"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
- 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
- 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)
- Severe impairment of both production AND comprehension
- Little or no language
- Generally associated with extensive strokes
- More reserved prognosis, but progress remains possible
- Difficulty repeating what has just been heard
- Relatively preserved comprehension and expression
- Difficulty finding the right word (paraphasias)
- 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)
- Hoarse, muffled voice
- Very weak voice (hypophonia)
- Difficulty modulating the voice (monotony)
- Voice that tires quickly
- 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
- Emotional support
- Adaptation of communication
- Encouragement and patience
- Daily stimulation
- Speaking for the patient
- Infantilizing ("do you want this? yes or no?")
- Becoming impatient
- Avoiding communication
The different types of aphasia:
Broca's aphasia (or expressive aphasia):
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):
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:
Conduction aphasia:
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:
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:
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:
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:
But the surroundings can also, unintentionally, act in a counterproductive manner:
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:
Rehabilitation:
Support:
Coordination:
When to start speech therapy?
As early as possible:
The maximum recovery window:
How often?
Recommendations:
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:
Targeted exercises:
Situational practice:
Advice and homework:
Supportive atmosphere:
How long does rehabilitation last?
It depends:
Typical duration:
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:
Typical results:
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:
Where to look:
Home speech therapy:
Selection criteria
Experience in neurology:
Geographical proximity:
The feeling:
Availability:
Reimbursement
100% coverage in ALD (Long-Term Condition):
Without ALD:
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:
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:
Level 2:
Level 3:
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:
Level 2:
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:
Automatisms:
Frequency: daily (and for pleasure!).
Exercise 4: Writing
Objective: sometimes, writing is more accessible than speaking.
How to do it:
Level 1:
Level 2 :
Level 3 :
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 :
Level 2 :
Commands with an object :
Level 3 :
Two-part commands :
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 :
Level 2 :
Level 3 :
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 :
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 :
Tongue :
Jaw :
Frequency : 2-3 times per day, 5-10 minutes.
Exercise 9 : Sound articulation
Objective : improve articulation accuracy.
How to do :
Level 1 : Isolated sounds
Level 2 : Syllables
Level 3 : Short words
Level 4 : Short 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 :
More difficult examples :
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 :
Level 2 :
Level 3 :
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:
Rules for the loved one:
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:
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:
Use all means of communication:
Ask for help:
Prepare for difficult situations:
Always have with you:
For the caregivers
Adapt your communication:
What to DO:
What NOT to do:
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:
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:
Technical and technological aids
Applications and software
Speech therapy applications:
Text-to-speech:
Communication through pictograms:
Classic tools
Communication binder:
Communication cards:
Alphabet board:
Typical training program
Typical week for a patient with Broca's aphasia (expression difficulty)
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
Total: about 2h30 per week outside of speech therapy sessions.
Factors that promote recovery
Controllable factors (that you can act on)
Regularity of training:
Motivation and positive mindset:
Family and social support:
Lifestyle:
Stress management:
General cognitive stimulation:
Non-controllable factors (but worth knowing)
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:
How to manage:
Avoiding social isolation
The temptation is great to withdraw, to avoid interactions to not face difficulties.
But isolation worsens everything:
Strategies to maintain social connection:
Post-stroke depression
30% of patients experience depression after a stroke. If you feel:
Consult! Depression is very treatable:
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. 💬
