Enabling fluent speech in non-fluent aphasia | Dr. Julius Fridriksson | TEDxColumbiaSC

Dr. Julius Fridriksson is an aphasiologist, a USC Health Science Distinguished Professor and the Director of the Aphasia Laboratory at the University of South Carolina, where he seeks to clarify the relationship between brain damage and speech/language impediments. His work has led to significant breakthroughs in helping stroke victims regain their ability to speak.

Dr. Fridriksson earned his Ph.D. in Speech-Language Pathology from the University of Arizona and both his M.A. in Speech-Language Pathology and B.A. in Communicative Disorders from University of Central Florida.

He received the Louis M. DiCarlo Award for Clinical Advancement from the American Speech and Hearing Foundation in 2011, and the 2010 Researcher of the Year Award from the Arnold School of Public Health at University of South Carolina.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

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)