Speaking Again After a Stroke: How to Start Speech Therapy

“I know what I want to say, but the words don’t come out.” “People talk to me, but I no longer understand what they are saying.” “My mouth no longer does what I want.” Many patients utter (or would like to utter) these phrases after a Stroke. Language and speech disorders affect about 30% of people who have suffered a cerebrovascular accident. Whether it’s aphasia (difficulty understanding or producing language), dysarthria (difficulty articulating), or dysphonia (voice disorders), these disorders can profoundly disrupt communication, identity, and social life. But here’s some good news: the brain can relearn to speak. Speech therapy, started early and practiced regularly, allows for remarkable progress. In this comprehensive article, we explain what language disorders after a stroke are, how speech therapy works, and most importantly, how you can start working right now, with or without a speech therapist, to regain your speech.

Understanding language and speech disorders after a stroke

The different types of disorders

After a stroke, several types of difficulties can arise. It is important to distinguish them well as they do not require the same approaches:

Aphasia: when language is affected

What is it?

Aphasia is a language disorder caused by damage to the areas of the brain dedicated to language (usually the left hemisphere). It is not a problem of intelligence, general memory, or motivation. The patient knows what they want to say, but the mechanism of language is disrupted.

The brain areas involved:

• Broca’s area (left frontal part): language production
• Wernicke’s area (left temporal part): language comprehension
• The connections between these two areas

The different types of aphasia:

Broca’s aphasia (or expressive aphasia):

• Difficulty producing language: words do not come out, or come out poorly
• Comprehension is relatively preserved (you understand what is being said to you)
• Telegraphic speech: short phrases, lack of small words (“I want to drink” becomes “me… drink”)
• Difficulty finding words (word-finding difficulty)
• Great frustration because the patient is aware of their difficulties

Example: You want to say “I would like a glass of water please” but you say “Me… water… uh… drink”.

Wernicke’s aphasia (or receptive aphasia):

• Difficulty understanding language: what others say seems to be gibberish
• Fluent but incoherent production: sentences are long but mean nothing (jargon)
• Use of nonexistent words (neologisms) or words in place of others (paraphasias)
• Little or no awareness of the disorder (anosognosia)

Example: You are asked “Do you want coffee?” and you do not understand. You respond “Yes, the frolin in the big house with the apples” (fluent sentence but incomprehensible).

Global aphasia:

• Severe impairment of both production AND comprehension
• Little or no language
• Generally associated with extensive strokes
• More reserved prognosis, but progress remains possible

Conduction aphasia:

• Difficulty repeating what has just been heard
• Relatively preserved comprehension and expression
• Difficulty finding the right word (paraphasias)

Dysarthria: when the mouth no longer responds

What is it?

Dysarthria is a speech articulation disorder caused by weakness or lack of coordination of the speech muscles (lips, tongue, cheeks, palate, vocal cords, breathing).

Important: in dysarthria, the language itself is not affected. You know which word to use, you know how to construct sentences, but your mouth cannot produce the sounds correctly.

The signs:

• Mumbled speech, difficult to understand
• Weak or muffled voice
• Difficulty controlling the speed (too fast or too slow)
• Drooling (difficulty controlling saliva)
• Difficulty chewing and swallowing (in severe forms)

Example: You want to say “hello” but it comes out as “ponchour” or indistinctly.

Dysphonia: voice disorders

What is it?

Problems with the voice itself:

• Hoarse, muffled voice
• Very weak voice (hypophonia)
• Difficulty modulating the voice (monotony)
• Voice that tires quickly

Apraxia of speech

What is it?

Difficulty programming and coordinating the movements necessary to speak, while the muscles themselves function well.

The patient knows what they want to say, their muscles are capable of moving, but the brain cannot coordinate the movements in the correct order.

The signs:

• Inconsistent errors (sometimes the word comes out well, sometimes not)
• Visible search for articulation (you can see that the person is “searching” how to position their mouth)
• Better success in automatic situations (“hello”, “thank you”) than voluntary ones

The psychological and social impact

Beyond the technical difficulty of speaking, language disorders have a profound impact:

On identity: “I no longer recognize myself. My voice, my words, it’s a part of me.”

