New York Times, Personal Health, C13, Wednedsay, June 10, 1992
Jane E. Brody

Phil G. was lucky to have survived his auto accident. He recovered nicely from his various physical injuries, but was unprepared for aphasia, the speech and writing difficulties that persisted after the swelling of his brain subsided.

As a single young man and a journalist, Phil depended both socially and vocationally on his way with words. Now he found himself continually at a loss for words. His speech was slow and deliberate, often marked by an inability to think of or say the right words. When listening to others he had difficulty keeping up with the speaker, and when trying to take notes he often could not remember how to write certain words.

Articles that he could once write in a few hours were now taking him days. His social life also ground to a halt now that it took minutes to convey in halting speech thoughts he once expressed glibly in a few seconds.

It is not hard to understand why Phil was frustrated, irritable and depressed. Without language fluency, his mind had become a prisoner of his damaged brain.

What Is Aphasia?

More than one million Americans struggle daily with aphasia. The main causes are strokes and accidents that permanently damage neurological connections within the brain. Each yea r 80,000 more Americans develop aphasia, a toll that could be reduced significantly if everyone in motor vehicles wore seat and shoulder belts and all cyclists wore helmets.

In a way, Phil is more fortunate than some; if he takes his time, he can get his ideas across. Others with more severe forms of aphasia may prattle on unintelligibly or may draw a blank when trying to read or do simple arithmetic. Some feel as if they are in a foreign country whose language they cannot understand.

The most common problem in aphasia involves thinking of or articulating the right names for things. A person might say "icing" or "biking" or a nonsense word like "bleating" when he meant skating. Also common is telegraphed speech that uses only nouns and verbs and omits articles, conjunctions and most adjectives and adverbs, as in "Go store" instead of "Will you go to the store?"

Then there is a problem with remembering words even after the injured brain has managed to come up with the right ones just moments before. The "found" words seem to fall out of one's mind as if through a sieve, adding to the frustration of the speaker or listener. And in some cases, people with aphasia will say wholly inappropriate things, counting to 10 or swearing without reason. Or they may laugh or cry at inappropriate times.

The speech of a person with aphasia may also become slurred and riddled with mispronounced words, as if the speaker were drunk.

The disorder can be severely disruptive for families and friends as well as for those who have it. People with persistent aphasia often find themselves isolated and ignored. With conversation so difficult, friends stop inviting them, calling or visiting.

They may be unable to do the jobs they were trained for and be forced to retire, a further assault on their egos that typically adds to feelings of isolation, frustration and worthlessness. Small wonder, then, that so many people with aphasia are lonely, desperate and even suicidal.

The Outlook

Children under the age of 8-10 are especially likely to recover language skills disrupted by a head injury, probably because in the young and more pliant brain healthy tissue can assume the roles once played by damaged nerve cells. But the brains of adults are less resilient, and lasting language difficulties are more likely to result.

Speech therapy and counseling can be very useful to those with persistent language problems. Therapists can train patients to use the language skills that remain intact more effectively. They can teach both patients and families alternative means of communicating, like singing, a skill in which the ability to summon words often remains intact even when non-melodic speech is seriously disrupted.

Experts say that the sooner after injury that speech therapy begins, the more effective it is likely to be. At least, therapy may help avert the serious emotional and social consequences of aphasia.

Therapists and counselors can help patients find new occupations and avocations that are less dependent on language.

More Help

To find a certified speech therapist in your area, consult the classified phone directory, ask local hospitals or nursing care facilities or write to Speech-Language Pathologist, American Speech-Language-Hearing Association, 2200 Research Blvd, Rockville, MD 20850.