Saturday, March 14, 2015

Aphasia pt.1

Steven H. Cornelius
Music and Stroke
Posted on January 25, 2012

In one of my first extended post-stroke remembrances (maybe four days after the event), a Massachusetts General neurology team—the hospital’s lead neurologist with residents in tow—came to see me. He asked me how I was doing.

“Okay,” I said.

Was I feeling depressed?

“No.” I said.  (As far as I could tell, I wasn’t.)

He asked if I wanted a prescription for depression.


He began speaking to the residents, saying that depression came with stroke territory and was going to prescribe an antidepressant.

Had he not heard me?

I tried to say something, but nothing came out.

They watched me struggle.

“Unusual to have strong aphasia with a right-brain stroke,” he said to the residents.

I wanted to tell him that as an adult I was left handed, but had been relatively ambidextrous when young (Might that be relevant?). And I could speak just fine, thank you very much. But nothing came out. Looking on silently as the residents digested the scene, I felt helpless and humiliated.

In fact, when not feeling pressured, I could construct short sentences. Speech was slow and slurred, uninflected, and too soft, but I could make myself understood. To speak a full sentence, I had to plan my words in advance, then marshal my forces. I soon developed a checklist.
  1. Avoid words with more than two syllables.
  2. Avoid tricky sound combinations.
  3. Keep the sentence short.
  4. Inhale before beginning. (Time and again, I ran out of breath mid sentence.)
  5. Support with my diaphragm, so I could be heard.
Because I couldn’t feel the left side of mouth or tongue, at first I thought the problem was lack of sensation. It wasn’t.

I noticed if I tried to speak spontaneously the words sometimes came out in a style I began to call “Yoda-speak.” Well, maybe “stoned-Yoda-speak.”  I misplaced words within the sentence; I sometimes left them out altogether.

My speech processes also seemed to have been fused with left side motor control.

In the weeks that followed, I paid attention to the various ways in which my left side would shut down when I spoke. If I had to negotiate a difficult sound combination, my left eye would flutter, sometimes close altogether. If I was trying to hold something in my left hand, it would drop when I spoke. When I was relearning how to walk, I would collapse if I tried to talk.

In late February of 2010, nearly five months after the stroke, I was released from speech therapy. I was told what could be done, had been done, though things might continue to improve over time.

I was determined they would. I still had trouble getting through a longish sentence, avoided multi-syllable words, and dreaded phone conversations. Practicing the therapist’s articulation exercises was offering only minimal help.

There had to be way to integrate speech thought with body action.

Now that I could walk without a cane, I linked speech and vocalization to ambulation. Sometimes I synchronized my steps to rhythmic patterns I was singing.

Besides providing an interesting format to practice speech articulation, the technique proved helpful in two additional ways. First, it helped regulate my uneven gait, by giving rhythmic markers. Second, it helped me process rhythm across my entire body.

For example, I might sing and walk to the North Indian tabla pattern:
ta-ki-ta ta-ki-ta (1-2-3-1-2-3. Bolds mark each step. Dashes mark measured space)
da-terikitada-terikita (1-2+3+1-2+3+)
      or with groups of two or four:
da-terikitetaka (1-2+1+2+)
da-terikitetakada-terikitetaka (1-2+3+4+1-2+3+4+)
Of course, each rhythm and tempo required different pacing. And different pacing also required different solutions to balance problems. When I sang,  frustrating walking became dance.  My lurching gait ceased to be annoying. Instead, it became an aesthetic challenge that could be reengaged with every step.

Other times I practiced speaking arrhythmically, outside of my walking pace. Every pattern (and any tempo change within) offered unique challenges and required different physical solutions.

These exercises (which I still practice) improved my ambulation. But they seemed to offer little or no help with my speech.  There had to be a way.

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