0:00:11.862,0:00:12.862
Hi.

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One of the most amazing skills[br]possessed by human beings

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is the ability to communicate[br]using language.

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I think that to most of us,[br]language, we realize how important it is.

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But if you're not completely convinced,

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consider what would happen[br]if you lost your ability to communicate.

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How would that affect your life?

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Would you be able to hold your job?

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Or if you're a student,[br]would you be able to continue studying?

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How would that affect your personal life -

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your relationships with your, let's say,[br]your spouse, your parents,

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your children?

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The reason I start out with this

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is because there is a group of people[br]for whom exactly this has happened.

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These people have something[br]that is called aphasia.

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Aphasia is a language problem[br]that is caused by damage to the brain,

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and I think one of the best ways[br]to explain aphasia in detail

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is to consider normal communication.

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Now,

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there are different ways that people[br]go about trying to understand this.

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The way that I like to do it

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is to try to understand[br]what the brain does

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when it's processing[br]speech and language.

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Now,

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as you are listening to me right now,[br]there are certain areas of your brain,

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primarily in the left posterior regions[br]of your left hemisphere,

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that are very important for comprehension.

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So as you're listening to me right now,[br]those areas are more active than not.

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But at the same time[br]as I'm talking to you,

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there are different areas[br]in my brain are more active,

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and those are primarily[br]in the left frontal lobe.

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We call these the motor speech[br]areas of the brain.

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Now, this is a really simplified model

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of speech and language[br]processing in the brain.

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But for the longest time,

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this is really how we thought[br]things happened.

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That is,

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the posterior portions of the left[br]hemisphere do speech comprehension,

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and the anterior regions[br]do speech production.

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So that brings me to aphasia.

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So aphasia is a problem

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that is caused specifically by damage[br]to the left hemisphere of the brain.

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Now, if we take a look[br]at this brain right here -

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this is actually somebody's brain -

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and everything that we've[br]highlighted there in red

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has been removed.

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This person had a stroke[br]and as a result, has major brain damage.

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Now, this is the left hemisphere,[br]which is dominant for language.

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So you can imagine,

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this person now has a very difficult time[br]with speech and language.

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Aphasia really affects[br]four different things:

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auditory comprehension,[br]speech production, reading, and writing.

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Now, there are different[br]constellations of problems

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or impairments of these modalities

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based on, you know,[br]where the lesion was,

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the size of the damage that occurred.

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But by and large, people with aphasia[br]have problems with these four things.

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But what does a person[br]with aphasia sound like?

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I want to give you a quick example

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of somebody who has aphasia[br]and is trying to tell a story.

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As a matter of fact,

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that's that person[br]whose brain you see right there.

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(Video) Aphasiac: Cinderella[br]this ... whiz.

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Ss ... small.

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Umm, dress, no ... clothes, no ... uh.

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Made happy.

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Playing game ... playing tin.

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Is ... Cinderella is ... is.

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Is poh ... ball ... it's ball.[br]Yes. Ball ...

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F...Foo... Full tiers

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Ball. (Laughter)

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Ball. (Laughter). Ball.

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Obviously we can tell that he's having[br]a very difficult time speaking.

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He has what we call non-fluent speech.

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By that I mean he's only getting out[br]one or two words per utterance.

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In addition to that,[br]his speech is very halting.

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And I call this non-fluent speech,

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and I'm going to be talking about that[br]quite a bit for the rest of this lecture.

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But what's really frustrating here for him[br]is that aphasia is a problem of language.

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It is not a problem of intellect.

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He knows exactly what he wants to say.

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And I'm sure some of you could tell[br]what he was talking about -

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he was trying to tell[br]the story of Cinderella.

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He knows of what he wants to say,[br]but he just cannot get the words out.

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So,

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you can imagine how frustrated he is,

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and it's not just a group of two or three[br]hundred people who have this condition.

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Aphasia is primarily caused by stroke.

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Stroke is the number one cause[br]of adult disability in the United States.

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So we're talking about[br]a large group of people here.

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Probably somewhere around a million[br]in the United States.

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So I would suggest that aphasia, inability[br]to process and communicate using speech,

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of all the chronic[br]conditions that we have,

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this probably robs people[br]of their freedom and their independence

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more than any other disorder.

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Because without language,[br]without the ability to communicate,

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people tend to become very isolated.

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So what it is that we can do to help them?

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What is it that we can do[br]to rehabilitate somebody who has aphasia?

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Well, typically, [br]this goes something like this:

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The person has a stroke.[br]They go to the hospital.

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And very early on,

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they get rehabilitation[br]from a speech-language pathologist.

