Author: Angela Hein Ciccia, Ph.D., CCC-SLP, and Jamie Harding, M.A., CCC-SLP

For most, a stroke has a startling and life-altering effect on both the survivor and family members. All involved find themselves trying to come to terms with changes that range from physical and sensory loss to loss of speech and language.

For many survivors, it is this loss or change in speech (dysarthria, apraxia) and language (aphasia) that profoundly alters their social life. Ironically, research has shown that despite the difficulty of socializing, it is one of the best ways to maximize stroke recovery. Many experts contend that socializing should begin right away in the recovery process.

The question then becomes how can they socialize if they cannot communicate how they used to? There are things you can do. Here are some tips you can use from the beginning of recovery.

During the first week or so of stroke recovery, become educated about aphasia. This is important for learning how to communicate in a new way. Learn the definitions and distinctions of aphasia, dysarthria and apraxia. Specifically identify how these conditions affect your communication abilities. Survivors often can learn this from a speech- language pathologist. It is accompanied by a speech and language evaluation that serves as an outline of individual strengths and challenges.

Not only is it important for survivors to become educated, close family members need to be involved so they can understand their loved one’s communication needs and begin to learn ways to facilitate speech and language. Early education of family members supports socialization because they become communication partners with whom the survivor begins to have success and establish confidence.

As the survivor moves out of the initial stage of recovery, rehabilitation begins. This is where people start to experiment with strategies that facilitate social interaction. This stage includes strategies for both survivors and family members as well as changes in the environment that support communication.

For example, many stroke survivors with communication challenges compensate by writing or drawing to supplement verbal expression. They may also use gestures or a picture communication book, or even a computer communication system. Using these strategies gives the survivor the tools to interact with others while continuing rehabilitation of speech and language skills.

Family members can facilitate communication with some simple techniques such as asking yes/no questions, paraphrase periodically during conversation, modify the length and complexity of conversations, use gestures to emphasize important points, and establish a topic before beginning conversation.

The environment also can help support successful socialization. Survivors have told us that it is easiest to begin practicing conversation in a one-on-one situation with someone they are comfortable with and who understands communication disorders. It always helps to practice conversation in a quiet, distraction-free environment. As you become more confident, slowly add more conversational partners but continue to limit distractions such as background noise (music, other talking, TV).

As you become more comfortable in one-to-one or small group interactions, explore less-controlled social situations with your speech-language pathologist, close friends and family, or other stroke survivors. Before you attend these gatherings, practice common things discussed in a variety of situations. For example, before going to a family function, rehearse phrases that are common in that situation (“how are you?” “It’s been a long time”). Practice a few statements about current events (“did you see the basketball game?” or “Boy, we are having beautiful weather!”) The more you practice the script, the greater your chances for success. For people with more severe communication challenges, family members can prepare written cues, or organize pictures to promote interactions.

Once you achieve a level of comfort with close family and friends, you can start getting involved in the community. This can be as simple as going to familiar large group activities such as church events or weekly social gatherings. Or they can be as new and challenging as volunteering, returning to work or joining a new interest group. And, remember, there is no rush. You should step into this stage at a comfortable pace.

An effective tool for expanding socialization opportunities is attending a stroke support group, especially if there are other members with speech and language challenges. In Cleveland, Ohio, Speakeasy is a conversational practice group that meets weekly for two hours. Its members have a chance to practice their communication skills and gain confidence in their ability to communicate. We asked them to share tips for communicating with speech and language limitations in social settings. They said:
1- Try, try, try to get your point across no matter what anybody says or thinks.
2- Waiters are impatient when I go out to dinner. I ask them to slow down when they are talking too quickly.
3- I prefer one-on-one conversations.
4- I gained confidence talking to others when my voice grew stronger and I could say three words at a time.
5- When talking on the phone with a new person, I repeat, “I’m a stroke survivor…can you understand me?”
6- I’m home a lot during the day since my stroke. I make a point to go out.
7- A group like Speakeasy gives me a place where I can talk and know that everybody will listen.
8- No matter who tells you that you can’t, it’s always possible to keep recovering!

Remember that the speech and language changes stroke survivors experience can last a lifetime in some form or another. As life circumstances change, and your speech and language needs evolve, reevaluate what works and what has not worked in social situations. And continue to expand your horizons. Socializing is an important part of the recovery process.

For more information on aphasia or to find an ASHA-certified speech-language pathologist in your area, call ASHA’s Action Center at 800-638-8255 or e-mail ASHA at stroke@asha.org or visit ASHA on the Web at www.asha.org

This article was taken from Stroke Connection’s May/June 2004 Issue. Click on Stroke Connection Magazine to sign up for this free publication.