On self-esteem: feeling of infantilization, shame, loss of confidence.

On relationships: communication difficulties with loved ones, misunderstandings, tensions.

On social isolation: tendency to avoid interactions, withdrawal, loneliness.

On autonomy: difficulties with administrative tasks, shopping, phone calls.

The immense frustration: knowing what you want to say without being able to say it is extremely frustrating and exhausting.

The crucial role of the surroundings

The surroundings play a major role in recovery:

• Emotional support
• Adaptation of communication
• Encouragement and patience
• Daily stimulation

But the surroundings can also, unintentionally, act in a counterproductive manner:

• Speaking for the patient
• Infantilizing (“do you want this? yes or no?”)
• Becoming impatient
• Avoiding communication

The balance is delicate: helping without doing it for them, encouraging without putting pressure.

To better understand language and communication disorders after a stroke, the DYNSEO training on stroke offers a comprehensive module on cognitive and language sequelae. You will learn how a stroke affects speech, how to communicate effectively, and how to best support rehabilitation.

What is speech therapy and how does it work?

The role of the speech therapist

The speech therapist is the professional specialized in communication, language, speech, and swallowing disorders.

Their role after a stroke:

Assessment:

• Complete assessment of abilities and difficulties
• Understanding of oral and written language
• Oral and written expression
• Articulation, voice
• Swallowing

Rehabilitation:

• Personalized individual sessions
• Targeted exercises according to difficulties
• Learning compensatory strategies
• Progressive retraining

Support:

• Psychological support
• Advice to the surroundings
• Adaptation of communication tools

Coordination:

• Link with the medical team
• Referral to other professionals if necessary (neuropsychologist, occupational therapist)

When to start speech therapy?

As early as possible:

• From the hospital phase, the speech therapist can intervene (swallowing assessment, early stimulation)
• As soon as discharged from the hospital: prescription of sessions
• The earlier rehabilitation starts, the better the results

The maximum recovery window:

• The first 3 to 6 months are crucial (maximum neuroplasticity)
• But progress remains possible well beyond (up to 2 years and more)
• The important thing: start early and maintain regularity

How often?

Recommendations:

• Acute phase (first months): 3 to 5 sessions per week (ideally daily if possible)
• Consolidation phase (6 months to 1 year): 2 to 3 sessions per week
• Maintenance (beyond): 1 to 2 sessions per week, or less if progress is stable

Duration of sessions: 30 to 45 minutes on average.

Important: rehabilitation is not limited to sessions with the speech therapist. Daily work at home is essential.

How does a session go?

Welcome and discussion:

• Review of the past week
• Difficulties encountered
• Progress observed

Targeted exercises:

• According to the type of disorder and objectives
• Varied to maintain motivation
• Adapted to your level of the day (if you are tired, the speech therapist adapts)

Situational practice:

• Conversation, role-playing, reading, writing
• Practical applications of exercises

Advice and homework:

• Exercises to do at home
• Strategies to apply daily
• Involvement of the surroundings

Supportive atmosphere:

• No judgment
• Encouragement
• Right to make mistakes

How long does rehabilitation last?

It depends:

• On the severity of the disorders
• On the timeliness and regularity of rehabilitation
• On your motivation and daily practice
• On your age and general condition
• On the support of the surroundings

Typical duration:

• Light disorders: 3 to 6 months
• Moderate disorders: 6 months to 1 year
• Severe disorders: 1 to 2 years, or even more

Important: even if some sequelae persist, progress continues beyond these timelines. Never give up!

Does it really work?

YES! Scientific studies and clinical experience demonstrate it:

Factors for a good prognosis:

• Early start of rehabilitation
• Intensive and regular rehabilitation
• Young age
• Small size stroke
• Good general cognitive state
• Patient motivation
• Family support

Typical results:

• About 60 to 70% of aphasic patients recover functional communication
• Progress is often significant in the first 3 months, then continues more slowly
• Even severe disorders can improve significantly

Attention: each stroke is unique. Your recovery will not necessarily be like others. Compare yourself to yourself, not to others.

Finding and choosing your speech therapist

How to find a speech therapist?

