The Man Who Forgot How To Speak - Treating Wernicke's Aphasia Through Non Dominant Language, A Live Study

Introduction

I have a friend who has lost the ability to speak coherently, although as far as he is concerned, he is speaking completely normally. The friend, who in order to protect his real identity, I shall call Albert, is displaying the signs of Wernicke Aphasia and more specifically a repeating phonemic paraphrastic error within his speech.

Put simply he replaces either the start, but often the entirety of each word with a 'B' sound, thus his speech is full of bees, boes and baas so for an example a sentence like:

*Shall we go to the shops?"

Turns into

"Babee boe bee boe boe?"

With concentration he could probably convert the sentence to :

"Ball bee boe boo ba bops?"

Needless to say, this makes Albert nigh on impossible to understand and the condition is clearly distressing to him. Usually he'll make by with a combination of language, improvised sign language, and writing.

Albert underwent a cardiac procedure two years ago, and though an embilotic stroke was not reported, Albert still shows signs of having Wernicke Aphasia.

Last night I made a suggestion that perhaps if we got him to learn a new language, or perhaps reignite some of the French he learned many years ago, he may well learn to speak properly. It was reported back to me, that it did indeed work and for the first time in two years, my friend spoke coherently.

This made me wonder about what other research has been done using foreign language to treat Wernicke's aphasia and what controls have been used. From initial searching there seems to have been a bit of research done in the area (referenced below), which hopefully I can add to.

This first extract will outline the severity of the condition, and give general information regarding prognosis and ongoing treatment. Any follow up papers will fill in these data points in more detail.

I am not a medical professional in any capacity and my knowledge on the subject has been gained mainly by reading lay books written by neuroscientists such as V.S. Ramachandran and Paul Bach y Rita. The purpose of this and subsequent papers on the subject, is to add to the general discourse in particular Wernicke's aphasia and to a wider extent Broca's aphasia and other related speech defects.

Aphasia is an impairment of language function which is localized to the dominant cerebral hemisphere. Wernicke aphasia is characterized by impaired language comprehension. (Aninda B. Acharya; Michael Wroten. 1.)

Wernicke aphasia, sometimes called receptive aphasia was discovered by German Physician Carl Wernicke in 1874 and is usually characterised by language incomprehension, this incomprehension will even count for the patient's own speech, thus they are often unaware of the grammatical mistakes they are making.

Patient History

Albert has not been able to speak properly for around two years now, he regularly attends speech therapy classes, which will not be discussed here.

Albert is a left-handed 59 year old male and was around the age of 57 when he underwent a cardiac procedure. Upon being revived it was discovered that Albert's speech had been badly effected. The original prognosis was that this was a temporary thing which would go away in the days after the operation, however it persisted.

Albert displays the signs of somebody suffering from Wernicke's aphasia, whilst his comprehension of incoming speech seems to have been unaffected, his speech output has been profoundly affected.

Albert displays high instances of phonemic paraphrastic errors, that is to say he swaps the phonemic sounds of words. A mild example of a phonemic paraphrastic error would be saying; Happy New Beer instead of *Happy New Year." We see phonemic paraphrastic errors used for comedic effect in Spoonerisms, for example someone might bash their bunny phone, instead of their *funny bone." However somebody with Wernicke aphasia has no control over these errors and the more the aphasic uses, the harder it is to understand them.

Albert displays a very specific type of phonemic paraphrastic error in that he substitutes the start of all syllables, with the "B" sound.

Examples:

Ball be bo? = *Shall we go?"

Bobay ben, bing bound bum beebab = Okay then, bring round some teabags

bee boo bobobow ben = See you tomorrow then.

As you can see from the examples above, it is sometimes impossible to work out what Albert is saying without him performing some kind of clue-giving mime. It gets harder when he has to speak sentences with lots of similar sounding words.

The two main sounds Albert makes seem to be bee and boe or slight variations thereof. When he tries to concentrate and make a different sound, he will often get frustrated as the sounds come out exactly the same, but slower.

One notable event happened not long after the initial loss of speech, Albert was up a ladder on the outside of his property, a concerned neighbour called out to him making sure he was okay. Albert answered back completely coherently with no sign of phonemic paraphrastic errors, however when the neighbour pointed this out in surprise, the errors immediately returned and Albert could not repeat the grammatically correct sentence he had just spoken.

This example of Albert displaying normal speech in a moderately high stress situation whereby he had to concentrate on not falling.

***Note: It is worth noting here that Albert's father died from a ladder fall when Albert was in his teens. This fact could have raised the stress levels that Albert was feeling when his neighbour called out to him.

