Transcript

Enabling fluent speech in non-fluent aphasia: Dr. Julius Fridriksson at TEDxColumbiaSC

[Applause] hi um one of the most amazing skills possessed by human beings is the ability to communicate using language I think that to most of us um language we realize how important it is but if you're not completely convinced consider what would happen if you lost your ability to communicate how would that affect your life would you be able to hold your job or if you're a student would you be able to continue studying how would that affect your personal life your relationships with your let's say your spouse your parents your children the reason why I start out with this is because there is a group of people for whom exactly this has happened these people have something that is called a fasia Aphasia is a language problem that is caused by damage to the brain and I think that one of the best ways to explain Aphasia in detail is to consider normal communication now there are different ways that people go about trying to understand this the way that I like to do it is to try to understand what the brain does when it's processing speech and language now as you're listening to me right now there are certain areas of your brain primarily in the left po posterior regions of your your um left hemisphere that are very important for comprehension so as you're listening to me right now those areas are more active than not but at the same time as I'm talking to you there are different areas in my brain that are more active those are primarily in the left frontal we call these the motor speech areas of the brain now this is a really simplified model of speech and language processing in the brain but for the longest time this is really how we thought things happened that is the posterior portions of the left hemisphere do speech comprehension and the anterior regions do speech production so that brings me to AP fasia so AP fasia is a problem that is caused specifically by damage to the left hemisphere of the brain now if we take a look at this brain right here this is actually somebody's brain and everything that we've highlighted there in red has been removed this P person had a stroke and as a result has major brain damage now this is the left hemisphere which is dominant for for language so you can imagine and this person now has a very difficult time with speech and language um AP fasia really affects four different things auditory comprehension speech production reading and writing now there are different constellations of problems or or impairments of these modalities based on you know where the leion was where the size of the damage that occurred but by and large people with aasia have problems with these four things um but what does a person with aasia sound like I want to give you a quick example of somebody who has aasia and is uh trying to tell a story as a matter of fact that's that person whose brain you see right there C yes is small dress no clothes no made PL PL yes yes Paul Paul yes PA yes B tires so obviously we can tell that he's having a very difficult time speaking he has what we call non-fluent speech that by that I mean he's only getting out one or two words per utterance in addition to that his speech is very halting and I call this non-fluent speech and I'm going to be talking about that quite a bit for the rest of this lecture but what is really frustrating here for him is that Aphasia is a problem of language it is not a problem of intellect he knows exactly what he wants to say and I'm sure that some of you could tell what he was talking about he was trying to tell the story of Cinderella he knows what he wants to say but he just cannot get the words out so you can imagine how frustrated he is and it's not just a group of two or 300 people who have this condition uh apasi is Prim caused by stroke stroke is the number one cause of adult disability in the United States so we're talking about a large group of people here probably somewhere around a million in the United States so I would suggest that AP fasia this inability to process and and communicate using speech um of all the chronic conditions that we have this is probably robs people of their freedom and their independence more than any other disorder because without language without the ability to communicate people tend to become very isolated so what is it that we can do to help them what is it that we can do to rehabilitate somebody who has a fasia well typically this goes something like this the person has a stroke they go to the hospital and very early on they get Rehabilitation from a speech language pathologist and what the speech language pathologist does is that they try to give them compensatory strategies or they work specifically on their speech starting to give them sort of what we call speech and language drill starting with single words trying to maybe go to longer words to phrases and then sentences but what is very frustrating about this kind of non-fluent speech that you just saw is that let's say six months or a year after the stroke if this is still your condition you still have nonfluent speech you're most likely not going to recover from this you're going to have this for the rest of your life now this brings me back to what I was talking about earlier with regards to the frontal areas of the brain being so very important for speech production primarily in the left hemisphere um what is interesting is that in addition to those areas being very active for speech production if we focus our attention on the articulators of the person that we're listening to those areas also increase in activation that is if you're looking at me right now the areas that you use for production are very active if you just home in on my articulators when we were first studying this years ago and many other people have looked at this we we thought well is there anything we can do with this to try to improve the rehabilitation of nonfluent speech and the reason for that is is as as so um when these people