Stroke affects communication in three primary ways, each requiring specialised therapeutic approaches: **Aphasia** impacts language—your ability to understand words, find the right words, read, or write. Research shows that one-third of stroke survivors develop aphasia, meaning 6-7 New Zealanders develop this condition every single day. There are several types: - **Broca's aphasia (non-fluent):** You understand what's said but struggle to speak, producing short phrases with significant effort - **Wernicke's aphasia (fluent):** You speak fluently but words may not make sense, with frequent word substitutions - **Global aphasia:** Severe impairment affecting both understanding and expression - **Anomic aphasia:** Primarily word-finding difficulties, with relatively preserved speech and comprehension **Dysarthria** affects the physical production of speech—weakness in the lips, tongue, or breathing muscles makes words sound slurred or unclear. Research indicates 24% of stroke survivors experience dysarthria alone, whilst 28% have both aphasia and dysarthria together. **Apraxia of speech** impacts the motor planning needed for speech—you know what you want to say, but your brain struggles to coordinate the mouth movements to say it clearly. In New Zealand, Māori and Pacific peoples experience strokes an average of 15 years earlier than European New Zealanders, and 25% of all stroke patients are below retirement age. This means communication recovery often affects younger adults, parents, and professionals still in their working years. Here's the hopeful truth that research now confirms: neuroplasticity—your brain's ability to reorganise and create new pathways—continues for years, not just the first few months. Whilst the first three months offer heightened neuroplasticity and the most rapid gains, studies demonstrate that further improvement is possible for years with ongoing, intensive therapy.

Research demonstrates that speech and language therapy produces clinically significant benefits for stroke survivors, with effect sizes showing meaningful improvement in functional communication, reading, writing, and expression. The key factor? High intensity, dose, and duration consistently predict better outcomes. **For Aphasia Recovery**, we use evidence-based approaches that leverage neuroplasticity: - **Constraint-Induced Aphasia Therapy (CIAT):** Uses neuroplasticity principles with intensive practice to rebuild language pathways - **Semantic Feature Analysis:** Strengthens word-finding by building connections between related concepts - **Melodic Intonation Therapy:** Harnesses music and rhythm to access language through undamaged brain pathways - **Script Training:** Practises personally relevant conversations for real-world communication success **For Dysarthria Treatment**, we focus on physical strengthening and coordination: - Oral motor strengthening targeting lips, tongue, and jaw muscles - Breath support techniques for adequate vocal power - Speech clarity drills with repetitive practice - Voice projection training for improved intelligibility - Pacing strategies to optimise speech rate Research confirms that even smartphone-based dysarthria therapy produces significant improvement in intelligibility within four weeks—demonstrating the power of intensive, targeted practice. **For Apraxia of Speech**, motor planning and prosody work together: - Focused practice on correct mouth movements for specific sounds - Prosody training incorporating rhythm, intonation, and stress patterns - Repetitive practice with immediate feedback for motor learning **Early Intervention Matters Most** The first three months post-stroke represent a period of heightened neuroplasticity—the most rapid gains occur during this window. However, studies confirm that neuroplasticity continues for years, and further improvement is possible with ongoing therapy well beyond six months. Starting intensive therapy early optimises outcomes, but it's never too late to make meaningful progress. **Family and Communication Partner Training** Evidence shows that Communication Partner Training (CPT) produces significant, maintained outcomes. Studies of over 720 communication partners demonstrate improvements sustained at 23-month follow-up. We incorporate methods from Supported Conversation for Adults with Aphasia (SCA™) and Better Conversations with Aphasia (BCA), training families in strategies that reduce burden and enhance communication success. Research consistently identifies communication difficulties as the most distressing and difficult issue for caregivers. Training family members isn't just beneficial—it's essential for recovery and quality of life. **Telehealth Effectiveness** Telehealth delivery enables consistent, high-intensity therapy regardless of geographic location. Studies confirm its effectiveness for aphasia treatment, and it offers particular advantages for ongoing therapy once hospital-based services have been discharged. We provide the intensive dose and duration research shows produces the best outcomes—from anywhere in New Zealand.

**Acute and Chronic Stroke Survivors:** Whether you're in the first weeks post-stroke or years into recovery, intensive speech therapy produces meaningful gains. Research confirms that neuroplasticity continues for years—recovery isn't limited to the first six months. We work with stroke survivors at all stages of recovery. **Families and Caregivers:** Communication Partner Training is evidence-based and essential. We train families in strategies that reduce burden, enhance communication success, and improve quality of life for everyone. Studies show these improvements are maintained long-term. **Younger Stroke Survivors:** Twenty-five percent of stroke patients in New Zealand are below retirement age. Communication recovery can mean returning to work, parenting effectively, and maintaining professional and social relationships. Intensive therapy supports these goals. **Māori and Pacific Whānau:** Māori and Pacific peoples experience strokes an average of 15 years earlier than European New Zealanders. We provide culturally responsive care that honours whānau involvement and recognises the unique challenges faced by these communities. **Those Discharged from Hospital Services:** Many stroke survivors are discharged from hospital-based speech therapy after initial recovery, yet research demonstrates that ongoing intensive therapy produces continued improvement. We provide that ongoing support—either in-person in Wellington or via telehealth throughout New Zealand—for as long as recovery continues.