Medical prescription:

• Your doctor (general practitioner or neurologist) gives you a prescription
• Prescription generally for 30 to 50 sessions (renewable)

Where to look:

• Ask your doctor, at the hospital (they often have contacts)
• Directory of the Order of Speech Therapists: www.fno.fr
• Word of mouth (other patients, associations)
• Private practices, health centers, day hospitals

Home speech therapy:

• Possible if you have difficulties moving
• Specify it on the prescription

Selection criteria

Experience in neurology:

• Not all speech therapists specialize in stroke
• Ask about their experience with post-stroke patients

Geographical proximity:

• Sessions are frequent, prioritize proximity
• Especially if you have difficulties moving

The feeling:

• The therapeutic relationship is important
• You need to feel safe, listened to, respected
• If the connection is not there, do not hesitate to change (after discussing it)

Availability:

• Waiting time (in some regions, it’s long)
• Hours compatible with your schedule

Reimbursement

100% coverage in ALD (Long-Term Condition):

• Stroke is part of ALD
• Ask your doctor to fill out the ALD protocol
• Speech therapy sessions are then reimbursed 100% by Health Insurance
• No upfront costs if the speech therapist practices third-party payment

Without ALD:

• 60% reimbursement by Health Insurance
• The rest may be covered by your mutual insurance

Exercises to do alone or with a loved one: start now

Even if you haven’t seen a speech therapist yet, or in addition to the sessions, you can start working right now.

General principles:

• Regularity: better to do 15 minutes a day than 2 hours once a week
• Progressivity: start easy and increase difficulty
• Kindness: right to make mistakes, no pressure
• Variety: alternate types of exercises to avoid getting bored

For Broca’s aphasia (difficulty in expression)

Exercise 1: Naming images

Objective: find the words.

Material: images (magazines, catalogs, cards, or images on the internet).

How to do it:

Level 1:

• Look at a simple image (e.g., apple)
• Try to say the word
• If it doesn’t come, the loved one gives the first syllable: “ap…”
• If it still doesn’t come, the loved one says the word and you repeat it

Level 2:

• More complex images (actions, scenes)
• Try to make a simple sentence: “The cat is sleeping”

Level 3:

• Describe the image with several sentences
• Tell a short story

Tip: start with familiar categories (household items, food, animals).

Frequency: 10-15 minutes a day.

Exercise 2: Completing sentences

Objective: facilitate production by providing context.

How to do it:

The loved one starts a very predictable sentence, you complete it:

Examples:

• “The sky is…” → blue
• “I brush my…” → teeth
• “We cut with…” → scissors
• “The sun shines during the…” → day

Level 2:

• Less predictable sentences
• “My favorite dish is…”
• “Yesterday, I…”

Frequency: 5-10 minutes a day.

Exercise 3: Singing and automatisms

Objective: use the preserved brain areas (music and verbal automatisms).

How to do it:

Familiar songs:

• Sing songs from your youth
• The loved one sings with you
• Often, the lyrics come back more easily in song!

Automatisms:

• Count: 1, 2, 3… up to 10, 20
• Days of the week: Monday, Tuesday…
• Months of the year
• Your address, your date of birth

Frequency: daily (and for pleasure!).

Exercise 4: Writing

Objective: sometimes, writing is more accessible than speaking.

How to do it:

Level 1:

• Write words under images
• Copy sentences

Level 2 :

• Write your first name, your address
• Write a shopping list
• Write what you did during the day (journal)

Level 3 :

• Write a postcard, an email
• Tell a memory

Tip : if you cannot write by hand, use a computer or tablet keyboard.

Frequency : 10 minutes per day.

For Wernicke’s aphasia (difficulty understanding)

Exercise 5 : Understanding simple commands

Objective : improve understanding of spoken language.

How to do :

Level 1 :

The relative gives very simple commands, you execute them :

• “Raise your hand”
• “Touch your nose”
• “Close your eyes”

Level 2 :

Commands with an object :

• “Show me the pen”
• “Give me the book”

Level 3 :

Two-part commands :

• “Take the pen and put it on the table”
• “Touch your ear then raise your hand”

Frequency : 10 minutes per day.

Exercise 6 : Image-word association

Objective : improve written and oral comprehension.

Material : images and written words.

