Aphasia following a stroke hits at ability to process language

By Kathy Ricketts - Gazette Reporter

Chris Hilliard, left, who suffers from aphasia, uses the Lingraphica, a communication device, at Sunnyview Hospital in Schenectady. Rachelle Trahan, right, a speech and language pathologist, has been helping Hilliard rehabilitate his speech for nearly a year. (photo by Barry Sloan)

Chris Hilliard of Schenectady describes himself as a social, fun-loving guy who loves to talk to people.

That's one of the reasons Hilliard, 42, is determined to overcome the aphasia that struck him following a stroke in April last year.

Aphasia is a language disorder that affects a person's ability to process language but does not affect intelligence. Aphasia can make it difficult to understand speech or to produce speech. It may also affect reading and writing ability.

Aphasia is common after a stroke, affecting about 30 percent of such patients. About one million persons in the United States have aphasia in some form, and it is estimated that approximately 80,000 individuals acquire aphasia each year.

While more common among older people, the disorder can occur in people of all ages, races, nationalities and gender.

"Aphasia is a language disorder that basically results from a neurological event such as a stroke or brain injury, and it affects all forms of communication, such as speaking, listening, reading comprehension and writing," explained Rachelle Trahan, a certified speech and language pathologist at Sunnyview Hospital, who is Hilliards' therapist.

Trahan said aphasia patients know what they're trying to say, for example, but they cannot find the right words.

"Because they often know what they want to say, people are aware it's happening and it's very frustrating," she explained.

"Yes, it is" agreed Hilliard, who spoke mainly in one- to three-word sentences.

Other people may substitute the wrong word. For example, they may say "dog" while looking at a cat.

"When they do that, they don't realize that it was incorrect," said Trahan. "So as a result, they may be talking but not making any sense, and they may not be aware that they are not making sense."

Sarah Kenning, speech and language pathologist at Albany Medical Center Hospital, said some people have a mixture of both expressive and receptive aphasia.

"You might ask people a simple question, and they are unable to understand what you are asking," she said. "Other people know in their head what they want to say, but they can't get it out. And it can range from very mild to severe and profound. It's very sad."

Recovery

Most people spontaneously recover during the first two to six months following the stroke, said Kenning. Others continue to improve for several more months, while others have some chronic impairment.

"A lot of getting better has to do with the degree of spontaneous recovery, the ultimate prognosis, the size, location and etiology of the lesion, the type and severity of the aphasia, the age of onset and the overall health of the person," said Kenning.

In some cases, speech language pathologists find alternate ways to help people with aphasia to communicate, as well as help them use and regain speech and language skills.

Hilliard, for example, is learning to use a computerized communication system called a Lingraphica.

"It's helping to create new neuropathways in his brain, and it's amazing how his language has been exploding since we started using it," said Trahan.

Here's how it works: Hilliard has a home page in his computer with several icons that lead to more pages.

So if Hilliard wants breakfast, for example, he double clicks on food. That brings up another page with pictures of different foods. Single click on pancakes, and the computer will say "pancakes."

"Chris is able to read and understand the words very well," said Trahan. "So it's helping him to say more words. It also builds phrases. So it's helping him to build sentences more easily. It's a speech-generating device that actually gets him to say the words himself."

People can also customize the device by taking pictures and downloading them onto the computer.

For example, Chris added photos of several of his favorite department stores, and one of his house.

Since his stroke, he has been living with his parents, Lena and Walter Hilliard, also of Schenectady.

"Some of the doctors said Chris wouldn't make it, but look at him now," said his mother. "He gets frustrated, but he doesn't let it get him down. He's always had a positive attitude."

Changes

Walter Hilliard said he misses the construction projects he and his son used to work on in their houses.

"Chris used to help me out a lot," he said. "I miss that father/son relationship we had. Now we have a different father/son relationship. He's always been a good son."

A former construction worker, the younger Hilliard was working as an insurance adjuster when he had a stroke. Today, he can walk independently but uses a wheelchair for long distances.

Hilliard's long-term goals are to move back to his home, live on his own, return to work, and to drive.

"He's getting more independent," said his mother. "He doesn't want us to do things for him."

Kenning said if people are able to speak, family members should be patient with them.

"Always wait and give the person time to speak," said Kenning. "And resist the urge to finish sentences. Always speak in a nondistracting environment - so turn off the television and make sure it's one-on-one communication."

Always confirm that you are communicating successfully, advised Kenning.

"The best way to do that is to use 'yes' and 'no' questions to clarify that people are understanding," she said. "And do that consistently."