Stroke patients can experience a variety of challenges in their recovery, including disorders that affect speech and communication.
Speech Therapy
Apr 2, 2022-10 MIN READ
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Can a stroke impact speech and communication?
Yes. A stroke can affect speech, language, thinking, swallowing, voice, and everyday communication. Some survivors have difficulty finding words, understanding what others say, reading, or writing; others may know what they want to say but have trouble coordinating the movements needed for clear speech. These communication changes can include aphasia, speech-motor disorders, and cognitive changes such as problems with attention, distractibility, inhibition, or problem-solving, as described in the American Stroke Association’s communication and aphasia guidance.
A speech language pathologist can help evaluate changes in communication and swallowing after a stroke and develop a treatment plan. If someone shows signs of stroke, call 911 right away; stroke care begins with emergency treatment, and rehabilitation may follow to address lasting effects, as outlined in the CDC’s stroke treatment guidance.
How can a stroke affect communication?
Stroke can affect communication in different ways depending on the part of the brain involved, the severity of the stroke, and the survivor’s overall health. Some people mainly have trouble with language, while others have difficulty with speech clarity, swallowing, attention, memory, or using communication in everyday situations.
Aphasia: A language disorder that can affect speaking, understanding, reading, or writing. A person with aphasia may know what they want to say but have trouble finding words, following a conversation, reading forms, or writing messages.
Dysarthria: A motor speech disorder that can make speech sound weak, slurred, slow, or unclear. After a stroke, dysarthria may affect speech clarity, coordination, strength, speed, or breath support.
Apraxia of speech: A motor planning disorder that affects the ability to plan or program the movements needed for speech. A person may know the word they want to say but have difficulty coordinating the speech movements to say it clearly and consistently.
Cognitive-communication changes: Difficulties with attention, memory, problem-solving, organization, inhibition, or social communication. These changes can make it harder to follow conversations, stay on topic, manage distractions, or communicate in complex situations.
Dysphagia: Difficulty swallowing that can affect safety, nutrition, hydration, and mealtime participation. SLPs are part of the interprofessional care team for oral and pharyngeal dysphagia, including assessment and management of swallowing problems.
Augmentative and Alternative Communication (AAC): Some stroke survivors benefit from AAC when speech is limited, unclear, unreliable, or tiring. AAC may include gestures, writing, picture boards, letter boards, communication apps, or speech-generating devices.
A stroke survivor may experience one of these concerns or several at the same time. An SLP can help identify which areas are affected and recommend therapy, communication strategies, swallowing support, or AAC tools based on the person’s needs.
Can a stroke affect swallowing?
Yes. Stroke can affect swallowing, a condition called dysphagia. Swallowing concerns should be discussed with the medical team because dysphagia can affect safety, hydration, nutrition, and quality of life. ASHA identifies SLPs as preferred providers of dysphagia services and describes SLPs as members of the interprofessional team involved in diagnosing and managing oral and pharyngeal dysphagia.
Caregivers should seek medical guidance if a stroke survivor coughs or chokes during meals, has a wet-sounding voice after eating or drinking, avoids foods or liquids, loses weight unintentionally, has repeated respiratory infections, or has new or worsening swallowing concerns.
What does a speech language pathologist do after a stroke?
A speech language pathologist may support stroke survivors in several ways, depending on the person’s diagnosis, goals, medical status, and daily communication needs:
Communication assessment: Evaluating speech, language, voice, cognition, reading, writing, AAC needs, and participation in everyday communication.
Speech and language therapy: Supporting skills such as word retrieval, sentence formation, comprehension, reading, writing, speech clarity, motor planning, and conversation.
Swallowing care: Assessing swallowing concerns and collaborating with the medical team on safe eating and drinking, as well as referral needs. SLPs are part of the interprofessional team involved in oral and pharyngeal dysphagia care.
AAC planning: Identifying AAC supports such as gestures, writing, picture boards, communication books, mobile apps, or speech-generating devices.
Caregiver and communication partner training: Teaching family members, friends, and caregivers how to reduce frustration, support independence, and communicate more effectively.
Daily-life participation: Helping stroke survivors practice communication tasks that matter to them, such as ordering food, talking with family, using a phone, attending appointments, or returning to work or community activities.
How long does communication recovery take after a stroke?
Stroke recovery varies. Some people improve quickly, while others need support for months or years. The National Institute on Aging notes that stroke rehabilitation may begin in the hospital and continue at home, and that supportive family, friends, and social networks can help with coping and coordinating therapy over time.
