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Viewpoints on Aphasia After living as a survivor of TBI nearly twenty-eight years, I have finally understood that communication is more than speaking to those around me. Rehabilitation, almost twenty years post injury, taught me ways to get around my difficulties but I still did not grasp the full meaning of aphasia. Call me slow or say I am still in denial but I am still learning. I wish I could say that I have learned to express my thoughts clearly and that I no longer have a problem but I can't. Today is every-bit as frustrating as it was in 1967 when I woke from my coma. I could hear myself saying words clearly but my mother only heard gibberish sounds coming from my mouth. Broca's aphasia meant nothing to me in 1967 but in 1985, after my communication problems caused havoc in the lives of those around me, I learned aphasia is the reason I fail to express my meaning. Aphasia is common to people who suffer a brain injury (even a minor brain injury). Recently I needed to share information on aphasia with my sister who suffered a mild stroke so I went to the library. The most important point I learned is that aphasia is not a disease but a symptom of a brain injury; it does not affect my intelligence nor does it reflect it. Even if I feel stupid or sound ignorant because I can't express what I am thinking, it does NOT mean I am. In other words, the way I relate my words does not affect my ability to think. Even though I need to use a compensation to express my verbs or because my speech is halting, jumbled or, at times, sounds incoherent .. I can still think. Inside I am still the same person. I have not lost intelligence nor the ability to learn. I simply need to become more creative in the ways I use to express myself and more patient with the learning process. The thought is in my mind but the ability to recall the correct word is not. The ability to use or organize language to express the idea is not available to me. I can hear the words or see the print but cannot make sense of them. Aphasia effects my communication through the written as well as the spoken word; the ability to express myself through proper gestures is also affected. Even though I was above average through twelve years of grade and high school, as well as two years of college, I still have trouble using the correct grammar, spelling, counting, using the telephone, repeating back, naming objects, telling time and using the correct gestures at the proper times. My speech can sound like a telegram or a broken record. To be blunt, I can be shocking in the use of four letter expletives. I may be aware of the proper words to use but unable to use more than the four letter ones. In short, I am a textbook case of expressive aphasia (also known as motor aphasia, nonfluent aphasia or sometimes called Broca s aphasia). I have less difficulty with receptive aphasia (also known as fluent aphasia or Wernicke's aphasia). However, at times, I do find I have most of the symptoms of both types. When reading the printed word or listening to people speak, it is difficult for me to maintain my concentration. I find that I have problems following instructions, interchanging meanings for related groups of words and that my speech can be unintelligible. I never had a problem with excessive talking but I can speak about things that really do not make much sense and I have great difficulty making my point. I am convinced the reason I have symptoms of both Broca s and Wernicke s aphasia is because my brain injury involved extensive swelling in all the language areas of my brain. My recovery from a closed head injury has been successful because my family refused to give up on me, even when I could not respond to their attempts to communicate. My mother was insistent that I received therapy before I regained full consciousness and my mother and therapists made me aware, from the very beginning, that my success in therapy depended on my desire to succeed. I believe these were the reasons for my recovery but it is also clear to me that good outcome of therapy depends on more than a mother s love. Intensive exercises in reading, writing, following instructions, repeating the sounds of the therapist s speech and using compensations or different techniques to retrieve lost words have helped my ability to communicate. Ideas such as phonetic cueing, semantic cueing, sentence completion, singing the words or cue-cards with actions, verbs or pronouns are also helpful in the treatment of aphasia. When I can remember to confirm that what I m hearing is what is being said or that what I am saying is what I mean, it makes communication much clearer. It has become painfully evident to me over the years that what I hear is not always what was said. I also have difficulty confusing verbs, prepositions, pronouns and negatives. Sometimes, I hear yes when no was said or I say yes when I mean no. Checking and confirming avoids confusion and misunderstandings. The ability to recognize when I am failing to express my meaning is clearly the most difficult compensation for me to use. I have learned to step back, take a deep breath and to try again if I am failing to express my feelings. Since feelings always complicate my ability to use the compensations I was taught, knowing when to step back is truly a sign of wisdom. I may know I need to step back but, when feelings are involved, I become unable to do so. When I find myself in a circular pattern of unproductive turmoil (repeatedly attempting to explain my position until I m ready to lose it ), I must be able to step back and review my mind-set without losing emotional control. I call this time-out because sometimes that is all I am capable of saying. I have been known to throw my hands up, forming a T like a football coach, because my words become unintelligible. Time-outs allow me to review what I am saying. They allow me the time I need to realize that I want everything to work out in the best interest of everyone concerned. And, finally, they allow me the time necessary to come up with an alternate explanation that will accomplish the communication I desire. |
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