How to do :

Level 1 :

• The relative shows an image (cat)
• The relative says “cat”
• You associate the sound with the meaning

Level 2 :

• The relative says “cat” without showing the image
• You point to the corresponding image among several

Level 3 :

• Written words: you read “cat” and point to the image

Frequency : 15 minutes per day.

Exercise 7 : Yes/no questions

Objective : understanding simple questions.

How to do :

The relative asks questions that can be answered with yes or no :

• “Is the sky blue?” → yes
• “Does a cat have wings?” → no
• “Do you like coffee?” → yes/no depending on your taste

Progression : increasingly complex questions.

Frequency : 10 minutes per day.

For dysarthria (difficulty articulating)

Exercise 8 : Mouth movements (bucco-facial praxias)

Objective : strengthen and mobilize the speech muscles.

How to do :

In front of a mirror, do these movements 10 times each :

Lips :

• Smile widely
• Pout (lips forward)
• Alternate smile/pout
• Puff out your cheeks
• Move air from one cheek to the other

Tongue :

• Stick out your tongue
• Touch your nose with your tongue
• Touch your chin
• Run your tongue over your teeth (outside and inside)
• Click your tongue

Jaw :

• Open your mouth wide
• Chew exaggeratedly (as if you were chewing gum)

Frequency : 2-3 times per day, 5-10 minutes.

Exercise 9 : Sound articulation

Objective : improve articulation accuracy.

How to do :

Level 1 : Isolated sounds

• Repeat each sound 10 times: AAAA, EEEE, IIII, OOOO, UUUU
• Then consonants: P, T, K, B, D, G, F, V, S, Z, CH, J, L, R

Level 2 : Syllables

• PA, TA, KA, BA, DA, GA
• PO, TO, KO, BO, DO, GO
• PI, TI, KI, BI, DI, GI

Level 3 : Short words

• Daddy, toto, baby
• Then increasingly longer words

Level 4 : Short sentences

• “The cat is sleeping”
• “I am doing well”
• Then increasingly longer sentences

Tip : articulate exaggeratedly at first, even if it seems strange.

Frequency : 10-15 minutes per day.

Exercise 10 : Tongue twisters (progressively)

Objective : improve articulation accuracy and speed.

How to do :

Start VERY slowly and clearly. Gradually increase the speed.

Easy examples :

• “A good bowl of good broth”
• “Three little cats”
• “Daddy paints the door”

More difficult examples :

• “A hunter who knows how to hunt”
• “The archduchess’s socks”

Frequency : 5 minutes per day (once you master the previous exercises).

Exercises for all types of disorders

Exercise 11 : Reading aloud

Objective : work on articulation, fluency, prosody (intonation).

How to do :

Level 1 :

• Read simple sentences
• Take your time
• Articulate well

Level 2 :

• Read a paragraph
• Pay attention to intonation (periods, commas)

Level 3 :

• Read a newspaper article, a chapter of a book
• Vary the tone according to the content

Tip : record yourself and listen to identify progress and areas to work on.

Frequency : 10-20 minutes per day.

Exercise 12 : Daily conversation

Objective : put the acquired skills into practice in a real situation.

How to do it:

Every day, have a real conversation with a loved one about a topic that interests you:

• Your activities of the day
• A memory
• A current event
• Your projects

Rules for the loved one:

• Give time to respond (do not finish sentences)
• Rephrase if you did not understand (rather than asking to repeat)
• Encourage, smile, show interest
• Do not systematically correct mistakes (unless asked)

Frequency: daily, 15-30 minutes.

Exercise 13: Board games

Objective: playful and social language stimulation.

Recommended games:

Scrabble: vocabulary, spelling

Bac/Petit bac: find words by category

Pictionary: naming, description

Card games: name the cards, count

Trivial Pursuit: general knowledge, understanding questions

Frequency: 2-3 times a week.

To complement your speech therapy, CLINT, your brain coach offers games that stimulate language in a playful way:

• Verbal fluency: find the maximum number of words from a category
• Naming: name objects, images
• Comprehension: follow instructions
• Verbal memory: remember lists of words

These games automatically adapt to your level and allow you to work 10-15 minutes a day, in addition to speech therapy sessions and “paper” exercises.

