With speech and language deficits, the greatest progress usually comes in the first few days of therapy. The two most common speech impairments are aphasia and dysarthria.
Aphasia. This is the term for difficulty using words. Some people with aphasia have trouble talking but can easily understand speech. Others talk easily but can't understand what people are saying. Aphasia is a common problem, especially when a stroke has damaged the left side of the brain, where language is processed. Some people with aphasia get better quickly, but even with speech therapy, others continue to have trouble speaking, finding words, reading, writing, or doing math (the same area of the brain that controls language also governs math skills).
Rehabilitation for someone with aphasia involves a variety of speech and language exercises to help the patient relearn the ability to understand, speak, read, and write to the extent that he or she is able. These include repeating words a therapist says, practicing following directions, and practicing reading and writing. Group therapy sessions led by a speech-language pathologist help people practice talking with others who are recovering from strokes. These sessions may involve role-playing common social scenarios, such as talking on the phone or ordering food in a restaurant. For someone who has trouble remembering, the therapist will suggest some practical tools, such as the use of a daily organizer or cue cards posted around the house as prompts for such things as planning meals or turning off the stove. A therapist may also recommend a voice-output, or speech-generating, device to aid communication in daily life. These devices are covered by Medicare and many other insurance providers.
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Dysarthria. This is a more specific problem: the inability to speak, even though you can understand speech and form proper words in your mind. The condition is caused by an injury to the brain centers that control the movement of the tongue, palate, and lips. Speech may be slow or slurred, and one side of the face may droop because the facial muscles are paralyzed. Drooling may also occur. Persons with dysarthria often can write their thoughts down even though they cannot speak them out loud.
A person with dysarthria can do exercises to help increase strength and endurance in the muscles used for speech. The therapist will also provide instruction on how to improve enunciation, such as by speaking more slowly or taking deeper breaths before speaking. Many people with dysarthria also have trouble swallowing, a problem called dysphagia. If this is the case, the speech-language pathologist will provide exercises to strengthen the mouth and throat muscles, as well as tips on how to prevent choking, such as taking small amounts of food at a time, eating slowly, and sitting up while eating. It may be necessary to eat pureed foods at first and gradually introduce more solid foods as muscle strength returns.