s as simple as that. Repeat until you reach ten reps.

Try These Speech Therapy Exercises Today

These five speech therapy exercises are a great way to get a head start on your recovery.

And if you’re looking for further rehabilitation for you or your loved one, Rainbow Rehab and Healthcare provides many different services to give you the quality care you deserve.

Are you ready to join our community? Don’t hesitate to arrange a private tour of our facility today.

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Best Online Speech Therapy Exercises for Stroke Management

What is stroke (offering best online speech therapy).

A stroke occurs when blood cannot access an area of the brain. This could be because of a blood clot (called an Ischemic stroke) or because of a broken blood vessel (a Hemorrhagic stroke).

Strokes can lead to:

• Muscle weakness
• Cognitive issues
• Speech and language impairment
• Decreased emotional control

There are many forms of speech impairment stroke patients can suffer from that are grouped under the general term aphasia.

Read a detailed blog on Online speech therapy for adults 

What Is Aphasia?

If the stroke happens in an area of the brain that controls speech or communication, it can cause aphasia.

Every stroke patient will not experience aphasia, but it’s estimated that as many as 40 percent of stroke survivors   have some form of aphasia.

While some stroke patients will regain normal speech patterns post-stroke others may need to practice some speech therapy exercises at home that can help during recovery.

Read a detailed blog on Tips for improve speech after stroke

Speech therapy can help with speech and language improvement after a stroke.

A patient who survives stroke has to go through moderate to severe speech and language impairments known as Aphasia.

• It can be corrected or at least reduced by Speech Therapy Exercises for stroke.
• These speech therapy exercises usually vary from person to person, depending upon many factors like age, severity, and needs etc.
• There are many speech therapy exercises that can be performed to minimise speech impairments.

Ideally, one should work with a Speech Language Pathologist to improve their language skills. Then they can use the following Best online Speech Therapy Excercises for Adults With Speech Disorders to practice at home.

Read a detailed blog on online speech therapy can help stroke cases.

Exercises for Stroke Management

Here are some most popular online speech therapy exercises for stroke patients that can be tried at home:, 1. tongue in and out.

• Stick the tongue out and hold it for 2 seconds, then pull it back in.

• Hold for 2 seconds, and repeat.
• This helps train the tongue to move with coordinated patterns, which will help produce better speech.

2. Tongue Side to Side

• For this speech therapy exercise, open your mouth and move your tongue to touch the right corner of your mouth.
• Hold for 2 seconds, and then touch the left corner of your mouth.

3. Tongue Up and Down

• Open your mouth and stick your tongue out. Then, reach your tongue up toward your nose.
• Hold for 2 seconds and then reach your tongue down toward your chin. Hold for 2 seconds, and repeat.
• It’s best to do all of these speech therapy exercises in front of the mirror so that you can get visual feedback.

4. Say Cheese!

Here’s another simple speech therapy exercise that improves oral motor skills.

• Practice smiling in front of a mirror. Smile and then relax. Repeat as much as possible.
• The mirror is important because it provides feedback, which is fuel for your brain!

5. Practice Kissing Face

• When done practicing those smiles, try making kissing face by puckering your lips.
• Pucker the lips together and then relax. Repeat as often as possible.
• One should slow down the movement for even better control.

6. Consonant & Vowel Pairing Repetition

• Now that we’ve completed the simple speech therapy exercises, let’s move onto more complex activities.
• Take a consonant that one have trouble saying, and then pair it with each of the 5 vowels (a, e, i, o, u).
• For example, if one has trouble with the “r” sound, then practice saying “ra, re, ri, ro, ru” over and over.
• If one is feeling ambitious, try this with all consonants.

7.  Breathing Exercises

• A common symptom of aphasia and speech impairment in stroke patients is trouble regulating breathing while speaking.
• This can cause a person to take breaths in the middle of sentences, which makes it difficult to speak at length as well as be understood by listeners.
• Doing breathing exercises can help one regulate their breathing while speaking much easier.
• Try demonstrating a deep breath and then speak while exhaling.
• Make the patient practice planning out the breaths they take while speaking. They have to repeat simple sentences and breaths to themselves to master when taking a breath.
• This will help the patient learn to plan breathing pauses as they relearn how to construct sentences and breathe properly during speech.

8.  Sentence Production

• Patients with speech apraxia, for example, have no trouble with the cognitive side of language production. However, their ability to move their lips and tongue is impaired.
• Therefore, reading aloud provides an opportunity to practice speaking.
• This can be frustrating for patients with moderate to severe aphasia, so be patient.
• Start small! By practicing a few very simple sentences for short periods of time, like one or two minutes. Then, increase the practice duration from there.

9. Phonological Processing

• Phonology refers to the pattern of speech sounds.
• Speech therapy exercises that help with phonology can also help patients improve their ability to produce speech.
• For this exercise, the patient will guess how many syllables are in a word and the caregiver will say different words.
• Each time the caregiver say a word, the patient has to guess how many syllables are in that word.
• The caregiver should always tell the patient whether he/she is right or wrong to provide feedback.
• The feedback is part of what makes this exercise therapeutic.

10. Word Games

• Word games make great speech therapy exercises for adults.
• Although one isn’t producing speech, these games challenge the patient’s language processing skills.
• To exercise problem solving and visual processing, try word games like word searches or crossword puzzles.
• Most brain games will help improve speech when one practices them regularly.

Tips for communication with stroke survivors:

A person with aphasia often faces difficulty to communicate in long sentence.

• A simple strategy that can help is to ask questions in a “Yes” or “No” framework. For example, ask the person if they are thirsty or hungry, which can be answered with a simple yes or no.
• Other strategies include keeping spoken messages simple, reducing environmental distractions like a loud TV, and using hand gestures in addition to verbal language.
• Simplify language by using short, uncomplicated sentences.
• Repeat or try writing down key words to clarify meaning as needed.
• Maintain a natural conversational manner appropriate for an adult.
• Encourage any type of communication whether it is speech, gestures, pointing, or drawing.
• Avoid correcting the person's speech.
• Allow the person plenty of time to talk.

A person with stroke deserves respect, attention, patience and the chance to be heard.

Important thing to Remember!

Your loved ones need your care, love, time and support to recover fast!

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The Benefits of Speech Therapy for Stroke Patients

A stroke can be so severe that it causes temporary or permanent paralysis and impairs memory and cognitive functioning. Part of what these side effects can impact the most is a stroke patient's speech and communication capabilities. Although it can be scary to face everyday activities without the ability to express thoughts and emotions easily or understand others, there is a way for patients to recover speech after a stroke through speech therapy.

This article will cover everything about speech therapy for stroke patients including what a stroke is, how having a stroke can affect a patient's speech and the speech therapy options available. If you have been wondering what a speech therapist does for stroke patients, keep reading to get some answers.

What Is a Stroke?

A stroke is a medical emergency in which the blood supply to part of the brain is seriously reduced or interrupted, cutting the brain tissue off from receiving oxygen and vital nutrients. Once cut off from oxygen and nutrients,  brain cells can begin to die within minutes . To reduce brain damage and other negative side effects from a stroke, early action and prompt treatment are crucial.

There are two main types of strokes to know:

• Ischemic stroke:  This type of stroke occurs when the blood flowing through the artery that delivers oxygen-rich blood to the brain gets blocked, causing severely reduced blood flow. During an ischemic stroke, blood vessels can become narrowed or blocked due to blood clots, fatty deposits built up in the blood vessels or other debris that has traveled through the bloodstream and become lodged in the brain's blood vessels.
• Hemorrhagic stroke:  When this type of stroke happens, an artery in the brain ruptures or leaks blood, which then floods the brain tissue. This leaked blood damages brain cells by placing an extreme amount of pressure on them. Within the hemorrhagic stroke category, there are two subtypes of strokes. An intracerebral hemorrhage is the result of a burst brain artery flooding the surrounding tissue with blood, and a subarachnoid hemorrhage refers to bleeding in the space between the brain and the thin tissues that cover the brain.

