Aphasia After Stroke: Symptoms, Recovery and How to Communicate

After a stroke, suddenly not being able to find the words you want can be incredibly frustrating.

You know what you want to say. The word may be right there in your head. But somehow, you just can’t get it out.

For some survivors, the words come out wrong. Others have trouble understanding what someone is saying, reading something they could easily read before or writing a simple sentence.

This is aphasia, a language disorder that commonly occurs after stroke.

And there’s one thing I want to make clear right from the start:

The thoughts are still there. The ability to communicate those thoughts is what has changed.

Understanding that difference is incredibly important, not only for stroke survivors but for the family members, friends and caregivers communicating with them.

What Is Aphasia?

Aphasia is a language disorder caused by damage to areas of the brain responsible for language. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), stroke is the most common cause of aphasia.

It can affect a person’s ability to:

• Speak
• Understand what other people are saying
• Read
• Write
• Find the right words
• Name familiar objects
• Form sentences

Aphasia can range from relatively mild word-finding difficulties to significant difficulty communicating basic needs.

Why Does Aphasia Happen After a Stroke?

Our ability to communicate depends on several areas of the brain working together. For most people, many of the areas responsible for language are located primarily on the left side of the brain. When a stroke damages these areas, the pathways involved in speaking, understanding, reading and writing can be disrupted.

The effects depend on where the stroke occurred and the extent of the brain injury.

One survivor might understand everything being said but struggle tremendously to respond. Another might speak easily but have difficulty understanding what other people are saying. Someone else might be able to talk but suddenly struggle to read or write.

There isn’t one single aphasia experience.

The National Institute on Deafness and Other Communication Disorders provides a helpful overview of how brain injury can affect different aspects of language.

What Are the Signs of Aphasia After Stroke?

Aphasia can show up in many different ways.

A stroke survivor might:

• Struggle to find familiar words
• Use the wrong word
• Say a related word instead of the intended one
• Speak in short or incomplete sentences
• Repeat words or phrases
• Have difficulty following conversations
• Struggle to read
• Have difficulty writing
• Have trouble naming familiar objects
• Become frustrated while trying to communicate

Imagine knowing you want a glass of water but suddenly being unable to say the word water. You might point toward the kitchen. You might gesture toward a cup. You might say another word entirely.

You know what you want. You just can’t get the word out.

Aphasia Does NOT Mean Someone Has Lost Her Intelligence

This deserves its own section because it’s one of the most important things for people to understand about aphasia.

Aphasia affects language, not intelligence.

Someone may understand complex ideas, recognize exactly what is happening around her and know precisely what she wants to say, while being unable to express those thoughts through words.

That’s why it’s so important to speak to a survivor with aphasia rather than talking about her as if she isn’t in the room.

• Don’t automatically direct questions to her spouse or caregiver.
• Don’t assume she doesn’t understand because she isn’t responding quickly.
• And please don’t talk to an adult stroke survivor as though she’s a child.

Give her time.

She may have plenty to say. Getting those thoughts from her brain into words may simply take longer.

The National Aphasia Association recommends including people with aphasia in conversations and family decisions, giving them time to communicate and asking what communication methods work best for them.

Different Types of Aphasia

Not everyone with aphasia experiences the same language difficulties. Several types of aphasia can occur after stroke.

These categories aren’t always neat and tidy. Stroke survivors can have different combinations and degrees of language difficulties. You can read more about the different patterns of aphasia through the NIDCD’s aphasia overview.

Aphasia Is Not the Same as a Speech Problem

This is another distinction that can be confusing after stroke. Aphasia is a language disorder. Other stroke-related conditions can affect the physical production or planning of speech.

• Dysarthria occurs when difficulty controlling the muscles used for speech can make someone’s speech slurred, slow or difficult to understand.
• Apraxia of speech affects the ability to plan and sequence the movements necessary to produce speech.

A survivor can have aphasia, dysarthria, apraxia of speech or a combination of communication problems. A speech-language pathologist (SLP) can evaluate what’s happening and develop a treatment plan based on the survivor’s specific needs.

How to Communicate With Someone Who Has Aphasia

Communication is a two-way street. Family members and friends can make an enormous difference simply by changing the way they approach conversations.

Give Her Time

This may be the biggest one. A word that once came automatically may now take much longer to find. Resist the urge to immediately finish every sentence.

Pause. Wait. Let her try.

If she wants help finding the word, that’s different. But don’t automatically assume she does.

Speak Normally

Aphasia does not make someone a child. Use your normal adult voice. You may need to slow down or simplify a sentence, but you don’t need to speak in an exaggerated way or raise your voice.

Reduce Distractions

Background noise can make communication much harder. Turn down the television. Put the phone away. Move somewhere quieter if you can. Focus on one conversation at a time.

Try Another Way

Communication doesn’t have to mean speaking. Depending on the survivor’s abilities, she may be able to communicate using:

• Gestures
• Pointing
• Facial expressions
• Writing
• Drawing
• Pictures
• Communication boards
• Phones or tablets
• Letter boards

Sometimes pointing to a picture communicates the message far more successfully than struggling for five minutes to find the word. And that’s okay. The goal is communication, not perfect speech.

