This section covers the range of speech and language problems that can occur after stroke with recommendations to help the person with stroke to communicate and increase social par...
This section covers the range of speech and language problems that can occur after stroke with recommendations to help the person with stroke to communicate and increase social participation. Swallowing impairment (dysphagia) is covered in Section 4.26 Swallowing. 
Aphasia refers to an impairment of language function affecting all aspects of communication including speaking, understanding, reading (separately called alexia) and writing (agrap...
Aphasia refers to an impairment of language function affecting all aspects of communication including speaking, understanding, reading (separately called alexia) and writing (agraphia). Aphasia affects about a third of people with stroke, and can have a significant impact on the lives of individuals and their family/carers. Aphasia has wide-ranging effects on mood, self-image, well-being, relationships, employment, leisure and social opportunities. Problems with communication can also occur following damage to the non-dominant hemisphere. 
Delivery of speech and language interventions can be described under two main approaches: interventions delivered by trained professionals (e.g. speech and language therapists), which are currently the majority and address many aspects of language use, and digital therapies delivered on computers, mobile devices or as apps, which tend to target a specific aspect of language function e.g. the ability to retrieve and produce specific spoken words. Some studies have investigated a blend of the two approaches and use mainstream and specialist software to augment therapist-delivered speech and language therapy. In order to evaluate complex interventions such as speech and language therapy (SLT) a broad range of studies are required (Skivington et al, 2021). 
People should be assessed early after stroke for communication difficulties by a speech and language therapist to diagnose the problem, devise and implement a treatment programme and explain the nature and implications to the person, their family/carers and the multidisciplinary team. 
People with aphasia after stroke should be given the opportunity to improve their language and communication abilities as frequently and for as long as they continue to make meaningful gains, under supervision from a speech and language therapist. 
People with aphasia after stroke should be offered access to appropriate practice-based digital therapies. Adherence to and engagement with these digital therapies will likely be improved if supported by a carer or healthcare professional. Telerehabilitation programmes should:
- be personalised to the individual’s goals and preferences;
- be used when it is considered to be a beneficial option to promote recovery and should not be used as an alternative to in-person rehabilitation;
- be monitored and adapted by the therapist according to progress towards goals;
- be supplemented with face-to-face reviews and include the facility for contact with the therapist as required. 
People with communication difficulties after stroke should:
- be assessed and offered access to a range of communication aids, prescribed according to the person’s needs, goals, and preferences;
- be assessed for their ability to use assistive technology and have programmes and equipment adjusted accordingly;
- be trained and supported in the use of the appropriate technology. 
People with communication difficulties after stroke should be offered access to social and participatory activities such as conversation partners, peer support groups, and return to work programmes as appropriate. 
People with aphasia after stroke whose first language is not English should be assessed and provided with information about aphasia and offered therapy and communication practice in their preferred language. Referral to appropriate services such as interpreters should be made promptly to facilitate early assessment and treatment. 
Intensive speech and language therapy such as comprehensive aphasia programmes may be considered from 3 months after stroke for those who can tolerate high-intensity therapy. 
People with aphasia after stroke should be monitored and assessed for depression and other mood disorders using validated tools. Accessible information should be provided and psychological interventions tailored to the person’s needs. 
The carers and family of a person with communication difficulties after stroke, and health and social care staff, should receive information and training from a speech and language therapist to improve their communication skills and enable them to optimise engagement in the person’s rehabilitation, and promote autonomy and social participation. 
People with persistent communication difficulties after stroke, that limit their social activities, should be offered information about local or national groups for people with aphasia and referred as appropriate. 
Dysarthria is a neurological motor speech impairment that is characterised by slow, weak, imprecise and/or uncoordinated movements of the speech musculature and may involve respira...
Dysarthria is a neurological motor speech impairment that is characterised by slow, weak, imprecise and/or uncoordinated movements of the speech musculature and may involve respiration, phonation, resonance, and/or oral articulation. Impaired muscular control affects speech intelligibility, which is usually described as slurred or blurred. Dysarthria is common in the early stages of stroke, and is often associated with dysphagia (see Section 4.26 Swallowing). 
People with unclear or unintelligible speech after stroke should be assessed by a speech and language therapist to diagnose the problem and to explain the nature and implications to the person, their family/carers and the multidisciplinary team. 
People with dysarthria after stroke which limits communication should:
- be trained in techniques to improve the clarity of their speech;
- be assessed for compensatory and augmentative communication techniques (e.g. letter board, communication aids) if speech remains unintelligible. 
The communication partners (e.g. family/carers, staff) of a person with severe dysarthria after stroke should be trained in how to assist the person in their communication. 
4.45 Apraxia of speech
A few people with stroke have specific and relatively isolated impairment of the ability to plan and execute the multiple skilled oral motor tasks that underlie successful talking ...
A few people with stroke have specific and relatively isolated impairment of the ability to plan and execute the multiple skilled oral motor tasks that underlie successful talking ‒ this is apraxia of speech. It is usually associated with damage to the non-dominant hemisphere, and requires careful separation from aphasia and dysarthria. Interventions such as syllable level therapy and metrical pacing have been studied and the use of computers to increase intensity of practice has been suggested. 
People with marked difficulty articulating words after stroke should be assessed for apraxia of speech and treated to maximise articulation of key words to improve speech intelligibility. 
People with severe communication difficulties but good cognitive and language function after stroke should be assessed and provided with alternative or augmentative communication techniques or aids to supplement or compensate for limited speech.