Speech and Language Therapy

When I was admitted to UCT Private Hospital I could not speak at all. A few words did come out but apparently it was mainly swearing. I was very frustrated as I couldn't communicate. In the beginning I thought that having had the stroke was like been in a car accident. Your mouth could be sore so you couldn’t speak and you may be confused but after a couple of weeks you would be able to speak again and understand everything. This isn’t what happened to me. I didn’t realise the full impact of what had happened to me and it took me months before I could speak in sentences again. I have been getting speech therapy at least three times a week ever since I had my stroke. It was one of the therapies that has continued for a long time after my discharge.

My speech therapist started working with me from the day I came in. She says my main problems were: 

  • Speech - apraxia (motor planning for speech)
  • Language - receptive (understanding) aphasia, expressive
  • Reading - text, numbers
  • Writing

  • Speech

  Verbal Apraxia ( motor planning for Speech)

The first time that I was assessed by the speech therapist I was unable to make any purposeful sounds, i.e. if I was asked to say a sound like ‘p’ I knew what she wanted me to do but couldn’t remember how to say the sound. Of all the sounds possible in English I couldn’t say any of them when asked to. I didn’t know what to do with my mouth.

Therapy started with teaching me single sounds, one at a time. I started with the ‘p’ sound and had to learn what to do with my mouth so that I could say it. We started with the ‘p’ as it is apparently the most visual sound and easiest to make. I still found it very difficult and got very frustrated. Only when I could make this sound with a little help did we go on to the ‘t’ and the ‘k’. It was drill work and took a lot of concentration. The first six sounds (p, t, k, b, d, g) took me about two weeks of daily therapy to get without a lot of help. Once I got these six sounds the rest seemed to come pretty fast but I still needed lots of help to say them. Only when I could say them without help did I start putting sounds together - first two sounds, then three and finally very short words. About two months after I started therapy, I could speak in short sentences but would still struggle to say longer words and sentences. At times I would go totally blank and then would forget what I wanted to say. This still happens now. It took me about a year to be able to speak in longer sentences and to manage in conversations. I am still having problems though - it is more difficult for me to know how to say words when I am very tired, emotional or stressed. I am busy learning strategies to help me with this.

  • Language

  Receptive Language

In the beginning I had problems understanding what was happening around me. I couldn’t follow commands and would get very easily confused. Apparently, together with occupation therapy, speech therapy focused on improving my concentration and attention difficulties. My understanding problems improved quite quickly. Although I still get confused sometimes when people go too fast or I get too must information at a time, I understand everything that goes on around me and don’t need a lot of help. My biggest problem is trying to understand people over the telephone, especially when I am phoning the bank, post office etc.

Expressive Language

Only when I started to speak again did it become obviously that I had language problems as well. I knew in my head what I wanting to say but just couldn’t find the words. My speech therapist says that when I couldn’t find the words I wanted I would slip in other words again and again, e.g. mission, blah di blah. At first I didn’t know that I was doing this once I was told about it I managed to stop doing it.

We did lots of “semantic” therapy to stimulate my language at the same time as working on my speech. On top of all that I had totally forgotten how to make a grammatical sentence. I had to start right at the beginning learning basic structures e.g. subject, verb and object – all the stuff I didn’t like at school. Past, future, present tense, him/her etc.

We started therapy with putting two words together and slowly making sentences longer and longed. This was difficult at the start as I could maybe think of the right grammar but then my speech problems stopped me from saying the words properly. It was struggling a lot of with making grammatical sentences, not just when talking but writing as well. All of a sudden, in September 2004 something just clicked and the sentences started coming easier. I still have problems where I can be talking and then just go blank or forget a word. My speech therapist is helping me to compensate for when this happens. For a long time I was nervous about speaking to people, especially on the telephone, but this has improved in the past three months. Now, when I first meet people they don’t think anything is wrong with me. But, when I am stressed, confused or in a noisy place my talking gets a lot worse and I have to tell people I have had a stroke and they need to go slowly so I can understand and take my time to think of my reply. I can get very frustrated when this happens and maybe panic but am getting better at managing this.

  • Reading

  At the time of my stroke I couldn’t read more than some singe words, i.e. match them to a picture. I couldn’t point to any sounds or letters – I didn’t know what was what. When we were working on my speech sounds we also used written sounds to match what I was saying. This way I learnt which letters went with which sound. This helped me a lot as I could start sounding out words and reading them aloud. It was very slow going and could sometimes take me minutes to read one word – I had to read them aloud as if I did it quietly I couldn’t “see” the word. At the moment I can read short articles in the newspaper – it takes long – and I need to concentrate very hard. This is another thing that makes me going make to work so difficult.

  • Writing

  Because of my limb Apraxia and problems matching sound to letters I had no idea how to write anything in the beginning. I had to start by copying letters which went with the sounds we were doing in therapy. This was one of my biggest problems and still is! I can know exactly what I want to write and start doing it but then get stuck on one word, either problems with spelling, thinking how to write the letter or trying to sound it out. I spend so much time trying to figure it out that by the time I have it I can forget the rest of what I wanted to say. This drives me crazy!

All this writing may look like I am fine but my speech therapist has helped me to write all of this. I still can’t write or speak long complex sentences or write them all together to tell a “story” or explain what is going on. I can’t sequence information properly. This is a big problem for going back to work. What I am doing sometimes is talking into a Dictaphone and then taking my time to write it later on.