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Abd what the speech-language[br]pathologist does

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is that they try to give them[br]compensatory strategies

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or they work specifically on their speech,

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starting to give them sort of what we call[br]speech and language drills

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starting with single words,[br]trying to maybe go to longer words,

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to phrases, and then sentences.

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But what is very frustrating[br]about this kind of non-fluent speech

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like you just saw

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is that, let's say,[br]six months or a year after the stroke

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if this is still your condition,[br]you still have non-fluent speech,

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you're most likely[br]not going to recover from this.

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You're going to have this[br]for the rest of your life.

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Now, this brings me back[br]to what I was talking about earlier

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with regards to[br]the frontal areas of the brain

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being so very important[br]for speech production,

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primarily in the left hemisphere.

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What is interesting is that

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in addition to those areas[br]being very active for speech production,

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if we focus our attention

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on the articulators[br]of the person that we're listening to,

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those areas also increase in activation.

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That is, if you're looking[br]at me right now,

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the areas that you use[br]for speech production are very active

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if you just home in on my articulators.

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When we were first[br]studying this years ago,

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and many other people have looked at this,

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we thought, "Well, is there anything[br]we can do with this

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to try to improve the rehabilitation[br]of non-fluent speech?"

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And the reason for that is as so:

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When these people have rehabilitation,

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they're trying to do a task[br]that's inherently very difficult for them.

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They're trying to produce speech.

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But what if instead of asking them

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to work on something that is very[br]frustrating and very difficult,

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we would simply do treatment

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having them watch and listen to a speaker,

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trying to activate the residual areas[br]in their left frontal lobe.

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What is also very interesting[br]about audiovisual speech -

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which is what we call it when you watch[br]the articulators very closely

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and you listen at the same time -

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what is very interesting about this kind[br]of audiovisual speech is that

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if I just slowed down[br]my speech a little bit,

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you would be able[br]to mimic me in real-time.

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There's no magic about it.

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There would be a couple of hundred[br]millisecond delay, but really,

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you could say exactly the same things[br]that I'm saying at the same time.

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I'm not talking about repeating my speech.

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I'm really talking about you[br]speaking the words that I'm saying

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exactly at the same time.

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Now, what is very interesting also[br]is that people with non-fluent speech,

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even though they can only[br]produce few words

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or maybe one or two words at a time,

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they can also mimic this kind of speech.

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And that brings me to my next slide.

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What I'm going to show you here[br]is how this works.

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What we have here[br]is a gentleman who has aphasia,

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and he's there[br]with a couple of clinicians,

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and they're asking him to describe[br]something that is very mundane,

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that is, how you make scrambled eggs.

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Let's take a listen.

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(Video) Clinician: Try to say[br]what you can about eggs.

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Donald Vankouvering: Eggs.

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Eggs ... buh ...

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(Sighs)

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Clinician: I like to ...[br]DV: eat eggs.

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But ...

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(Grunts)

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I know ... th ... this.

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Clinician and DV: I like to eat eat eggs

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DV: ... and ... (Video ends)

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A couple of things I want to say,[br]but before talking about his speech,

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I want to mention that this gentleman[br]is in the second row

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and is watching this.

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His name is Donald Vankouvering.

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You can tell he's very[br]frustrated in the video,

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but I want to tell you[br]some personal information about Donald.

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He was a Green Beret in the Army.

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He fought tours in Vietnam,

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and he's a tough guy.

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We know that the Green Berets -[br]these are a tough bunch of dudes,

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right?

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There are some that would say[br]that your ability to recover,

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or how far you're going to recover,[br]is really linked to your motivation.

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That is, how hard you try[br]in rehabilitation and just true grit.

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If you just give it everything you got,[br]you're going to get better.

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Now,

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Donald has participated[br]in hours and hours upon of treatment,

0:10:22.967,0:10:25.080
trying to improve his ability[br]to communicate.

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In spite of all of that,

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he can only really say[br]a couple of two-words phrases.

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He can say, "I know" and "Yeah boy."

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Every once in a while[br]he says something else,

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but that's pretty much all he can do.

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If it was simply the case[br]that if you try hard enough,

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you were going to get better,[br]he would have recovered years ago.

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The other thing[br]that I would say about Donald

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is that - we have here his brain scan.

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What you see in his right hemisphere[br]is that it's intact.

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This is probably what we would expect[br]in anybody his age,

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normal-looking right side.

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If you look at the left side of his brain,[br]something isn't right there.

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That big black spot or that dark area,

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it's gone.

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It's missing.

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Those are the areas[br]that he used to communicate before,

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at least used for speech production.

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Now, there are many different areas[br]that are affected,

0:11:17.456,0:11:20.486
but this is how his brain[br]has been for 22 years.

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Imagine trying to speak with that.

