Hi.
One of the most amazing skills possessed by human beings
is the ability to communicate using language.
I think that to most of us, language, we realize how important it is.
But if you're not completely convinced,
consider what would happen if you lost your ability to communicate.
How would that affect your life?
Would you be able to hold your job?
Or if you're a student, would you be able to continue studying?
How would that affect your personal life -
your relationships with your, let's say, your spouse, your parents,
your children?
The reason I start out with this
is because there is a group of people for whom exactly this has happened.
These people have something that is called aphasia.
Aphasia is a language problem that is caused by damage to the brain,
and I think one of the best ways to explain aphasia in detail
is to consider normal communication.
Now,
there are different ways that people go about trying to understand this.
The way that I like to do it
is to try to understand what the brain does
when it's processing speech and language.
Now,
as you are listening to me right now, there are certain areas of your brain,
primarily in the left posterior regions of your left hemisphere,
that are very important for comprehension.
So as you're listening to me right now, those areas are more active than not.
But at the same time as I'm talking to you,
there are different areas in my brain are more active,
and those are primarily in the left frontal lobe.
We call these the motor speech areas of the brain.
Now, this is a really simplified model
of speech and language processing in the brain.
But for the longest time,
this is really how we thought things happened.
That is,
the posterior portions of the left hemisphere do speech comprehension,
and the anterior regions do speech production.
So that brings me to aphasia.
So aphasia is a problem
that is caused specifically by damage to the left hemisphere of the brain.
Now, if we take a look at this brain right here -
this is actually somebody's brain -
and everything that we've highlighted there in red
has been removed.
This person had a stroke and as a result, has major brain damage.
Now, this is the left hemisphere, which is dominant for language.
So you can imagine,
this person now has a very difficult time with speech and language.
Aphasia really affects four different things:
auditory comprehension, speech production, reading, and writing.
Now, there are different constellations of problems
or impairments of these modalities
based on, you know, where the lesion was,
the size of the damage that occurred.
But by and large, people with aphasia have problems with these four things.
But what does a person with aphasia sound like?
I want to give you a quick example
of somebody who has aphasia and is trying to tell a story.
As a matter of fact,
that's that person whose brain you see right there.
(Video) Aphasiac: Cinderella this ... whiz.
Ss ... small.
Umm, dress, no ... clothes, no ... uh.
Made happy.
Playing game ... playing tin.
Is ... Cinderella is ... is.
Is poh ... ball ... it's ball. Yes. Ball ...
F...Foo... Full tiers
Ball. (Laughter)
Ball. (Laughter). Ball.
Obviously we can tell that he's having a very difficult time speaking.
He has what we call non-fluent speech.
By that I mean he's only getting out one or two words per utterance.
In addition to that, his speech is very halting.
And I call this non-fluent speech,
and I'm going to be talking about that quite a bit for the rest of this lecture.
But what's really frustrating here for him is that aphasia is a problem of language.
It is not a problem of intellect.
He knows exactly what he wants to say.
And I'm sure some of you could tell what he was talking about -
he was trying to tell the story of Cinderella.
He knows of what he wants to say, but he just cannot get the words out.
So,
you can imagine how frustrated he is,
and it's not just a group of two or three hundred people who have this condition.
Aphasia is primarily caused by stroke.
Stroke is the number one cause of adult disability in the United States.
So we're talking about a large group of people here.
Probably somewhere around a million in the United States.
So I would suggest that aphasia, inability to process and communicate using speech,
of all the chronic conditions that we have,
this probably robs people of their freedom and their independence
more than any other disorder.
Because without language, without the ability to communicate,
people tend to become very isolated.
So what it is that we can do to help them?
What is it that we can do to rehabilitate somebody who has aphasia?
Well, typically, this goes something like this:
The person has a stroke. They go to the hospital.
And very early on,
they get rehabilitation from a speech-language pathologist.
Abd what the speech-language pathologist does
is that they try to give them compensatory strategies
or they work specifically on their speech,
starting to give them sort of what we call speech and language drills
starting with single words, trying to maybe go to longer words,
to phrases, and then sentences.
But what is very frustrating about this kind of non-fluent speech
like you just saw
is that, let's say, six months or a year after the stroke
if this is still your condition, you still have non-fluent speech,
you're most likely not going to recover from this.
You're going to have this for the rest of your life.
Now, this brings me back to what I was talking about earlier
with regards to the frontal areas of the brain
being so very important for speech production,
primarily in the left hemisphere.
What is interesting is that
in addition to those areas being very active for speech production,
if we focus our attention
on the articulators of the person that we're listening to,
those areas also increase in activation.
That is, if you're looking at me right now,
the areas that you use for speech production are very active
if you just home in on my articulators.
When we were first studying this years ago,
and many other people have looked at this,
we thought, "Well, is there anything we can do with this
to try to improve the rehabilitation of non-fluent speech?"
And the reason for that is as so:
When these people have rehabilitation,
they're trying to do a task that's inherently very difficult for them.
They're trying to produce speech.
