Caring Web

Communication Challenges

For many people who have suffered a stroke, one of the most upsetting effects is difficulty communicating. This can mean trouble with talking, reading, writing, and even understanding. Here is information about some of the words healthcare persons use in talking about communication problems, along with tips for dealing with the communication challenges and frustrations.

Language and Speech Problems

communicationSome people have trouble simply processing what they hear or read, such as understanding what a word or sentence means. People with stroke may know what they want to say, but simply can not get their brain to find that word or make their mouth say that word. They may also come up with a completely different word, such as calling their wife their sister or may say something that is a mixed up word or not even a real word. They may even have trouble understanding how sentences are put together. Some people are not aware that what they are saying does not make sense or think that the people around them are not speaking clearly. These problems communicating are called language problems.

Speech problems for people with stroke are the inability to coordinate their talking as well as they used to. Their thinking is fine, but they simply have trouble speaking words and their speech is slurred or somehow difficult to understand.

It is possible to have a combination of these speech and language problems or they can occur by themselves. These communication problems can also range from just occasional or mild difficulty communicating to a complete inability to communicate.

What's going on in the brain to cause these problems?

The problem is in the speech center of the brain. Your brain has a speech center for being able to express yourself and one for the ability to understand. The following words are usually used to describe language and speech problems:brain

Aphasia is a problem with language, meaning speaking, writing, listening, and/or reading.
Think of it as people who have trouble saying words. For example, they know what the word "telephone" is, but they can not say "telephone." The word just does not come out.

In addition, there are other people that do not understand the word "telephone." You tell them to pick up the "telephone," but they do not know what you are talking about. These individuals can not seem to understand words that are spoken to them or read written words. The actual words, when they are able to say them, may be relatively normal. However, they may not understand and they can not seem to connect a word with what it means.

For instance, imagine yourself in a room with a bunch of people speaking another language like French and they are all talking. You do not have the ability to understand French, because you have never learned it. At the same time, if you were to try to speak French, you can not do that because you have not learned to do that either. So aphasia means that you have trouble either creating those words or being able to understand them. This is incredibly frustrating for everyone, but especially the person with stroke.

Apraxia means that a person can not do something even though they have the actual motor skill to do it. For example, they have the skill to move the muscles, to make speech or words, have enough feeling and coordination, but they can not put it all together. Apraxia is really a problem with trying to start that movement.

Dysarthria is slurred speech. This usually means people have some weakness that keeps them from being able to articulate speech, to be able to efficiently take the positions of their muscles to be able to create the sounds that make words.

Tips for Caregivers to Deal with Communication Problems

  1. Use a communication board to help your loved one communicate with you. You can make one, using pictures with one word under each for important activities or feelings. These pictures can be cut from magazines, newspapers, or photographs. You can use Polaroid pictures to make a quick board. Hungry, angry, happy, bathroom, pain, sleepy, and I love you are some examples that you can include on the board. In addition, your favorite sayings can be wonderful, if you have a picture that goes with it. Picture boards may really make both your lives easier.

  2. Treat the person with stroke like you did before the stroke happened. This is very comforting for all. Admit your mutual frustration and always try to understand. For example, guessing what someone is trying to say can be very tiresome. A communication board will decrease the guessing. However, if the board does not have the pictures you need, try to limit the guessing to three at a time. Then, take a deep breath and come back to it a bit later.

  3. Old songs that you remember from childhood can be comforting. Sometimes these old songs can be recalled, when nothing else can be. Sing these songs together. The laughter that ensues can be marvelous and a great stress reliever.

  4. Humor is a wonderful stress reducer. Not taking life too seriously, especially when so much of it seems to be wrapped up in caregiving, can keep you from feeling like you are losing your mind.

  5. Watching old family movies, going through photo albums, and/or just talking about your lives together can be comforting. If your photos are not in albums, make one or try making a scrapbook. Pictures may help to relive the happy times in both your lives.

  6. Depression after a stroke is quite frequent. Having trouble communicating with your loved one may make the depression worse. Ask your doctor, nurse practitioner, or physician assistant for a referral to an appropriate healthcare professional for treatment as soon as possible. Treating depression may help in all areas of recovery.

  7. Taking a day off from trying to understand each and every word, need, or desire of your loved one can be a great relief. Remember, in the old days before the stroke, did you really pay attention to each of these so closely? Sometimes, a quiet day for just being together can release both of you from the burden of communicating.

  8. Tell your loved one that though you can not really understand how it feels to have a communication problem, you are trying your best to make it as easy as possible for both of you.

  9. Saying "I love you" can mean a great deal and help with communication problems.

  10. Use slowly spoken, short simple phrases with key words instead of long and involved sentences. Remember to be patient with each other.

  11. Communicate in a quiet and non-distracting environment. Remember to turn off the television or radio.

  12. Use written words or gestures, such as pointing or acting things out along with the words you are speaking. Be consistent with your gestures so you can use them over an over to help increase communication.

  13. Communicate using yes - no questions, if appropriate. Sometimes asking a simple yes or no question can help you get to the bottom of things more quickly.

  14. Get more ideas from your speech therapist. Talk to other caregivers who are dealing with communication problems. Inquire with your health care provider about a local stroke support group in you area.

  15. Allow your loved one to make decisions and try to encourage as much independence as possible.

  16. Support participation in leisure activities.

Additional Information:

American Speech-Language-Hearing Association

National Aphasia Association

Aphasia Hope Foundation


Braddom, R (2000). Physical medicine and rehabilitation. (2nd ed.). New York: W.B. Saunders.

Derstine, J., & Hargrove, S. (2001). Comprehensive rehabilitation nursing. New York: W. B. Saunders.

National Stroke Association, (2009). Hope: The Stroke Recovery Guide. Retrieved from

National Stroke Association (2009). Caregivers and Families. Retrieved from

Developed in 2002 by Amy Govoni, MSN, RN, CS at The University of Toledo for the Caring~Web©

Revised: 2010, 2012

Last Updated: 6/27/22