The Pressure to “Get Back to Normal” After Stroke
The Role of Speech Therapy for Young Adults With Aphasia
By Melissa Katz, MS, CCC-SLP, in collaboration with BrainStorm
A Note from BrainStorm
At BrainStorm, we have always believed that the story of stroke doesn't belong only to survivors.
Survivor voices are at the heart of what we do, but recovery is rarely a solitary experience. Therapists, caregivers, family members, support workers and the people who walk alongside us often see parts of recovery that even we don't. Their experiences, frustrations, lessons and perspectives are an important part of understanding what life after stroke actually looks like.
We want BrainStorm to be a place where those voices are heard too.
That is why we're excited to collaborate with Melissa Katz, MS, CCC-SLP, a speech-language pathologist with more than 12 years of experience working with adults with neurological conditions. Melissa spent much of her career as a Senior Speech-Language Pathologist at Magee Rehabilitation Hospital in Philadelphia on its stroke and brain injury unit and now owns Beyond Words Language & Cognition LLC.
For this piece, Melissa is tackling something we hear constantly from young survivors, and something we have experienced ourselves: the pressure to “get back to normal.”
But what happens when normal isn't where recovery is taking you?
We asked Melissa to share what she sees from the other side of the recovery relationship, and how speech therapy can help young survivors navigate not just communication, but the lives they are trying to rebuild
Melissa's Perspective
Imagine being in your 20s, 30s, or 40s and suddenly having a stroke. You might have been in school, traveling, building a career, raising children, or planning the next chapter of your life. Then overnight, communicating becomes difficult.
You know what you want to say - but can't think of or say the words. Reading a text or an email takes longer. Following a fast-paced conversation is exhausting. You struggle to express yourself and keep up in a work meeting or with friends.
And then you hear, “You're young. Young people don't get strokes. You'll get back to normal.” Or, “But you don't look like you had a stroke.”
For young stroke survivors, these expectations can carry a lot of weight.
The truth is, recovery isn't always linear, and “back to normal” may not be a realistic or helpful definition of recovery.
Instead, rehabilitation, including speech therapy, can focus on improving what has become more difficult and also help make communicating easier and less frustrating.
And finally, you learn there's a word for it: aphasia.
What is Aphasia?
Aphasia is a language disorder caused by damage to the brain that can affect a person's ability to communicate. It most commonly occurs after a stroke, but can also result from traumatic brain injury, brain tumors, or other neurological conditions. It can impact talking, understanding, reading comprehension, and writing skills. Importantly, aphasia does NOT mean someone has lost their intelligence or has a hard time hearing.
Aphasia can have a particularly significant impact because communication is woven into nearly every part of adult life.
Communication isn't just talking.
It's interviewing for a job.
It's reading a book for book club.
It's advocating for yourself at a doctor's appointment.
It's helping your child with their homework.
It's ordering dinner.
It's expressing your personality, opinions, humor, and emotions.
From BrainStorm - Erika & Paul
One thing stroke teaches you very quickly is that the things we once considered “small” rarely feel small once they become difficult.
Sending a text. Following a conversation. Making a joke. Remembering what you wanted to say before it's your turn to speak. Keeping up when several people are talking at once.
These aren't necessarily the milestones people ask about when they ask how your recovery is going. But they are pieces of independence, identity and connection.
Recovery isn't only measured by what happens in a therapy room. Sometimes it's measured by getting a little piece of your everyday life back.
Melissa Continues
A person may begin avoiding situations where they worry they won't be able to communicate. They may feel frustrated when others finish their sentences. They may say the “wrong” thing or get stuck on a word and freeze during a presentation. They may withdraw socially because conversations require so much effort.
Speech therapy can be about much more than “getting words back.”
For young adults with aphasia, speech therapy can focus on the communication skills that are meaningful in everyday life.
Thinking of and saying words
Understanding what is being said to you
Reading comprehension and writing skills
Conversation skills
Communication strategies
Cognitive-communication skills such as attention, memory, organization, and problem solving
Managing cognitive fatigue when communicating
Preparing for a return to work or school
Practicing real-world situations such as meetings, phone calls, presentations, or interviews
Learning how to advocate for yourself
Helping family, friends, and coworkers become better communication partners
The goal isn't necessarily to make someone communicate exactly as they did before their stroke.
The goal is to help them communicate as effectively and confidently as possible so they can participate in the current life they want to live.
One of the most important shifts after stroke may be moving from asking:
“When will I be back to normal?”
to:
“What do I want my life to look like now, and what can help me get there?”
From BrainStorm - Erika & Paul
This is something both of us have had to wrestle with in our own recoveries.
After stroke, there can be enormous pressure to measure progress against the people we were before it happened.
Can you walk like you did before? Can you work like you did before? Can you communicate like you did before? Are you back to normal yet?
But recovery isn't necessarily about finding your way back.
For both of us, part of recovery has been learning who we are now, what we're capable of now, and what we still want from our lives. Some things returned. Some changed. Some required completely new ways of doing them.
And somewhere along the way, we've both had to learn that there isn't one correct version of recovery.
There is no “supposed to.”
Melissa Concludes
Speech therapy can be one part of that process.
Because communication isn't just a skill we use occasionally.
It is how we connect, build relationships, and express who we are.
When a stroke changes communication, supporting a young adult means looking beyond the words themselves and helping them reconnect with the life, goals, relationships, and future they are still building.
A Final Thought from BrainStorm
One of the reasons we wanted to share Melissa's perspective is because recovery doesn't happen in isolation.
Survivors bring lived experience. Therapists bring knowledge, experience and a perspective we often can't see from inside our own recovery. Caregivers, families and support staff see another side entirely.
None of those voices tells the whole story on its own.
BrainStorm was built around the idea that our stories can become lighthouses for someone else. Increasingly, we believe that shouldn't mean survivor stories alone. The people who help us rebuild our lives have stories worth hearing too.
Because stroke may happen to one brain, but recovery involves an entire community.
And perhaps “getting back to normal” was never the right destination in the first place.
Meaningful recovery is possible.
About Melissa Katz
Melissa earned her master's degree in Speech-Language Pathology from Ithaca College and has been a speech therapist for over 12 years. She spent most of her career as a Senior Speech-Language Pathologist at Magee Rehabilitation Hospital in Philadelphia on the stroke and brain injury unit. While at Magee, she worked with patients who had complex neurological conditions involving communication, language (aphasia), cognitive, and swallowing disorders. She also helped co-initiate the music therapy department and led the Cancer Care Committee. Currently, Melissa is the owner of Beyond Words Language & Cognition LLC, a speech therapy private practice for adults. She provides teletherapy services throughout Connecticut and mobile services in select towns in Fairfield County. Melissa is passionate about advocating for her clients while supporting and educating their families.
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