But what if instead of asking them
to work on something that is very frustrating and very difficult,
we would simply do treatment
having them watch and listen to a speaker,
trying to activate the residual areas in their left frontal lobe.
What is also very interesting about audiovisual speech -
which is what we call it when you watch the articulators very closely
and you listen at the same time -
what is very interesting about this kind of audiovisual speech is that
if I just slowed down my speech a little bit,
you would be able to mimic me in real-time.
There's no magic about it.
There would be a couple of hundred millisecond delay, but really,
you could say exactly the same things that I'm saying at the same time.
I'm not talking about repeating my speech.
I'm really talking about you speaking the words that I'm saying
exactly at the same time.
Now, what is very interesting also is that people with non-fluent speech,
even though they can only produce few words
or maybe one or two words at a time,
they can also mimic this kind of speech.
And that brings me to my next slide.
What I'm going to show you here is how this works.
What we have here is a gentleman who has aphasia,
and he's there with a couple of clinicians,
and they're asking him to describe something that is very mundane,
that is, how you make scrambled eggs.
Let's take a listen.
(Video) Clinician: Try to say what you can about eggs.
Donald Vankouvering: Eggs.
Eggs ... buh ...
(Sighs)
Clinician: I like to ... DV: eat eggs.
But ...
(Grunts)
I know ... th ... this.
Clinician and DV: I like to eat eat eggs
DV: ... and ... (Video ends)
A couple of things I want to say, but before talking about his speech,
I want to mention that this gentleman is in the second row
and is watching this.
His name is Donald Vankouvering.
You can tell he's very frustrated in the video,
but I want to tell you some personal information about Donald.
He was a Green Beret in the Army.
He fought tours in Vietnam,
and he's a tough guy.
We know that the Green Berets - these are a tough bunch of dudes,
right?
There are some that would say that your ability to recover,
or how far you're going to recover, is really linked to your motivation.
That is, how hard you try in rehabilitation and just true grit.
If you just give it everything you got, you're going to get better.
Now,
Donald has participated in hours and hours upon of treatment,
trying to improve his ability to communicate.
In spite of all of that,
he can only really say a couple of two-words phrases.
He can say, "I know" and "Yeah boy."
Every once in a while he says something else,
but that's pretty much all he can do.
If it was simply the case that if you try hard enough,
you were going to get better, he would have recovered years ago.
The other thing that I would say about Donald
is that - we have here his brain scan.
What you see in his right hemisphere is that it's intact.
This is probably what we would expect in anybody his age,
normal-looking right side.
If you look at the left side of his brain, something isn't right there.
That big black spot or that dark area,
it's gone.
It's missing.
Those are the areas that he used to communicate before,
at least used for speech production.
Now, there are many different areas that are affected,
but this is how his brain has been for 22 years.
Imagine trying to speak with that.
So I want to show you next
actually what happens if he tries to speak with this kind of audiovisual feedback.
Now, there are a couple of things that I want to point out to you.
What's he looking down at here is an iPod.
There's an there iPod on the table.
And what he sees on that iPod
is what we call the audio-visual speech model,
and that's what you see in the lower-left corner.
That person is going to talk.
As a matter of fact,
that person is going to talk about what he was trying to describe before -
how you make scrambled eggs.
But in addition to watching,
he's also listening through the headphones on the iPhone.
I'd suggest that during the whole time that we listen to the video
that you focus your visual attention on the speech model,
but listen.
First we start with the speech model, and we slowly fade out to him.
Let's see how this goes.
(Video) Speech model: I like to eat scrambled eggs
for breakfast.
SM and DV: I like them because they are fast and easy.
DV: To make eggs, and then out a pan
and melt some butter over medium heat,
and crack the eggs,
into the pan
and shh.
I like scrambled eggs best.
No, I until they are done. (Video ends)
Pretty good, huh?
(Applause)
What's especially exciting about this
is that during this one minute that he was speaking,
he probably said a greater variety of words
than he had done in any span of, let's say, three to four years
during the 22 years since he had his stroke.
Now, I've been studying aphasia for quite a bit of time,
and we've never seen these kinds of results.
Now, you might think, "Well, perhaps he's the only guy who this works for.
Well then, it only means something then to him."
But that's not the case.
We tried this on a group of people who have aphasia,
but he is the most severe case of non-fluent speech
that I've seen probably.
But this really works well for people who are even having milder form of this.
What is also nice about it is that if you practice,
and we've had people do this for six weeks straight,
not only does your ability to speak improve with the iPod,
it also improves when you take the iPod away.
Now, these are only preliminary data here.
We are extremely encouraged,
but I think we have something to go with here.
There are a couple of things that I would like to say in closing.
The first one is that with the iPod,
even if their speech does not improve just with the training
when you take the iPod away,
what if you could only use the iPod to tell somebody your story?
If you could say, "You know what? This is what happened to me.
There's not something wrong with my intellect.
I just can't speak."
I think that that would make a huge change.
The other thing that I would say is that we study the brain in my lab.
We don't really understand
why this works so incredibly well for people with non-fluent speech.
But,
I am very encouraged,
and I think this is going to get us somewhere.
Thank you.
(Applause)