Restore speech after a stroke: causes, methods of restoring impaired speech after a stroke

As a result of an acute circulatory disorder, the patient experiences damage to different areas of the brain. In accordance with the volume and damaged structure, problems with the functioning of the body develop. In most cases, the speech center is affected, which is accompanied by complete or partial loss of speech after a stroke. Such consequences are possible with different types of stroke: hemorrhagic, when the brain receives excess blood, and ischemic, when there is insufficient blood supply.

Stroke ranks third in mortality worldwide. In 25% of clinical cases, patients develop disability, more than 60% become disabled. Deterioration of articulation is the main sign by which a vascular rupture can be detected. If a person has had a stroke, there is a high probability of the following consequences:

confusion in words (arrangement in a chaotic order);
difficulty pronouncing certain sounds clearly;
difficulty in remembering the names of some objects;
difficulty in understanding speech addressed to him;
loss of the ability to express one's thoughts.

Speech impairment persists for a long time, but can be corrected through special exercises and drug therapy. Let's take a closer look at how to restore speech after a stroke.

Signs and reasons why speech function is impaired

Aphasia is a speech disorder that is diagnosed in a patient if he cannot pronounce words clearly, has difficulty reading or understanding spoken speech. Such signs appear against the background of a disturbance in the nutrition of neurons.

Depending on the severity of the lesion, after diagnosis, it is possible to predict how quickly a person’s speech function will normalize. The speed of speech restoration depends on a number of criteria, including: the area of the lesion, the support of loved ones, the speed of treatment, and the quality of rehabilitation.

Patients and their relatives often wonder whether speech will be restored after a stroke on the left side. The approach to therapy must be comprehensive. Several specialists take part in drawing up a treatment plan: neurologists, speech therapists and rehabilitation specialists. An individual plan is developed for each patient, which has a positive effect on the dynamics of recovery after a stroke.

What are the types of speech disorders in stroke?

When a blood vessel ruptures in the brain, speech functions are first affected. With hemorrhage, various disorders appear (difficulty in understanding one’s own speech, inability to form words). In addition to aphasia, there are other types of disorders - dysarthria and dyspraxia.

Features of aphasia

It is characterized by deterioration of speech functions against the background of damage to speech centers in the brain. It is divided into complete (when there is no speech at all) and partial. Also, there are 6 forms, including:

Motor. It can be afferent and efferent. With afferent, a person has difficulty maintaining an articulatory posture. Many people lack instinctive speech. With efferent, difficulties arise with the assimilation and reproduction of the motor program. Speech is characterized by rearrangement of sounds and syllables.
Sensory. With this form, Wernicke's center, localized in the temporal lobe, is affected. As a result, a person loses the ability to understand speech, but conversational function is preserved. Sometimes visual function deteriorates.
Dynamic. It is characterized by difficulty or complete absence of the possibility of active expression. The person is unable to pronounce long sentences and has great difficulty constructing phrases. During a conversation, speech patterns dominate.
Acoustic-mnestic. The main clinical manifestation is difficulty retaining recently acquired information in memory. There are patients who cannot repeat a phrase of several words after a speech therapist. It is difficult for them to name the objects around them, because they simply do not remember their names.
Semantic. Patients do not perceive complex speech formulations. Many people have difficulty solving problems that contain complex syntactic structures. Patients with this form read very slowly.
Total. This is the most severe form, which is characterized by a complete absence of speech (due to damage to many speech areas of the brain). Most patients do not even recognize their closest relatives. This form requires a long recovery.

Features of dysarthria

With dysarthria, the mobility of the speech organs is limited, which makes articulation difficult. As a rule, in adults the disease does not lead to the collapse of the speech system. It is often accompanied by problems with swallowing and breathing. In more than 70% of cases, it occurs as a result of a stroke. The main signs of dysarthria include:

difficulties in the mobility of articulation organs;
disturbances in fluency of speech (constant hesitation);
unintelligible and slurred speech;
problems with speech rate (slow or accelerated);
monotony of intonation (monotonous speech);
grimaces;
changes in voice timbre.

