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Approximately 25% of all stroke survivors experience some type of language impairment which may include:

• Impaired content of speech: aphasia, cognitive-communication impairment
• Impaired acoustic features of speech: apraxia, dysarthria

Speech and language disorders may be diagnosed by both formal testing and conversational interaction.

Aphasia is defined as an "acquired impairment of verbal language behavior at the linguistic level," and is characterized by decreased word finding or syntax, word substitutions, and errors in understanding conversational questions or statements. Aphasias are classified as non-fluent, characterized by slow, telegraphic style of delivery; fluent, characterized by rapid style with paraphasias (patient's speech is fluent but contains paraphasic errors such as "treen" for "train") or neologisms (an invented new word or expression); and global, which involve all modes of speech and may be fluent or non-fluent.

There are two types of aphasia, each related to impairment in a different part of the brain. Damage to Broca's area of the brain causes expressive aphasia which is expressive language impairment manifested in difficulty to speak the words they are thinking in a coherent manner. Damage to Wernicke's area causes receptive aphasia which is a receptive language impairment resulting in difficulty understanding spoken or written language though the patient's expressive abilities are not affected.

Intensive treatment by a speech and language therapist for communication disorders in stroke patients has proven in many studies to be effective, particularly if initiated very soon after the stroke. Greater improvement was seen with greater intensity of therapy. Studies have also shown that there is a positive, moderate effect when speech therapy is started within the first three months after the stroke and a smaller, but positive effect was seen even when speech therapy was initiated 3 months to one year or more after the stroke. The major focus of speech and language therapy is to restore at least functional communication to the patient and teach them compensatory strategies for alternative methods of communication if they are unable to communicate effectively.

Cognitive-communication impairment usually is associated with right-hemisphere dysfunction. It is characterized by decreased concentration, attention, memory, initiation, sequencing, problem solving, calculations, and orientation; confusion; confabulation; concrete or irrelevant thinking; executive dysfunction; or vague language. Associated functional problems may include unilateral neglect, difficulty with initiating or coordinating functional activities, denial of illness, or impairments in safety awareness and judgment.

Treatment for cognitive-communication impairment consists of retraining intact abilities and teaching compensatory strategies. Educating the stroke survivor and his/her caregivers on the implications of and compensatory strategies for cognitive deficits is essential to maximize independence and safety. Persistent cognitive problems may cause an otherwise independent stroke survivor to require up to 24-hour supervision.

Apraxia is defined as a "deficit in willed or planned purposeful movement despite the presence of adequate motor or sensory function, coordination, or comprehension." Apraxias are characterized by inconsistent errors either in programming the positioning of the speech musculature (oral) or in sequencing muscle movements for articulation of volitional speech (verbal).