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Communication and Cognition Problems Following a Stroke

If you're experiencing cognition and communication problems following a stroke, the stroke rehabilitation specialists at Mary Free Bed can help.

Cognition and communication deficits after a stroke are common. Problems in these areas are caused by the location and size of the stroke as well as other pre-existing medical conditions, such as prior stroke or head injury. Generally speaking, the larger the stroke, the greater the changes. Pre-existing medical conditions and behaviors, such as smoking and drinking excessive alcohol, usually worsen the effects of a stroke. 

With a stroke that occurs in the left side of the brain, resulting in right-sided weakness, you may have problems with: 

  • Language 
  • Understanding spoken and/or written words
  • Expressing ideas through talking, writing, or gesturing
  • Math
  • Confusing right and left
  • Slower thinking
  • Seeing things on the right
  • Increased frustration
  • Concentration
  • Facts and details
  • Missing or misperceiving words
  • Impaired understanding 

With a stroke that occurs in the right side of the brain, resulting in left-sided weakness, problems may include:

  • Seeing items on the left
  • Doing things more rapidly or impulsively 
  • Minimizing or denying impairments
  • Poor judgment
  • Problem solving and organizing information
  • Distractibility or a shorter attention span
  • Memory, particularly with things that have happened since the stroke and with new learning
  • Losing sight of the “big picture” by focusing on details
  • Thinking about things in more than one way

After a stroke, you may also experience problems with written and verbal communication:

  • Not reaching the left margin when writing
  • Adding or omitting letters or strokes to letters
  • Communication effectiveness
  • Reduced facial expression and eye contact
  • Over talkative or rarely talks
  • Limited ability to stay focused on a topic or complete a topic

If your doctor has concerns regarding changes in communication or thinking skills, a speech-language pathologist (SLP) will evaluate your skills. If problems are found, the SLP will work with you in therapy. 

In general, the healing process for communication and thinking skills tends to be slower than physical abilities, such as walking. However, improvements can be seen over a longer period of time (over a year) with the greatest and quickest improvements occurring in the first six months.

Aphasia, Apraxia, and Dysarthria

If you have aphasia, it means you're having a hard time with communication. All areas of language — talking, listening, reading, and writing — are affected. However, they may be affected to varying degrees. It occurs most commonly with damage to the left side of the brain. Characteristics are:

  • Word finding problems - Experiencing the feeling that the word is on the “tip of your tongue” but can’t find it.  You may substitute other words to compensate, or you may not be able to communicate your idea.
  • Perseveration – You may continue to say the same thing again and again when you don't intend to.
  • Paraphasias – You may substitute words or sounds within words unintentionally. For example, you may say "yes" instead of "no," or "night" instead of "knife." 
  • Neologisms – You may say things that aren't really words.

Often apraxia of speech coexists with aphasia. Apraxia is a difficulty with positioning and sequencing the muscles used in speech. It's as though the muscles have lost the idea of what they need to do to talk. If you have apraxia, it will appear as though you're groping for sounds, or sometimes as though you can't initiate talking.

Dysarthria is caused by muscle weakness. If you're dysarthric, your speech sounds slurred. This can affect how well you're understood. It's common to experience changes in your voice that may affect whether or not you're understood. Your voice may sound soft or hoarse. You may also have difficulty coordinating breathing with talking.

Not everyone who's had a stroke has all these issues. Your Mary Free Bed physician, nurse, and therapy staff can explain these problems in greater detail.

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