The National Aphasia Association’s communication guidance recommends using visual aids, gestures, yes/no or choice questions and other methods to help people with aphasia participate in conversations.

Ask Simpler Questions When Needed

Instead of asking, “What do you want for lunch?” try, “Do you want a sandwich?”

Questions with limited choices or yes/no answers can sometimes make communication easier. But there’s an important caveat: not everyone with aphasia can reliably answer yes/no questions. Confirm important information when necessary.

Don’t Constantly Correct Her

Imagine how exhausting it would be if someone corrected you every time you struggled to find a word. If you understand what she’s trying to communicate, sometimes that’s enough.

If you aren’t sure, confirm what you think she means: “Do you mean you want to go outside?” That gives her an opportunity to confirm or correct you without turning every conversation into a speech therapy session.

Aphasia Therapy After Stroke

For many survivors with aphasia, working with a speech-language pathologist is an important part of stroke rehabilitation. An SLP may work on:

• Word finding
• Naming objects
• Understanding spoken language
• Conversation
• Reading
• Writing
• Sentence formation
• Alternative ways to communicate

Treatment should be individualized. One survivor may desperately want to have a conversation with her grandchildren again. Another may want to order her own food at a restaurant. Another may be working toward returning to her career. Those real-life goals matter.

Mayo Clinic explains that speech and language therapy aims both to restore as much language ability as possible and to help people develop other ways to communicate. Clinical stroke rehabilitation guidance summarized by ASHA also supports speech and language therapy after stroke.

Practicing Communication at Home

Practice outside of formal therapy can also be helpful, particularly when it’s connected to real life. Depending on the survivor’s abilities and recommendations from her SLP, practice might include:

• Naming familiar objects
• Describing pictures
• Reading short passages
• Practicing common phrases
• Talking about familiar subjects
• Writing important words
• Using communication cards
• Practicing family members’ names
• Practicing words connected to hobbies and daily routines

The key word here is meaningful. If someone loves gardening, talking about flowers and plants may be much more engaging than repeatedly naming random objects on flash cards.

If an activity is causing significant frustration, however, harder isn’t necessarily better. Talk with the SLP about how to adjust the activity to the survivor’s current abilities.

What About Reading and Writing?

Aphasia isn’t limited to speaking. Some survivors are surprised to discover that reading and writing have changed too.

A person might be able to read but struggle to write. Another may understand spoken conversation but have trouble understanding written words. These skills can also be addressed during speech-language therapy.

And just like spoken communication, improvement may happen gradually.

Can Technology Help With Aphasia?

Yes. Phones and tablets can provide another way to communicate when words aren’t cooperating.

Depending on someone’s individual needs, technology might be used to:

• Display pictures
• Type messages
• Store commonly used words and phrases
• Show important personal or medical information
• Use augmentative and alternative communication (AAC) apps
• Make video calls

Technology isn’t meant to replace human interaction. It’s another tool that can help someone participate more fully in conversations and everyday life.

An SLP can help determine which communication tools are appropriate based on a survivor’s language, vision, cognition and physical abilities.

The Emotional Side of Aphasia

We can’t talk about aphasia without talking about what it can do emotionally.

Imagine knowing exactly what you want to say but not being able to say it. Imagine sitting in a room while people talk around you because communicating with you takes longer. Imagine having a funny thought and not being able to get the joke out quickly enough.

Or knowing the answer to a question but being unable to find the words to explain it. That can be incredibly frustrating and isolating.

Aphasia can affect confidence, relationships, work, friendships and someone’s willingness to participate socially.

This is another reason patience and inclusion matter so much. Don’t stop inviting someone into conversations because communicating takes longer. Don’t assume silence means she doesn’t want to participate. And don’t underestimate how meaningful it can be simply to give someone enough time to be heard.

Can Aphasia Improve After Stroke?

Yes, although there is no universal timeline.

Some survivors experience significant improvements relatively early in recovery. Others continue improving months or even years later.

According to the NIDCD, significant changes in the brain occur following a stroke or other non-progressive brain injury that can support recovery, and many people experience substantial improvements in language and communication during the first few months. Therapy can help people continue improving their ability to communicate.

How much someone recovers depends on many factors, including the location and severity of the brain injury and the individual’s specific language difficulties.

Recovery doesn’t always mean getting back to exactly the way communication worked before the stroke. Sometimes it means developing new ways to successfully express thoughts, needs, humor, opinions and personality.

That’s still communication. That’s still progress.

When Sudden Speech or Language Changes Are an Emergency

A Final Thought

Aphasia can change the way someone communicates. It does not erase her intelligence, personality, opinions, humor or need to be part of the conversation.

That’s something I think all of us need to remember.

Recovery looks different for every stroke survivor. Some regain much of their previous language ability. Others continue living with aphasia while developing new and effective ways to communicate.

Perfect speech doesn’t have to be the only measure of success. Being able to connect, express yourself and be heard matters too.

Frequently Asked Questions About Aphasia After Stroke

More Stroke Sisters Resources

You may also find these Stroke Sisters articles helpful:

• Speech Recovery After Stroke
• Stroke Recovery Timeline
• Cognitive Recovery After Stroke
• Stroke Survivors Community
• Mental Health After Stroke

Trusted Resources for Aphasia After Stroke