Communication support for people who have had a stroke

Recovery After Stroke

Strokes often affect speech and/or the understanding of language. The most common speech problems following stroke are called aphasia or dysphasia, and involve difficulty in retrieving wanted words, and comprehension of language. Recovery following a stroke occurs over a period of months or years, and varies according to the individual. Of the people who survive a stroke, two out of three achieve some level of independence. Family members may find it difficult that there is no established timetable for recovery.

The amount of recovery depends on several factors, including:

i) The amount and extent of brain involvement. Problems will be most severe directly after a stroke. There is a natural tendency towards improvement and healing. However, an area of the brain that has been completely deprived of its blood supply dies and the cells cannot grow again. The larger the area that is affected, the more likely it is that the person will have residual impairments.

ii) The specific area(s) of the brain damage. Undamaged areas can take over the work of some damaged areas, and compensate for their loss. This compensation is what therapy aims to stimulate.

iii) The amount of stimulation The amount of stimulation the person receives, and the timing of therapy influences their progress. Although natural recovery does occur, therapy can complement this, and stimulate further recovery that would not have occurred naturally. Residents with dysphasia should receive regular communication therapy and stimulation to encourage recovery and compensatory changes. Therapy should be provided as early as possible for maximum benefit.

iv) Motivation. The dysphasic person must want to regain his communication skills, and may have to work hard to do so. Family members and friends play a crucial role in stimulating and maintaining the person's motivation.

v) The person's level of awareness. Some people who have had a stoke have little insight into their dysphasia. They may not have realise that they have a communication impairment, or insist that communication breakdowns are caused by other people's problems, not their own. One of the goals of therapy with such people should be to increase their insight into their problems, so they can accept assistance.

Interacting With People with Aphasia

Many people suffer communication impairment following a stroke.   The most common communication impairment is called aphasia (or dysphasia).   People with aphasia have difficulty expressing themselves and/or understanding speech.   There are many ways in which you can help an aphasic person cope with his difficulties and use his remaining language skills.   Because a person cannot speak and be understood, or seems unable to listen and understand, this does not mean he is unable to communicate.


The person is essentially the same person he was before his stroke.  The inability to communicate effectively is a sign of the dysphasic condition; it is not a sign of general mental incompetency or childishness.

Regardless of the severity of his language loss, the individual must be treated as a mature, intelligent adult.  Include him in decision making as much as possible.

Do not talk about the person and his problems in front of him, even if you think he cannot understand.  Even someone with comprehension difficulties can pick up the tone of your voice, body language, etc.  If you must say something in front of him, let him know that you realise it is unpleasant to be discussed. 

Do not treat the dysphasic person as if he is deaf, and shout at him.  This does not help him to understand and may actually make it more difficult for him.

Speak and move in a relaxed manner.  Face the person as you speak. Say his name first to establish his attention.  If the person has difficulty understanding, use short simple sentences and clear language.  Slow down your speech so that the person has time to take in what you are saying.  Use gestures and facial expression to help communicate your message.

If the person has difficulty speaking, phrase questions so that he can answer yes/no.  Yes/no questions should have one, not two parts.
Would you like tea?
  Would you like tea or coffee?

Some people with dysphasia may indicate 'no' when they mean 'yes' and vice versa.  If this occurs provide other ways to respond, for example, use multiple choice questions. If possible, show the person the objects as you ask the questions, eg. "Do you want toast or cereal?"

Be alert to the individual's gestures, and eye signals, so that you can gauge his responses.  When you do interpret body language, check with him, eg. "Did you mean no?".

Sometimes a person with dysphasia will "get stuck" on a particular sound, word, or phrase, and repeat it many times (perseveration).  This can be a result of fatigue, a lack of coordination, or anxiety about communication.  The more that this is repeated the more habitual it becomes, and therefore harder to stop.  Gently stop the person, and acknowledge that you are aware that they are trying to say something else.  Ask them to relax, take some deep breaths and try again in a few minutes.  Do not encourage the perseverative response in any way, as this leads to increased frustration for the person.

Don't speak for the person unless it is absolutely necessary.  Anticipating what the person wants to say and saying it for him is natural, but sets back his language progress, and can be very frustrating.  Encourage him to say it himself, or to use alternative communication forms, such as pointing, even if it is slow.  Be patient, give the person time to speak, and try not to interrupt his speech efforts.

Never assume that the person is not trying.  He is not lazy or playing games with you.  He is trying to communicate under very difficult conditions.  Sometimes he will be unable to say something that he said a few minutes before.

Don't push a person with aphasia when he is tired (and he will tire much more easily than he did before).  Communication attempts will be most successful when he is rested and alert.  Pushing him will only create frustration and perhaps depression.

Make sure that you have the person's full attention and that they have yours.  Try not to do other tasks at the same time as talking with him.  Try not to hurry, as this can provoke anxiety and make the person's communication problems worse.

The unintentional use of swearing and emotional phrases is sometimes part of the condition.  Try not to respond to swear words, and acknowledge that you know that it is not what the person meant to say.

If the person has slurred speech (dysarthria) gently remind him to take a breath before speaking, say each syllable clearly, and slow down his speech.  If he drools, gently remind him to close his mouth, purse his lips together, and swallow frequently.

If you can't work out what the person is trying to say, encourage him to use gesture, eg. "Show me what you want", or communication aids.  Ask questions which narrow down the subject, eg. "Is it about your family?", or "Are you asking me to do something for you?"  There will be times when you won't be able to work out what the person is trying to tell you.  If this happens, apologise and suggest trying again later.

Allow the person to do all that he can for himself.  This will help him to re-establish himself and maintain his self-esteem and confidence.  Confidence is particularly important.  A person who is not confident that everyone will welcome his communication attempts and help him to get his meaning across is unlikely to try to communicate.







Anne McDonald Centre. 538 Dandenong Road, Caulfield 3162 Victoria, Australia Ph: 03 9509 6324, Fax: 03 9509 6321
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