Communication after a stroke: text to speech and aphasia

Communication after a stroke can change suddenly, most often because of aphasia, a language condition that can affect speaking, understanding, reading and writing. Text to speech and other AAC tools can help some people with aphasia get their message across, but they suit some people far better than others, because aphasia can affect reading and typing too. The most important support is speech and language therapy, alongside patient, aphasia-friendly communication from the people around them.

What is aphasia?

The NHS describes aphasia (also called dysphasia) as “a condition that makes it difficult to communicate. It can make it hard to speak, read, write and understand others.” It’s caused by damage to the parts of the brain that handle language, and stroke is the most common cause. Head injuries, brain tumours, infections and some progressive conditions such as dementia can cause it too.

It’s common. The Royal College of Speech and Language Therapists says around a third of people have some level of aphasia after a stroke, and the Stroke Association puts it at over a third of stroke survivors.

Crucially, aphasia affects language, not intelligence. The person usually still knows what they think and what they want. The difficulty is getting it into words, or making sense of the words of others.

Types of aphasia, simply explained

Every person’s aphasia is different, but you’ll often hear two broad types:

• Expressive aphasia (sometimes called Broca’s or non-fluent aphasia). Speech is slow and effortful, words are hard to find, and sentences may be short or incomplete. Understanding is often relatively good.
• Receptive aphasia (sometimes called Wernicke’s or fluent aphasia). The person may speak in long sentences that don’t make sense, use wrong or made-up words, and find it hard to understand what others say. They may not realise their speech is unclear.

Many people have a mix of both, and reading, writing and numbers can be affected in any of them.

Dysarthria and apraxia are different conditions

Stroke can also cause speech problems that aren’t aphasia:

• Dysarthria is caused by weakness or poor control of the muscles used for speech. Speech may sound slurred, slow or quiet, but language itself (finding words, understanding, reading) is usually unaffected.
• Apraxia of speech is a problem planning and coordinating the movements for speech. The muscles work, but the brain struggles to send the right sequence of instructions, so sounds come out wrong or inconsistently.

A person can have more than one of these at once. A speech and language therapist (SLT) can assess which apply, and this matters a lot when it comes to choosing communication tools.

Can text to speech help with aphasia?

It depends on what the stroke has affected. This is where honesty matters, because an app that’s ideal for one person can be frustrating for another.

Text to speech for reading support

Text to speech can also be used the other way round: to read text aloud while the person follows along. Research by Knollman-Porter and colleagues (2021, American Journal of Speech-Language Pathology) found that adults with aphasia using personalised text to speech settings didn’t, on average, understand more accurately, but many read substantially faster, and most preferred having the support. Benefits varied from person to person, and the right speech speed was individual.

Picture-based AAC and other options

For people whose reading and spelling are significantly affected, symbol or picture-based AAC apps, communication books, gesture, drawing and pointing to written key words are often more useful than a keyboard. We cover the wider range in what is AAC? and the best AAC apps in 2026. An SLT can help match the tool to the person.

How an aphasia app like MyVoice can help

For someone who can type and read reasonably well, MyVoice can be a practical everyday tool:

• Saved phrases and favourites. Common needs (“I need a drink”, “Can you speak more slowly please”, “I have aphasia, please give me time”) can be saved and spoken with one tap, which avoids typing them each time.
• Phrase categories keep those phrases organised, so they’re quicker to find.
• Natural voices. A clear, natural voice helps listeners understand first time. MyVoice has 278 AI voices across 15 languages, with filters for gender, age and accent, so people can choose one that feels right for them. You can hear them on our voice sampler.
• Live word highlighting and adjustable text size make it easier to check what’s on screen before and while it’s spoken.

MyVoice is available on Android now, with iOS coming soon, and the free plan includes offline on-device voices. It’s not a replacement for therapy or a specialist AAC assessment, and family members or an SLT can help set up a useful phrase list.

For more on how text to speech supports people after stroke and with other neurological conditions, see text to speech for neurological conditions.

Communication tips for families and carers

Small changes in how you talk can make a big difference. Stroke and aphasia organisations and NHS speech and language therapy teams commonly recommend:

• Reduce background noise. Turn off the TV or radio and talk somewhere quiet.
• Get their attention first and face them, so they can see your face and gestures.
• Use short, simple sentences and one idea at a time, without talking down to them.
• Give plenty of time to understand and to answer. Resist finishing their sentences unless they want you to.
• Ask yes/no questions or offer choices when they’re struggling (“Tea or coffee?”).
• Write down key words, draw, point or use gestures to back up what you say.
• Check you’ve understood by summarising back what you think they meant.
• Keep them included in conversations and decisions, and talk to them, not about them.
• Stay calm and patient. Frustration is natural on both sides; take a break if needed.

Our carers and families page has more on supporting someone who communicates differently.

The role of speech and language therapy

Speech and language therapy is the core of aphasia rehabilitation. An SLT assesses which parts of communication are affected, works on language skills, and helps the person and their family find other ways to communicate, such as drawing, gesture or communication aids. The NHS notes that therapy can include tasks like matching words to pictures and practising ways of communicating without words.

A 2016 Cochrane review of speech and language therapy for aphasia after stroke found evidence that therapy improves functional communication, as well as understanding and expressive language, compared with no therapy.

Recovery varies widely, and many people keep improving over months and years. If you’re supporting someone after a stroke, ask their stroke team or GP about a referral to speech and language therapy. Speech and language therapists can also advise on AAC, including whether a text to speech app makes sense; we’ve written more for therapists on our speech-language pathologists page.

FAQs

Can people with aphasia use text to speech apps?

Some can. People with good reading and typing (for example, with mild aphasia, dysarthria or apraxia) often find them very useful. When reading and spelling are badly affected, picture-based AAC or other strategies usually work better.

Does aphasia affect intelligence?

No. Aphasia affects language, not intelligence. People with aphasia usually know what they want to say, but have trouble with words.

Will speech come back after a stroke?

Many people improve, especially with speech and language therapy, but recovery is different for everyone. The stroke team and SLT are best placed to advise on an individual’s outlook.

What’s the difference between aphasia and dysarthria?

Aphasia affects language: finding, understanding, reading and writing words. Dysarthria affects the muscles used for speech, so speech sounds slurred or weak while language is usually intact.

This article is for general information and isn’t medical advice. If you or someone you care for has had a stroke, speak to the stroke team, GP or a speech and language therapist about communication support. In an emergency, or if you think someone is having a stroke, call 999.

← Back to blog