How Strokes Can Affect Reading: Understanding Alexia
After a stroke or concussion, many people experience changes in their ability to read—something that often catches families off guard. This difficulty with reading after a brain injury is called alexia, and it’s different from developmental dyslexia in both cause and presentation. While dyslexia typically emerges in childhood and affects the way the brain processes sounds and letters, alexia is acquired—meaning it results from damage to previously intact reading systems in the brain. These challenges can be frustrating, especially for people who once enjoyed reading books, emails, menus, or even simple signs.
Types of Alexia and How They Show Up
There are several forms of alexia, each linked to damage in specific brain areas. In pure alexia, individuals can write and understand spoken language, but they can no longer read—even their own writing. They might recognize letters but not whole words, reading them slowly, letter by letter: “C… A… T…” instead of “cat.” In surface alexia, people struggle with irregular words like yacht or colonel, mispronouncing them as they would be spelled phonetically ("yakht", "colon-nel"). Phonological alexia affects the ability to sound out unfamiliar or nonsense words, so reading new vocabulary or made-up words becomes nearly impossible. Finally, deep alexia includes a mix of errors—like saying “boat” instead of “ship”—and often co-occurs with broader language challenges like aphasia.
What's Normal and What's Cause for Concern?
After a stroke or concussion, it’s common to experience temporary confusion, mental fog, or slower reading—especially in noisy or busy environments. That’s not always cause for alarm. However, if someone suddenly can’t read everyday words, is substituting unrelated words, struggles to match written text with meaning, or becomes emotionally distressed by reading tasks, that’s worth a closer look. These are signs that a brain injury may have affected the brain’s reading systems, and it’s time to consult a Speech-Language Pathologist (SLP) with experience in aphasia and cognitive-communication disorders.
Helpful Strategies to Support Reading After Brain Injury
When reading is difficult, don’t rush. Encourage your loved one to take breaks and read in short, focused bursts—10 minutes at a time is often more manageable. Use larger font sizes and high-contrast backgrounds to reduce visual strain. For example, changing an iPad to “dark mode” or increasing font size in browser settings can instantly reduce cognitive load.
Simplify the reading material. Try menus, flyers, short news stories, or text that includes pictures. Highlight key words in bold or use a ruler or piece of paper to track line by line—this can help with attention and prevent skipping or rereading the same lines. For someone with surface alexia, avoid words with irregular spelling at first, and use flashcards to reintroduce familiar words. If phonological alexia is present, use rhyme games or letter-sound drills to rebuild decoding skills. Read aloud together, and model correct pronunciation without pressuring them to repeat it.
Reading support apps can also make a big difference. Text-to-speech software like Dragon Text to Speech or even the accessibility reader on your phone or tablet will be able to assist in reading. Browser extensions like Read&Write can help people follow along with audio while tracking the words visually. Many public libraries also offer audiobooks with synced text. For some people, listening while reading the text aloud improves comprehension and memory retention.
Strokes and concussions can disrupt once-automatic reading skills, but that doesn’t mean the door is closed. With support, repetition, and tailored strategies, many people with alexia rebuild their reading abilities—sometimes in new ways. An SLP can help identify the type of alexia present and guide families in choosing tools and approaches that work. The most important thing? Don’t give up on reading—it may look different now, but it’s still possible.
