We've all been there: the tip-of-the-tongue moment when you know you have the word in your head, but it just won't come out.
Momentary lapses of memory are common in most of us, but for stroke victims, this is everyday life -- except the behavior is not a memory lapse, but rather a condition called aphasia caused by the brain damage brought on by the stroke.
"People refer to it as kind of being in a prison because they have the words. They retain their knowledge and intellect," says Ellayne Ganzfried, executive director of the National Aphasia Association in New York. "They know what it is they want to say, but they can't access it the way they used to."
Ganzfried estimates that between 25 and 40 percent of stroke victims suffer from aphasia, a condition that can also result from brain tumors or other neurological disorders. With stroke victims, various levels of communication can be affected, depending on what part of the brain was most damaged and how significant the stroke was, adds Michelle Troche, director of clinical science research at the University of Florida Health Upper Airway Dysfunction Lab.
"Aphasia is when someone has trouble coming up with words, grammar, comprehension ... There can also be the speech problem," Ganzfried adds. "It's not as crisp because of weakness in the muscles."
Secondarily, stroke can also affect memory and cognition, she continues, although it's important to recognize that strokes do not cause a drop in overall intelligence.
The Sweet Spot of Recovery
The brain is most plastic -- as in malleable, and receptive to repair -- during the first month after a stroke, says Troche, who is also an assistant professor at UF's College of Public Health and Health Professions. "The brain is going to heal itself, but you want to help the brain along so it doesn't develop compensatory behaviors."
The most essential thing for stroke victims to do in that first month is to find a well-qualified speech pathologist who can identify the problems in the same way a physical therapist would work with someone recovering muscle function after an accident. Both the problems and the road to recovery are entirely individual, Troche says. One person may not understand words; another may not be able to express them.
The underlying physiological problem is a breakdown of communication among neurons, or brain cells, Troche explains. Some of that marred communication will pick up naturally, and other forms of communication will have to be kick-started through various exercises. Say you're searching for a word. It still lives somewhere in your brain, but you can't access it directly because the neurons have stopped talking to one another. Thus, your therapy may involve describing the word without using it. "You are strengthening the connections back to that word, so it becomes easier to access that word," Troche says.
The duration of the treatment will depend on the damage, but Ganzfried says some research shows that intense treatment programs -- those lasting five to six hours a day for four to six weeks -- can make a big difference.
"Typically we see spontaneous recovery," Ganzfried says. "Within the first six months to a year, we see things come back quicker." While speech therapy is key to this recovery, music therapy can also bring back language skills. Language ability lies in the brain's left hemisphere, which is where stroke damage usually occurs, so sometimes exercising other parts of the brain -- which haven't been damaged -- can aid in linguistic recovery.
Music ability is one example of a skill that lies in the right side of the brain and can be coaxed into working to repair language, Troche says. "Someone may be able to sing, but not speak the word. The hope is that if you can access language through song or melody, maybe this will transfer to general conversation."
Technological aids -- mostly in the form of computer-assisted programs -- are also key to long-term recovery. Some programs will essentially speak for you, provided that you have a certain amount of intact language to share, Troche says. And phone apps for everything from reading to writing, grammar and sentence construction also help people continue to recover.
Perhaps most importantly, continuity is key. "We now know that people with aphasia continue to improve over [their] life span, which is why it's important to continue to work on their speech and language," Ganzfried says. That can be hard, she adds, since insurance typically covers initial speech therapy, but not long-term therapy.
Community support groups can help fill that gap, she adds. The National Aphasia Association has a list of such groups on its website. However, it's important that stroke victims engage not just with each other, but with the community at large, she continues.
"Having a stroke can be very isolating. [Victims] tend to have more depression," Ganzfried says. "It's important to raise awareness so that people understand what aphasia is. Some people mistake [stroke victims] for being drunk because they can't communicate properly."
And for stroke victims, she adds, "It's important for people to know there's life after aphasia. You can never be cured, but you can regain a good quality of life."