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So I want to show you next

0:11:25.744,0:11:30.390
actually what happens if he tries to speak[br]with this kind of audiovisual feedback.

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Now, there are a couple of things[br]that I want to point out to you.

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What's he looking down at here is an iPod.

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There's an there iPod on the table.

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And what he sees on that iPod

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is what we call[br]the audio-visual speech model,

0:11:43.552,0:11:46.070
and that's what you see[br]in the lower-left corner.

0:11:46.070,0:11:48.201
That person is going to talk.

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As a matter of fact,

0:11:49.200,0:11:52.673
that person is going to talk about[br]what he was trying to describe before -

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how you make scrambled eggs.

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But in addition to watching,

0:11:57.086,0:11:59.967
he's also listening through[br]the headphones on the iPhone.

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I'd suggest that during the whole time[br]that we listen to the video

0:12:03.508,0:12:06.657
that you focus your visual attention[br]on the speech model,

0:12:06.657,0:12:07.733
but listen.

0:12:07.838,0:12:12.311
First we start with the speech model,[br]and we slowly fade out to him.

0:12:12.311,0:12:13.718
Let's see how this goes.

0:12:16.139,0:12:21.443
(Video) Speech model:[br]I like to eat scrambled eggs

0:12:21.624,0:12:23.295
for breakfast.

0:12:24.232,0:12:30.908
SM and DV: I like them[br]because they are fast and easy.

0:12:31.860,0:12:37.517
DV: To make eggs, and then out a pan

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and melt some butter over medium heat,

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and crack the eggs,

0:12:47.255,0:12:50.083
into the pan

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and shh.

0:12:52.706,0:12:56.516
I like scrambled eggs best.

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No, I until they are done. (Video ends)

0:13:04.288,0:13:05.568
Pretty good, huh?

0:13:05.794,0:13:08.794
(Applause)

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What's especially exciting about this

0:13:18.625,0:13:21.198
is that during this one minute[br]that he was speaking,

0:13:21.298,0:13:23.857
he probably said[br]a greater variety of words

0:13:23.857,0:13:27.283
than he had done in any span of,[br]let's say, three to four years

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during the 22 years[br]since he had his stroke.

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Now, I've been studying aphasia[br]for quite a bit of time,

0:13:33.709,0:13:36.164
and we've never seen[br]these kinds of results.

0:13:36.164,0:13:39.857
Now, you might think, "Well, perhaps[br]he's the only guy who this works for.

0:13:40.107,0:13:42.799
Well then, it only means[br]something then to him."

0:13:42.799,0:13:44.078
But that's not the case.

0:13:44.444,0:13:47.547
We tried this on a group of people[br]who have aphasia,

0:13:47.717,0:13:50.189
but he is the most severe case[br]of non-fluent speech

0:13:50.189,0:13:51.792
that I've seen probably.

0:13:52.123,0:13:56.601
But this really works well for people[br]who are even having milder form of this.

0:13:56.772,0:14:00.607
What is also nice about it[br]is that if you practice,

0:14:01.007,0:14:03.717
and we've had people do this[br]for six weeks straight,

0:14:03.791,0:14:08.641
not only does your ability to speak[br]improve with the iPod,

0:14:08.641,0:14:11.552
it also improves[br]when you take the iPod away.

0:14:12.860,0:14:15.624
Now, these are only preliminary data here.

0:14:15.624,0:14:17.577
We are extremely encouraged,

0:14:17.577,0:14:19.826
but I think we have[br]something to go with here.

0:14:19.879,0:14:23.030
There are a couple of things[br]that I would like to say in closing.

0:14:23.626,0:14:26.276
The first one is that with the iPod,

0:14:26.915,0:14:29.746
even if their speech does not improve[br]just with the training

0:14:29.746,0:14:31.523
when you take the iPod away,

0:14:31.523,0:14:35.087
what if you could only use the iPod[br]to tell somebody your story?

0:14:35.504,0:14:38.410
If you could say, "You know what?[br]This is what happened to me.

0:14:38.410,0:14:40.559
There's not something wrong[br]with my intellect.

0:14:40.559,0:14:42.033
I just can't speak."

0:14:42.033,0:14:44.843
I think that that[br]would make a huge change.

0:14:45.672,0:14:50.144
The other thing that I would say[br]is that we study the brain in my lab.

0:14:50.622,0:14:52.104
We don't really understand

0:14:52.104,0:14:56.337
why this works so incredibly well[br]for people with non-fluent speech.

0:14:56.444,0:14:57.463
But,

0:14:57.667,0:14:59.304
I am very encouraged,

0:14:59.304,0:15:01.468
and I think this is going to[br]get us somewhere.

0:15:01.468,0:15:02.620
Thank you.

0:15:02.620,0:15:05.203
(Applause)