There are several forms of dysarthria: bulbar, pseudobulbar, cerebellar, subcortical and cortical. Each of them is associated with a specific location of brain damage. To restore speech, the help of a speech therapist is required. He conducts diagnostics to identify which aspects of speech are impaired and draws up an individual therapy program.

Features of articulatory dyspraxia

Articulatory dyspraxia is a disorder in which the facial muscles maintain the normal tone of the body, but the movements and coordination required to produce sounds are impaired (pronunciation is slurred). There are problems remembering the next movement in a sequence, which causes a lot of inconvenience in everyday life.

People with dyspraxia may speak continuously and repetitively. Ensuring content and consistency in language is often very difficult. Speech is often unclear and tempo and tone cannot be fully controlled. For treatment, an integrated approach is used.

Aphasia

The disease is characterized by complete or partial impairment of speech activity while maintaining hearing and articulation. The brain does not receive enough nerve impulse to express thoughts through the speech organs. Depending on the location of the lesion and the identified dysfunctions, aphasia is divided into several types:

Motor aphasia

It is observed when the upper parts of the main artery of the brain are damaged.

The main organs of speech retain their functionality, but the patient finds it difficult to control them.

With a mild form of motor aphasia, the ability to pronounce words and sentences is preserved.

In speech, there are changes in the sequence of presentation, a violation of the order of words and their forms. It is difficult for a person to pronounce some consonant sounds; he pronounces simple words syllable by syllable. At the same time, the meaning of what was said is clear.

More severe forms of motor aphasia are characterized by complete speech impairment after a stroke. The patient is unable to form words and can only pronounce vowel sounds. He understands other people's speech.

Treatment should begin one week after the stroke. To do this, it is enough to try to pronounce simple words and sing songs.

Sensory aphasia

The disease occurs due to damage to Wernicke's area. Characterized by complete or partial loss of speech understanding. Hearing function is preserved.

The patient is able to reproduce fragments of words, individual sounds that have no semantic connection with each other. There are problems with reading, writing and counting.

The patient enters a state of excitement and actively gestures with his hands. Can follow directions (open mouth, turn head, sit down). Able to repeat simple words, but does not find meaning in them. In speech addressed to him, he hears incoherent sounds. The ability to read and write is lost.

When the parietal region of the left hemisphere is damaged, disorientation in space is observed.

Sensory aphasia can manifest itself in a mild form, then a person recognizes everyday words and phrases. The difficulty of treatment lies in the lack of understanding of speech.

With regular practice, sensory aphasia is partially curable.

Dynamic aphasia

It occurs due to damage to the posterior frontal areas of the dominant hemisphere.

Characterized by the lack of wording of the text.

The patient cannot mentally construct a sentence and reproduce it orally. The thought process is distorted.

A person confuses the forms of words, uses simple sentences, template phrases, and swaps sounds.

Dynamic aphasia is characterized by spontaneous utterances. The structure of the text and semantic integrity are violated, only fragments of phrases are spoken. The patient forgets words, tries to find a synonym, or explain what he wants in other ways.

With a mild form of the disease, a person is able to understand slowly spoken speech. But when the pace of conversation accelerates, the patient loses the meaning of the statement. When answering a question, he uses the same words that the interlocutor said.

A more complex form of dynamic aphasia puts the patient in an inert state . There are difficulties in understanding long sentences. Speech may be completely absent. The patient shows no interest in what is happening around him.

To restore the sequence of thinking, the speech therapist suggests describing interconnected pictures and images. Together with the patient, various stories and dialogues are compiled, as a result of which the ability to plan speech returns.

Stroke is one of the most common causes of death in people worldwide. Signs of a stroke in a woman and methods of prevention are described in detail in the article.

We will tell you further how the recovery period goes for a patient after a stroke.

Acoustic-mnestic aphasia

Associated with disruption of the middle and posterior parts of the temporal part of the brain.

Characterized by a decrease in auditory-verbal memory. The ability to retain and process the required amount of information is lost.

The patient's understanding of the figurative meaning of words is distorted, and the meaning of the text is lost. Characterized by multiple repetitions of one word.