Along with an ischemic stroke and a hemorrhagic stroke, there is another stroke-like condition called a transient ischemic attack, commonly referred to as a mini-stroke. During a transient ischemic attack, blood flow to the brain is blocked for a fairly short amount of time, typically no longer than five minutes. Because blood flow is not blocked for an extended amount of time, the damage done to the brain by a transient ischemic attack is limited.

Although a stroke is a very serious medical event, it is not uncommon. In fact, someone in America  suffers from a stroke every 40 seconds . Without proper medical attention and treatment, a stroke can be fatal or cause permanent damage to the body's ability to function regularly.

Depending on how long the blood flow to the brain was impaired and which part of the brain was most affected, the long-term effects of a stroke may include temporary or permanent disabilities. Here are some of the most common post-stroke complications:

• Paralysis:  A severe stroke may result in paralysis on one side of the body or loss of muscle movement in certain muscles.
• Pain:  A stroke may cause pain, numbness or other unusual sensations like tingling in certain parts of the body.
• Memory loss:  Stroke survivors may experience some memory loss or difficulty thinking clearly, understanding concepts, reasoning and making decisions.
• Emotional changes:  After a stroke, it may be more difficult to control emotions. It is not unusual for a stroke survivor to develop depression.
• Difficulty speaking:  A stroke can affect the muscles in the mouth and throat, making it a challenge to talk clearly, swallow or eat. These side effects can make speaking, understanding speech, reading or writing to be more difficult.

Raising awareness about what a stroke is and how to recognize one can help people respond quicker to mitigate the effects of a stroke. Whenever someone suddenly has difficulty speaking, a drooping face or arm weakness, it is imperative to seek medical assistance.

How Having a Stroke Can Affect Your Speech

A stroke can have a major impact on the survivor's ability to communicate clearly, especially if the stroke affected the left hemisphere of the brain where the language center resides. The exact communication problems a stroke survivor has will depend on which part of the brain the stroke impacted and how large of an area was damaged.

The  three main ways having a stroke can affect speech   include aphasia, dysarthria and dyspraxia:

Aphasia is the most common language disorder a stroke causes. In general, aphasia can affect how someone speaks, their ability to understand what is being said as well as their reading or writing skills. Mild aphasia affects only one form of communication, such as speaking, while more severe aphasia can impact several modes of communication at once.

There are three subcategories of aphasia:

• Receptive aphasia:  This type of aphasia involves problems understanding what is being said. With receptive aphasia, an individual may not be able to understand long, complex sentences and may be able to write but unable to read back what they have written.
• Expressive aphasia:  Those with expressive aphasia have difficulty expressing what they want to say, might not be able to speak at all or may communicate with sounds instead of words. Those with less severe expressive aphasia may skip words while speaking, take long pauses while speaking or be unaware that what they just said was unrecognizable.
• Mixed aphasia:  Also known as global aphasia, mixed aphasia is a combination of problems that can change most or all of a person's communication skills. Those with mixed aphasia deal with components of both receptive and expressive aphasia.

Because having a stroke is the most common cause of aphasia,  stroke-related aphasia  is a well-researched topic. The effects of aphasia may be temporary or long-term, which means the proper treatment may alleviate the symptoms and clear up communication. Medical professionals have developed multiple approaches to reduce the effects of stroke-related aphasia.

2. Dysarthria

After a stroke, a person may suffer from dysarthria, which can inhibit communication by causing weakness in the muscles used to speak. Dysarthria can affect the muscles used to move the mouth, lips, tongue or the muscles that help regulate breathing while speaking. For these reasons, those with dysarthria may sound different or less clear than before.

Unlike aphasia, dysarthria does not affect the ability to understand others or find the right words to say.

3. Dyspraxia

Similar to dysarthria, dyspraxia affects the movement and coordination of muscles. While the muscles used to produce the voice may be fully functional in a patient with dyspraxia, they might not be able to move those muscles in the correct order or sequence to make the necessary sounds for consistently clear speech. In this way, dyspraxia makes correct pronunciation difficult.

How Speech Therapy Can Reduce the Effects of Stroke-Related Aphasia

The negative impact a stroke can have on one's ability to communicate can be frustrating and distressing. Although aphasia does not affect intelligence, the way it presents itself can sometimes make people think it does. Fortunately, speech therapy can minimize the symptoms of stroke-related aphasia to make everyday activities like joining in conversations, reading and writing easier.

In speech therapy, speech-language pathologists assess, diagnose and treat disorders regarding speech, voice, language, cognitive-communication, the ability to swallow and other related issues. Through working with the patient and their caregiving team, a speech-language pathologist comes up with an individualized treatment plan tailored to the patient's needs. This plan will be geared toward helping the patient achieve the highest level of communication and language function possible.

Part of the personalized care plan a speech-language pathologist creates may involve techniques for neuromuscular re-education of the voice and swallowing muscles, cognitive language exercises to restore or adapt language understanding and communication skills along with some activities to adjust communication ability.

Much of a speech-language pathologist's work revolves around  neuroplasticity  — the brain's natural ability to rewire itself. By activating neuroplasticity, the healthy areas of the brain get stimulated to take over the function of language. Because neuroplasticity is sparked by repetitive stimulation, working through various speech therapy exercises with a speech-language pathologist will encourage new areas of the brain to take on the functions of speech and communication.

If necessary, a speech-language pathologist may also provide medical speech pathology services and diagnostic studies to evaluate the capacity of the muscles used for swallowing, the vocal cords and functional voice. By increasing their awareness of any functional deficits within the patient, a speech-language pathologist can proactively address those issues and provide the most meaningful care possible.

What to Expect in Speech Therapy

Working alongside a professional speech-language pathologist is the best way to recover communication skills. There are some speech therapy exercises a speech-language pathologist may teach patients that can be easily done at home. When practicing speech therapy exercises on your own, they should always be done in front of a mirror to check form. The following are some exercises you may expect in speech therapy:

1. Tongue Side-To-Sides

For this speech therapy exercise, open your mouth and move your tongue over to the left side of your mouth until it touches the corner. Hold your tongue there for a count of two, then move it to the right corner of your mouth. Hold it there for another two seconds, and repeat.

2. Tongue Up-And-Downs

Open wide and stick your tongue out for this exercise. Reach your tongue up toward your nose and hold it as high as you can for two seconds before reaching your tongue down to your chin. Hold this position for another two seconds, then repeat the cycle.

3. Tongue In-And-Outs

Stick your tongue all the way out for two seconds before pulling it back in. After two more seconds, stick your tongue out and hold it there for two seconds again. Doing this move repeatedly will help train your tongue to move in coordinated patterns, as it will need to in order to produce clearer speech.

A simple smile can help improve oral motor skills while boosting your mood. Stand in front of a mirror and smile, then relax. Repeat this exercise as much as you can to get your muscles in the habit of moving smoothly.

5. Kissy Face

For this exercise, first pucker your lips together, then relax them. Repeat this for as many reps as you can, slowing down the movement to challenge your muscle control even more.

6. Word Games

Word games are fun and great speech therapy exercises. By testing your language processing skills, word games can help you improve your level of communication. Playing brain games on a regular basis can help improve your speech by training your mind to think in different ways.

The type of word games you play will depend on which skills you need to work on most. To enhance your problem solving and visual processing, try word games like crossword puzzles or word searches. For sharpening your comprehension skills and visual processing, try your hand at computer games such as solitaire or alchemy.

7. Phonological Processing

The term "phonology" pertains to the pattern of speech sounds. This means that speech therapy exercises focused on phonological processing are intended to help patients better their ability to produce speech.

A popular phonological processing exercise you can practice at home with a loved one is guessing how many syllables are in a word. Ask your loved one to say different words and each time they say a new word, try to guess how many syllables the word contains. Your loved one will be able to tell you whether you are correct or not, which is the feedback that is key to making this exercise therapeutic.

Speech Therapy for Patients Who Cannot Talk Yet

For stroke patients who have sustained major damage to the brain's language center, it may take some time to be able to talk again. However, speech therapy can still be highly beneficial for stroke patients who cannot speak yet. Although the patient will not be able to participate in most traditional speech therapy exercises, there are alternative voice therapy options.

