Saturday, May 16, 2015

Horse Sense

Steven H. Cornelius
Music and Stroke
Posted on March 28, 2012

Two-and-one-half years after my stroke, I continue to have difficulty with speech. On the best days, my speech is relatively normal, at least to the casual listener. On those days, astute conversation partners tell me my speech is perhaps a bit slow, that my speech gait is different from what it once was (though not “unnatural”), or my articulation occasionally sounds “careless” (as does the speech of many English speakers). But speech does not sound “impaired” in a pathological sense.

That is not how it sounds and feels to me. Even on my best days speech production feels clumsy. Many sound combinations present articulation landmines that, unless approached slowly and with the focus and technical rigor of Professor Higgins, are certain to be mangled.

Until recently, I assumed my lingering problems had to do with aphasia. Why? Because that was how a neurologist labeled my problem while I was still in the ICU a few days after the Big Event. Now I doubt that aphasia was the correct diagnosis.

Clearly, I did not have receptive aphasia. From my earliest post-stroke memories, I had no difficulty understanding spoken language. (Believing the dire scenarios my caretakers presented me was a different issue.) As soon as I could focus my attention, I could read as well.

But I had great difficultly speaking. Was the problem with language recollection (expressive aphasia), the sequencing of sounds (apraxia), or simply difficulty controlling or coordinating the muscles when speaking (dysarthria)?  I believe mostly the last.

Usually, I was having little trouble finding the concepts I needed. Even though I sometimes skipped words or even put them in the wrong order, I suspect those problems mostly came from avoidance.

Let me offer an analogy. Everyone who jumps horses has experienced his mount bolting to the side at the last moment before the hurdle, or even coming to a skidding halt with inches to go.

I was similar for me, when my horsey brain decided an upcoming word was too difficult to articulate, if I couldn’t get around it by substitution, and if I didn’t want to stop speaking altogether, I simply made it disappear. (I suspect my horse would have liked to make me disappear as well.)

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