What Is the Recovery Time for Stroke Speech Loss?

If someone you care for has recently had a stroke, you’re probably wondering what the timeline for stroke recovery looks like—and if they’ve had speech loss, when it might come back.

While the timeline will vary from one person to the next, the first few weeks will see the most significant progress when it comes to speech recovery, says Parneet Grewal, M.D., an assistant professor in the department of neurology at the Medical University of South Carolina in Charleston. Progress should continue after that, with the most dramatic improvements in the first three months. But improvements can even be seen even a year out, or more, she says.

Here's why, exactly, speech might be affected by a stroke, the timeline for speech recovery, treatment options, and more.

A stroke occurs when blood flow is blocked to the brain, killing off brain cells and affecting areas of the brain that aid in everything from language processing to movement of the arms and legs. It can affect your body and brain in a variety of ways, including causing paralysis on one side of the body, memory loss, and vision problems. It can also cause speech and language difficulties, depending on what side of the brain the stroke was located on, according to the American Stroke Association. That’s because “parts of the brain responsible for language can be damaged by the stroke,” says Dr. Grewal.

If this happens, you may be diagnosed with a condition called aphasia, per the National Institute on Deafness and Other Communication Disorders (NIDCD). Aphasia most often involves damage to the left side of the brain, which contains the language network. The extent of these difficulties depends on several factors, including the exact location of the stroke and severity of brain damage, Dr. Grewal says. A stroke survivor may have difficulty talking, understanding speech, reading, or writing, she says.

Post-stroke, people are most likely to experience a type of aphasia called Broca's aphasia. “Speech becomes broken and halting, and you lose most of your connecting words like and, or, and but,” explains Heather Smith, a speech-language pathologist in the Institute for Stroke and Cerebrovascular Diseases at UTHealth Houston. In addition, as someone searches for a word, they may say a-a-a-a before eventually finding it. “It’s a struggle to get it out,” says Smith.

Your physical ability to speak can also be affected. For instance, if a stroke affected the muscles you use for speaking, you may also have slurred or unclear speech, a disorder called dysarthria, according to the American Speech-Language-Hearing Association.

How Frequently Does Stroke Affect Speech?

Speech changes or difficulties after stroke are common—about one-third of stroke survivors experience aphasia after a stroke, according to research on aphasia after stroke published in Scientific Reports. Your probability of full recovery depends on the severity of your stroke and your aphasia, as well as your age, the type of stroke you had, and other factors. Though aphasia can be caused by head trauma, brain tumors, and progressive neurological disorders, says the NIDCD, stroke is the most common cause, according to the National Aphasia Association.

The likelihood of developing aphasia after a stroke depends on the stroke location (namely if the language centers were damaged), says Sean Savitz, M.D., the director of the Institute for Stroke and Cerebrovascular Diseases at UTHealth Houston. Beyond that, there aren’t definitive risk factors that would predispose you to having speech difficulties following a stroke.

General Risk Factors for Stroke

However, there are personal, medical, and lifestyle factors that put you at an increased risk for having a stroke in the first place. Doing what you can to decrease your risk of a stroke—or a second stroke—is important, since stroke can causes the brain damage that leads to aphasia. According to the National Heart, Lung, and Blood Institute, some of the risk factors for a stroke include:

• Diabetes

• Genetics

• Heart disease

• High blood pressure

• High cholesterol

• Older age

• Overweight or obesity

• Smoking

• Race and ethnicity (African American, Alaska Native, American Indian and Hispanic adults are at a higher risk for a stroke, which may be explained by elevated levels of other risk factors in these groups.)

• Unhealthy lifestyle habits, such as a poor diet or sedentary behavior

Following a stroke, your doctor will send you in for an imaging scan, which can be done via MRI (magnetic resonance imaging) or CT (computed tomography). This scan will provide your doctor with important details about the part of the brain that was damaged during the stroke, per the NIDCD. The results of the imaging test, as well as a medical exam looking at the effects of the stroke, may suggest to your doctor that you have aphasia.

