Two Plans

Article by Moody Neuro

While working on their recoveries at TLC, patients often tell staff about all of the activities they will engage in once they are “all better.”  They will share these plans regarding work, vacations, school and family clearly having spent significant time planning future activities assuming an identical skill level as that enjoyed pre-injury.  There is nothing inherently wrong with this kind of planning, but there is an important complementary plan that is missing.  The majority of the patients at TLC have suffered severe traumatic brain injuries and contend with multiple areas of deficits.  Moreover, insurance companies and other funding sources inevitably only fund rehabilitation for a finite span of time.  Those spans of time almost never cover the entirety of a patient’s incremental progress back to “100%,” and no such funding source can make allowances for an indefinite stay.   After a number months (the exact number differing among funding sources and insurance plans), sources will cut off funding and force discharges even if patients would benefit from further therapy.   This is why it is important for patients and their families to make at least two plans.  One of these plans can assume a full recovery, but another plan should recognize the very real likelihood of a less than full recovery.

The first plan, based on a full recovery, tends to be fairly straightforward.  Patients generally want to return back to the majority (if not all) of pre-injury daily activities.  The second plan, based on a less than full recovery, can be more difficult.  This plan is far more emotionally taxing, as it requires patients and families to confront the possibility that the journey of recovery will be longer and more complex than they originally hoped it might be.  It also means that patients and families will have to identify needs, resources and accommodations necessary to be successful incorporating effectively permanent deficits into any planning equation.  This takes a considerable amount of time and effort.  Neglecting to make these plans though can be very problematic, and in some cases quite dangerous.  For instance, if a patient has difficulties with balance and there is no plan in place to make accommodations for those difficulties, a patient may go home without necessary equipment such as grab bars and a shower chair to compensate for balance problems in the bathroom.  This would place the patient with balance deficits at a high risk for a fall, which could lead to a serious injury.  Similarly, if no secondary plan is made for a patient who is confused and experiences disorientation, that patient may be left at home alone.  This confused and disoriented patient may then leave home unaccompanied and become lost wandering the streets, which clearly places that patient in extreme personal danger.

The obvious question when making a plan for a less than full recovery is how does one best make such a plan when the patient is still actively recovering?  Does one guess that a patient will be 25, 50 or 75% better at eventual discharge?  Experience dictates that it is generally preferable to make this secondary plan based on the worst-case scenario (which makes it more likely that all contingencies will be covered) regardless of the rate of improvement a patient appears to exhibit.  So what is the worst-case scenario?  The worst-case scenario is the situation arising if a patient were to make no further improvements beyond current status.  After all, as long as a patient does not have some additional health issue arise (e.g. seizures), then overall recovery should not decline significantly.  This promotes the valid assumption that the current state is the worst possible state and should then be used to inform secondary planning.  So how does one talk about this thorny issue with a patient currently devoting so much of his or herself to the recovery process?  After introducing the topic and having the patient agree to a discussion, I usually start with a version of the following:  “I can see that you are working hard and getting better through rehabilitation.  However, no one has a crystal ball to predict the future.  All we know for certain is today.  Let’s pretend for a moment that you do not get any better than you are right now or that perhaps the insurance company decides to force your discharge tomorrow.  What would you need at home to be successful?  What activities could you take part in on your own or with help?  In addition, which activities might you be unable to take part in at your current recovery level?  By doing this, we can be better prepared for even the hardest post-discharge situation.”  With this type of introduction framing the discussion, patients are able to more comfortably explore these distressing potential eventualities.

As alluded to earlier, this discussion can be very emotionally difficult for patients and family members.  It forces focus on a troubling “what if” and can provide a quite painful reality check resulting from a practical assessment of skills impacting needs.  It is important that everyone understands that this does not mean that it is assumed the patient will not get better or that rehabilitation is useless.  This planning is to raise the likelihood that the patient and family members will be prepared for all possibilities and to lower the likelihood of unexpected dangers and headaches later in the recovery journey.  Overall, the goal is to have a smooth, safe and successful transition to home life after inpatient rehabilitation.

Learn about how Moody Neuro can help with neuropsychology and counseling, speech and language disorders, physical therapy, outpatient rehabilitation assistance, community integration programs, and occupational therapy.

Strokes are medical conditions that affect millions globally. In the United States, more than 795,000 people have a stroke each year, with about 610,000 cases being first or new strokes. 