Progress can depend on many factors, including stroke severity, the area of the brain affected, other health conditions, access to rehabilitation, fatigue, mood, family support, and the person’s communication goals. Recovery may include regaining skills, learning compensatory strategies, using AAC, changing communication environments, or combining several approaches.
How can family and caregivers support communication after a stroke?
Family members, friends, and caregivers often become important communication partners after a stroke. Support at home does not need to be complicated, but it should be respectful, patient, and matched to the survivor’s needs. The American Stroke Association recommends using more than one way to communicate, including speech, writing, facial expressions, pictures, and phone or communication apps when helpful. Its aphasia guidance also emphasizes giving the person time, confirming what was understood, and involving them in conversation and decisions.
Helpful communication strategies may include:
Reduce distractions. Turn down the TV, move to a quieter space, and try to have one conversation at a time.
Give the person extra time. Pause after asking a question or making a comment so the stroke survivor has time to process and respond.
Use clear, direct language. Shorter sentences and one question at a time can make conversation easier without talking down to the person.
Offer choices when helpful. Instead of asking a broad question such as “What do you want to do today?” try offering two or three options.
Use more than speech. Writing keywords, pointing to pictures, using gestures, or trying a communication app may help the person express themselves.
Confirm the message. Repeat back what you think the person said or meant, and give them a chance to correct or confirm.
Support independence. When safe and appropriate, give the survivor opportunities to speak or communicate for themselves, such as ordering food, greeting a visitor, or participating in an appointment.
Ask what works best. Communication needs vary, so families should ask the treating SLP which prompts, tools, and supports fit the survivor’s diagnosis, goals, fatigue level, and home environment.
What should families ask before practicing speech or communication at home?
Home practice can support stroke recovery, but it should be guided by the treating speech language pathologist or medical team. Stroke survivors may have different needs depending on whether they have aphasia, dysarthria, apraxia of speech, dysphagia, cognitive-communication changes, or more than one concern. A generic list of tongue, facial, word, or voice exercises may not match the person’s diagnosis, therapy goals, fatigue level, or swallowing safety needs.
Before practicing at home, families can ask the SLP:
What should we practice this week? Home activities should reinforce the survivor’s current therapy goals, not replace the treatment plan.
Should we focus on speech, language, reading, writing, memory, AAC, or swallowing? Different post-stroke concerns require different kinds of support.
How long should practice last, and when should we stop? Practice should be paced around the survivor’s endurance, frustration level, medical status, and the SLP’s guidance.
How should we help if communication becomes frustrating? Communication partners may be able to reduce pressure by using short sentences, allowing extra time, reducing distractions, using writing or gestures, and confirming their understanding.
Are there swallowing precautions? If coughing, choking, wet-sounding voice, reduced intake, dehydration concerns, or other swallowing changes are present, families should follow the medical team’s guidance and ask what is safe to practice at home.
What changes should prompt a call to the care team or emergency help? Sudden new or worsening stroke symptoms require emergency care, and new or worsening swallowing or communication concerns should be discussed with the medical team.
What is AAC, and when might it help after a stroke?
Augmentative and alternative communication, or AAC, includes tools and strategies that support communication when speech is limited, unclear, unreliable, or tiring. AAC may include gestures, writing, pictures, communication boards, letter boards, mobile apps, or speech-generating devices.
AAC does not mean a person has “given up” on speech. For some stroke survivors, AAC supports communication while speech and language skills are improving. For others, AAC becomes part of a long-term communication system that helps them express needs, make choices, participate in conversations, and maintain independence.
When should stroke survivors or caregivers seek help?
Call 911 right away if someone has signs of stroke or sudden new neurological symptoms. CDC guidance emphasizes emergency response when stroke signs appear.
Contact the medical team or treating clinician if a stroke survivor has:
New or worsening speech, language, swallowing, voice, memory, or attention problems.
Coughing, choking, or changes in breathing during meals.
Trouble taking medications safely.
Reduced eating or drinking.
Unexplained weight loss or dehydration concerns.
Repeated pneumonia or respiratory infections.
Depression, anxiety, isolation, or caregiver strain.
The National Institute on Aging notes that stroke can affect speech, swallowing, thinking, judgment, memory, emotions, and fatigue, and that depression after stroke may need treatment.
Frequently asked questions
Can speech therapy help after a stroke?
