Monday, January 2, 2012

The Chicago Tribune frequently has a lot of irrelevant and immaterial "stories." THIS is NOT one of those.

After injury, brain can keep on healing

Speech difficulties like Rep. Giffords' can improve over time, expert says

By Bonnie Miller Rubin, Chicago Tribune reporter

January 4, 2012

Arizona Rep. Gabrielle Giffords recently gave her first public interview since she was shot in the head almost a year ago. Her journey — from critically ill patient to someone whose personality was largely intact but still struggled with words — has increased awareness and interest in speech and language impairments.

Cynthia Thompson, a Ralph and Jean Sundin professor of communication sciences at Northwestern University, is one of the nation's leading experts in the kind of deficits exhibited by Giffords, called aphasia. It affects 1 million Americans and by 2020, the numbers are expected to double.

For almost two decades, Thompson's research has focused on how language is recovered in persons with brain damage. She weighed in on the topic recently.

Q. What is aphasia?

A. It's a language disorder affecting the ability to understand and/or produce spoken and/or written language caused by a stroke — or other injury — that disrupts blood supply to regions of the brain involved in processing language.

Q. What is a key finding of your research?

A. We used to think that patients with a brain injury like Gabby Giffords' did not get better after a certain length of time — that there was a window of time to improve, called spontaneous recovery. But we now know that the brain is an organ of plasticity and it continues to change and improve throughout life.

Q. How did you reach this conclusion?

A. Using experimental training protocols. … My research team to date has trained more than 80 individuals (all in the chronic stage of aphasia, often several years post-stroke), with 90 percent showing significant improvement in language ability. In contrast, control participants … showed little if any language improvement. We also used functional magnetic resonance imaging to study how the brain functions before and after treatment. Results showed evidence of neural reorganization in those who received treatment.

Q. Anything else you've learned?

A. That the brain can recover and respond even 10 years after the original injury. But too often, medical insurance will pay only for a few weeks or months of speech-language therapy. Once a patient stabilizes, they are likely to be discharged before reaching maximum gains. The insurance hasn't really caught up with the research.

Q. Giffords, of course, is young, healthy and has resources. Can you see the same kind of progress in an older person?

A. Yes. Age is not necessarily a determinant in whether someone's speech improves. There are other factors, such as treatment, motivation and environment. Involvement in social and group activities, where there is language stimulation, rather than being isolated, can affect recovery. When it comes to language, there's a lot of truth to the adage of "use it or lose it."

Q. How do you explain people who have trouble speaking but are able to sing fluently?

A. Singing, or music in general, involves neural networks that differ from language. In particular, the right hemisphere is recruited more so for music than for language. Hence, people with aphasia — with left hemisphere brain damage — often retain the ability to sing. Some treatments for aphasia exploit this ability and pair music and singing with language production. One such treatment, called melodic intonation therapy, is likely what Giffords was provided, but I don't know that for sure.

Q. If you notice a change in someone's speech and language, what should you do?

A. You'd want to see specialists in cognitive disorders — a neurologist, neuropsychologist, speech-language pathologist — as soon as possible for testing. Changes can occur for many reasons other than stroke or degenerative disease. It's important to see a team of specialists to understand what's going on.

Q. Why is this an important public health issue?

A. Because of the aging population, the number of stroke-prone individuals will increase. The incidence doubles each decade after age 55. Speech and language affects everything, from work to friendships. If you can't communicate, it's very difficult to participate in life.