These can lead to a wide range of physical and cognitive impairments. Speech and language disorders are among the most common and most challenging consequences of strokes, occurring in about a third of stroke survivors. 

Understanding Stroke-Induced Speech & Language Disorders

Stroke-induced speech and language disorders significantly impact communication abilities. Among these, aphasia, dysarthria, and apraxia of speech are prevalent. Understanding how they are diagnosed and their specific symptoms can aid in prompt and effective management.


Aphasia is a common outcome of stroke, manifesting as difficulty in speaking, understanding, reading, and writing. There are many different types of aphasia, depending on the affected brain area, and are categorized based on the symptoms present:

  • Expressive Aphasia (Broca’s Aphasia): Characterized by broken speech, limited vocabulary, and difficulty forming complete sentences. Patients often understand what is being said to them but struggle to verbalize responses.
  • Receptive Aphasia (Wernicke’s Aphasia): Patients can produce fluent speech but may lack meaning or include nonsensical words. They often have significant difficulty understanding spoken language.
  • Global Aphasia: A severe form of aphasia where individuals have extensive difficulties with both speech production and comprehension.
  • Anomic Aphasia: Individuals have difficulty finding words, particularly nouns and verbs, making their speech sound vague.


Dysarthria is a speech disorder that affects 20-30% of stroke survivors. It occurs when stroke impacts the muscles responsible for speech, leading to slurred or slow speech that can be hard to understand. It is typically diagnosed through a physical examination and a series of speech evaluations conducted by a speech-language pathologist (SLP). 

It is characterized by the following symptoms:

  • Slurred or slow speech that can be difficult to understand
  • Monotone or robotic-sounding speech
  • Difficulty controlling the volume of speech, which may be too loud or too soft
  • Challenges with the rhythm and flow of speech, including rapid speech that’s hard to interrupt or slow, drawn-out speech
  • Respiratory issues affecting the ability to speak loudly or for extended periods

Apraxia of Speech (AOS)

Apraxia of speech is a neurological disorder characterized by difficulty sequencing the movements needed for speech. This is caused by the impact of the stroke on the brain’s pathways involved in producing speech. 

Patients with AOS know what they want to say but struggle to coordinate the muscle movements to articulate words correctly. This results in distorted speech, difficulty initiating speech, or the inability to accurately produce speech sounds or sequences of sounds. 

How Long Is the Stroke Speech & Language Recovery Time?

According to one study on post-stroke speech and language therapy, approximately one-third of stroke patients experience speech problems after a stroke. Many of these individuals begin to recover within a few months, with significant progress typically observed within three to six months.

In another study, 62% of subjects had speech challenges after suffering from a stroke. By six months post-stroke, 74% were able to completely recover their communication abilities. 

However, the figures above provide a general timeline for post-stroke speech and language recovery. Stroke speech recovery time is highly individualized and can vary depending on several factors. These can include the following:

  • Severity of the Stroke: More severe strokes often lead to extensive brain damage, resulting in longer and more challenging recovery periods for speech.
  • Location of the Brain Injury: The brain’s specific regions control different speech and language functions; damage to these areas directly impacts recovery complexity and duration.
  • Age and Overall Health of the Patient: Generally, younger patients with better overall health before the stroke tend to experience faster and more complete recoveries.
  • Pre-existing Conditions and Comorbidities: Conditions such as diabetes or hypertension can slow down recovery by complicating the overall health scenario and rehabilitation process.
  • Individual Variability and Resilience: Personal resilience, the support system’s strength, and the individual’s motivation significantly influence the pace and success of speech recovery efforts.

The first three months after a stroke is a crucial period for recovery, as a majority of stroke patients see the most significant improvement during this period. However, it’s also important to note that, although at a slower pace, recovery can continue well past the 6-month mark with continued therapy and practice. 

This underpins the importance of early intervention and ongoing rehabilitation efforts, including speech therapy, to maximize each patient’s recovery potential. 

What Does the Stroke Speech & Language Recovery Process Look Like?

The journey to regain speech and language after a stroke is multifaceted and varies significantly from one individual to another. Understanding the structured phases of recovery can provide insight into what patients and their families can expect during this challenging time. 

Here’s a closer examination of each phase in the stroke speech recovery process.