Surprisingly, patients who cannot talk are most often able to sing their words. This phenomenon is due to speech being a left-brain function while singing is a right-brain function. Because of this,  singing therapy  is a highly effective strategy for helping stroke patients regain their ability to speak conversationally.

By training the undamaged right side of the brain to speak, singing therapy can make speaking a reality for stroke patients. With routine singing therapy sessions, there is hope for recovering the ability to speak, even for patients who have not spoken since their stroke occurred.

Contact PAM Health to Learn More About Speech Therapy for Stroke Patients

Working with a team of qualified speech-language pathologists and medical professionals can make all the difference when recovering from a stroke. At  PAM Health , our staff is fully equipped to help stroke patients achieve an optimal quality of life through  speech therapy  and other treatment techniques. Our speech-language pathologists achieve long-term positive outcomes by prioritizing patient care and satisfaction.

To learn more about how the speech therapy services from PAM Health can help stroke patients communicate clearly again,  find the facility nearest you  and call today for more information.

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Early, intense therapy for language problems after a stroke is linked to the greatest benefits

doi: 10.3310/nihrevidence_59653

This is a plain English summary of an original research article . The views expressed are those of the author(s) and reviewer(s) at the time of publication.

Speech and language therapy helps people with language problems (aphasia) after a stroke. A large international analysis showed that this therapy is most effective when it is delivered early (within 28 days of the start of aphasia), frequently and in high doses. The greatest improvements in recovery were seen when people practiced tasks at home.

Aphasia is commonly caused by a stroke and can result in difficulty speaking, understanding speech, reading or writing. To date, there has been a lack of evidence about the how much therapy people with aphasia after a stroke need to support their recovery.

Researchers analysed 174 studies of speech and language therapy for aphasia after stroke. They found that the best recovery was linked to 20 – 50 hours in total of speech and language therapy. The best improvements in general language were linked to 2 – 4 hours of therapy, given over 4 to 5 days per week.

Optimal recovery for younger adults, men and people with milder aphasia was linked to more speech and language therapy. People under 55 years were likely to improve the most. However, the research showed that older people (75+ years) still improved with therapy.

The timing of therapy was important. Starting therapy within a month of experiencing aphasia was linked to the greatest improvements. People who had had aphasia for more than 3 months needed more therapy. However, people whose stroke occurred more than 6 months earlier could still improve with therapy.

Therapy could be effectively delivered in-person or via video. Family members who had received training from a speech and language therapist could support the delivery of a therapy programme to their loved one.

These findings have informed national and international guidelines. They are relevant to professionals who design and deliver programmes of speech and language therapy. People with aphasia after a stroke, and their carers, will also be interested.

For more information about aphasia, visit the NHS website .

What’s the issue?

More than 3.5 million people around the world have a stroke that affects their speech and understanding of speech, reading and writing (aphasia). Stroke patients with aphasia can struggle more with daily activities, and have poorer recovery and wellbeing than those who did not develop aphasia. Speech and language therapy improves people’s recovery, but therapists lack information on how to optimise the delivery of therapy for each individual.

This review brought together data from previous studies. Researchers assessed the impact of various types of treatment, delivered with greater or less intensity, and over different lengths of time.

What’s new?

The review included 174 studies from 28 countries (including 47 randomised controlled trials). Together, these studies included individual information on almost 6000 people.

Overall, the review concluded that for people with aphasia after stroke, their best recovery is associated with:

• therapy started within 28 days of the onset of aphasia
• 20 – 50 hours of speech and language therapy in total
• 2 – 4 hours of therapy a week, delivered over 4 – 5 days, for general language improvement
• tasks that are practiced at home.

Starting therapy early was important. People who had had aphasia for more than 3 months needed extra therapy to make their best recovery. However, those who had a stroke more than 6 months previously could still improve with therapy.

Younger adults (under 55) were likely to improve the most, though people over 75 still made gains with therapy. Men and people with milder aphasia were likely to need more therapy than others, the study found.

The intensity of therapy necessary varied according to the problem being addressed. The greatest improvements in overall language abilities and functional communication (the ability to communicate in real settings) were associated with 2 – 4 hours of therapy per week. But improvements in understanding speech were only evident when there were 9+ hours of therapy per week.

Neither the delivery method (in-person versus video, for example), nor who (professional therapist versus a family member who had received training from a professional therapist) delivered the speech and language therapy programme, made a meaningful difference.

Why is this important?

Overall, the greatest gains were linked to therapy that was delivered early (within 28 days of the start of aphasia), frequently and in high doses. Home practice and therapy tailored to the individual’s needs (and the level of their language difficulty) was linked with the greatest improvements.

Some of the studies in the review were small. The researchers noted variation in how data was collected and reported, including information about the people who took part, their aphasia (such as reading and writing problems) and the therapy delivered. Some of the findings therefore need to be interpreted with caution. Further research could explore groups of people unrepresented in the data, examine in more detail the link between dose of therapy and recovery, and develop more tailored speech and language therapies.

What’s next?

The findings have been included in the UK and Ireland National Clinical Guideline for Stroke and in Australian and New Zealand Clinical Guidelines. They are being considered by the National Institute for Health and Care Excellence (NICE) for its forthcoming update to guidelines on stroke rehabilitation in adults, and by the European Stroke Organisation Guidelines on Aphasia Rehabilitation after Stroke .

You may be interested to read

This summary is based on: Brady MC, and others. Complex speech-language therapy interventions for stroke-related aphasia: the RELEASE study incorporating a systematic review and individual participant data network meta-analysis . Health and Social Care Delivery Research 2022; 10 (28).

Information about aphasia after stroke from the Stroke Association .

Conflict of interest: One of the authors has received fees from pharmaceutical companies outside of this research. Full disclosures can be found in the original research paper .

Funding: This research was funded by the NIHR Health and Social Care Delivery Research programme and the Tavistock Trust for Aphasia , UK.

Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.

NIHR Evidence is covered by the creative commons, CC-BY licence . Written content may be freely reproduced provided that suitable acknowledgement is made. Note, this license excludes comments made by third parties, audiovisual content, and linked content on other websites.

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What does a Speech Therapist do for Stroke Patients?

Suffering a stroke can be a frightening and traumatic experience. Most people know that getting to the hospital for treatment as soon as possible when a stroke has occurred is highly important. For many people who have had a stroke, recovering from the stroke itself is just the start of a longer period of recovery and rehabilitation to restore lost function and abilities due to the stroke.

At least one-third of those who suffer a stroke have problems with speech and communication as a result. Aphasia is a term referring to difficulties related to language, a condition that is often the result of a stroke. This includes difficulty speaking, listening and comprehending information, and reading and writing. Some or all of these areas of communication can be affected and to varying degrees. For stroke patients, and their loved ones, these difficulties can add another layer of frustration and challenges to an already difficult and worrying situation. Speech therapy is a highly beneficial resource for people who are struggling with lost communication skills related to a stroke. Support is at hand – get started by scheduling your free introductory call today!

What is a Stroke?

A stroke occurs when there is a sudden interruption or reduction of blood supply and oxygen to the brain. When this happens, brain cells begin to die within minutes, which can lead to impairments including paralysis, lack of movement in the body, and the loss of an overall ability to communicate. A stroke is a medical emergency, and immediate treatment is essential. Early action and medical treatment can reduce brain damage and other complications significantly.

What are the Signs of a Stroke?

If you or someone you’re with is possibly having a stroke, it is important to pay particular attention to the time that the symptoms begin to emerge. Some of the most effective treatment options are most successful when administered soon after the onset of a stroke.

The Most Common Signs and Symptoms of a Stroke are:

Difficulty speaking and comprehending what others are saying – Some people may experience confusion, slurring of words, or difficulty understanding the speech of others.

Numbness or Paralysis of the face, arm, or leg – In most cases, this affects just one side of the body. Some doctors advise trying to raise both arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Also, one side of the mouth may droop when smiling or speaking.

Difficulty with vision in one or both eyes – Some people experience sudden blurred or blackened vision in one or both eyes, or for others, they may see double.

Headache – A sudden, severely painful headache can occur, which in some cases is accompanied by vomiting, dizziness, or an altered state of consciousness.

