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Treating Giffords’s aphasia

By Karen Weintraub
Globe Correspondent / February 20, 2012
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WHO

Marjorie Nicholas

WHAT

Nicholas, associate chairwoman of the department of communication sciences and disorders at the MGH Institute of Health Professions, is an expert in the language disorder aphasia, and has been treating former Arizona Representative Gabrielle Giffords, who has the condition.

Q. What is aphasia and how do people get it?

A. Aphasia affects your ability to speak, to understand language, to read and to write. It’s extremely variable. Some might have a severe problem in expression but really pretty good understanding of spoken language, and somebody else might have a very different profile. Typically, people get aphasia by having a stroke that damages parts of the left side of the brain, which is dominant for language. People can also get aphasia from other types of injuries like head injuries, or in Gabby’s case, a gunshot wound to the head that damages that same language area of the brain. It is more common than people realize.

Q. How does Giffords fit into the spectrum of symptoms you’ve described?

A. Her understanding of spoken language is really very good. Her difficulties are more in the expression.

Q. You obviously can’t violate her privacy, but what can you say about your work with Giffords?

A. I worked with her for two weeks last fall, and [colleague Nancy Helm-Estabrooks of the University of North Carolina] and I are planning to work with her again for a week this spring. We’ll need to see where she is again. I’m assuming she will have continued to improve and we’ll want to keep her going on that track.

Q. How are people with aphasia treated?

A. It’s totally variable. Speech pathologists do a very thorough evaluation of language and nonverbal cognition, and then they develop an individualized treatment plan.

Q. Your concern is that insurance usually doesn’t cover therapy for long enough?

A. Treating aphasia takes a lot of therapy. People will continue to improve spontaneously as well as with therapy for years and years, and yet the typical person is not getting ongoing therapy. Many people’s insurance will cover two weeks of inpatient rehab and then you’re on your own.

Q. People with aphasia can continue to improve long after their stroke or injury?

A. My experience, now over 25 years, is you will continue to see improvements. Maybe not as rapid a rate as it was in the beginning, but people will continue to change for the rest of their lives.

Q. Having aphasia must be incredibly frustrating.

A. We’ve all experienced word-finding problems. “What is that word? It’s on the tip of my tongue.’’ That’s the kind of experience a lot of people have with aphasia every minute of every day. Many people with aphasia can lead wonderful productive lives, and it helps to have the public just be aware that “oh, that’s what’s going on.’’

Q. How has working with people with aphasia changed you?

A. My feelings about disability and how people change has definitely been affected by working with people with aphasia. It’s made me realize that we’re all new people. You’re changing every day. The person I am today, at age 55, is very different than the person I was at 35. It just wasn’t as sudden a change as with aphasia, but I’ve had to adjust to it as well.

Q. You think there’s a positive side for patients, too?

A. There’s a lot of good things that you can learn about yourself from having something like this happen. Realizing that you can weather these things and it’s not the end of the world.

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