Reading and writing after a stroke
Reading a menu, writing a card, sending a text: these often become harder after a stroke, even for people who speak fairly well. Here is what causes it, what to check first, and how to practice at home.
By Frederick F. Weiner, Ph.D., speech-language pathologist. Former Professor in Charge of Speech Pathology, The Pennsylvania State University. Last reviewed November 5, 2026.
Why reading and writing change
Aphasia affects language in all its forms, not only speech. Most people with aphasia have some trouble with reading (called alexia) and writing (called agraphia), though the pattern differs from person to person. Some read fairly well but cannot write; some can copy words but not spell them from memory; some understand single words but lose track in a long sentence.
Weakness in the dominant hand can also make handwriting slow or messy. That is a physical problem rather than a language one, and it calls for different help, such as writing with the other hand or typing.
Check vision first
A stroke can affect vision in ways that look like a reading problem:
- Visual field loss (hemianopia). Part of the visual field on one side is missing, so the person may miss the beginning or end of each line.
- Neglect. The person does not pay attention to one side of space, usually the left, and may read only the right half of a page.
- Ordinary eyesight changes. Old glasses or a new need for reading glasses can make everything harder.
Ask the doctor or an eye care professional to check vision after a stroke. If a visual problem is found, simple changes can help: a ruler or bright line down the margin to mark where lines start, a finger or card under the line being read, and large print.
Reading exercises, from easiest to hardest
Start at the step where the person gets about seven or eight out of ten right, and move up when it feels easy.
1. Match a word to a picture
Show three or four pictures and one printed word, and point to the picture that matches. Start with common, concrete words (cup, dog, car).
2. Read single words aloud or silently
Use words from daily life: names of family members, labels in the kitchen, street names. Large, clear print helps.
3. Read a short sentence and answer a yes/no question
"The man is washing the car." Is he cooking? Yes/no answers check understanding without asking for speech or writing.
4. Read short real-world text
Menus, recipe steps, weather forecasts, TV listings, headlines. Then answer one or two questions about what was read.
5. Read a paragraph
Short news items or a page from a favorite magazine. Read it, then talk about the main point or answer a few questions. Reading aloud can help some people keep their place.
Writing exercises, from easiest to hardest
1. Copy words
Copy names, everyday words, and your own address. Copying builds the motor pattern of writing letters and words.
2. Write words from memory
Look at a word, cover it, write it, then check. Start with short, familiar words and build up.
3. Spell words that are dictated
A helper says a word and the person writes it. Choose words the person will actually use.
4. Write lists
A grocery list, a to-do list, names of grandchildren. Lists are useful, short, and do not need full sentences.
5. Write short messages
A birthday card, a note on the fridge, a text message. Keep it to one or two sentences at first.
Tools that help right now
Practice takes time. Meanwhile, these accommodations help with daily life and are not a sign of giving up:
- Large print and higher contrast on phones, tablets and e-readers.
- Word prediction on a phone keyboard, which suggests the word after the first few letters.
- Voice typing, for people whose speech is clearer than their writing.
- Text-to-speech and audiobooks, so reading for pleasure or news does not have to wait.
Reading practice in Parrot Software
Parrot Software has programs that practice reading at different levels, including:
- Word Recognition and Reading Comprehension and Picture Association for single words and pictures
- Definitions Yes or No, Open Definitions and Reverse Definitions for word meaning
- Determine Word Function and Spelling Knowledge
- Literal Reading Comprehension for Adults and Inferential Reading Comprehension for Adults for sentences and paragraphs
- Remembering Written Directions, which combines reading with memory
These are among 94 programs covering speaking, understanding, reading, writing, memory and attention. The first week is free, with no credit card. For more ideas, see free aphasia exercises and how much practice is enough.
Common questions
- Why can my family member talk but not read after a stroke?
- Reading and writing depend on several brain systems, and a stroke can affect them unevenly. Some people speak fairly well but struggle to read (alexia) or write (agraphia); others have the reverse pattern. Most people with aphasia have some difficulty with reading and writing as well as speaking, but the amount varies a great deal from person to person.
- Could the problem be eyesight rather than language?
- It could be both. A stroke can cause loss of part of the visual field (hemianopia) or a tendency to ignore one side of space (neglect), and either can make a person lose their place or miss the start or end of each line. Ask the doctor or an eye care professional to check vision after a stroke before assuming a reading problem is purely language.
- Where should reading practice start?
- Start where the person gets most items right, roughly seven or eight out of ten. For some that means matching a single printed word to one of a few pictures. For others it means short sentences or a paragraph with a question afterward. Move up a step only when the current level feels easy.
- Is it cheating to use voice typing or word prediction?
- No. Accommodations such as voice typing, word prediction on a phone, large print, and audiobooks help people communicate and keep up with daily life now. They can be used alongside practice. A speech-language pathologist can help decide which tools suit the person.
- Can writing improve after a stroke?
- Many people do improve, especially with regular practice that starts at the right level, such as copying words, then writing them from memory, then writing short lists and messages. Progress varies, and a speech-language pathologist can tell you what is realistic for one person.