Speech therapy may help stroke survivors address language, speech clarity, motor planning, voice, cognition, swallowing, AAC, and communication participation. The right plan depends on the person’s specific needs and should be guided by a licensed SLP and medical team. The American Stroke Association’s communication and aphasia guidance explains several ways stroke can affect communication after stroke.
Does aphasia affect intelligence?
Aphasia affects language and communication, not intelligence. The American Stroke Association’s aphasia communication strategies encourage communication partners to be respectful, allow extra time, and use multiple ways to communicate when helpful.
What is the difference between aphasia and dysarthria?
Aphasia affects language, while dysarthria affects the motor control and clarity of speech. A stroke survivor may have one condition or both. ASHA’s clinical resources explain aphasia as a language disorder and dysarthria in adults as a motor speech disorder.
What is apraxia of speech after a stroke?
Acquired apraxia of speech is a neurologic speech disorder involving difficulty planning or programming speech movements. A person may know what they want to say, but have trouble coordinating the speech movements to say it clearly and consistently. ASHA’s resource on acquired apraxia of speech explains how the condition affects speech motor planning.
Can a stroke cause swallowing problems?
Yes. A stroke can cause dysphagia, or difficulty swallowing. SLPs are part of the interprofessional team involved in oral and pharyngeal dysphagia care, including assessment and management when swallowing problems are present.
Should caregivers do speech exercises at home?
Caregivers should follow the treating SLP’s guidance rather than using generic exercises. At-home practice should match the survivor’s diagnosis, therapy goals, medical status, fatigue level, and swallowing safety needs.
What communication tools can help after a stroke?
Helpful tools may include gestures, writing, pictures, communication boards, letter boards, smartphone or tablet apps, texting, text-to-speech tools, or speech-generating devices. ASHA’s AAC guidance explains that augmentative and alternative communication can include both unaided options, such as gestures, and aided options, such as communication boards or speech-generating devices.
When should communication changes be treated as urgent?
Sudden new or worsening speech, language, face, arm, balance, vision, or confusion symptoms may be signs of stroke and require emergency care. CDC’s stroke signs and symptoms guidance advises calling 911 right away when someone shows signs of stroke.
Stroke recovery communication terms and resources
The terms below can help families understand common changes in speech, language, swallowing, and communication after stroke. For individualized guidance, stroke survivors and caregivers should work with the treating medical team and speech language pathologist.
Aphasia: A language disorder that can affect speaking, understanding, reading, or writing. ASHA’s aphasia resource explains how aphasia can affect different parts of communication, and the American Stroke Association offers patient-friendly communication and aphasia guidance.
Apraxia of speech: A neurologic speech disorder that affects the planning or programming of speech movements. A person may know what they want to say but have trouble coordinating the movements needed to say it clearly. ASHA’s acquired apraxia of speech resource provides a clinical background.
Dysarthria: A motor speech disorder that can affect speech clarity, strength, coordination, speed, or breath support. ASHA’s dysarthria in adults resource explains how neurologic conditions can affect speech movement and clarity.
Dysphagia: Difficulty swallowing that can affect safety, nutrition, hydration, and quality of life. ASHA’s adult dysphagia resource explains the role of SLPs in swallowing assessment and management.
Aspiration: Entry of material such as food, liquid, saliva, or stomach contents into the airway. Because swallowing problems can affect airway safety and overall health, caregivers should discuss coughing, choking, a wet-sounding voice, reduced intake, or repeated respiratory infections with the medical team. ASHA’s adult dysphagia resource provides more background on swallowing concerns.
Cognitive-communication changes: Communication difficulties related to attention, memory, problem-solving, organization, inhibition, or social communication. The American Stroke Association’s communication and aphasia guidance describes how stroke can affect attention, distractibility, inhibition, and problem-solving.
Augmentative and alternative communication (AAC): Tools and strategies that support communication when speech is limited, unclear, unreliable, or tiring. AAC may include gestures, writing, picture boards, communication apps, or speech-generating devices. ASHA’s AAC guidance explains unaided and aided communication supports.
Ischemic stroke: A stroke caused by blocked blood flow to part of the brain. CDC’s stroke resource explains that stroke can happen when blood flow to the brain is blocked.
Hemorrhagic stroke: A stroke caused by bleeding in or around the brain after a blood vessel bursts. CDC’s About Stroke resource explains the difference between blocked blood flow and bleeding-related stroke.
For broader stroke recovery and caregiver support, readers can also use:
CDC Stroke for stroke basics, signs and symptoms, prevention, treatment, and emergency guidance.