Tips to improve daily communication

For the person with aphasia

Take your time:

• Do not rush
• Breathe
• Stress worsens difficulties

Use all means of communication:

• Gestures
• Drawings
• Writing
• Pointing
• There is no “cheating,” all means are good!

Ask for help:

• “Please speak more slowly”
• “I did not understand, can you rephrase?”
• “Give me time to respond”

Prepare for difficult situations:

• Phone: prefer texts, emails
• Shopping: prepare a written list
• Important appointments: come accompanied

Always have with you:

• A card explaining your situation: “I had a stroke, I have difficulties speaking, thank you for your patience”
• A notebook and a pen
• Your phone with frequent images or words

For the caregivers

Adapt your communication:

What to DO:

• Speak slowly and clearly (but not loudly! This is not a hearing problem)
• Use simple and short sentences
• Ask closed questions (yes/no) rather than open ones
• Give time to respond (count to 10 in your head before prompting again)
• Use gestures, images to accompany your words
• Rephrase rather than ask to repeat: “Do you mean that…?”
• Encourage, smile
• Maintain eye contact
• Reduce distractions (turn off the TV, speak in a quiet place)

What NOT to do:

• Speak for the person
• Systematically finish their sentences
• Talk about the person as if they were not there
• Infantilize (“Do you want cake? Say ‘cake’!”)
• Become visibly impatient
• Systematically correct mistakes
• Fake understanding when it is not the case
• Avoid communicating for fear of doing it wrong

Important: the person with aphasia often understands much better than they can speak. Do not assume they do not understand simply because they cannot respond.

Involve the person in conversations:

• Do not exclude them from family discussions
• Ask for their opinion (even if it’s just a yes/no)
• Tell them about your day
• Maintain social connection

For caregivers, the DYNSEO guide to support people after a stroke contains a complete chapter on communication with a person with aphasia. You will learn:

• How to adapt your way of speaking
• How to understand what your loved one means despite the difficulties
• How to help them without devaluing them
• How to maintain emotional connection despite language barriers
• How to take care of yourself as a caregiver in the face of these difficulties

Technical and technological aids

Applications and software

Speech therapy applications:

• Many applications available on tablets to work on language
• Ask your speech therapist for advice

Text-to-speech:

• If you really can no longer speak, applications allow you to type text that will be read by a synthetic voice
• Applications: Proloquo2Go, Predictable, TD Snap

Communication through pictograms:

• Applications with images that you can point to communicate
• Useful in the acute phase or for very severe aphasias

Classic tools

Communication binder:

• Notebook with images categorized by themes (food, clothing, activities, emotions, people)
• You point to the image to communicate
• Your speech therapist can help you create a personalized one

Communication cards:

• Small cards with useful phrases: “I don’t understand”, “Speak more slowly”, “Yes”, “No”

Alphabet board:

• To spell words by pointing to letters
• Useful if you can write but not speak

Typical training program

Typical week for a patient with Broca’s aphasia (expression difficulty)

Monday:

• Morning: 15 min – Naming images + singing
• Evening: 15 min – Completing sentences + writing

Tuesday:

• Speech therapy session (45 min)
• Evening: 10 min – Exercises given by the speech therapist

Wednesday:

• Morning: 15 min – Naming + automatisms (counting, days of the week)
• Evening: 20 min – Reading aloud

Thursday:

• Speech therapy session (45 min)
• Evening: 10 min – CLINT (application)

Friday:

• Morning: 15 min – Writing (journal) + naming
• Evening: 30 min – Conversation with a loved one on a chosen topic

Saturday:

• Morning: 15 min – Reading aloud
• Afternoon: Family board games (Scrabble, Pictionary)

Sunday:

• Morning: 10 min – Singing + automatisms
• Light rest in the afternoon (leisure activities without pressure)

Total: about 2h30 per week outside of speech therapy sessions.

