What is your approach to counseling older patients and their families regarding expected recovery of aphasia following a large hemispheric stroke?

There is no precise answer for this question. Every patient follows their own course after a stroke. The size of the infarct and the age of the patient will affect the prognosis. Older patients and those with larger infarcts tend not to have as much recovery. The improvement of aphasia can proceed over many months, and I advise patients and families to wait and see how the patient is doing 9-12 months after the stroke. It is important to continue speech therapy for as long as possible.

The general approach I take is the same as with all stroke recovery conversations. First, assuming the patient survives (10-15% mortality at 30 days when considering all ischemic stroke), all patients will improve from stroke, and the critical issue is to what degree. Recovery of function to the level that most families think about means recovery to something close to the prior level of neurological ability. With a large region of infarction, that is not on the cards for stroke in either hemisph...

I spent much of my career studying aphasia, and there are many variables, including how much of the language cortex and deep structures are affected. Aphasia recovery can continue for a long time, and the amount and duration of speech/language therapy are important. Families can help by asking SLPs for exercises to continue and keeping up therapy for as long as possible. Gestures and inflections of speech often help the patient comprehend. Some predictions can be made based on lesion size, but t...