Speech therapy after a stroke

About a third of people who have a stroke have aphasia, and others have slurred speech or trouble planning speech movements. Speech therapy helps: randomized trials show better communication with therapy than without it.

• Improvement is usually fastest in the first months, but it can continue for years.
• The amount of practice matters. More total practice, spread over most days, is associated with better results.
• Formal sessions usually end long before recovery does, so practice at home is often what keeps progress going.

• Aphasia: difficulty with language. Finding words, understanding speech, reading, and writing can all be affected. Intelligence is not affected.
• Dysarthria: weakness of the muscles for speech, so speech sounds slurred or quiet.
• Apraxia of speech: the brain has trouble planning the movements for speech, so sounds come out in the wrong order or inconsistently.

The treatment for each is different, which is why an assessment by a speech-language pathologist is the first step.

In hospital

A speech-language pathologist assesses communication and swallowing, helps the person find a way to communicate basic needs, and advises the family.

In rehabilitation and outpatient therapy

Sessions target the specific problems found in the assessment: naming, building sentences, understanding, reading, and, for many people, strategies such as gesture, writing, or pointing to pictures. The therapist usually gives exercises to practice between sessions.

After formal therapy ends

Therapy is often limited by insurance to a number of sessions or weeks. Before the last session, ask for a written home program: which skills to practice, which exercises, and how often.

• Practice a little every day. Twenty to thirty minutes on most days is better than a long session once a week. Our guide to aphasia exercises at home has specific exercises.
• Talk normally, just more slowly. Use short sentences, one idea at a time, and give time to answer. See communicating with someone who has aphasia.
• Watch for fatigue and low mood. Both are common after stroke and both make practice harder. Mention them to the medical team.
• Keep up social contact. Aphasia can be isolating. Aphasia support groups and conversation groups provide practice and company.

People are often told that recovery stops after six months or a year. That is not what the research on chronic aphasia shows. Studies, including one of Parrot Software with people an average of about three years after onset, have found improvement long after the stroke. Progress is usually slower than in the early months, but it is still possible. See how much aphasia practice is enough.

How long does it take to regain speech after a stroke?

It varies widely. The fastest improvement usually happens in the first few months, but many people keep improving for years, especially with continued practice. Severity, the size and location of the stroke, and general health all affect the pace.

Does speech therapy work after a stroke?

Yes. A Cochrane review of randomized trials found that speech and language therapy improved functional communication, reading, and expressive language compared with no therapy. Therapy delivered at higher intensity tended to produce greater benefit.

What happens when insurance stops paying for speech therapy?

Recovery does not stop when sessions do. Ask the speech-language pathologist for a home program before discharge, keep practicing most days, and consider practice software to provide structure. Private therapy, university clinics, and aphasia support groups are other options.

Is it aphasia, dysarthria, or apraxia?

Aphasia is a language problem: finding, understanding, reading, or writing words. Dysarthria is weakness or poor coordination of the muscles used for speech, which makes speech slurred. Apraxia of speech is difficulty planning the movements for speech. A person can have more than one, and a speech-language pathologist can tell them apart.