Imagine waking up one morning and discovering to your amazement that you are not able to move one side of your body, not able to speak so others can understand you or not able to understand what others are saying to you. This awful wakeup call will happen to approximately 750,000 Americans each year, suffering a new or recurrent stroke. Changes in the ability to communicate will occur in a large percentage of these strokes.

Communication is an integral part of our relationships, and loss of the ability to understand or speak can be frightening. The most common difficulty is aphasia, literally a “loss of words.” A person with aphasia may know exactly what they wish to say, but the words will not come out, or will be spoken incorrectly (paraphasia), as in saying “round” for “ball” or “before” for “after.” Helen Harlan Wulf, author of Aphasia, My World Alone, describes aphasia: “Substitution was a constant solution and isn’t it amazing when simple words refuse to come, one can hunt and scratch and find others—an exhausting procedure, but one that often got the job done.”

Aphasia can also be a receptive problem meaning that the stroke survivor will not understand what is said and may have difficulty answering questions or following directions. Receptive aphasia may also make it difficult for a person to sort out conversations in a group of people or on the phone.

Dysarthria is another type of speech deficit occurring with stroke. A person with dysarthria may have slurred, halting speech which is difficult to understand. This person may be mistakenly thought to be drunk or on drugs. Dysarthria can also affect the voice, making it a different pitch, tense or hoarse in quality. When the loudness of a voice is decreased it may be difficult to be heard in groups or on the phone.

With apraxia (a motor speech disorder rather than a language problem), a speaker will sound dysfluent or hesitant, as though stuttering. It may be hard to initiate words, or the words may be distorted and spoken in a groping manner.

Recovery from stroke and aphasia or other speech problems involves hard work and adjustment. Communication is not the same and may never be. Ram Dass wrote the last chapter of his book Still Here after having a stroke in 1997. He expresses his feelings about communication and the changes resulting from his aphasia. “I’ve got to treat words as if they are precious now...when words don’t come as easily it requires that what I say be as much ‘essence’ as possible. I don’t have the energy for all the digressions I used to run through.”

And so it can be for thousands of men and women who have had strokes and experienced communication difficulties. It is heartening, though, to read Helen Harlan Wulf’s words six years post stroke. “One thing is obvious to me; my recovery continues.”

And so it does.


REFERENCES:
Ram Dass, Still Here, 2000; Riverhead Books;
May Sarton, After the Stroke, A Journal. 1988; Norton Books;
Helen Harlan Wulf, Aphasia, My World Alone. 1973; Wayne State University Press