When communicating, the patient may forget the sound design of words and is able to explain using synonyms. Verbal paraphasias dominate in speech. For example, instead of the word “table,” a person says “chair” or “sofa.”

Reading and writing are partially preserved. Retelling text is difficult due to the inability to retain information in memory. Difficulties in counting arise when performing arithmetic tasks orally.

Amnestic aphasia

Deviation occurs when the lower part of the temporal region is affected.

It is considered the most “benign” type of aphasia. Characterized by awareness and adequacy of speech.

The patient retains intellectual, thinking, and auditory functions.

The main feature of Amnestic aphasia is the difficulty of choosing words when communicating. The patient forgets names and names of objects, but is able to describe them using adjectives and verbs.

After examining the affected areas of the brain, the patient is prescribed individual medication and speech therapy.

Total aphasia

It is observed with extensive damage to the speech and sensory areas of the dominant hemisphere.
Appears immediately after an ischemic stroke.

The patient loses the ability to reproduce and understand speech, while auditory function does not change.

Sensitivity decreases. A person ceases to recognize written and oral speech, gestures, articulation, and sounds. The ability to pronounce individual sounds, cough, and moo is preserved.

With more serious focal lesions, the patient's right arm is paralyzed. General behavior is passive.

Total aphasia can develop into more complex forms, so treatment begins immediately after abnormalities are identified.

Damage to any part of the brain can adversely affect the functioning of the central nervous system.

A person who has suffered a stroke needs the attention and care of loved ones. Try to be patient with the patient. Surround him with positive emotions, and the healing process will noticeably speed up.

Basic methods of speech restoration

As a result of an acute circulatory disorder, a person learns to communicate again. This is a labor-intensive and long process. During the rehabilitation period, coordinated work between doctors and the patient’s family is important. In order for him to recover faster, his close relatives should be patient and follow the following rules:

Do not forget to let your loved one know that he is dear and important.
Support the person as much as possible, show full confidence in a speedy recovery, and celebrate his progress.
Talk regularly, tell all the latest news.

During treatment, your support and participation is very important to the patient. You can listen to his favorite music, watch movies, read books with him.

Let's take a closer look at the main methods of restoring speech function.

Training with a speech therapist

A speech therapist plays a major role in the rehabilitation process. He conducts tests, assesses the patient's condition and performs appropriate exercises with him. A specialist is present at every session, helps the patient and monitors the correctness of the technique. In the future, constant supervision by a speech therapist is not required; the patient can train independently. It is important to adhere to the following rules:

complete tasks gradually, starting with simple ones and moving on to more complex ones;
be sure to avoid overwork (if the patient gets tired, the training will be over);
maintain regularity of classes (the optimal frequency of classes is 5-7 times a week for half an hour).

The task of a speech therapist is to involve various areas of the brain in the process of speech control. Several complexes are used at once that are aimed at restoration:

phonetic. They are required to improve facial control. During classes, individual sounds and words are repeated;
visual. If sensory aphasia is diagnosed, then in classes they use cards with pictures and special aids that encourage finding sequences;
semantic. They are required to stimulate active thinking. During classes, he is asked to continue the phrase he started or engage in an impromptu dialogue on a specific topic.

Massage

In addition to problems with speech, people who have experienced an acute circulatory disorder experience a number of other complications, in particular, sagging soft tissues (cheeks, corners of the mouth), impaired chewing function and excessive salivation.

Thanks to special massage sessions, it is possible to restore the tone of the facial muscles and significantly improve facial expressions. As a result, it will be much easier for the patient to pronounce words. Only a specialist can find the necessary points for massaging. He knows exactly which areas should be toned and which, on the contrary, should be relaxed.

In addition to facial massage, a person is prescribed a massage of the tongue, lips, cheeks, ears, scalp, and hands. Thanks to an integrated approach, it is possible to relieve muscle stiffness and improve speech.

Articulation exercises

Exercises that will be prescribed on an individual basis allow you to restore speech after a stroke. Their main task is to improve control over facial expressions, tongue and lips. Exercises to develop the muscles of the tongue may look like this:

movement of the tongue in a circle;
moving the tongue across the palate;
tongue clicking;
biting a relaxed tongue;
sticking out the tongue, directing first to one corner of the mouth, then to the other;
moving the tip of the tongue across the palate in different directions.

