Aphasia After Stroke: Speech and Language Problems
Aphasia is a disorder of language caused by damage to the language areas of the brain, usually in the left hemisphere. It can affect speaking, understanding, reading and writing. It does not affect intelligence: the person knows what they want to say but cannot find or process the words.
Types of aphasia
- Expressive (non-fluent) aphasia: speech is slow and effortful, with difficulty finding words, while understanding is relatively preserved
- Receptive (fluent) aphasia: speech flows but may contain wrong or meaningless words, and understanding is impaired
- Global aphasia: all language functions are severely affected
Aphasia is different from dysarthria, which is slurred speech caused by weakness of the speech muscles.
Further reading: the guide “Stroke” and the articles Stroke Rehabilitation: Ischaemic and Haemorrhagic Stroke and Swallowing Problems (Dysphagia) After Stroke.
Treatment
Speech and language therapy improves functional communication, reading, writing and expressive language [1]. A randomised trial showed that intensive therapy (at least 10 hours per week) improved communication even in chronic aphasia, six months or more after stroke [2]. Current European guidance recommends speech and language therapy for people with aphasia and highlights the role of intensity and family involvement [3].
How families can help
- Speak slowly, in short sentences, and allow time to answer
- Use gestures, pictures and writing
- Avoid speaking for the person or correcting every mistake
- Reduce background noise
The typical course of recovery
Language usually improves most in the first weeks and months after a stroke, partly through natural recovery of the brain and partly through therapy. The pattern varies: some people regain fluent speech, while others continue to have word-finding difficulties (trouble retrieving the right word) or problems with reading and writing. Fatigue, stress and noisy environments often make aphasia temporarily worse. Progress can continue for years with regular practice.
How aphasia is assessed
A speech and language therapist assesses speaking, understanding, repetition, naming, reading and writing, and checks for related problems such as dysarthria (slurred speech) or apraxia of speech (difficulty planning the mouth movements for speech). Hearing and vision should also be checked. The PM&R physician considers aphasia together with movement, swallowing, mood and cognition, so that the whole rehabilitation programme is coordinated and communication goals fit everyday life.
Treatment options in general terms
- Impairment-based therapy: exercises to improve naming, sentence building and understanding
- Functional communication therapy: practising real conversations, such as ordering food or using the phone
- Supported communication: using gestures, drawing, written key words and communication boards or apps
- Group therapy and conversation partner training for family members
- Treatment of low mood, which is common in aphasia and can reduce participation
Research is exploring brain stimulation as an add-on to speech therapy, but it is not a replacement for therapy and is considered only for selected patients.
Daily life and safety at home
- Keep important phrases, phone contacts and medical information written down
- Check understanding with yes/no questions and confirm important decisions in writing
- Include the person in conversations and decisions; do not talk over them
- Make sure they can call for help, for example with a pre-programmed emergency button
When to see your physical medicine and rehabilitation specialist
After acute hospital care, the rehabilitation process is best led and advised by a physician specialised in physical medicine and rehabilitation (PM&R, also called physiatry). At home, too, it is worth consulting a PM&R specialist, who examines the patient, sets goals and guides therapy and supportive treatments together with the physiotherapist and the wider team. Ask for a review if:
- function is getting worse instead of better, or progress has stalled for several weeks
- new pain, stiffness, swelling or falls appear
- mood, sleep, swallowing or bladder control change
- you are wondering whether a robotic or other advanced therapy might be suitable
Whether robotic or other advanced therapies are suitable is decided by a PM&R specialist focused on neurorehabilitation. Prof. Dr. Engin Çakar works in this field and can be consulted online or in person; otherwise, consult a PM&R specialist near you.
Call emergency services immediately for sudden new weakness, facial drooping, difficulty speaking, a severe headache or loss of consciousness: these can be signs of a new stroke.
Frequently asked questions
Can aphasia improve years after a stroke? Improvement is usually greatest in the first months, but therapy can still help in the chronic phase.
Is aphasia more common in left-sided strokes? Yes, because language is located in the left hemisphere in most people. See Left or right-sided stroke.
Should we speak more loudly? No, unless there is also hearing loss. Speaking slowly and clearly, with short sentences, helps more than speaking loudly.
Can a person with aphasia return to work? Some can, often with adjustments. This depends on the type and severity of aphasia and the demands of the job, and is planned with the rehabilitation team.
Assessment and contact
You can request an appointment or a second-opinion review of existing reports and imaging: Contact & second opinion (WhatsApp). This page is general health information. Diagnosis and treatment decisions are made individually after examination.
Sources
- Brady MC, et al. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev. 2016. PMID: 27245310
- Breitenstein C, et al. Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting. Lancet. 2017. PMID: 28256356
- Brady MC, et al. European Stroke Organisation (ESO) guideline on aphasia rehabilitation. Eur Stroke J. 2025. PMID: 40401776