Trouble walking – Some people who have had a stroke may stumble or lose their balance. They may also experience sudden dizziness or a loss of coordination.

How Does a Stroke Affect Speech?

A stroke can affect cognition, speech, and language abilities in a variety of ways.

Difficulty talking or swallowing – In many cases, a stroke affects the ability to control the muscles in your mouth and throat. This can make it difficult to speak clearly, swallow correctly or eat. Some people may have difficulties related to language, including speaking or understanding speech, as well as reading and writing.

Memory loss and thinking difficulties – Many people who have suffered a stroke experience some degree of memory loss. Others may struggle with thinking, reasoning, making decisions or judgments, and understanding concepts.

Can Speech Therapy Help after a Stroke?

It is normal for someone who has suffered a stroke to experience some degree of “spontaneous recovery” in the days, weeks, and months that follow. During this time, physical, cognitive, and communication deficits may gradually improve on their own as the brain heals. Therapeutic intervention can enhance and expedite the spontaneous recovery process.

An experienced and knowledgeable Speech and Language Pathologist (SLP) can help improve and strengthen communication skills beyond what will occur naturally after the stroke. The therapist will teach strategies to help overcome communication challenges such as difficulty producing or understanding speech correctly (aphasia), slurred speech caused by muscle weakness (dysarthria), and/or difficulty in programming oral muscles for speech production (apraxia). Some individuals also experience difficulties related to social communication, such as challenges with taking turns in conversation, navigating the general flow of conversation, and problems maintaining a topic when talking with others.

When working to improve a stroke patient’s ability to produce or understand language, a specialized speech therapist will work on specific exercises and strategies, focusing on such things as word retrieval and social/conversational skills. When dysphagia or difficulty swallowing occurs, there is a wide variety of therapeutic interventions that have proven to be successful in remediating these challenges. Learn more about speech therapy for a stroke patient by scheduling your free introductory call today!

How Long Does Speech Therapy Take After a Stroke?

Recovering speech and language skills can be a long, slow process. With the right support and some patience and persistence, however, most people will make significant progress over time. Some people may not completely return to the level of function they had before a stroke, but significant improvements are always possible. Speech therapy may occur over the first six months after a stroke, and for some may be ongoing for years after the event.

It is important to seek treatment for speech and language deficits related to a stroke, because, if left untreated, communication challenges can lead to feelings of embarrassment, decreased independence, relationship problems, and, in some cases, depression.

How do you Help a Stroke Patient’s Speech?

In addition to seeking the help and support of an experienced SLP, here are a few other things you can do to support someone whose communication skills have been affected by a stroke:

Always look directly at the person when you are speaking to them. Speak slowly and clearly, but using a normal tone of voice. Use short sentences and stick to one topic at a time. Keep background noise to a minimum. Reassure the person that you understand their frustration. Write things down, if it will be helpful. Find out about the person’s employment, interests, and passions — now and before the stroke — and try to relate to these. Give people a chance to say what they want to say, without jumping in or correcting them.

If you want to learn more about how to support someone who has had a stroke, or how speech therapy can help, get started by scheduling your free introductory call today!

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How we can help people who have had a stroke

A stroke happens when the blood supply into the brain is cut off. Without this supply, brain cells can be damaged and destroyed as nutrients and oxygen will not reach the cells and will not be able to function as normal. This is known as an attack of the brain.

Speech and language therapy can treat and support any speech, language, communication and swallowing difficulties caused by a stroke. Speech and language therapy will provide an individualised therapy programme to help improve and support communication and swallowing difficulties.

What is a stroke?

A stroke is an attack on the brain when the blood supply to the brain is cut off. This can either be through a blood clot or a burst blood vessel. In the UK, every year roughly 145,000 people have a stroke. It is more common in people over 65 however can occur at any age. It is important to note, that a stroke affects people in many different ways and varies in severity.

A stroke can affect speech, movement, memory and thought processes. The extent of damage will depend upon which part of the brain is affected, as well as the health of the person before the stroke.

The two hemispheres of your brain affect different functions of your body. For example; the right side of the brain will control the left side of your body. Therefore damage to the right side of your brain will mean problems with the left side of your body. Language, talking, writing and reading are all controlled in the left hemisphere of the brain. Perceptual skills and spatial awareness are controlled in the right hemisphere.

There are two types of stroke, an ‘ischaemic stroke’ or a ‘haemorrhagic stroke’.

Ischaemic stroke

An ischaemic stroke is a blockage to an artery carrying blood to the brain. Causes can vary from a blood clot, air or fat bubble in the blood vessel or main artery. This is the most common cause of stroke.

Haemorrhagic stroke

A haemorrhagic stroke is the bursting of a blood vessel resulting in bleeding into the brain. This hemorrhage may be caused by either a vessel bursting in the brain, or a vessel bursting on the surface and leaking into the area between brain and skull.

Another cause of a stroke includes a ‘transient ischaemic attack’.

Transient ischaemic attack

A transient ischaemic attack occurs when the brain has the blood supply interrupted for a brief amount of time. Commonly known as a mini stroke, the symptoms are the same as a normal stroke, however only last for a maximum 24 hours. This could be a warning sign that the brain is not getting enough oxygen and so may lead to a more serious form of stroke.

What causes a stroke?

The cause of a stroke is a blood clot or bleed into the brain. This cuts off the supply of oxygen to the brain and does not allow it to function properly. There are a number of risk factors associated with a stroke. Some of these can be changed but some cannot. Things such as age, family history and ethnicity are non-changeable risk factors. Manageable risks are things such as; high blood pressure, diabetes and high cholesterol.

What problems caused by a stroke can SLT UK help with?

SLT UK can help with a number of problems arising after a stroke. Depending upon which type of stroke someone has had, a speech and language therapist will tailor therapy to suit each patients needs.

Our speech and language therapists can help individuals who have had a stroke with attention and listening problems, communication problems, swallowing difficulties, voice and speech problems.

There are many benefits to having speech and language therapy after a stroke, speech therapy will improve a patient's communication. This may, in turn, increase the patient's confidence, independence and relieve the stress and anxiety after stroke.

How does speech and language therapy help with a stroke?

Speech and language therapy can help with the effects of a stroke and improve on many different associated difficulties. This includes, swallowing, eating, drinking and associated language problems.

After a stroke, many people have difficulties with their language. This is known as aphasia, either expressive which involves not being able to find the right words or receptive which is the understanding of words. It is possible to have a mixture of each type. If difficulties are more to do with the formation of words, this is known as dysarthria. This is when the stroke affects the movement in your face, tongue or throat.

If the right hemisphere is affected this can be termed right hemisphere communication disorder. Right hemisphere communication disorder can often go unnoticed as it doesn’t directly affect speech or language. Instead it affects how an individual uses language in everyday social situations, known as social communication. An individual’s ability to take turns in conversation, attention and ability to concentrate can be affected.

What would speech and language therapy treatment for a stroke involve?

Speech and language therapy treatment for a stroke will involve trying to build upon the parts of the brain which are affected and help to compensate and improve associated problems of a stroke. An initial assessment will be done to decide upon the best type of treatment and treatment that is specific.

Speech and language therapy may involve assessment, reports, reviews, therapy programmes, support groups and advice or education.

Specific treatment for difficulties after stroke may also include:

• Stroke rehabilitation group
• Social skills group
• Total communication approach
• Articulation therapy

A stroke is caused by a blockage or burst blood vessel in the brain. This leads to a lack of oxygen, and causes the brain not to function as it should. A stroke is individual and will depend upon where the blockage is as to what is affected. Speech and language therapy can be extremely beneficial to someone who has had a stroke.

If you feel you may benefit from speech and language therapy or would like any more information on our services please email [email protected] or call 0330 088 5643.

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A Neurosurgeon’s Guide to Stroke

Stroke is an abrupt interruption of constant blood flow to the brain that causes loss of neurological function. The interruption of blood flow can be caused by a blockage, leading to the more common ischemic stroke, or by bleeding in the brain, leading to the more deadly hemorrhagic stroke. Ischemic stroke constitutes an estimated 87 percent of all stroke cases. Stroke often occurs with little or no warning, and the results can be devastating.