Lip exercises include smiling with your lips open, curling your lips, pulling them forward, puffing out your cheeks, and rolling air from one side to the other.

Exercises for correct and clear pronunciation include attempts to pronounce consonants alternately (first voiceless, then voiced), then vowels (with one sound flowing into another).

Exercises for facial expressions: include opening the mouth wide (hold for a few seconds and relax), raising, lowering and relaxing the eyebrows, folding the lips into a tube, stretching the tongue in different directions.

These exercises are not universal; the doctor develops a plan for each patient individually. There are many similar exercises. They should be performed in the presence of a speech therapist. To achieve positive results faster, it is recommended to perform the exercises regularly.

Abdominal breathing

Abdominal breathing (with the diaphragm) allows you to increase the volume of inhaled air and improve the saturation of cells with oxygen. As a result, heart function normalizes, blood pressure stabilizes, and anxiety goes away.

The breathing technique is carried out under the supervision of a specialist. There are many exercises, one of which could be this: in a comfortable horizontal position, take a deep breath through your nose, and then slowly exhale through your mouth. This exercise is repeated several times and then made a little more complicated. To do this, adding several sounds while exhaling:

stretched [f];
stretched [s];
stretched [w];
stretched [x].

The optimal number of repetitions is determined by a specialist.

Drug therapy

In addition to exercise, another important component of the rehabilitation period is drug therapy. Good cerebral circulation plays one of the key roles. A stroke significantly impairs the functioning of brain cells, so doctors prescribe medications that stimulate their functioning. Depending on the nature of the lesion, different groups of drugs are additionally prescribed to restore speech after a stroke. These include:

Antihypertensive drugs (ACE inhibitors) to stop a strong jump in blood pressure.
Antidepressants to combat chronic stress and bad mood.
Nootropics to stimulate regeneration, improve memory, help restore the functioning of brain cells.
Sedatives to relieve emotional stress and normalize sleep.
Anticoagulants to reduce blood viscosity and prevent blood clots.

Medicines help to significantly reduce the severity of disorders, but they are not able to completely restore lost functions. A positive result will only come from an integrated approach to solving the problem (due to combination with other methods of therapy).

Stroke: the essence of pathology, types and causes of disorders

Stroke (English: “stroke” - blow) is a neurological pathology that is characterized by an acute disorder of cerebral circulation.

The blood supply to the structures of the central nervous system is carried out primarily through the internal carotid artery system and the formation of a vascular formation (Circle of Willis).

Depending on the mechanism of development of disorders, two variants of pathology are distinguished.

Ischemic (from “ischaemia” - to stop bleeding) occurs due to an acute decrease in the transport of nutrients to the nervous tissue. Lack of oxygen and nutrient supply leads to degeneration of functional units, atrophy of nerve tissue and dysfunction.
Hemorrhagic (from “haemorhagia” - bleeding). The pathology is characterized by a violation of the integrity of the vascular wall with the formation of an intracranial hematoma.

There is no specific reason that causes stroke in patients. Therapists, neurologists and cardiologists share a group of predisposing and triggering conditions.

Risk factors include: age over 50 years, male gender, concomitant diseases of the cardiovascular system, hypertension, atherosclerosis, inadequate treatment of diabetes mellitus.
Trigger factors: traumatic brain injuries, transient ischemic attacks (TIA) and major surgical interventions on the thoracic and abdominal organs.

In addition, predisposing factors include a family history (presence of stroke in relatives), smoking and stressful work. Treatment of all forms of cerebrovascular accident is carried out in a hospital setting.

Speech disorders after stroke

The consequence of acute cerebrovascular accident is focal symptoms depending on the affected area. Characteristic symptoms of a stroke:

Asymmetry of facial muscles caused by central facial palsy.
Unilateral muscle paralysis is the inability of volitional contraction and movement. In one of the early diagnostic tests, the patient is asked to raise his hand or stick out his tongue. The absence of movements while the patient is clearly conscious and attempting to fulfill the request indicates paralysis.
Anisocoria – the pupils in both eyes are of different diameters.
Incoherent or absent speech is associated with impaired innervation of the articulatory apparatus. Speech impairment after a stroke occurs due to damage to the middle cerebral artery of the dominant hemisphere.

