When speech is missing in hospital

In hospital, speech can go missing without warning. A person intubated in intensive care can no longer produce sound with their vocal cords. A person with aphasia after a stroke may struggle to find words, to string them together, or to understand those addressed to them. In both cases, the need to say that something hurts, that something is uncomfortable, or to ask a question, does not disappear with the voice.

Why speech goes missing

Speech requires air to pass through the vocal cords and set them vibrating. An endotracheal tube passes through exactly that space in order to bring air to the lungs: while it is in place, the person cannot speak, as the Cleveland Clinic, an American university hospital, points out. A tracheostomy, carried out when intubation goes on beyond a few days, moves the airway but does not make speech immediately available either.

The aphasia that follows a stroke has another origin: an area of the brain that processes language is affected, which touches the production of speech, its comprehension, or both at once. The Cochrane Library, an international network that synthesises health research, notes that about one third of people who survive a stroke develop aphasia.

These two situations differ in their duration. Intubation lasts as long as a stay in intensive care: speech becomes mechanically possible again as soon as the tube is removed. Aphasia arises from an injury to the brain whose duration varies from one person to another, which is why a means of communicating should stay available for as long as necessary, with no limit set in advance.

What research in intensive care shows

An observational study carried out in a general intensive care unit in an Australian hospital, covering 87 patients, puts at about one third the proportion of people who meet a communication difficulty during their stay. A qualitative study published in 2025 in Nursing in Critical Care describes a finer breakdown, not across all patients but among those who cannot speak: 28% meet a mild difficulty, 23% a moderate one, and 49% an extreme one. The two figures therefore do not concern the same population, and they cannot be added together.

• Anger, frustration and a sense of powerlessness, described by patients, families and nursing teams alike.
• Anxiety that can persist for several months after leaving intensive care.
• Care poorly matched to real needs when communication fails, whether care that is missed or care given in error.

What research after a stroke shows

A Cochrane review covering 57 trials and more than 3000 participants concludes that speech and language therapy improves functional communication, reading, writing and spoken language, compared with no treatment. The authors also note that more intensive therapy, with more and longer sessions, achieves better results on functional communication, at the cost of treatment being abandoned part way through more often. They name no optimal approach, and the review itself points out that the level of certainty varies from one result to another: we carry that caution over as it stands.

A study published in 2022 in the International Journal of Community Medicine and Public Health looked at the use of a communication board with hospitalised patients with aphasia. Its authors report that the pattern of communication was judged poor in 90% of patients before the board was used, and in 10% after it was introduced, with 46.7% then reaching a pattern judged good and 43.3% one judged moderate, a difference they describe as statistically significant. These are the figures of a single study, in a single unit, and they describe what its authors observed: neither a measurement of what this site does, nor a result that can be promised to anyone.

What it changes for the team and for families

For a nursing team, a communication tool changes the nature of the exchange with a person who does not speak: it makes it possible to check a pain, a need or an understanding without having to guess. For families, it removes part of the uncertainty that weighs on every visit. The qualitative study of 2025 cited above notes that the absence of such a tool complicates the work of the teams as much as the experience of patients and their families, all three groups describing the impossibility of speaking as a major difficulty of the stay.

In practice, a communication board allows a person to point to a pain scale, to signal thirst or an uncomfortable position, or to ask a simple question before a procedure, rather than undergoing it without understanding it. None of these situations calls for a sophisticated device: a printed board, held by a family member or displayed above the bed, is enough to open that exchange.

A communication board, on paper or on a screen, replaces no care: it only gives the person a means of saying what they can no longer put into words out loud, for as long as speech is missing, whether that is a few days or several months.

Sources

• Endotracheal Intubation: Procedure, Risks & Recovery, Cleveland Clinic.
• Speech and language therapy for aphasia following stroke, Cochrane.
• Characteristics of patient communication and prevalence of communication difficulty in the intensive care unit: An observational study, Freeman-Sanderson, Morris, Elkins, Australian Critical Care, 2019.
• Communication difficulties in mechanically ventilated voiceless patients in intensive care units: A qualitative study, Brambilla et al., Nursing in Critical Care, 2025.
• Effectiveness of communication board on the communication pattern among aphasic patients, Kaur, Sharma, International Journal of Community Medicine and Public Health, 2022.

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