It is crucial that proper blood flow and oxygen be restored to the brain as soon as possible. Without oxygen and important nutrients, the affected brain cells are either damaged or die within a few minutes. Once brain cells die, they generally do not regenerate and devastating damage may occur, sometimes resulting in physical, cognitive and mental disabilities.

Symptoms + Types

Ischemic stroke.

• Thrombotic (cerebral thrombosis) is the most common type of ischemic stroke. A blood clot forms inside a diseased or damaged artery in the brain resulting from atherosclerosis (cholesterol-containing deposits called plaque), blocking blood flow.
• Embolic (cerebral embolism) is caused when a clot or a small piece of plaque formed in one of the arteries leading to the brain or in the heart, is pushed through the bloodstream and lodges in narrower brain arteries. The blood supply is cut off from the brain due to the clogged vessel.

Transient ischemic attack (TIA)

This is a warning sign of a possible future stroke and is treated as a neurological emergency. Common temporary symptoms include difficulty speaking or understanding others, loss or blurring of vision in one eye and loss of strength or numbness in an arm or leg. Usually these symptoms resolve in less than 10 to 20 minutes and almost always within one hour. Even if all the symptoms resolve, it is very important that anyone experiencing these symptoms call 911 and immediately be evaluated by a qualified physician.

Hemorrhagic Stroke

• Subarachnoid Hemorrhage is bleeding that occurs in the space between the surface of the brain and skull. A common cause of subarachnoid hemorrhagic stroke is a ruptured cerebral aneurysm, an area where a blood vessel in the brain weakens, resulting in a bulging or ballooning out of part of the vessel wall; or the rupture of an arteriovenous malformation (AVM), a tangle of abnormal and poorly formed blood vessels (arteries and veins), with an innate propensity to bleed.
• Intracerebral Hemorrhage is bleeding that occurs within the brain tissue. Many intracerebral hemorrhages are due to changes in the arteries caused by long-term hypertension. Other potential causes may be delineated through testing.

Stroke Statistics

• Stroke is the third leading cause of death in the U.S.
• Statistics indicate that an estimated 135,592 people in the U.S. died from cerebrovascular disease in 2007.
• Of all strokes, 87 percent are ischemic, 10 percent are intracerebral hemorrhage and 3 percent are subarachnoid hemorrhage.
• While the incidence has increased, there has been a steady decline in mortality rates since 2002.
• Of the more than 795,000 people affected every year, about 610,000 of these are first attacks and 185,000 are recurrent.
• About 25 percent of people who recover from their first stroke will have another stroke within five years.
• Stroke is a leading cause of serious long-term disability, with an estimated 5.4 million stroke survivors currently alive today.
• In 2010, stroke cost about $73.7 billion in both direct and indirect costs in the U.S. alone.

Source: American Heart Association (AHA), Heart Disease and Stroke Statistics – 2010 Update.

Risk Factors

Although they are more common in older adults, strokes can occur at any age. Understanding the factors that increase your risk of a stroke and recognizing the symptoms may help you prevent a stroke. Receiving early diagnosis and treatment may improve your chances for complete recovery.

Controllable or treatable risk factors for stroke include:

• Smoking: You can decrease your risk by quitting smoking. Your risk may be increased further if you use some forms of oral contraceptives and are a smoker. There is recent evidence that long-term secondhand smoke exposure may increase your risk of stroke.
• High blood pressure: Blood pressure of 140/90 mm Hg or higher is the most important risk factor for stroke. It usually has no specific symptoms and no early warning signs. That is why it is important to have your blood pressure checked regularly. Controlling your blood pressure is crucial to stroke prevention.
• Carotid or other artery disease: The carotid arteries in your neck supply blood to your brain. A carotid artery narrowed by fatty deposits from atherosclerosis may become blocked by a blood clot. Carotid arteries are treated by neurosurgeons through carotid endarterectomy, a procedure in which an incision is made in the neck and plaque is removed from the artery; or carotid artery angioplasty and stenting, an endovascular procedure that requires no surgical incision in the neck.
• History of TIAs: About 30 percent of strokes are preceded by one or more TIAs that can occur days, weeks or even months before a stroke.
• Diabetes: It is crucial to control your blood sugar levels, blood pressure and cholesterol levels. Diabetes, especially when untreated, puts you at greater risk of stroke and has many other serious health implications.
• High blood cholesterol: A high level of total cholesterol in the blood (240 mg/dL or higher) is a major risk factor for heart disease, which raises your risk of stroke. Recent studies show that high levels of LDL (bad) cholesterol (greater than 100 mg/dL) and triglycerides (blood fats, 150 mg/dL or higher) increase the risk of stroke in people with previous coronary heart disease, ischemic stroke or TIAs. Low levels (less than 40 mg/dL) of HDL (good) cholesterol also may increase stroke risk. You can often improve your cholesterol levels by decreasing the salt and saturated fat in your diet. However, some people inherit genes associated with elevated levels of cholesterol. Although they may eat well and exercise, they still may have high cholesterol and must take medication to control it.
• Physical inactivity and obesity: Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. Getting 30 minutes of moderate exercise, five days a week can help reduce your risk of stroke. Check with your doctor first before starting any exercise program if you have any health problems or have been inactive.
• Recent research shows evidence that people receiving hormone replacement therapy (HRT) have an overall 29 percent increased risk of stroke, in particular ischemic stroke.

Uncontrollable risk factors include:

• Age: People of all ages, including children, have strokes. But the older you are, the greater your risk of stroke.
• Gender: Stroke is more common in men than in women. In most age groups, more men than women will have a stroke in a given year. However, women account for more than half of all stroke deaths. Women who are pregnant have a higher stroke risk. Some research has indicated that women may experience and interpret stroke symptoms differently than men, causing them to delay seeking medical care and contributing to their higher stroke mortality rates.
• Heredity and race: You have a greater risk of stroke if a parent, grandparent, sister or brother has had a stroke. African Americans have more than two times the risk of stroke compared to Caucasians, partly related to the prevalence of hypertension. Hispanics also have an elevated stroke risk.
• Prior stroke or heart attack: If you have had a stroke, you are at much higher risk of having another one. If you have had a heart attack, you are also at higher risk of having a stroke.

Stroke Symptoms

The range and severity of early stroke symptoms vary considerably, but they share the common characteristic of being sudden. Warning signs may include some or all of the following symptoms:

• Dizziness, nausea or vomiting
• Unusually severe headache
• Confusion, disorientation or memory loss
• Numbness, weakness in an arm, leg or the face, especially on one side
• Abnormal or slurred speech
• Difficulty with comprehension
• Loss of vision or difficulty seeing
• Loss of balance, coordination or the ability to walk
• It is especially important to note that many strokes may cause an utterly painless loss of neurological function, leading to potential hesitation to call 911 or visit an emergency room.

Stroke Effects

The effects of a stroke depend primarily on the location of the obstruction and the extent of brain tissue affected. One side of the brain controls the opposite side of the body, so a stroke affecting the right side will result in neurological complications on the left side of the body. A stroke on the right side may result in the following:

• Paralysis on the left side of the body
• Vision problems
• Quick, inquisitive or purposeless behavior
• Memory loss

A stroke on the left side may result in the following:

• Paralysis on the right side of the body
• Speech/language problems
• Slow, cautious behavior

Treatment + Care

Rehabilitation following a stroke may involve a number of medical specialists; but the early diagnosis of a stroke, its treatment or its prevention, can be undertaken by a neurosurgeon. Rapid and accurate diagnosis of the kind of stroke and the exact location of its damage is critical to successful treatment. Technical advances such as digital imaging, microcatheters and other neurointerventional technologies, the use of the operating microscope (microsurgery) and the surgical laser have made it possible to treat stroke problems that were inoperable a few years ago.

Ischemic Stroke Treatment

Ischemic stroke is treated by removing obstruction and restoring blood flow to the brain. The only U. S. Food and Drug Administration (FDA)-approved medication for ischemic stroke is tissue plasminogen activator (tPA), which must be administered within a three-hour window from the onset of symptoms to work best. Unfortunately, only 3- 5 percent of those who suffer a stroke reach the hospital in time to be considered for this treatment, and the actual use of tPA is considerably lower. This medication carries a risk for increased intracranial hemorrhage and is not used for hemorrhagic stroke.

