Ich bin ein [Texas-Born] Berliner

For a little over a week, I’ve been talking with Paul almost daily. Usually our conversation lasts no more than about 10 or 15 minutes, but it has been regular direct contact with him which has been encouraging to us both.

Dr. Robert K. Bolan, Paul’s former physician when he was in the U. S., recently raised an interesting point that he has given me permission to share with all of you. I’ll do that below after I tell you that I read Bob’s comments to Paul who wanted a copy of them so that he could share them with his speech therapist on Wednesday of this coming week. Bob found it encouraging, as did I, that Paul comprehended them when I read them to him. It says that what is going on inside his head is just fine. The primary problem he seems to have manifests itself when he tries to express his thoughts verbally.

So here is the email exchange that Bob Bolan and I had during the last several days.

Hi Perry,

This is pretty obvious but I’ll ask it anyway since I haven’t seen mention of it–music… Has anyone thought to bring Paul a selection of his favorite music? Music is processed in a much different way than written or spoken communication and even though we don’t know the exact extent or subtleties of Paul’s neurological damage I wager that music may bring him an inner fluency he might not otherwise be able to experience.

Bob

Hi, Bob.

To the best of my knowledge no one has brought Paul a selection of his favorite music. Who would dare? That would be like buying a bottle of wine from your local Walgreen’s for a connoisseur, wouldn’t it?

Seriously though, I understand the logic behind your suggestion and it is probably an excellent idea. I’ll ask him the next time I talk with him whether he has access to his music and whether he might like to have a personal CD player to permit him to listen to some things from his collection.

I’ve spoken to him about four times in the last week and to me he seems in good spirits. His extended sentences do sometimes drift off into verbiage that doesn’t connect with the original direction of his thought, so I’ve tried not to tax him by giving him too many open ended questions, but that’s hard to avoid without considerable thought and concentrated effort.

That raises a question for me. Is it generally desirable or not to require someone recovering from a stroke to stretch himself by challenging him with such open ended questions or is it better not to place any more demands on him than are necessary? I know that he (and anyone in his position) experiences frustration when he can’t express what he wants to say because his brain won’t find the right words. But just as you have to exercise muscles to strengthen them, perhaps you also have to do the same with the brain. Should I push him or coddle him?

Regards,
Perry

Perry,

Hahaha. Nah, you just buy the most expensive bottle they have and make sure it doesn’t have a screw cap.

The brain is like any other organ: when it is damaged a functional unit (like speech) will compensate by using surviving, but often less efficient, pathways to transmit the nerve impulses. And perhaps it may even develop some new pathways. One problem with brain injury is that neural tissue is probably the slowest to repair or regenerate of any in the body. Another problem is that brain functions are so incredibly complex with innumerable modulating interconnections that are built up over a lifetime of hearing, seeing, processing, remembering and speaking, and each of these “associations” combine to determine how you “remember” what you want to say about something. So if a new pathway or a less used one lacks some or many of these associations you may be able to recall something under some circumstances but not others. What I’ve said so far assumes that the input or receptive arm of communication remains intact; if not, then receptive aphasia results and you have a more profound communication problem. I assume from what I’ve heard so far that Paul’s problem is a “pure” expressive aphasia. But the punch line is that the brain can and does repair itself after injury, albeit slowly and incompletely if enough “good” tissue remains.

This is kind of where the music connection fits in. What I said earlier about familiar music creating an inner fluency that might not otherwise exist was intended as an attempt to bring him pleasure where he is now most likely experiencing frustration (to the extent that he knows that what he says is not being understood and that is because he is not speaking correctly). But the other reason I mention it is for a purely hypothetical reason. Maybe a clever neurolinguist (kind of a special speech therapist) could use Paul’s music to help him recover proper speech. I’m not sure how this might be attempted other than by having him name instruments while listening to music, or through some other associative exercise that they might dream up. There is actually a whole discipline of music therapy and it is doubtless much more advanced than I know about.

Another thing was that I did a cursory literature review and learned that there is active research into speech recovery among aphasics. There is evidence that some language activity may be able to transfer from one brain hemisphere to the other (which is quite an incredible thing) and that perhaps therapy as mundane as exercising the non dominant hand at the same time as intensive speech/naming therapy can “force” or “encourage” this switch. Further, I discovered a whole literature on bilingual aphasia recovery and learned that language facility may not be lost equally when one has more than one learned language. So, this tells me that there may be some hope that with appropriate therapy Paul may recover quite a bit. It will probably take time however.

So to finally come to your concern about overtaxing him; no, do not worry about that. You aren’t going to slow or confuse his recovery. Patient persistence will be reassuring to him. He’ll let you know when he’s tired, then you can leave him be, just as you would when he was in the pink of health and became weary.

Best,

Bob

Hi, Bob.

Fascinating stuff! Thanks for going to the trouble to explain it in depth to me. I have just gotten off the phone with Paul to whom I read your message. He asked that I send a copy of it to him by air mail as soon as possible because he has a scheduled session with a therapist and he wants to “lay it on him” when they meet. I’m going to print out your message therefore and send it out today by the quickest means possible. Paul said to tell you how grateful he is for your comments.

Again, I’d like you to know that both Paul and I found your message very interesting and encouraging and that we sincerely appreciate it.

Regards,
Perry

Perry,

Wow! That’s terrific that Paul understood and is going to “lay it on” his therapist. I so hope this helps.

Bob

I was able to package this exchange with Dr. Bolan up in a PDF file and email it to one of Paul’s Berlin friends, who has printed it out and will deliver it to him on Monday.