have Rehabilitation they're trying to do a task that is inherently very difficult for them they're trying to produce speech but what if instead of asking them to work on something that is very frustrating and very difficult we would simply do treatment having them watch and listen to a speaker trying to activate the residual areas in their left frontal lob what is also very interesting about audiovisual speech which is what we call it when you watch the articulators very closely and you listen at the same time what is very interesting about this kind of audiovisual speech is that if I just slow down my speech a little bit you would be able to mimic me in real time there's no magic about it there would be a couple 100 millisecond delay but really you could say exactly the same things that I'm saying at the same time I'm not talking about repeating my speech I'm really talk talking about you speaking the words that I'm saying exactly at the same time now what is very interesting also is that people with non-fluent speech even though they can only produce few words or maybe one or two words at a time they can also mimic this kind of speech and that brings me to my next slide what I'm going to show you here is how this works what we have here is a gentleman who has a fasia and he's there with a couple of clinicians and they're asking him to describe something that is very mundane that is how you make scrambled eggs let's take a listen try to say what you can about eggs eggs eggs but I like to eat EGS the I know to just I like to eat eat eggs and a couple of things I want to say but before I get into talking about his speech I want to mention that this gentleman is sitting actually here in the second row and is watching this his name is Donald Vancouver you can tell he's very frustrated in the video but I want to tell you some personal information about Donald he was a Green Beret in the Army he fought tours in Vietnam and he's a tough guy we know that the Green Beret these are these are a tough bunch of dudes right there are some that would say that your ability to recover or how far you're going to recover is really linked to your motivation and that is how hard you try in Rehabilitation and just True Grit if you just give it everything you got you're going to get better now Donald has participated in hours and hours upon of treatment trying to improve his ability to communicate and in spite of all of that he can only really say a couple of two words phrases he can say I know and yeah boy every once in a while he says something else but that's pretty much all he can do if it was simply the case that if you tried hard enough you were going to get better he would have recovered years ago the other thing that I would say about Donald is that we have here his brain scan what you see in his right hemisphere is that it's intact this is probably what we would expect in anybody his age normal looking right hemisphere if you look at the left side of his brain something isn't right there that big black spot or that that dark area it's gone it's missing those are the areas that he used to communicate before at least used for speech production now there are many different areas that are affected but this is how his brain has been for 22 years imagine trying to speak with that so I want to show you next actually what happens if he tries to speak with this kind of Audio Visual feedback now there are a couple of things that I want to point out to you what he's looking down at here is an iPod there's an iPod there on the table and what he sees on that iPod is what we call the audiovisual speech model and that's what you see in the lower left corner that person is going to talk as a matter of fact that person is going to talk about what he was trying to describe before how you make scrambled eggs but in addition to watching he's also listening through the headphones on the iPhone I would suggest that during the whole time that we listen to the video that you focus your visual attention on the speech model but listen first we start with a speech model and we slowly fade out to him let's see how this goes I like to eat scrambled eggs for breakfast I like them because they are fast and easy to make eggs and KN up and pan and B some B over medium heat I crack the eggs into the pan and S I like Rambo eggs best no I into the are done pretty good huh what is especially exciting about this is that during this one minute that he was speaking he probably set a greater variety of words than he had done in any span of let's say 3 to four years during the 22 years since he had his stroke now I've been studying aasia for quite a bit of time and we've never seen these kinds of results now you might think well perhaps he's the only guy who this works for well then it only means something then to him but that's not the case we tried this on a group of people who have a fasia but he is the most severe case of nonfluent speech that I've seen probably but this really works well for people who are even have a milder form of this what is also nice about it is that if you practice and we've had people do this for 6 weeks straight not only does your ability to speak improve with the iPod it also improves when you take the iPod away now these are only preliminary data we we are extremely encouraged but I think we have something to go with here there are a couple of things that I would like to say in closing the first one is that with the iPod even if their speech does not improve just with the training when you take the iPod away what if you could only use the iPod to tell somebody your story if you could tell somebody you know what this is what happened to me there's not something wrong with my intellect I just can't speak I think that that would could make a huge change the other thing that I would say is that we study the brain in my lab we don't really understand why this works so incredibly well for people with non-fluent speech but I am very encouraged and I think this is going to get us somewhere thank you