Emergency Surgical Stroke Treatment: Neurointerventional Procedures

Microcatheter-based surgical interventions for stroke may include the use of a small microcatheter, delivered through a larger guiding catheter inserted at the groin through a small incision. A microguidewire is used to navigate the microcatheter to the site of obstruction in the brain. Thrombolytic medication, such as tPA, can then be administered directly to the occluding thrombus. This kind of treatment, which delivers thrombolytic medication intraarterially, is more specific than IV (intravenous) tPA and consequently may require significantly lesser dosages of medication. The time limit to implement this type of intervention is also significantly (double) longer than that for IV TPA. Generally, only Comprehensive Stroke Care Centers offer this type of treatment.

Clot Retrieval Devices

The Merci Retriever, approved in 2004 by the FDA, is a corkscrew- shaped device used to help remove blood clots from the arteries of stroke patients. A small incision is made in the patient’s groin, into which a small catheter is fed until it reaches the arteries in the neck. At the neck, a small catheter inside the larger catheter is guided through the arteries into the brain, until it reaches the brain clot. A straight wire inside the small catheter pokes out beyond the clot and automatically coils into a corkscrew shape. It is pulled back into the clot, the corkscrew spinning and grabbing the clot. A balloon inflates in the neck artery, cutting off blood flow, so the device can pull the clot out of the brain safely. The clot is removed through the catheter with a syringe.

Penumbra is also a microcatheter-based system device, which works by an aspiration principle. It was approved by the FDA in 2008.

Stentriever devices are the newest generation of embolectomy devices for stroke. They are still in an investigative phase but work by breaking up the occluding clot, combined with aspiration or withdrawal.

Medical Prevention

Medications used to help prevent stroke in high-risk patients (especially those who have experienced a previous TIA or ischemic stroke) fall into two major categories: anticoagulants and antiplatelet agents.

Anticoagulants thin the blood and prevent clotting. Heparin acts quickly and is given intravenously or subcutaneously (beneath the skin) while a patient is in the hospital. Slower-acting warfarin can be given orally and is used over a longer period. Because these drugs affect the blood’s ability to clot, they require close monitoring by a physician.

Antiplatelet drugs prevent platelet aggregation. Platelets are specialized cells in the blood that initiate a healing process. Large numbers of platelets clump together to form a clot, which can sometimes block an artery or break loose, travel through the bloodstream and block a smaller artery. Antiplatelet drugs make platelets less sticky and less likely to form clots, reducing the risk of ischemic stroke in patients who have had TIA or prior ischemic stroke.

Preventive Surgical Procedures

Carotid endarterectomy surgery (carotid endarterectomy, cea).

Patients will be given either a general or local anesthetic before surgery. In this procedure, the neurosurgeon makes an incision in the carotid artery in the neck and removes the plaque using a dissecting tool. Removing the plaque is accomplished by widening the passageway, which helps to restore normal blood flow. The artery will be repaired with sutures or a graft. The entire procedure usually takes about two hours. One may experience pain near the incision in the neck and some difficulty swallowing during the first few days after surgery. Most patients are able to go home after one or two days and return to work usually within a month. Patients should avoid driving and limit physical activities for a few weeks after surgery.

There are potential complications with carotid endarterectomy surgery, just as there are with any type of surgery. There is a 1-3 percent risk of stroke following surgery. Another fairly rare complication is the reblockage of the carotid artery, called restenosis. This may occur later, especially in cigarette smokers. Numbness in the face or tongue caused by temporary nerve damage is a possibility, but uncommon. This usually clears up in less than one month and most often does not require any treatment.

Carotid Angioplasty and Stenting

An alternative, newer form of treatment, carotid angioplasty and stenting (CAS), shows some promise in patients who may be at too high risk to undergo surgery. Carotid stenting is a neurointerventional procedure in which a tiny, slender metal-mesh tube is fitted inside the carotid artery to increase the flow of blood blocked by plaques. Access is gained through a small (0.5 cm) groin incision, but no incision is made in the neck. The stent is inserted following a procedure called angioplasty, in which the doctor guides a balloon-tipped catheter into the blocked artery. The balloon is inflated and pressed against the plaque, flattening it and reopening the artery. The stent acts as scaffolding to prevent the artery from collapsing or from closing up again after the procedure is completed.

There are several potential complications of endovascular treatment. The most serious risk from carotid stenting is an embolism caused by a disrupted plaque particle breaking free from the site. This can block an artery in the brain, causing a stroke. These risks are minimized using small filters called embolic protection devices in conjunction with angioplasty and stenting. There is also a slight risk of stroke due to a loose piece of plaque or a blood clot blocking an artery during or right after surgery. The risks are balanced against the advantages of a shorter occlusion time (10 seconds, as opposed to 30 minutes for endarterectomy), shorter anesthesia and a small leg incision.

Hyperperfusion, or the sudden increased blood flow through a previously blocked carotid artery and into the arteries of the brain, can cause a hemorrhagic stroke. Other complications include restenosis and short periods of medically treatable reduced blood pressure and heart rate. These risks are similar for CEA and CAS.

Hemorrhagic Stroke Treatment

Hemorrhagic stroke usually requires surgery to relieve intracranial (within the skull) pressure caused by bleeding. Surgical treatment for hemorrhagic stroke caused by an aneurysm or defective blood vessel can prevent additional strokes. Surgery may be performed to seal off the defective blood vessel and redirect blood flow to other vessels that supply blood to the same region of the brain.

For a patient with a ruptured cerebral aneurysm, surgical elimination of the aneurysm is only the beginning. Intensive care recovery for the next 10-14 days is the rule, during which time a multitude of complications related to subarachnoid hemorrhage (SAH) can and do occur. At some time during that period (often immediately upon completion of surgery), cerebral angiography or a substitute study is done to document that the aneurysm has been eliminated. The first two to five days after SAH represent the greatest threat of brain swelling; at which time special measures (both medical and surgical) are used to diminish the effect of swelling on intracranial pressure. Near the end of this initial period, the risk period for delayed cerebral vasospasm begins and lasts the better part of the next 14 days. Intercurrent infections such as pneumonia are common, and hydrocephalus may develop.

Surgery/Clipping

Prior to surgery, the exact location of the subarachnoid hemorrhage or aneursym is identified through cerebral angiography images. An operation to “clip” the aneurysm is performed by doing a craniotomy (opening the skull surgically) and isolating the aneurysm from the normal bloodstream. In addition, a craniectomy, a surgical procedure in which part of the skull is removed and left off temporarily, may be done to help relieve increased intracranial pressure.

One or more tiny titanium clips with spring mechanisms are applied to the base of the aneurysm, allowing it to deflate. The size and shape of the clips is selected based on the size and location of the aneurysm. Clips are permanent, remain in place and generally provide a durable cure for the patient. Angiography is used to confirm exclusion of the aneurysm from the cerebral circulation and the preservation of normal flow of blood in the brain.

Endovascular (Neurointerventional) Treatment

Neurointerventional procedures for cerebral aneurysm share the advantages of no incision made in the skull and an anesthesia time that is often dramatically shorter than for craniotomy and microsurgical clipping.

In endovascular microcoil embolization, a needle is placed into the femoral artery of the leg, and a small catheter is inserted. Utilizing x-ray guidance, the catheter is advanced through the body’s arterial system to one of the four blood vessels that feed the brain. A smaller microcatheter is fed into the aneurysm, and once properly positioned, a thin wire filament or “coil” is advanced into the aneurysm. The flexible, platinum coil is designed to conform to the shape of the aneurysm. Additional coils are advanced into the aneurysm to close the aneurysm from the inside. This prevents flow of blood into the aneurysm by causing a clot to form on the inside.

Balloon-assisted coiling uses a tiny balloon catheter to help hold the coil in place. Although this has been shown in several studies to increase risks, ongoing innovations in this relatively new technology has helped improve its efficacy. Combination stent and coiling utilizes a small flexible cylindrical mesh tube that provides a scaffold for the coiling. Intracranial stenting and other innovations are quite new, and endovascular technology is in a constant state of development. These adjuncts allow coiling to be considered for cerebral aneurysms that may not have an ideal shape for conventional coiling.