Clinical characteristics of oral speech disorders

Impaired oral communication is one of the most traumatic factors for a stroke patient. There are two types of violations:

Dysarthria (from “dys” - disorder, “art” - pronunciation) is a pathology that occurs as a result of damage to the innervation of the articulatory apparatus. It is characterized by an imbalance in the contraction of the vocal cords, tongue and lips.

Clinical symptoms of the disorder: unclear speech that is incomprehensible to others, sound mixing, distortion of words, lack of differentiation of sounds of individual groups.

Treatment of this form is considered the most effective.

Aphasia is a disorder characterized by the absence of speech in a person with normal hearing and intelligence against the background of already formed oral communication skills. There are three types of aphasia: motor, sensory and semantic.

The motor form occurs due to damage to the lower part of the frontal lobe of the dominant hemisphere (Broca's area), which is responsible for contracting the speech muscles of the larynx, pharynx and tongue. People with this pathology understand well the spoken language of others, but are unable to pronounce words, phrases, or even individual sounds.

Sensory aphasia is characterized by a disorder of perception and understanding of speech and occurs when the superior gyrus of the temporal lobe (Wernicke's center) is damaged.

A distorted understanding of complex structures, phrases, and sentences is observed in patients with semantic aphasia. Patients with the disorder do not understand associations, metaphors, or space-time relationships.

In addition, there is total aphasia, a clinical form of pathology characterized by a disorder in the reproduction and understanding of oral speech.

Important! The method of recovery and the choice of speech therapy tactics are determined by the clinical variant of the pathology.

Additional impact of stroke on communication skills

Oral speech is the most common means of communication, which involves not only the participation of the vocal apparatus, but also the involvement of other mental and physical functions. Acute circulatory disorders cause the following changes:

Emotional accompaniment of speech. Due to diffuse damage to higher mental functions in people after a stroke, uncontrolled changes in intonation often occur during a conversation.
Sensory system disorders. Intermittent visual and hearing impairments make it difficult to adequately use oral and written language skills.
Impaired memory and concentration. A stroke affects the functioning of short-term memory, so the frequent loss of the main idea of a conversation makes the communication process long and uninformative.

In addition, the cerebrovascular accident affects the mental spheres of the individual: emotions, mood and character traits, which also affects the patient’s communication skills.

Music therapy

Music affects many brain sectors at the same time, which allows it to “break through” to a person’s consciousness even when everything else does not work. Some patients after a stroke are not able to speak normally or pronounce individual words, but they manage to sing. In such situations, classes to restore lost speech in the format of singing are especially useful.

Music is good for returning to movement after a stroke. There are scientific reports that people who underwent rehabilitation with lessons in playing a musical instrument had changes in the activity of the sensory cortex of the brain and noticeably improved motor functions. Listening to music during the rehabilitation period is a useful activity that stimulates brain function.

In addition, music evokes a feeling of joy and relaxation. You can cope with severe stress or anxiety by listening to a calm tune. It is believed that this is very useful during the rehabilitation period after a stroke. Due to the inability to freely control their limbs, people often feel depressed and angry. A soothing melody will balance emotions, which will prevent psycho-emotional disorders.

Acupuncture

Acupuncture (acupuncture) is a popular technique of ancient Chinese medicine. It is based on stimulation of reflexogenic zones using special needles. Acupuncture is effective for both forms of stroke: ischemic and hemorrhagic. It may be prescribed if the patient has developed motor aphasia in order to improve the general condition of the body, stimulate cardiac and brain activity, and restore motor functions. Contraindications to the procedure are minimal: malignant neoplasms, acute infectious pathologies, epilepsy and exacerbation of chronic diseases.

The procedures are prescribed in courses of 6-10 sessions with a short interval. An individual treatment regimen is developed by a reflexologist.

Why does speech impairment occur after a stroke?

