Sunday, October 18, 2009

aphasia myth #4

To continue our series, I'd like to introduce aphasia myth #4, which has to do with progression or regression in aphasia. I hope that when you receive speech or other therapies that you have experienced some progress in your skills. This is, after all, the whole point of attending therapy. I want to address a misconception about a patient's skills after he has completed therapy. People will often say to me that they don't want their loved one to "get worse" by not attending therapy.

The idea of "use it or lose it" is generally true in most of life, and can apply to aphasia as well. What this adage means is that if you don't continue to work on and use the skills you've learned, you will see a decrease in those skills over time. In this scenario, you could conceivably "get worse" because you have fallen backwards from the improvement you were making while in therapy. If you imagine a typical line graph, you start at some low number and then the line goes upwards as it travels over time to the right of the graph. There may be some zigzagging and up-and-down movement in which some days are better than others in this progression. No matter what you do, however, you will never return to zero. Zero represents you the day of your stroke or immediately afterwards. If you receive therapy and start to heal the brain injury from your stroke, you will not remain at the baseline of when you had your stroke. Therefore, you will not ever "get worse" in the sense that you will be the same as you were that day or week.

The idea of aphasia recovery would be to continue to make progress, moving that imaginary line upwards and outwards over time. Rest assured that every bit of effort that you put in to your recovery will count over time. Keep working!!

Sunday, October 4, 2009

aphasia treatment

Myth #3 deals with what professionals call "time post onsent" or TPO. This is the number of days, weeks, or years since your stroke or brain injury occurred. There is a myth flying around out there, and often miscommunicated by your medical personnel, that you can only make gains within the first few months after your stroke, and that you are finished by one year. This is not so, for either physical deficits or for aphasia. While there is such a thing as a "spontaneous recovery period", research has shown by neuroimaging (functional MRI generally) that the brain can continue to make recovery without therapy up to two years after a stroke. The spontaneous recovery period is that time from your stroke up to two years in which your brain will re-wire itself, clean out the dead cells, form new pathways, and form scar tissue. It will do this with or without treatment. Getting therapy during this time is a bonus, since this is the time in which you will earn the quickest gains.

However, this in no way should be interpreted to mean that after this spontaneous recovery period, you can no longer make changes to the brain or make gains in therapy. This is a common myth. While it is true that you will make faster or larger gains during the recovery period, you can continue to make gains no matter when your stroke occurred. These gains may not be as fast or as large, but they can definitely add up. We have seen gains in persons who have been living with aphasia for 14 years, 5 years, 20 years, etc. The key is to keep going and to keep teaching yourself. After all, if brains couldn't make changes, none of us would ever learn anything! We continue to learn throughout our lifespans because of neural plasticity. Loosely translated, this means the brain has the ability to change and form new connections = learning! If you are able to learn new things after brain damage, which you are, then you are able to continue to improve your speech, language, memory, arm strength, walking, and anything you can think of.

The moral of this story is--don't let anyone tell you that you can't get any better. It may take more time and effort, but it can be done. Get started now! Go!