Factors that promote recovery

Controllable factors (that you can act on)

Regularity of training:

• Every day, even 10 minutes
• Do not skip days

Motivation and positive mindset:

• Believe in your ability to progress
• Celebrate small victories
• Only compare yourself to yourself

Family and social support:

• Surround yourself with caring people
• Join a speaking group (France Stroke offers groups for aphasics)
• Do not isolate yourself

Lifestyle:

• Sufficient sleep (the brain repairs itself during sleep)
• Balanced diet
• Physical activity (improves neuroplasticity)
• Avoid alcohol and tobacco

Stress management:

• Stress worsens language difficulties
• Relaxation techniques, heart coherence, meditation

General cognitive stimulation:

• Read, listen to the radio, watch documentaries
• Maintain your intellectual activities
• Use applications like CLINT

Non-controllable factors (but worth knowing)

• Age (younger people generally recover better, but progress is possible at any age)
• Size and location of the lesion
• Presence of other pathologies
• Delay before starting rehabilitation

Even if these factors are unfavorable, do not lose hope: progress remains possible!

Managing emotions and psychological difficulties

Accepting frustration

Aphasia is deeply frustrating. Knowing what you want to say without being able to say it is exhausting and devaluing.

It is normal to feel:

• Anger
• Sadness
• Shame
• Discouragement

How to manage:

• Accept these emotions as legitimate
• Talk about it (even awkwardly) with your loved ones, with a psychologist
• Cry if you need to
• Do not stay alone with these emotions

Avoiding social isolation

The temptation is great to withdraw, to avoid interactions to not face difficulties.

But isolation worsens everything:

• Less stimulation = less recovery
• Increases the risk of depression
• Loss of motivation

Strategies to maintain social connection:

• See friends one by one (easier than in a group)
• Favor activities where speaking is not central (walking, gardening, games)
• Explain your situation to the people who matter
• Join a group of aphasic patients

Post-stroke depression

30% of patients experience depression after a stroke. If you feel:

• Persistent sadness
• Loss of interest in everything
• Intense fatigue
• Sleep disturbances
• Dark thoughts

Consult! Depression is very treatable:

• Antidepressants if necessary
• Psychotherapy
• Support from loved ones

Testimonials: they have regained their voice

Testimony from Jean, 65, Broca’s aphasia

“After my stroke, I could only say ‘yes’ and ‘no’. It was hell. I saw my wife talking and I didn’t even understand if it was French. With the speech therapist, we started very simply: showing images, trying to say the name. At first, nothing came out. Then, one day, I said ‘table’. I cried. It was long, very long. Six months, a year. Today, two years later, I don’t speak perfectly, I still have difficulties finding my words, but I communicate. I can have a conversation. I can tell my wife that I love her. It’s huge.”

Testimony from Sophie, 58 years old, dysarthria

“My speech was very slurred, people didn’t understand me. I was so ashamed that I stopped talking. The speech therapist had me do mouth exercises, articulate sounds, syllables. It seemed ridiculous at first. But little by little, my mouth responded better. Today, people understand me. I still have to articulate a lot, speak slowly, but I can make myself understood. And that is freedom.”

Testimony from Marie, 72 years old, mild aphasia

“My difficulties were mild, sometimes I couldn’t find my words, I would reverse syllables. But it bothered me a lot. The speech therapist reassured me: it was normal, it would improve. We worked on naming exercises, reading. I also used the CLINT app every day. After 6 months, it was much better. Today, a year later, my loved ones don’t even notice my difficulties anymore. I know they are there, but they no longer hinder me.”

Conclusion: speech can return

Language disorders after a Stroke are a difficult, overwhelming, frustrating ordeal. But they are not a fatality. With early, intensive, regular rehabilitation, and a lot of perseverance, significant progress is possible.

Keys to success:

1. Start early: consult a speech therapist as soon as possible

2. Be consistent: practice every day, even 10-15 minutes

3. Vary the exercises: to stimulate different aspects of language

4. Involve your surroundings: their support is essential

5. Use all means: speech, gestures, writing, images, apps

6. Be patient: progress is gradual

7. Keep hope: even after a year, improvements are still possible

8. Don’t isolate yourself: maintain social connections

9. Manage your emotions: don’t hesitate to consult a psychologist

10. Celebrate every progress: every word regained is a victory

You are not alone. Speech therapists, associations like France Stroke, tools like the DYNSEO training, the CLINT app, and the guide for loved ones are here to support you.

Your voice can return. Your words can return. Start today. One exercise, one word at a time. You can do it. 💬