When speech is a problem after a stroke


MEN'S HEALTH MATTERS:There are a number of ways communication can be improved

Q My father has just had a stroke and is having difficulty talking to us and it appears he doesn’t understand what we say. This is very distressing both for my dad and our family and I wonder what can be done about it.

A It sounds like your father has aphasia which is a difficulty with language following a stroke. As you rightly say this can be very distressing and can often be very frustrating for a patient. Aphasia can affect expression (difficulty finding words and formulating sentences), understanding what you say (particularly longer sentences and complex questions), and sometimes reading and writing.

The speech and language therapist (SLT) in his hospital will assess his language skills, help you to find ways to communicate more easily, and will work through a communication treatment programme which will be aimed at improving his communication skills. The following is a list of tips you can employ to help communicate with him:

  • Reduce background distractions.
  • Gain his attention by touching his arm/say his name before starting to speak.
  • Slow your own rate of speech when talking to him.
  • Reduce sentence length.
  • Stress key words.
  • Talk about events and people familiar to him.
  • Encourage all attempts at communication (speech, gestures, writing).
  • Give him ample time to respond to you.
  • Offer alternatives (eg, “do you want tea or coffee?”).
  • Encourage description of an item if he can’t think of the word.
  • Use yes/no questions if he is having severe difficulty (eg, is it in the room? is it something you eat?).

He may also have a speech problem: dysarthria, where his speech may sound slurred due to muscle weakness, or dyspraxia, where he may use the wrong sounds when speaking due to muscle inco-ordination.

The speech and language therapist will assess his speech and provide appropriate treatment. If speech is the main problem then you can encourage your father to speak slowly with short sentences and reduce background noise and ensure he has his listener’s attention.

If your father is tired or unwell his speech may be less clear, particularly at the end of the day. If his speech is very unclear, encourage him to gesture to you, write down what he wants or use picture charts.

Remember that while your father is having difficulty communicating right now, he is still the same person and may understand more than you expect. Always involve him in conversations and give him the respect you did before he had a stroke.

Q I am 56 years old and had an MRI scan of my brain recently for headaches and my doctor told me that it showed lots of “spots” but that there was nothing to worry about. Can you explain what the spots might have been?

A As people get older, tiny blood vessels supplying different areas of the brain may become blocked. If a vessel to an area of the brain which controls some particular function (eg movement or vision) becomes blocked then you may develop a “stroke” with some impairment related to the affected area.

A significant proportion of the brain is “silent” and blockage of the blood vessels to these areas has no demonstrable effect but they do appear as “bright spots” on certain types of MRI scans. Your doctors have ways of telling whether the areas are significant or not, based on the appearance on the images, but in general you are allowed to have several bright spots in your brain and the number increases with age.

It sounds like your doctors have decided that as these spots are so common that they are unlikely to have anything to do with your headaches.

This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James’s Hospital, Dublin with a contribution from Emma Shaw, senior speech and language therapist, Department of Medicine For The Elderly, St James’s Hospital, Dublin and Dr Jim Meaney, consultant radiologist, St James’s Hospital, Dublin