Foreign Language Therapy

Further to my deliberation on the problem, last night (20/07/22) I opined that perhaps if Albert learned a new language and perhaps one close to English, that he may be able to retrain himself to speak.

Albert has rudimentary French, learned at school up to A-Level standard and has used the language sparingly over the last forty or so years.

Rather than make Albert aware of the plan to use French in a therapeutic manner, I felt that it should be introduced by stealth as I wanted to recreate a spontaneous reaction similar to the neighbour/ladder incident.

So I instructed another friend of ours who was going to see him that night (Helper A ) to ask Albert out of the blue parlez vous Français? (do you speak French?).

This was done and Albert immediately responded in clear and coherent French. Albert himself was surprised by this and carried on with a stream of unbroken French.

Helper A is a Spanish/English bilingual with some smatterings of French, so was able to hold a simple conversation with Albert for a few minutes.

After the conversation Albert reverted to using the same repeating phonemic paraphrastic error in English.

Existing Studies On The Effect of Bilingualism In Wernicke Aphasias

Research by Dr. Ana Inés Ansaldo, researcher at the Research Centre of the Institut universitaire de gériatrie de Montréal (IUGM), and a professor at the School of Speech Therapy and Audiology at Université de Montréal, suggests that bilingualism may help with aphasia patients.

Inés Ansaldo showed that when patients were stronger in one language than the other, training the weaker language had therapeutic benefits as opposed to training their dominant language.

The best results were found by when training synonyms in the two languages, like table and table in French and English. Although this benefit was only seen when the synonym meant the same thing in both languages, when it meant different things, it tended to cause confusion in the aphasic patient.

Whilst there have been a few studies done with bilingual and multilingual aphasics, as far as I can tell there has been no research done when it comes to teaching an aphasic a completely new language and then using that to try and build the dominant language back.

Future Studies And Questions

For Albert, French seems to be the best language to proceed in, however I would like to bring in a similar language to English such as German, although Swedish may lend itself better to the task. The Swedish language is rated as one of the easiest one for English speakers to learn, as it is almost structurally identical to English with many common words and phrases. Whereby German can be similar, however there are several instances whereupon the verb is placed at the end of the sentence and the article at the beginning. Plus I have met several Germans who simply cannot tell me the rules for the three instances of the word 'the', Der Die and Das, so the potential for confusion is higher with German.

An example of such potentical confusion, *Kann ich mit her Schmidt spreche bitte?" Literally translated as *Can I with Mr Smith speak please?"

As opposed to *Can I speak to Mr Smith please?" It is possible to rearrange the words in German, by changing the verb ending, however Swedish does not appear to have this problem, and there are many synonyms between the two languages.

Of course Swedish is not that functional for a man living in London with no Swedish relatives or friends, but the hope is that after not too long, we can start trying to introduce English words whilst he is speaking Swedish and therefore slowly extrapolate his latent potential to speak English normally again.

Although we must keep up his French as he already knows this language and is fairly used to performing internal translations as he speaks.

Limitations Of A Single Person Study

Single person studies in neurology often produce far more useful data than multi person studies, this is largely due to the variance of brain injuries we witness, therefore trying a multi study on Wernicke aphasia will provide limited beneficial data because of the potential variance in the study group.

However the main limitation of a single person study is the quality of the experimental control imposed. For instance, French has already been spoken to Albert and thus any other languages that are introduced later, are always going to be affected by the fact that French is present. There is no way to wipe Albert's memory of last night and start afresh, for that we would need another patient with Albert's exact nature of aphasia.

Another limitation is that we will have nothing to measure Albert's subsequent success or failure in building back his dominant language. For instance, we might study French with him and then decide to bring in some Swedish after a couple of weeks. If then he improves, there is no way of telling whether that improvement was going to happen anyway, or whether it is the introduction of the new element.

Regardless of these limitations, it is still worthwhile pursuing, firstly what we discover may help others who are trapped by this strange affliction and more than anything, I will get to hold a conversation with my good friend again and he will be able to converse with his daughter and granddaughter once more.

Credits & Further reading

Wernicke Aphasia -NIH - Aninda B. Acharya; Michael Wroten.


Aphasia therapy in the age of globalisation: Cross-linguistic therapy effects in bilingual aphasia. Ana Inés Ansaldo , Ladan Ghazi Saidi


The role of language proficiency and linguistic distance in cross-linguistic treatment effects in aphasia. Peggy S Conner Mira Goral, Inge Anema, Katy Borodkin, Yair Haendler, Monica Knoph, Carmen Mustelier, Elizabeth Paluska, Yana Melnikova, Mariola Moeyaert