How can I improve my speech after stroke or TBI

How to evaluate difficulty with speaking clearly (e.g., Apraxia, Dysarthria), and some exercises for home rehab

 Is it difficulty with speech or language (word retrieval)?

Speech & Language pathologists treat speech and language. Difficulty with speaking could be caused by difficulty with language  (word-retrieval difficulty) or by a speech-production problem. If the survivor can easily and clearly repeat back any word you say, but have difficulty speaking the word on their own it may be difficulty with word-retrieval (due to expressive aphasia, etc.).

Speech usually (and in this article) refers to the ability to move the mouth and use the voice to form words.  It can be impaired by Apraxia or Dysarthria.

Dysarthria vs Apraxia

Dysarthria often results in muscle weakness or discordination. It often gets worse for whole sentences and may affect rate & rhythm.

Apraxia is difficulty with the brain telling the muscles how to move. The types of Apraxia that affect speech, Verbal & Oral Apraxia,  affect the brains ability to tell the lips and tongue how to move.  Often, spontaneous ("automatic") speech is clearer. View more detailed comparison of Dysarthria vs. Apraxia

Dysarthria is like you can't walk.  Apraxia is like you can't dance. If you do not know which of the above you have, you can try exercises for both. 

Start with something easy then work your way up through the levels below

Advance to the next level only if they can finish the current step ok. The goal here is just to see what they can do, not to challenge them yet. Let them see your mouth/tongue modeling the sounds (unless otherwise indicated below)

1. Can they repeat back a few simple words after you demonstrate (so they can watch your mouth)? maybe Way, We, Pay, Pea, Pie
2. Repeat more useful (but harder words):  Yes, No
3. Repeat back harder words (still single syllable, but more words involving the tongue).  The worksheets below have some example words like:  pack, pad, pen, pill, pan.

 

1. Repeat the above steps but without seeing your mouth
   (i.e., they will only hear the the word).
   You can cover your mouth with a book, or put a blind fold on them, or have them look away. etc.
   

2. Photo & Text

   
   Repeat but show them only the  word and/or Picture (i.e, they will not hear them). Note: you should first make certain they can read at the word level (or retrieve and say the word for the picture). I covered how to evaluate reading-ability previously.

Apraxia Drills for Adults

•  /p/ sounds
•  /w/ sounds
• Sound Practice_ _b_.pdf
• Sound Practice_ _bl,br,cl,cr_.pdf
• Sound Practice_ _d_.pdf

Get more home therapy materials with our free  Home Therapy Course or Clinician Resources

Interactive exercises more effective than worksheets

Oral Motor skills are very difficult to practice with worksheets. Survivors usually need an audio and/or visual model, so the caregiver should provide that. However, many survivors don't want to fail in front of anyone, especially a spouse or close family member. The ideal solution is to practice alone.  I've created a solution for this.

My wife made me do it

Once upon a time there was a speech therapist who realized her patients needed more therapy than insurance was providing.  So she asked her husband, a software engineer if he could help.  So he created interactive treatment software for her to use at work.  And her patients loved it. So did other therapists. So they made it available to everyone and he worked full time creating even more programs.

I am that software engineer. And I continue to work on that software today. It's used  in the top Rehab Hospitals and all around the world. 

Our latest program is MoreSpeech.com which provides unlimited practice for all areas of speech & language, including Apraxia (for articulation). You can create a free account and try it out. It's based on the Rosenbek Apraxia Hierarchy, which has been proven effective in research studies.

Try MoreSpeech.com   (claim your free account)