Stroke Rehabilitation

Recovery and rehabilitation are among the most important aspects of stroke treatment. As a rule, most strokes are associated with some recovery, the extent of which is variable. In some cases, undamaged areas of the brain may be able to perform functions that were lost when the stroke occurred. Rehabilitation includes physical therapy, speech therapy and occupational therapy. This type of recovery is measured in months to years.

• Physical therapy involves using exercise and other physical means (e.g., massage, heat) and may help patients regain the use of their arms and legs and prevent muscle stiffness in patients with permanent paralysis.
• Speech therapy may help patients regain the ability to speak.
• Occupational therapy may help patients regain independent function and relearn basic skills (e.g., getting dressed, preparing a meal and bathing).

Note from AANS

The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon online tool.

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Using novel discourse treatment to improve communication in people with aphasia

by City University London

Aphasia is a condition that affects a quarter of stroke survivors. It impairs communication abilities, including speaking, listening, reading, and writing. Aphasia can have a profound impact on social relationships, employment, and overall quality of life.

In current UK practice, 90% of speech and language therapists acknowledge the importance of discourse assessment and treatment. However, they face considerable barriers such as limited resources, time, and expertise. Addressing this critical need, the Language Underpins Narrative in Aphasia (LUNA) intervention used in the study offers a multi-level approach targeting words, sentences, and discourse macrostructure through personalized narratives. This aligns more closely with real-life communication needs.

The study, which was led by Professors Madeline Cruice and Lucy Dipper from the Centre for Language and Communication Sciences Research at City, involved 28 participants with chronic aphasia, split equally into immediate treatment and delayed treatment (control) groups. Treatment was structured into 20 sessions over 10 weeks, each lasting an hour. Sessions were conducted via Zoom, making the therapy accessible during the COVID-19 pandemic.

The LUNA treatment focused on personal narrative monologues, helping participants reconstruct their chosen narratives through structured language exercises targeting words, phrases, sentences, and discourse macrostructures.

It was seen that LUNA improved the narrative abilities of participants who received the treatment compared to the control group. Improvements were also seen in terms of language functioning and mood. These results underscore the potential of LUNA to effectively enhance communication skills among aphasia patients. The study has been published in the journal PLoS One .

Professor Dipper, Professor of Clinical Linguistics, said, "Traditional therapeutic approaches often focus on word and sentence-level treatments, but LUNA represents a shift in aphasia treatment to align more closely with real-life communication needs."

Professor Cruice, Professor of Aphasia Rehabilitation and Recovery, said, "Our findings demonstrate the potential of narrative-based interventions to make a real difference in the lives of people with aphasia . We hope this study encourages further research and adoption of discourse-focused therapies, ultimately leading to more holistic and effective rehabilitation practices."

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Survival Rates After a Stroke

• Signs and Symptoms

Life Expectancy

Side effects, life after a stroke.

Strokes are the fifth leading cause of death in the United States and a leading cause of long-term disability. Every year in the United States, about 795,000 people have strokes and 137,000 of those people die. Of the people having a stroke in any year, 185,000 have survived a stroke in the previous five years.

Survival rates for stroke depend on many factors, including the type of stroke, its severity, the treatment used, your age, and overall health.

This article reviews the prognosis, life expectancy, and side effects of strokes, and what life can look like after a stroke.

Types of Stroke

The three main types of stroke are:

• Ischemic stroke : The most common type of stroke, ischemic strokes result from a clot that prevents oxygen-rich blood from flowing into the brain.
• Hemorrhagic stroke : This type of stroke is due to blood vessels bleeding or rupturing. The bleeding puts pressure on brain cells and leads to brain cell death.
• Transient ischemic attack (TIA): This is known as a ministroke. These differ from the other two strokes because symptoms usually last for only a few minutes to an hour.

Stroke Signs and Symptoms

Stroke symptoms may include:

• Severe headache that occurs out of the blue
• Facial drooping
• Numbness and/or weakness of the legs, arms, and/or face (particularly on one side)
• Vision issues in one or both eyes
• Confusion, difficulty understanding speech, and trouble speaking
• Difficulty walking, sudden incoordination, or loss of balance

Call 911 immediately if you notice any of the following "FAST" signs of a stroke :

• F = Face drooping, including numbness and one-sided drooping
• A = Arm weakness, including weakness and numbness, especially on one side
• S = Speech slurring or difficulty
• T = Time to call 911 fast and let the dispatcher know the time that symptoms began

Think FAST With a Stroke

Stroke survivors will spend some time in the hospital to recover and rehabilitate. Many will require long-term physical , occupational , and speech therapy and need disability assistance.

Having access to certain treatments, such as tissue plasminogen activator , improves the chances of recovering from a stroke. The chances of preventing another stroke from occurring are improved by treating the underlying cause of the stroke, including high blood pressure , high cholesterol , diabetes , and more.

Stroke Recurrence

Stroke survivors are at risk of having another stroke. About one in four stroke survivors will have another one within the following five years.

Even though the effects of a TIA appear to be temporary, they should be taken seriously because they are often followed by major strokes in the future. The chance of having another stroke within 90 days of a TIA is 17%, with the highest risk of occurrence during the first week.

Hemorrhagic stroke has a 40% to 50% death rate in the first 30 days after the event, which is double the rate of ischemic stroke.

A 2021 study in Sweden found that about 66% of people who had a first-time ischemic stroke survived past the three-year mark. Survival factors included:

• The person's age
• Their overall health
• Stroke severity

People with cerebrovascular disease (a group of conditions affecting blood flow and blood vessels in the brain) and heart disease were most likely to die before the three-year mark.

A 2018 study indicated that the type of stroke also plays a role in life expectancy after a stroke. At 5 years, death or physical dependency occurred for 79% of people who had a hemorrhagic stroke and 70.6% of people who had an ischemic stroke.

Statistics also show that age is a significant factor in long-term survival after a stroke. People age 85 and older have the highest death rate: the risk of dying is 13 times higher than people 65 to 74 years old. And the risk of dying is three times higher for people ages 75 to 84 compared to people 65 to 74 years old.

Ministrokes are not life-threatening by themselves, as they lead to a full recovery in the short term. However, they are a sign of potentially significant health problems that put a person at a much higher risk of having a major stroke in the future.

Anyone who has stroke symptoms—even temporarily—needs to seek medical care as soon as possible.

Strokes can lead to physical, emotional, and behavioral challenges.

Stroke survivors have residual health issues of the brain and body. Common disabilities that remain include:

• Complete paralysis or weakness on one side of the body
• Cognitive problems and issues with awareness, thinking, attention, memory, learning, and judgment
• Speech difficulties and problems understanding speech
• Emotional issues and depression
• Strange sensations and numbness of the extremities

Stroke type and severity will determine the kind of recovery a person requires. Rehabilitation may include working with a few different types of specialists, including:

• Speech therapist : Helps stroke patients who have difficulty speaking or understanding speech
• Physical therapist : Helps stroke patients with exercises that help them relearn physical movement and coordination
• Occupational therapist : Helps stroke patients with activities of daily living, such as dressing, bathing, eating, drinking, reading, and writing

Many stroke patients also struggle with depression , anxiety , and other mental health issues. Therapy or support groups can help stroke victims come to terms with their prognosis and adjust to a new normal after a stroke.

Talk with your healthcare provider to find stroke support groups and mental health providers specializing in stroke recovery.

Life may feel daunting in the weeks and months following a stroke. Some people recover more quickly. However, others may require months to years of rehabilitation.

Some of the residual effects of a stroke that patients may have include:

• Difficulty with memory, thinking, awareness, attention, learning, and judgment
• Difficulty with speaking or understanding speech
• Trouble controlling or expressing emotions
• Bladder and bowel control issues
• Paralysis, weakness, or numbness (or all three) on one side
• Extremity pain, especially in the hands or feet and especially in cold weather
• Difficulty with chewing or swallowing
• Depression and anxiety

Rehabilitation can help stroke victims regain their strength and help them feel more confident completing everyday tasks.

