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.


  1. Dear Dr. Bartels-Tobin.

    I have a friend who had a stroke and got aphasia from the stroke. It was all new to me, I never knew what aphasia was. I developed a communication device for my friend. Now he always carries the device with him to communicate.
    If you would like to see it go to---
    Thank you, Robert Mayo

  2. I don't think the connection, or lack of correlation, between intelligence and primary progressive aphasia (i.e. developmental aphasia, as opposed to aphasia resulting from a stroke or injury) is as easily determined as you suggest in this blog.

    I'm afraid mental processing and reasoning ability may often be seriously impeded in later stages of PPA - though I'm afraid we are going to find that out the hard way, as my husband continues down the frightening path of PPA.

    In fact, the longer I live with a PPA sufferer, the more unsatisfactory I find conventional aphasia therapies to be in meeting my husband's needs. I think most therapists are beginning to recognise this, too. But there is relatively little information in wide circulation about PPA-specific therapies. So we just blunder on as best we can.

  3. my father had a stroke in October last year. At first all our focus was on more serious problems. Now though we realize we are dealing with Broca's aphasia. He seemed to be able to talk better months back than he is doing now. We thought he would progress along. So did he. We live in Jacksonville NC if you have any person or office you would refer us to.We are currently reading things on line to see what we can do. My dad does well at espressing himself and did well after the stroke, but like i said before he actually does less now than he did months back. He wants to talk. Our family will continue to read what we can find. And he has had speech therapy continually but not often enough during the week. I just wonder why did he regress? Other things are coming slowly along.