Finding words

Imagine one day losing your ability to find the words to describe how you feel or what you just saw or something you read. Or imagine knowing the words you want to say but not being able to order them into the grammar and syntax that give your words their full meaning. 

These are just two struggles that can result from what’s known as aphasia, a language disorder that results from damage to the brain’s language centers, often the result of stroke or head trauma. According to the National Aphasia Association, about one million Americans suffer from aphasia. 

Boston University is increasingly a hub of research into aphasia diagnostics and treatment. Since 2005, Sargent College of Health and Rehabilitation Sciences has hosted the monthly meetings of a local aphasia support group. Last month, the biannual national aphasia conference, Speaking Out, took place at the University, and the Boston Foundation awarded Sargent College a one-year $50,000 grant to establish the Aphasia Community Resource Center. In September, the center will begin offering group therapy activities for people with aphasia, and education, training, and counseling to their families and caregivers. 

To find out more about the growing role of BU in aphasia research and treatment, we spoke with Gloria Waters, the dean of Sargent College.

BU Today: Can you give us a description of the different types of aphasia and how they affect the brain?

Waters: Aphasia is a language disorder that occurs subsequent to neurological damage. The most common cause of aphasia is a stroke – usually to language centers in the left hemisphere of the brain, although aphasia can also come about due to a head injury, tumor, or other neurological disorder.

The most common form of aphasia is difficulty in producing language – particularly trouble finding words. This is called anomia. People with aphasia may also have difficulty putting words together to form a sentence. They may produce speech that is referred to as agrammatic. Agrammatic speech lacks many of the function words in the language, and as a result often sounds telegraphic. Some people with aphasia also have trouble actually producing speech with their speech musculature.

Another major area people with aphasia have difficulty with is understanding language. The severity of these difficulties varies along a continuum, from not understanding language at all, to people who just don’t understand some of the subtleties of language, such as drawing inferences from a story.

What is the history of aphasia research and therapy at Boston University?

There’s actually a long history of aphasia therapy and research at BU. One center of this research is at the Harold Goodglass Aphasia Research Center at the VA Boston Healthcare System hospital in Jamaica Plain, affiliated with Boston University Medical Center. Goodglass was an aphasia researcher who died just a few years ago. He and Edith Kaplan, a School of Medicine associate professor of neurology, developed a test called the Boston Diagnostic Aphasia Exam which is used to classify patients into different types. The researchers in the Goodglass Center are working on aphasia across multiple fronts, from investigating the neurological basis of aphasia to testing the efficacy of different therapies.

There’s also been a long history of aphasia research at Sargent College’s speech-language pathology program, which is part of the college’s department of speech, language, and hearing sciences. David Caplan, a SAR adjunct professor and a professor of neurology at Harvard Medical School, and I have developed an assessment battery for aphasia which is based on current work in psycholinguistics or the study of language. While that part of our work is quite applied, we’ve also been involved in large-scale studies using magnetic resonance imaging to look at where people have damage in the brain and the relationship between the location of that damage and the type of problems people have with language. We also do studies in normal young college students, people without aphasia or language problems, using fMRI (functional magnetic resonance imaging) to look at what areas of the brain are activated when they process language.

What can you tell us about the planned Aphasia Community Resource Center at Sargent College?

People with aphasia have ongoing needs for help with their language difficulties, and one of the problems with the current health-care system is that it’s very difficult for people to get therapy beyond the acute stage of rehab (usually just a few months). They quickly run out their health insurance benefits.

The Community Resource Center will capitalize on the expertise in the area of aphasia among the Sargent College faculty, and on the manpower which is made available because we have students training to be speech-language pathologists. By tapping into those resources, we can extend the therapy available to people with aphasia. Between support groups and therapy groups, we hope that the center will serve 150 to 200 people over the course of the next academic year.

So BU students will be heavily involved in providing care? 

Yes. Students in our master’s program in speech-language pathology will actually administer the therapy while being observed by our faculty. This work will count towards their clinical practicum hours.

What sorts of services will the center provide?

People will receive therapy in groups as opposed to the individual therapy sessions they typically have in the acute settings. Also, this therapy will be given in the context of daily life activities. For example, people will participate in things like computer classes, or a book club, where they will work on their ability to read texts and their ability to express themselves.

This is an approach to therapy that people sometimes refer to as the life-participation approach. It’s done in groups because that’s more efficient and because there’s some evidence that it’s more efficacious. We focus on these common activities because there’s a hope this will transfer more and help them out more in their daily lives.

One problem clinicians face is that there is not really enough research about what type of therapy works for patients with particular types of problems. There really needs to be good efficacy studies, and that’s one of the goals of the Community Resource Center, to collect data on the usefulness of these different therapies.