Initial Assessment and Diagnosis

Before recovery can begin, a thorough evaluation is conducted by a team of healthcare professionals led by an SLP. This assessment aims to identify the type and severity of the speech and language disorder, be it aphasia, dysarthria, or AOS. The evaluation may include cognitive-linguistic assessments, comprehension tests, speech production analysis, and functional communication measures. 

Based on this assessment, a personalized therapy plan is crafted to address the patient’s specific needs.

Acute Phase

The acute phase typically occurs within the first days to weeks following a stroke. During this period, medical stabilization is the primary focus, with healthcare teams working to manage the immediate effects of the stroke. 

Speech therapy may begin with simple exercises or assessments to gauge the patient’s abilities. However, intensive therapy usually does not start until the patient is medically stable. During the acute phase, the goal is to support overall recovery and prevent complications immediately after the stroke.

Subacute Phase

The subacute phase generally spans from two weeks to three months post-stroke and is characterized by more intensive speech therapy interventions. As the patient’s medical condition stabilizes, the focus shifts to active rehabilitation. Therapy during this phase is tailored to the individual’s specific speech and language deficits and may include:

  • Exercises to improve articulation, fluency, and voice control for those with dysarthria.
  • Language therapy to enhance understanding, speaking, reading, and writing skills in patients with aphasia.
  • Motor speech exercises and strategies to improve speech planning and production in apraxia of speech.

The subacute phase is crucial for taking advantage of the brain’s natural recovery processes and neuroplasticity, where the brain begins reorganizing and adapting to the loss of function.

Chronic Phase

The chronic phase of recovery extends from several months to years after the stroke. It focuses on long-term rehabilitation and adjustment to any residual speech deficits. During this time, patients may continue to see gradual improvements in their speech and language abilities, although the rate of recovery may slow. Therapy in the chronic phase often includes:

  • Advanced communication strategies to cope with ongoing challenges in daily life.
  • Maintenance exercises to preserve and enhance speech gains achieved in earlier phases.
  • Supportive technologies and aids, such as communication devices, to assist in effective communication.
  • Community reintegration activities to help patients return to as normal a life as possible, engaging in social, vocational, or recreational activities.

What Is the Role of Neuroplasticity in Speech & Language Recovery?

Neuroplasticity refers to the brain’s fundamental property to change and adapt its responses to new experiences, learning, and environmental changes. This adaptive capacity enables the brain to reorganize itself by forming new neural connections.

When the brain, or a part of the brain, is damaged after a stroke, neuroplasticity is what allows the other parts of the brain to take over the functions of the damaged area. Through targeted rehabilitation and therapy, such as speech therapy for stroke survivors, patients can retrain other brain areas to perform the lost functions and facilitate recovery.

Enhancing Stroke Speech & Language Recovery Time

Adopting a comprehensive approach involving several key strategies is vital to enhance the stroke speech and language recovery time. This multifaceted approach can maximize the chances of regaining speech and communication abilities.

This comprehensive approach must incorporate the following strategies:

  • Early intervention to leverage the brain’s highest potential for neuroplasticity in the initial period following a stroke, significantly improving the chances for recovery.
  • Alternative communication strategies, such as gestures, writing, and visual aids, to help maintain communication during the recovery process. 
  • Adopting technology, including speech-generating devices and software applications designed for speech rehabilitation, for personalized exercises and continuous practice, which is vital for progress.
  • Providing continuous support from psychologists, support groups, and therapy to help manage feelings of frustration, depression, and anxiety, fostering a positive mindset essential for rehabilitation.
  • A healthy diet and lifestyle to supply essential nutrients that support brain function, along with regular physical activity, adequate sleep, and management of medical conditions.

Begin Your Post-Stroke Recovery Journey With Moody Neurorehabilitation

Moody Neurorehabilitation understands the complexities and challenges that come with post-stroke rehabilitation. We are dedicated to supporting patients and their families through this critical time with specialized care and personalized treatment plans.

Since our inception in 1982, Moody Neurorehabilitation has been a leader in brain injury rehabilitation. Our approach centers on providing comprehensive care tailored to each patient’s needs and goals. We believe in treating the whole person, not just the symptoms, to improve overall quality of life.

We invite you to start your recovery journey with us. Contact Moody Neurorehabilitation today to schedule a consultation with our experts. Let us help you navigate the path to recovery with care, compassion, and expertise.