Excerpted from the article "Talking Tough?", Stroke Connection May/June 2004 (Science update August 2009)

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 ranging from physical and sensory loss to loss of speech and language.

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

For many people living with aphasia, dysarthria or apraxia, the question then becomes: How can they socialize if they can't communicate the way they used to?

Here are some tips you can use to begin your recovery:

• Educate yourself about aphasia so you can learn a new way to communicate.
• 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.  
• Experiment with strategies that facilitate social interaction during your rehabilitation. 
• Many stroke survivors with communication challenges compensate by writing or drawing to supplement verbal expression, or use gestures or a picture communication book, or even a computer communication system.

Family members can facilitate communication with some simple techniques:

• Ask yes/no questions.
• Paraphrase periodically during conversation.
• Modify the length and complexity of conversations.
• Use gestures to emphasize important points.
• Establish a topic before beginning conversation.

Your 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.

In addition:

• 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, “How are you?” “It’s been a long time since I've seen you.”
• Practice a few statements about current events: “Did you see the basketball game?” or “Boy, we are having beautiful weather!”
• The more you practice this script, the greater your chances for success.
• 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 by:

• Going to familiar large group activities such as church events or weekly social gatherings.
• Volunteering, returning to work or joining a new interest group.
• Remembering there's no rush. You should step into this stage at a comfortable pace. 
• Attending a stroke support group.

Speakeasy is a conversational practice group in Cleveland, Ohio that meets weekly for two hours. Its members have a chance to practice their communication skills and gain confidence in their ability to communicate. 

Speakeasy's tips for communicating with speech and language limitations in social settings:

• Try, try, try to get your point across no matter what anybody says or thinks.
• If waiters speak too fast when you go out to dinner, ask them to slow down.
• Try one-on-one conversations.
• When talking on the phone with a new person, repeat, “I’m a stroke survivor…can you understand me?”
• Make a point to go out and interact with people — socializing is an important part of recovery.
• 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.

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 visit ASHA on the Web at www.asha.org.