Communication Facts: Special Populations: Stroke - 2004
Stroke is a cerebrovascular injury that occurs when blood flow
to the brain is interrupted by a clogged or burst artery. The
interruption deprives the brain of blood and oxygen, thereby
causing brain cells to die. The specific abilities that will be
lost or affected by stroke depend on the extent of brain damage
and, most importantly, where in the brain the stroke occurred.
When brain cells die, functions may become impaired or lost,
causing paralysis, speech and language problems, memory and
reasoning deficits, coma, and possibly death.
- Stroke is a leading cause of death in the United States,
and a major cause of serious, long-term disability in adults.
Estimates of stroke incidence in the medical and allied health
literature range from 500,000 to 760,000 in the United States
annually. However, these figures are based on symptomatic
strokes and most likely do not reflect the incidence of
non-symptomatic infarcts (tissue death resulting from
insufficient blood supply) and hemorrhages (massive internal
- One third of stroke survivors are expected to experience
another stroke within five years (3).
- Projected health care costs due to stroke vary from $40.9
million to $51 million annually. These estimates include
nursing home costs and lost productivity (3, 4).
- There are few studies that analyze stroke in women, taking
into account the vascular risk factors, cause of stroke,
clinical picture, and outcome. According to one study, sex
determines some clear differences in patients suffering a
first-ever stroke (5).
- Stroke is a major cause of death and disability among
African Americans (6, 7). Yet research on stroke knowledge and
barriers to stroke prevention among African Americans is
- Despite recent advances in treatment for stroke, there has
been limited improvement in the public's knowledge of
stroke signs and symptoms, initiation of stroke-risk-reduction
behaviors, and the importance of early treatment-seeking
- The number of patients affected by stroke will increase as
an effect of aging (8).
- Stroke in the young is rather rare. The proportion of
juvenile stroke is strongly linked to the structure of the
- Individuals 15-44 years of age are generally considered
young adults and have many risk factors mentioned that may
include drug use, alcohol abuse, pregnancy, head and neck
injuries, heart disease or heart malformations, and infections.
Some other causes of stroke in the young are linked to genetic
Communication Disorders and Stroke
Changes in communication abilities after stroke are common.
These changes can cause mild, moderate, or severe problems. The
degree to which stroke-related communication changes will affect
a person's functioning depends in part on how much the person
used communication skills in everyday life before he or she had a
Cognitive-communication skills are the way individuals use the
thought process to communicate. To communicate well, people need
to be able to see and concentrate on what is going on around
them. Cognitive-communication disorder after a stroke is the loss
of the ability to see and concentrate on what is happening during
communication. Because basic communication is often not impaired,
people with cognitive-communication disorder may not realize that
they have communication problems until they are in more complex
Aphasia is a language disorder that results from damage to
portions of the brain that are responsible for language,
typically located in the left side. The disorder impairs the
expression and understanding of language, as well as reading and
- It is estimated that approximately 1,000,000 individuals in
the United States have aphasia. The majority of these cases are
a result of stroke (13).
- It is estimated that approximately 80,000 individuals
acquire aphasia each year (12).
- Aphasia may co-occur with speech disorders, such as
dysarthria or apraxia of speech, which also result from brain
Dysarthria refers to a group of speech disorders resulting
from weakness, slowness, or poor coordination of the speech
mechanism resulting from damage to a variety of points in the
nervous system. Dysarthria may involve disorders to some or all
of the basic speech processes such as respiration, phonation, and
- Speech errors that occur in dysarthria are highly
consistent from one occasion to the next (14).
- The prevalence of dysarthria following a stroke is not well
Apraxia of Speech
Apraxia of speech is a loss of the ability to make sequenced
patterns of movements for talking.
- For most people, apraxia of speech comes from a stroke on
the left side of the brain (11).
- Apraxia of speech is characterized by highly inconsistent
- Although several studies have examined developmental
apraxia of speech in children (15), a general population
prevalence estimate is not provided.
- Leary, M.C., & Saver, J.L. (2003). Annual incidence of
first silent stroke in the United States.
Cerebrovascular Disease, 16
- No Author. (2002, May 24). State-specific mortality from
stroke and distribution of place of death - United States,
Morbidity and Mortality Weekly Report, 51
- Miller, E.T., & Spilker, J. (2003, August). Readiness
to change and brief educational interventions: Successful
strategies to reduce stroke risk.
Journal of Neuroscience Nursing, 35
- No Author. (2003, June 27). Public health and aging:
Hospitalizations for stroke among adults aged >/= 65 years -
United States, 2000.
Morbidity and Mortality Weekly Report, 52
- Roquer, J., Campello, A.R., & Gomis, M. (2003, July).
Sex differences in first-ever acute stroke.
- Pratt, C.A., Ha, L., Levine, S.R., & Pratt, C.B. (2003,
July-August). Stroke knowledge and barriers to stroke
prevention among African Americans: Implications for health
Journal of Health Communication, 8
- Imam, I. (2002, July). Stroke: A review with an African
Annals of Tropical Medicine and Parasitology, 96
- Carolei, A., Sacco, S., De Santis, F., & Marini, C.
(2002, October-November). Epidemiology of stroke.
Clinical and Experimental Hypertension, 24
- Gandolfo, C., & Conti, M. (2003, May). Stroke in young
Neurological Sciences, 24
(Suppl. 1): S1-S3.
- National Institute of Neurological Disorders and Stroke.
Stroke: Hope through research
(NIH Pub. No. 99-2222). Bethesda, MD: Author.
- Baron, C. (2000). Communication and swallowing problems. In
P.R. Rao, M.N. Ozer, & J.E. Toerge (Eds.),
Managing Stroke: A Guide to Living Well After Stroke
. Washington, DC: NRH Press.
- National Institute on Deafness and Other Communication
Disorders. (1997, August).
Facts Sheet: Aphasia
(NIH Pub. No. 97-4257). Bethesda, MD: Author.
- National Aphasia Association. (1999, June 22).
Aphasia facts sheet
. (Accessed December 13, 2003,
- Yorkston, K.M. (1996, October). Treatment efficacy:
Journal of Speech and Hearing Research, 39
- Shriberg, L., Aram, D., & Kwiatkowski, J. (1997,
April). Developmental apraxia of speech: Descriptive and
Journal of Speech, Language, and Hearing Research, 40
Compiled by Andrea Castrogiovanni * American
Speech-Language-Hearing Association * 2200 Research Boulevard,
Rockville, MD 20850 *