Aphasia exercises at home: how to practice speech after a stroke

Good aphasia exercises at home are short, regular and built around words the person actually needs. Think ten to fifteen minutes on most days, with you giving hints instead of answers. Start by asking their speech-language pathologist (SLP) for a home program, then use the steps below to practice naming, yes and no, reading and writing at the right level.

One thing to keep in your head the whole time. Aphasia is trouble with language, not with thinking. You're practicing with an adult who knows what they want to say, so keep the material and your tone adult too.

Start with the SLP, even if therapy is ending

Home practice works best as an extension of what the SLP is doing. ASHA, the professional body for SLPs, describes care partners and volunteers as people who can be trained to give communication practice at home, and says that practice helps skills carry over into daily life. The SLP decides what to practice. You make sure it happens between visits.

If sessions are being cut back or ending, ask for a home program before the last visit. Bring a notebook and ask:

• Which kinds of exercises should we do, and at what level?
• Which hint works best when a word gets stuck?
• Is there anything we should not practice, such as mouth exercises?
• Can you show me how to support a conversation?
• When should we come back, or ask for a new referral?

If they never had an assessment, ask their doctor for a referral to an SLP. An SLP can tell which parts of language are affected. You can't see that from the outside, and neither can a workbook.

The Stroke Association, a UK stroke charity, makes the case for keeping going after therapy ends. Its guide for families says rehabilitation carries on after therapy stops, and that the more someone practices outside sessions, the more progress they will see.

How to set up aphasia exercises at home

Pick the time of day when they're sharpest. Fatigue is common after a stroke, and the Stroke Association's advice to survivors is simple: if you're getting tired, take a rest.

Before you start:

• Turn off the TV and put phones face down.
• Glasses on, hearing aids in, good light.
• Sit across the table so they can see your face.
• Have a pen and a pad of paper ready for writing key words in big letters.

Keep it to 10 or 15 minutes at first. Stop while it's still going fairly well, not after it falls apart. A Cochrane review of 57 trials found that speech and language therapy improved everyday communication, reading, writing and expressive language compared with no therapy. Therapy at higher intensity or over a longer time did better, but more people dropped out of the intensive programs. Those were hours with a therapist, not homework. For you, the lesson is to pick an amount you can both keep up week after week.

Cueing: from least help to most

The most useful thing you can learn is how to hint. ASHA describes two kinds of cue SLPs use. One gives the first sound of the word. The other gives clues about its meaning. Here is one sensible order, from the least help to the most. No research fixes the order, so ask the SLP which hints suit the person you help.

1. Wait. Count to five silently. This is the hardest step for most helpers.
2. Give a meaning hint. "It's a fruit." "You cut with it."
3. Start the sentence. "You spread butter with a..."
4. Give the first sound, not the letter name. For knife, say "nnn," not "kay."
5. Show the word written down.
6. Say it together, then ask them to say it on their own.
7. Move on kindly and try that item again later.

Stop climbing as soon as the word comes. When a hint works, ask them to say it once more without help.

Exercises by level

The NHS lists the kinds of tasks speech therapy uses, including matching words to pictures, sorting words into categories and repeating words. These home versions use the same ideas. Use the person's own words wherever you can: family names, their street, their foods, the tools from their old job.

Naming and finding words

• Easiest: finish a familiar phrase. "Salt and..." "Bread and..." "Ham and..."
• Middle: answer a question with one word. "What do you drink in the morning?" "What do you open to get into a car?"
• Harder: name things in a group. "Name three things in the kitchen." Start with three, not "as many as you can."

Yes and no, and understanding

Read a question aloud and let them answer by saying, nodding or pointing to YES or NO written on a card.

• Easiest: questions about themselves. "Is your name Frank?" "Do you live in Ohio?"
• Middle: everyday facts. "Do you keep milk in the oven?"
• Harder: two steps. "Touch your nose, then point to the window."

Reading

• Easiest: read a single word on a card, like DOOR or CUP, and point to the real thing.
• Middle: read a short sentence and answer yes or no. "A fish can walk."
• Harder: read a real-life item, such as a menu, a TV listing or a bus timetable, and find one fact. "What time does the game start?"

Writing (optional)

Many people with aphasia after a stroke also have weakness in the right arm and hand, which makes writing harder. Nobody has to write to practice language. If they want to try, start with copying a word, then covering it and writing it from memory, then a two-item grocery list.

If they can say very little

Start with automatic speech, the words that come without planning. Count from 1 to 10 together, say the days of the week, or sing a song you both know. Start it, then let your voice fade so they carry on.

What to avoid

Keep practice and conversation separate. During practice there are right answers, and you can say the right word plainly and move on. During conversation there are no right answers. The Stroke Association puts it as "a conversation, not a test," and advises against correcting someone you've understood. The guide on how to talk to someone with aphasia covers everyday talk.

Take Ray, whose wife practiced with him every evening after his outpatient sessions ended. When he got stuck she used to say the word for him within a second or two. Once she started counting to five first, he found about half the words himself, and he enjoyed the sessions more.

What to say during practice

End on something they can do. Close the notebook after a success, not after a failure.

When to call 911 or the doctor

Practice can make you notice changes. A slow, uneven pattern with good days and bad days is normal. A sudden change is not.

If they refuse practice day after day, seem low or stop wanting to see people, talk to their doctor. The NHS notes that aphasia can bring anxiety, low mood and depression, and that talking therapies and support from the care team can help.

Questions families ask

How do you do speech therapy at home for a stroke patient?

You can't do speech therapy yourself. That needs an SLP's assessment and plan. What you can do is home practice: short daily sessions using the exercises the SLP chose, the hints above and the person's own words. If there's no SLP right now, start at the easiest level in each section and move up only when it's easy.

What are good aphasia activities for adults?

Activities that use real life: reading a menu before you go out, practicing a short script for ordering coffee, naming the people in family photos, talking through the TV guide. Word searches and mazes are fine for fun, but they give little practice with words.

Can exercises make aphasia go away?

Practice can help, and improvement can continue for years after a stroke, but nobody can promise how much will come back. The guide on whether aphasia goes away explains what the sources say about recovery.