Speech Therapy and Stroke Recovery
By Phyllis Mazurski, MS ,CCC - SLP
Stroke is the third leading cause of death among Americans, claiming the
lives of 160,000 people each year. Among those who survive stroke, two-thirds
have some type of resulting disability. However, with immediate medical
intervention and the help of rehabilitation specialists, over time many stroke
victims are able to reclaim some or all of their former abilities.
The most common stroke-related disabilities we treat in the hospital setting
involve speech and language skills, and swallowing. Because strokes affect
different areas of the brain, the problems people face
in recovery can vary widely. For example, a stroke in the left side of the
brain can impair speech and language, whereas a stroke in the right side can
have an impact on cognitive functions such as the abilities to reason, problem
solve, and remember. Anyone who has had a stroke should be evaluated by a
Aren't speech and language the same
Speech and language are connected, but different. Speech is the dynamic
production of voice sounds for communication. Language comprises the
organization of our thoughts into words and sentences to convey something
meaningful. Stroke can impact both speech and language, or just one and not the
How do strokes affect swallowing?
A stroke can impact areas of the brain that control movement of the muscles
in the mouth, the pharynx (or throat), and in the laryngeal area (which
includes the vocal cords). Strokes can also affect enervation, resulting in
reduced sensation in the throat. This means that people aren't aware of the
weakness they are experiencing. They may have trouble swallowing food and
liquid, which puts them at risk for aspiration, meaning that materials are
passing into the lungs. For the elderly, aspiration can be fatal because it may
lead to pneumonia.
What role does the speech-language
We are often called in within 24 hours of hospital admission to assess
patients who have had strokes. During a clinical evaluation at the bedside, we
observe the eating and swallowing process. We try to determine how effectively
the patient can move food from the front of the mouth to the back of the
throat. We assess how effectively and safely they swallow. By observing the
entire cycle, we can make recommendations on diet, oral exercises, and
compensatory strategies to make swallowing safe. Sometimes we will order a videofluoroscopy study to get a clearer idea if food is
going into the esophagus or is heading for the lungs.
How do you help people whose
communication skills have been impaired by stroke?
We start by examining all parameters of communication including language
comprehension and the person's ability to find the right words and express
entire thoughts. We also assess the quality of the voice and the ability to
articulate clearly. Once we have determined both their capabilities and the
areas in which they have difficulty, we can target treatment strategies for
developing means of communication. It is important that patients recovering
from stroke are able to communicate their needs. And for those patients who
have lost their ability to understand what is being said to them, we start
building those skills.
How long does it take to recover?
Everyone's recovery is different, depending on the location and severity of
the stroke. Most spontaneous recovery occurs in the first three to six months
following the stroke. Speech-language therapists can help patients make the
most of that recovery and we can help patients develop compensatory strategies
for areas in which they will not fully regain their abilities.
The more we challenge and stimulate the brain, the more likely we are to
continue to make gains over time. This means that people should continue
talking even if it is difficult. They should try to read and write and attempt
to learn new skills. For many of the elderly this might even include learning
to use a computer. Through continual use of each different communication mode
affected by the stroke, many people continue to improve. Some recoveries are
Phyllis Mazurski is a speech-language
pathologist in the Department of Rehabilitation at Cayuga Medical
Center. She holds a
master's degree in speech pathology from Boston University
and has 20 years of rehabilitation experience, primarily in the hospital
setting. She sees inpatients on the Medical Rehabilitation Unit and sees
outpatients on referral from their physicians.