Your neurologist or healthcare provider will then refer you to a speech-language pathologist who will give you an exam analyzing your speech, comprehension, reading, and writing, among other tests, according to Johns Hopkins Medicine. Those results can confirm an aphasia diagnosis.

Seeking treatment early if you have speech difficulties is your best bet for regaining speech. “Ample research shows that stroke rehabilitation therapy improves recovery,” Dr. Grewal says. And more is better: Stroke survivors who did more intense courses of therapy within two to three months after the stroke experienced the greatest improvement in their symptoms by the one year mark compared to those who did therapy later or were in a control group, found research on stroke recovery timelines in PNAS.

You can work with your doctor, as well as a speech therapist, to determine what types of treatments are best for you. These treatments may include:

• Behavioral speech and language therapy, either in-person or virtual, which is the mainstay of treatment, according to an article in the Journal of Stroke

• Book clubs, technology groups, art and drama clubs, per the NIDCD

• Music therapy, according to Dr. Grewal

• Support groups

Most importantly, your treatment should be customized so that it’s “engaging, relevant, and personal” for you, says Smith. “The literature shows that when we make it personal and interesting versus something you’d give to everyone else, there’s a better response and outcomes,” she explains. That could mean tailoring it to your individual medical needs, strengths, and challenges. Or, it could mean using Madonna, not Mozart for music therapy, or reading aloud the sports section as you work on your speech, notes a review in Topics in Language Disorders.

In addition, including family members in stroke recovery is key, says Smith, as loved ones can keep the stroke survivor engaged in conversation, something that will help someone who’s had a stroke regain their speech skills.

Duration of speech language therapy is dependent upon progress, as well as insurance coverage. Inpatient rehabilitation immediately following the stroke will involve a variety of therapies, including physical, occupational, and speech therapy, and may occur five days a week for two to three weeks, says Smith. Following that, outpatient speech therapy may occur twice a week for a few months. “As we know, earlier and more intense is better for speech recovery after a stroke,” she says.

It’s completely normal if you’re eager to put a timeline on post-stroke speech recovery.

“Speech difficulties can be frustrating for patients, and they can have a significant impact on their quality of life after a stroke. Communication is a fundamental core of our social interaction and well-being,” explains Dr. Grewal. Speech difficulty can affect how you express yourself, understand others, and participate in conversations, and this can make everyday activities more difficult.

However, the timeline for recovery varies, and Dr. Grewal says can be dependent on factors such as:

• Age

• Comorbidities (other health conditions)

• Location of the stroke

• Severity of the stroke

“This is an area that still needs a lot of science research to try to fully understand the full extent of recovery,” says Dr. Savitz.

The first three months following a stroke are the most important “in all facets of stroke recovery,” Dr. Grewal says. “People make significant progress in the first few weeks and then steady improvements after,” she explains.

In this early window, there are molecular and biological events occurring in the areas around the stroke that allow the brain to be engaged in repair and more responsive to therapy, Dr. Savitz explains. Circulation improves, damaged cells begin to repair, and new nerve cells and connections are made.

That said, one of the prevailing myths is that once someone gets past the three-to-six-month mark post-stroke, recovery—to whatever extent it’s occurred—is over. “We don’t believe that. People a year or longer out from a stroke with aphasia can still get better, even years out. We’ve seen it happen,” Dr. Savitz says. Indeed, research on predictors of post-stroke aphasia recovery in the journal Stroke found that early intervention (within one month of the stroke) helped maximize speech recovery, with gains still being made past the six-month point.

Speech difficulties are a common consequence of a stroke due to brain damage in the language centers of the brain. Early and intensive speech therapy during stroke rehabilitation can help stroke survivors shore up their speech skills, with improvements being made a year or more post-stroke. There’s reason for a lot of optimism. With work in rehabilitation, you can start to feel more like yourself again.