When Words Fail: A High-Profile Case of Aphasia May Shed Light on the Condition

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The world was shocked when the family of Bruce Willis — the tough, handsome charismatic actor and star of movies such as “Die Hard” and “The Sixth Sense”— announced in May that Willis, 67, would be retiring from acting, because he has aphasia.

Most people have a vague notion of what aphasia is; something to do with memory, maybe? The announcement brought attention to the condition. And California State University, Northridge has several faculty members who are quite actively working in the field, both researching and treating aphasia, in the Communications Disorders and Sciences Department in the College of Health and Human Development.

“Aphasia is a language disorder,” said Michael Biel, CScD, “It’s not a disease.” Biel is a professor in the department and a CSUN alumnus (MS, 1993) who got his doctorate in medical speech pathology at University of Pittsburgh.

Aphasia is also considered a communication disorder, a disconnect between thought and expression.

Causes of aphasia

Aphasia can be caused by a stroke, a head injury, an infection, a tumor, or a progressive neurological disease such as dementia or Alzheimer’s, according to the National Institute on Deafness and other Communication Disorders. The National Aphasia Association reports that more than 2 million Americans currently have aphasia, with approximately 180,000 acquiring it each year. Most people who have it are middle-aged or older, but children are susceptible, too.

“Of the 2 million Americans in the US who have aphasia, the most common cause is stroke,” Biel explained. There are different types of aphasia, depending on the cause and depending also on what area of the brain is affected.

Types of aphasia

People with Broca aphasia, a type most often associated with stroke, “have difficulty expressing themselves,” explained CSUN Communication Disorders and Sciences Professor Vickie Yu, Ph.D. Which makes sense, she said, because “The left hemisphere of the brain is dominant for language function, and a stroke that is in the left side of the brain, in the frontal lobe, will often cause a patient to have difficulty finding words to express wants and needs.

“Whereas, if the damage is affecting the brain near the temporal lobe, the Wernicke’s area, the individual would have more difficulty understanding what they hear, understanding what has been said to them,” said Yu, who is also a certified bilingual speech language pathologist.

There also is a kind of aphasia that is progressive, called primary progressive aphasia, or PPA, which can be caused by an atrophy of the brain, dementia and even Alzheimer’s; early signs of PPA can be trouble finding words, “but that’s [also] a common occurrence with age,” Biel asserted. ”It doesn’t mean you have aphasia, “it’s just a fact of life,” he said.

Either of these types of aphasia would, of course, be a significant disability for an actor; one of Yu’s frustrations with the reporting on Willis’ condition, she said, is that “none of the media reports emphasized the fact that there are different types of aphasia, and that with neither of these types——cognition is not affected. Intelligence is not affected, only communication.”

Treatments for aphasia

“In general, the treatments for aphasia fall pretty much under speech therapy,” Yu explained. “And in our field, that means both speech, meaning articulation, and semantics, or the meaning of words.”

“That’s what a speech pathologist does,” Biel agreed. “I see patients with aphasia every day, and it’s a tough condition to treat. Basically, it’s behavioral therapy.

“What we’ve found is that most patients with aphasia want to work on their word-finding ability. And since most adults have a vocabulary of 20,000 words or more, it can be a challenge to decide which words to work on. Some clients definitely know. I had a patient who loved to bet at the horse racetrack, and he couldn’t place a bet anymore. So, there it was easy, we had a specific set of topics and vocabulary we could work on.

“Another challenge is that with a stroke, for instance, there will be a great amount of initial improvement with speech therapy, then it might taper off,” Biel added. “But the research shows that with the right therapy, specifically naming treatments, people with aphasia can definitely gain some of that vocabulary back.”

About nine years ago, Biel and his wife started an aphasia book club for the public. It meets every week at the Echo Park Library. The club is for people with aphasia, who find a supportive environment in the discussions. The books are of general interest; it’s the pace that is distinct:

“We do just one chapter a week and only choose books that also have an audio book available. It’s been a very rewarding and interesting experience,” Biel said.

There also is a CSUN book club for people with aphasia, as well as group therapy activities, run by the CSUN Language, Speech and Hearing Center at Monterey Hall (lshc@csun.edu).

And there are many opportunities for students interested in this work to get involved, no matter their backgrounds.

Yu is inviting students to get involved in her specialty: bilingual aphasia, “So we can continue to help patients with diverse cultural and linguistic backgrounds.,” she said.

The Program at CSUN

Nayiri Adessian, MS, CCC-SLP (2018) graduated from the CSUN CDS program. She is now working as a speech language pathologist at the West Los Angeles Veterans Affairs Medical Center. “I work in the inpatient acute-care and outpatient setting with individuals who have swallowing, voice and neurogenic communication disorders,” she said.

What drew Adessian to speech pathology was a personal experience: “My mother acquired aphasia in her early 30’s after having a left-sided stroke.  Additionally, she had chronic health difficulties that required close attention and support,” Adessian said. “CSUN’s program offered the training I needed, flexibility, and close proximity to my home that allowed me to continue as my mother’s primary caregiver.”

There are about 500 students in the undergraduate and graduate programs in the Communications Disorders and Sciences Department. Entry level, masters’ and doctorate degrees are offered. The mission is to provide a platform for teaching, research and service for the advancement of human potential in speech, language and hearing.


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