Wednesday, October 13, 2010

Improving Communication

"I want him/her to talk!"
I was explaining our philosophy and our program to a prospective client the other day, and I heard these familiar words. Of course, it seems everyone's goal is to speak better--that's the hallmark problem of aphasia. However, we want to explain why using gesture and other multimodal forms of communication are so important. Speaking better and being able to use gesture, written words, or writing are all part of the same goal!

Communication is important, we all know that. But communication doesn't consist entirely of speech. If you've been having issues or frustrations because your loved one plays "20 questions" with you, then wouldn't it be nice for both of you to have alternative and augmentative systems of communication. Our goal is to reduce the amount of frustration for all parties involved, as well as to improve the communication pathways. If your loved one cannot say at the time "I want to get the boat cleaned" but can point to the boat or give you the number for the boat-cleaner, isn't this a good place to start?

What most people don't know is that by using these alternatives, or multimodal, forms of communication, comprehension and expression of language are improved for both the listener and the speaker. The person with aphasia may produce speech more quickly and easily when the gesture and verbal attempts are paired. For example, unable to say "toothbrush", the person with aphasia may make the gesture, then spontaneously produce the word while gesturing. Additionally, seeing the word "toothbrush" may cue the verbal production. This happens ALL THE TIME!

So please remember, your goals are our goals, we may just go about them differently. The end result, however, should be improved overall communication. This is what we're striving for!

Wednesday, September 22, 2010

Isolation in aphasia

Statistics show that persons with aphasia tend to be isolated from other persons with aphasia. This is the result of several factors, such as lack of area resources, lack of knowledge in the medical community about aphasia, and lack of direction from medical professionals before you are discharged from therapy. If you use Google or other search engines, you'll realize that there really aren't alot of information or resources out there. It's even rarer to find something near to your location. Family and friends may have slowly dropped out the social scene because they feel uncomfortable about interaction. So many times I hear that the person with aphasia is just sitting at home watching TV. This "activity" isn't helping anyone recover unless they are actively engaging in the process, which is hard to do with a TV.

If there aren't any aphasia support groups or aphasia centers in your area (check at, one solution could be to find support or treatment online. I have recently become acquainted with Bill Connors at the Aphasia Solutions Network (, whose therapists have both group and individual sessions online. I tried it out myself today and found that there really isn't too much technological knowledge needed on my end. I speak with people all over the country who don't have the financial resources or perhaps the physical capabilities to attend our intensive program, and I think this may be an option. Especially for younger persons with aphasia, social isolation is devastating. The online groups would provide socialization while helping to improve the aphasia. Like our aphasia center, the ASN will work with your financial situation to provide affordable therapy. With all of the technology available today, there's no reason not to try it! Let me know what YOU think!

Monday, March 15, 2010

Testing and aphasia

When you are receiving speech therapy or other therapy services, your therapist will typically do a standardized test (a test that tells how well someone in doing in relation to other people who have the same problem) at the beginning to decide how severe the aphasia is and your strengths and weaknesses with language. Depending upon what kind of test is given, and there are only a few out there, your therapist may set goals based upon your performance on these tests. Typical goals produced in this manner will deal with auditory comprehension or verbal expression. Using the test to target weak areas is one school of thought, whereas the other school of thought is to use the test to show me your strengths. I prefer this approach because, through your strengths, I can help you target your weaknesses in one area while providing success in other areas. I already know that you have aphasia, and that you probably have difficulty with some test items. What I don't know is, what are you good at? For example, if you're good at writing single words, then we may use that in therapy to help you communicate your ideas.

A recent survey by the American Speech-Language and Hearing Association showed that not all outpatient therapists give discharge tests to show your progress. This is most likely to do with insurance reimbursement and lack of available time for the therapist. If you have received post-testing, it's important to keep the scores in perspective. I would caution that put too much emphasis on scores, whether good or bad, is confusing the issue. You could have great final scores and only be able to do the tasks that are on the test, such as being able to point to alphabet letters. You could get poor scores (let's face it, no one likes tests), but now be able to say "hi" to your friends and better follow a conversation. Most aphasia tests only give credit for verbal responses, meaning that if you drew, wrote, or gestured the answers, you don't get credit for it.
As always, demand that your therapist work on things that are important to you! Even I fall asleep doing those silly reading questions about aardvarks and such!

Sunday, November 29, 2009

myths about aphasia #5

The final installment about aphasia deals with intelligence. When a person gets aphasia, it's difficult to determine where they are cognitively. The general consensus is that the person's intelligence remains intact, but their abilities to communicate that intelligence have been affected. After all, how do we generally assess intelligence? Language!
We listen to what a person says, how he speaks, and give him directions using language (writing or speaking). All modalities of communication--writing, listening, reading, and speaking--are the ways in which we determine someone's intelligence.
Almost every person who comes into our center is assessed for both language and cognitive skills. Almost every single person performs above 85% on the cognitive tests, while scoring in the severe to mild range for language skills. Believe that the person with aphasia knows what they want to say, knows all of the information they knew before the brain injury, but the methods to get this information to others is more difficult.
I once spoke with a gentleman who was convinced that his wife, having had two strokes and little speech, had no idea what was going on around her. He used this belief to behave inappropriately, and wanted someone like myself to validate his belief. He said, "I can ask her what 2 plus 2 is and she don't know". This was his criteria for believing that she was more or less in a waking coma. Now, I firmly believe that this woman knew what the answer was, but did not have the means to communicate the answer. People with aphasia may need a pen and paper, to have the question written out for them, or to have multiple choices in writing to communicate. The information is in there, it's a matter of finding a way to help get that information out that may take a bit of work.

