WEBVTT

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Hi.

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One of the most amazing skills
possessed by human beings

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is the ability to communicate
using language.

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I think that to most of us,
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
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,
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,
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
for whom exactly this has happened.

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These people have something
that is called aphasia.

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

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and I think one of the best ways
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
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
what the brain does

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when it's processing
speech and language.

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Now,

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

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primarily in the left posterior regions
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,
those areas are more active than not.

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

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there are different areas
in my brain are more active,

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and those are primarily
in the left frontal lobe.

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We call these the motor speech
areas of the brain.

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Now, this is a really simplified model

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of speech and language
processing in the brain.

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But for the longest time,

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this is really how we thought
things happened.

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That is,

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the posterior portions of the left
hemisphere do speech comprehension,

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and the anterior regions
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
to the left hemisphere of the brain.

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

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this is actually somebody's brain -

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and everything that we've
highlighted there in red

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has been removed.

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

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Now, this is the left hemisphere,
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
with speech and language.

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Aphasia really affects
four different things:

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auditory comprehension,
speech production, reading, and writing.

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Now, there are different
constellations of problems

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or impairments of these modalities

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based on, you know,
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
have problems with these four things.

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But what does a person
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
and is trying to tell a story.

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As a matter of fact,

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that's that person
whose brain you see right there.

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(Video) Aphasiac: Cinderella
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.
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
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
one or two words per utterance.

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In addition to that,
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
quite a bit for the rest of this lecture.

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But what's really frustrating here for him
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
what he was talking about -

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he was trying to tell
the story of Cinderella.

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He knows of what he wants to say,
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
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
of adult disability in the United States.

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

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Probably somewhere around a million
in the United States.

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

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of all the chronic
conditions that we have,

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this probably robs people
of their freedom and their independence

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more than any other disorder.

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Because without language,
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
to rehabilitate somebody who has aphasia?

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Well, typically, 
this goes something like this:

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The person has a stroke.
They go to the hospital.

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And very early on,

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they get rehabilitation
from a speech-language pathologist.

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Abd what the speech-language
pathologist does

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is that they try to give them
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
speech and language drills

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starting with single words,
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
about this kind of non-fluent speech

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like you just saw

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

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

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

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

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

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with regards to
the frontal areas of the brain

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being so very important
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
being very active for speech production,

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if we focus our attention

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on the articulators
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
at me right now,

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the areas that you use
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
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
we can do with this

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to try to improve the rehabilitation
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
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
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
in their left frontal lobe.

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What is also very interesting
about audiovisual speech -

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which is what we call it when you watch
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
of audiovisual speech is that

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if I just slowed down
my speech a little bit,

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you would be able
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
millisecond delay, but really,

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you could say exactly the same things
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
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
is that people with non-fluent speech,

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even though they can only
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
is how this works.

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What we have here
is a gentleman who has aphasia,

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and he's there
with a couple of clinicians,

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and they're asking him to describe
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
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 ...
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,
but before talking about his speech,

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I want to mention that this gentleman
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
frustrated in the video,

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but I want to tell you
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 -
these are a tough bunch of dudes,

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right?

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There are some that would say
that your ability to recover,

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

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

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

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Now,

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Donald has participated
in hours and hours upon of treatment,

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trying to improve his ability
to communicate.

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In spite of all of that,

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he can only really say
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
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
that if you try hard enough,

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

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The other thing
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
is that it's intact.

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This is probably what we would expect
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,
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
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
that are affected,

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but this is how his brain
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

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actually what happens if he tries to speak
with this kind of audiovisual feedback.

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Now, there are a couple of things
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
the audio-visual speech model,

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and that's what you see
in the lower-left corner.

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That person is going to talk.

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As a matter of fact,

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that person is going to talk about
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,

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he's also listening through
the headphones on the iPhone.

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

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that you focus your visual attention
on the speech model,

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but listen.

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First we start with the speech model,
and we slowly fade out to him.

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Let's see how this goes.

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(Video) Speech model:
I like to eat scrambled eggs

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for breakfast.

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SM and DV: I like them
because they are fast and easy.

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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,

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into the pan

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and shh.

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I like scrambled eggs best.

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

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Pretty good, huh?

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(Applause)

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What's especially exciting about this

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is that during this one minute
that he was speaking,

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he probably said
a greater variety of words

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than he had done in any span of,
let's say, three to four years

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during the 22 years
since he had his stroke.

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

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and we've never seen
these kinds of results.

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Now, you might think, "Well, perhaps
he's the only guy who this works for.

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Well then, it only means
something then to him."

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But that's not the case.

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We tried this on a group of people
who have aphasia,

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but he is the most severe case
of non-fluent speech

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that I've seen probably.

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But this really works well for people
who are even having milder form of this.

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What is also nice about it
is that if you practice,

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and we've had people do this
for six weeks straight,

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not only does your ability to speak
improve with the iPod,

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it also improves
when you take the iPod away.

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Now, these are only preliminary data here.

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We are extremely encouraged,

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but I think we have
something to go with here.

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There are a couple of things
that I would like to say in closing.

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The first one is that with the iPod,

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even if their speech does not improve
just with the training

00:14:29.746 --> 00:14:31.523
when you take the iPod away,

00:14:31.523 --> 00:14:35.087
what if you could only use the iPod
to tell somebody your story?

00:14:35.504 --> 00:14:38.410
If you could say, "You know what?
This is what happened to me.

00:14:38.410 --> 00:14:40.559
There's not something wrong
with my intellect.

00:14:40.559 --> 00:14:42.033
I just can't speak."

00:14:42.033 --> 00:14:44.843
I think that that
would make a huge change.

00:14:45.672 --> 00:14:50.144
The other thing that I would say
is that we study the brain in my lab.

00:14:50.622 --> 00:14:52.104
We don't really understand

00:14:52.104 --> 00:14:56.337
why this works so incredibly well
for people with non-fluent speech.

00:14:56.444 --> 00:14:57.463
But,

00:14:57.667 --> 00:14:59.304
I am very encouraged,

00:14:59.304 --> 00:15:01.468
and I think this is going to
get us somewhere.

00:15:01.468 --> 00:15:02.620
Thank you.

00:15:02.620 --> 00:15:05.203
(Applause)