Lack of nutrition to the brain, caused by a disorder of the blood supply, causes a malfunction of the body's functions. Speech impairment occurs when blood does not flow to the areas responsible for it, tissue atrophy occurs in them. The brain has two speech zones, located in the left hemisphere of right-handed people. One of them - motor (Broca's center) - has the following features:

responsible for sign language, reproduction of written and oral speech;
sends signals that move the muscles responsible for pronouncing sounds;
it is located in the third frontal gyrus;
forms the anterior speech center.

The second zone is sensory (Wernicke's center). It is characterized by the following properties:

located in the posterior part of the superior temporal gyrus;
is responsible for constructing sentences from individual words;
stores information through which speech is perceived meaningfully;
forms the posterior speech center;
has a connection with the functions of hearing, memory, and object recognition.

There are two other areas that affect speech disorders - the visual cortex, which is responsible for the ability to read words, and the auditory cortex, which helps to perceive and recognize sounds. During a stroke, due to the close proximity of these zones, several areas responsible for speech are often damaged at once. The danger is that brain cell atrophy is an irreversible process. To restore speech impairment during a stroke, you need:

the ability to perform speech functions with intact areas of the brain;
the patient’s desire to recover;
a long period.

Doctors note the structural features of the brain of left-handers. Their lack of speech functions during a stroke can occur if any of the hemispheres is affected. In this case, the left-sided disorder will be more easily tolerated, the symptoms will be smoothed out. This is explained by the localization of the speech center in left-handers:

in 20% of cases it is located on the right;
in 60% - on the left;
in 20% - between the two hemispheres.

How long does it take to recover speech after a stroke?

The period of speech restoration, as a rule, begins 7-10 days after the stroke (possibly if the patient is in a stable condition). But sometimes there are situations when the patient is not able to start working with a speech therapist after 3-4 weeks. In any case, recovery should begin no later than after 6-8 weeks, otherwise it will be much more difficult to restore impaired functions.

Speech restoration as part of a rehabilitation program after a stroke is quite slow. Depending on the form of aphasia and the severity of the clinical case, it can take several weeks or even months. It often happens that articulation returns to the patient in spurts: for a long time, the exercises do not bring positive results, but one day the speech improves noticeably.

It is problematic to provide an accurate forecast for the timing of speech restoration in advance (individual for each patient). Rehabilitation is a strictly gradual and step-by-step process. The duration of all stages is individual for each patient: for some it takes several weeks, while for others it takes up to a year. As practice shows, in most patients, speech abilities noticeably improve 3-4 months after regular classes. However, the entire recovery period takes from 3 to 5 years.

Advantages of visiting the Yusupov Hospital

The main advantages include: our own staff of caregivers, the opportunity to stay with relatives, varied meals, round-the-clock supervision, classes for 5-6 hours a day.

Experienced specialists at the Yusupov Hospital practice treatment of speech loss due to stroke. A full diagnostic is preliminarily provided to identify the severity of disorders and assess the general state of health. For this purpose, modern equipment is often used (computed (CT) and magnetic resonance imaging (MRI) are prescribed).

According to the severity of the clinical case, doctors develop a suitable recovery method. Examinations are necessary both before starting treatment and for subsequent observation and monitoring of dynamics. The Yusupov Hospital staff includes experienced neurologists, speech therapists, massage therapists and exercise therapy instructors. Thanks to the highly qualified specialists and individual approach, it is possible to significantly reduce the length of stay in the inpatient department. To make an appointment, you can call the numbers listed on the website or leave a request online.

What types of aphasia are there?

Speech impairment can be different; this condition depends on which centers were damaged during ischemia or hemorrhage. Each Broca's area is responsible for its activity; based on the presence of specific signs, doctors determine the severity of the attack.

Types of speech impairment in stroke:

if the patient cannot name specific objects, optical-mnestic aphasia is diagnosed - the patient usually says “what they write with” instead of the word “pen”;
if conversational perception is impaired with preserved hearing, sensory aphasia is diagnosed;
when the patient cannot repeat a word or phrase that is spoken to him, he suffers from an acoustic-mnestic form;
If a person cannot speak words, but understands everything and can pronounce syllables and letters, motor aphasia is diagnosed.