Sunday, October 18, 2009

aphasia myth #4

To continue our series, I'd like to introduce aphasia myth #4, which has to do with progression or regression in aphasia. I hope that when you receive speech or other therapies that you have experienced some progress in your skills. This is, after all, the whole point of attending therapy. I want to address a misconception about a patient's skills after he has completed therapy. People will often say to me that they don't want their loved one to "get worse" by not attending therapy.

The idea of "use it or lose it" is generally true in most of life, and can apply to aphasia as well. What this adage means is that if you don't continue to work on and use the skills you've learned, you will see a decrease in those skills over time. In this scenario, you could conceivably "get worse" because you have fallen backwards from the improvement you were making while in therapy. If you imagine a typical line graph, you start at some low number and then the line goes upwards as it travels over time to the right of the graph. There may be some zigzagging and up-and-down movement in which some days are better than others in this progression. No matter what you do, however, you will never return to zero. Zero represents you the day of your stroke or immediately afterwards. If you receive therapy and start to heal the brain injury from your stroke, you will not remain at the baseline of when you had your stroke. Therefore, you will not ever "get worse" in the sense that you will be the same as you were that day or week.

The idea of aphasia recovery would be to continue to make progress, moving that imaginary line upwards and outwards over time. Rest assured that every bit of effort that you put in to your recovery will count over time. Keep working!!

Sunday, October 4, 2009

aphasia treatment

Myth #3 deals with what professionals call "time post onsent" or TPO. This is the number of days, weeks, or years since your stroke or brain injury occurred. There is a myth flying around out there, and often miscommunicated by your medical personnel, that you can only make gains within the first few months after your stroke, and that you are finished by one year. This is not so, for either physical deficits or for aphasia. While there is such a thing as a "spontaneous recovery period", research has shown by neuroimaging (functional MRI generally) that the brain can continue to make recovery without therapy up to two years after a stroke. The spontaneous recovery period is that time from your stroke up to two years in which your brain will re-wire itself, clean out the dead cells, form new pathways, and form scar tissue. It will do this with or without treatment. Getting therapy during this time is a bonus, since this is the time in which you will earn the quickest gains.

However, this in no way should be interpreted to mean that after this spontaneous recovery period, you can no longer make changes to the brain or make gains in therapy. This is a common myth. While it is true that you will make faster or larger gains during the recovery period, you can continue to make gains no matter when your stroke occurred. These gains may not be as fast or as large, but they can definitely add up. We have seen gains in persons who have been living with aphasia for 14 years, 5 years, 20 years, etc. The key is to keep going and to keep teaching yourself. After all, if brains couldn't make changes, none of us would ever learn anything! We continue to learn throughout our lifespans because of neural plasticity. Loosely translated, this means the brain has the ability to change and form new connections = learning! If you are able to learn new things after brain damage, which you are, then you are able to continue to improve your speech, language, memory, arm strength, walking, and anything you can think of.

The moral of this story is--don't let anyone tell you that you can't get any better. It may take more time and effort, but it can be done. Get started now! Go!

Sunday, September 13, 2009

aphasia myths #2

Hello everyone and welcome to #2 in the Aphasia Myths blog.

Today I'd like to talk about isolation and aphasia. This is a relevant topic for discussion because there are relatively few aphasia support groups and limited information readily available for caregivers and persons with aphasia. Many people with aphasia are not aware that there are aphasia support groups, or that there is an organization called the National Aphasia Association (NAA)( According to the NAA, approximately 40% of persons with aphasia have no contact with other persons with aphasia. Considering the frequent social and other losses that come when someone gets aphasia, this number is staggering! Imagine having a disorder that robs you of your ability to communicate, that you receive little information about this disorder and your prognosis, and that you can no longer work and relate effectively to others. Then imagine that you don't know that there are others out there like you--that there are others who can provide hope, give advice, provide cameraderie, and have "been there". We, as clinicians and physicians, need to make a greater effort to reach out to those with aphasia.

If you have aphasia, you are one of over one million folks in the U.S.! There are people all over the world with aphasia! Some of them have better communication than you do, some of them do not. Some of them are in wheelchairs, some walk with canes, some walk without any assistance. Some persons with aphasia have severe difficulties with their arms and legs, some do not. Persons with aphasia are young and old, all nationalities, all education levels, all careers, and may have different causes. I encourage you to make the effort to find others with aphasia--you'll be glad that you did. If you join a group and you don't like that group--make your own or find another group. You can find organizations online at the NAA website, or do a search for "aphasia support groups" and your location. Whatever your choice, get involved in your life!