A stroke occurs when oxygen-rich blood flow to the brain becomes blocked by a clot or a blood vessel bleed. Post-stroke prognosis and life expectancy depend on several factors, including the type of stroke, its severity, the person's age, and overall health. Stroke survivors are also at risk of having another stroke in the following years.

A stroke is a frightening and challenging life event. Coping with the long-term effects may seem overwhelming or discouraging at times. Know that there are healthcare professionals, treatments, and resources available that can help.

Work with your healthcare providers to manage symptoms, relearn skills, and find ways to adapt to your new circumstances. You might find it helpful to gather a support network that understands your stroke recovery struggles.

Frequently Asked Questions

You can help prevent stroke by controlling any health conditions you may have and making healthy lifestyle choices, including:

• Eating a healthy diet
• Maintaining a healthy weight
• Being physically activity
• Not smoking
• Drinking little or no alcohol

No. A heatstroke is an illness that occurs when the body's temperature rises rapidly and the body is unable to control its temperature. During a heatstroke, the body's sweating mechanism fails and is unable to cool itself.

A brain stroke occurs when oxygen-rich blood flow to the brain becomes blocked by a clot or a blood vessel bleed.

Most people who have a first-time stroke also have high blood pressure (hypertension). High blood pressure damages blood vessels in the body and brain, making them more likely to clog or burst. Managing hypertension is an essential way to help reduce your risk of stroke.

American Stroke Association. About stroke .

National Institute of Child Health and Human Development. How many people are affected by stroke? .

Centers for Disease Control and Prevention. Stroke types .

Centers for Disease Control and Prevention. Stroke signs and symptoms .

American Stroke Association. Stroke symptoms .

Centers for Disease Control and Prevention. Recovering from stroke .

Centers for Disease Control and Prevention. Stroke treatment .

Woo D, Comeau ME, Venema SU, et al. Risk factors associated with mortality and neurologic disability after intracerebral hemorrhage in a racially and ethnically diverse cohort . JAMA Netw Open. 2022;5(3):e221103.doi:10.1001/jamanetworkopen.2022.1103

Aked J, Delavaran H, Lindgren AG. Survival, causes of death and recurrence up to 3 years after stroke: A population-based study . Eur J Neurol . 2021;28(12):4060-4068. doi:10.1111/ene.15041

Sennfält S, Norrving B, Petersson J, Ullberg T. Long-term survival and function after stroke: a longitudinal observational study from the swedish stroke register .  Stroke . 2019;50(1):53-61. doi:10.1161/STROKEAHA.118.022913

Centers for Disease Control and Prevention. QuickStats:  Death Rates fromStroke Among Persons Aged ≥65 Years, by Sex and Age Group — National VitalStatistics System, United States, 2018 .

National Institute of Neurological Disorders and Stroke. Stroke information page .

Centers for Disease Control and Prevention. Prevent stroke: what you can do .

Centers for Disease Control and Prevention. Frequently asked questions about extreme heat .

American Heart Association. How high blood pressure can lead to stroke .

By Sarah Jividen, RN Jividen is a freelance healthcare journalist. She has over a decade of direct patient care experience working as a registered nurse specializing in neurotrauma, stroke, and the emergency room.

• Recommended

How neurologists can repair the home of broken promises

“I broke our only promise,” swelling with guilt, Sarah wept as she stumbled out of the front door. Two years ago, her father asked her to never leave him in a nursing home. They pinky promised.

But how could anyone have predicted what would follow in the upcoming years? His dementia progressively worsened, complicated by falls every three months. Despite balancing his growing needs while also providing for her family, there was not much she could do when he woke up slurring his words and could not move the entire right side of his body. She ran out of options.

Sarah and her father’s broken promise is not alone. It joins a growing graveyard of wishes focused on avoiding a nursing home at all costs. And I wish I could say it is misplaced. But it’s not. 39.5 percent of patients admitted to a nursing home after a hospital hospitalization never go home. 26.1 percent pass away within one year.

As the President of Create Circles , a non-profit centered around reducing loneliness in nursing homes, I have spent thousands of hours speaking to these patients and their families. When reflecting on the series of events that occurred prior to admission, families often mention neurological conditions that quickly changed, leaving them scared and unprepared.

These experiences are consistent with countless studies. Research shows that stroke and dementia are the main chronic medical conditions associated with NH admission. The growing prevalence of these conditions and their subsequent skilled nursing facility admissions highlights the need to shift how we approach neurological care and follow-up. Just as patients after a stroke receive comprehensive physical, occupational, and speech therapy, we need aggressive care plans that prevent skilled nursing facility (SNF) admissions.

Neurological research has categorized the trajectory of illness into one of four categories: 1) short period of decline, 2) entry/reentry, 3) prolonged dwindling, and 4) sudden neurologic impairment. Based on the neurological condition, neurologists should engage patients in early conversations about disease course, resources, complications, prognosis, and recommendations to avoid SNF admissions. Involving case management to ensure proper coordination and follow-up has been shown to significantly decrease admissions to nursing homes.

While the role of SNFs will never disappear, it is important for us to acknowledge that many SNF admissions may have been avoidable. With neurologists leading early care plans and case management guiding the execution, we can help our older adults avoid a place where very few people choose to be.

Harsh Moolani  is a medical student.

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Speech Language Pathologist Inpatient-Supplemental

Job posting for speech language pathologist inpatient-supplemental at rhi rehab.

The Rehabilitation Hospital of Indiana (RHI), named Best Rehabilitation Hospital in Indiana in 2022 and 2023, provides quality rehabilitation services to those facing life-changing injuries or illness. We specialize in the areas of brain injury, stroke, spinal cord injury and complex medical conditions. RHI is the only Traumatic Brain Injury (TBI) Model System in the state of Indiana and one of only 16 in the U.S. Our campus on the west side of Indianapolis specializes in inpatient and outpatient evidence-based, patient-centered therapy for ages 15 and older. We offer a competitive compensation and benefits package, along with a 401k match and tuition reimbursement program.

The Inpatient Speech-Language Pathologist (SLP) is responsible for the assessment, diagnosis and treatment of communication, cognitive and swallowing disorders for an inpatient and/or outpatient population age 15 and older, under the referral of a physician or qualified non-physician provider.

ESSENTIAL FUNCTIONS

• Administers SLP evaluations to inpatients and outpatients and determines appropriate treatment programs and/or equipment needs, integrating age specific needs and issues for physical medicine rehabilitation population. Provides comprehensive and accurate assessment for adults with speech, language, cognitive, voice, swallowing, and hearing impairment per policy for inpatients or outpatients.
• Develops a patient-centered treatment plan for rehabilitation patients based on the evaluation, patient goals and age-related issues/needs to optimize treatment and functional communication, cognition and/or swallowing. Responsible for ensuring the treatment plan supports medical necessity and incorporates evidence-based treatments and outcome measures. Responsible for ensuring the treatment plan is revised/updated appropriately per policy, communicated to appropriate team members including attendance at team conferences, and reviewed and signed off by referring physician (as appropriate).
• Accurately completes documentation in compliance with department and regulatory timelines to ensure a complete medical record that supports skilled services and appropriate medical necessity. Charges appropriately for services provided and appropriately documents outcome measures.
• Provides clinical supervision, including but not limited to coordination of care and delegation of duties, to techs and students according to state/federal regulations and hospital guidelines. Responsible to assure that patient care interventions provided by students are appropriate for the patient's plan of care.

EDUCATION AND EXPERIENCE

• Master's Degree in Speech-Language Pathology from an accredited college or university required.
• Certificate of Clinical Competence from the American Speech, Language and Hearing Association required.
• Speech-Language Pathologist IN state license required.
• Must have current CPR certification in accordance with AHA standards or be able to obtain within 4 weeks of start date.
• One (1) year of clinical experience in rehabilitation preferred but will consider Clinical Fellowship Year candidates.

HOURS : 7:30 AM-4:30 PM; Scheduled days as needed

The Rehabilitation Hospital of Indiana is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, or any other characteristic protected by law.

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