Dr. IV on Aphasia
Alex: Hello, Dr. IV Mirus! How are you doing?
Dr. IV Mirus: Good, good! I’m happy to be here with you today.
Alex: Great. I reached out to talk about aphasia. In recent news, we learned that actor Bruce Willis has severe aphasia and had to retire from acting because of that. That condition is new to many of us. Can you explain what aphasia is, what causes it, and what the symptoms are?
Dr. IV Mirus: Yeah, of course. The word “aphasia” is derived from the Latin language, and it means losing the ability to speak. It can also mean having problems with writing, reading, understanding language, and communicating. Communication goes two ways, having a message that you communicate through speaking, writing, or signing, and also understanding the messages other people give you that you have to interpret and understand. Your brain has two places to run information. One is called the Broca, and if that part of your brain fails, then that means you can’t speak. You can understand words and write just fine, but you’ll lose the ability to speak. Another place on your brain - both are on the left side - is called the Wernicke, so if you lose that part of your brain, you will have a problem understanding. That means you might be able to speak just fine, but you won’t be able to understand what other people are saying and what their message is. If both areas of the brain don't work, that’s called global aphasia and that means you can’t understand and you can’t speak. That’s really severe, right. But why does that happen? There are a few possible causes of aphasia. The most common cause that I see in the ER department is due to a stroke, and people with a stroke will try to speak but can’t say anything and they get frustrated. Or a part of their face becomes paralyzed. That’s really concerning, with stroke as the cause. But there are other causes, like brain injuries from bad falls or something, or specific kinds of dementia, or something that slowly develops such as a brain tumor. That can be a cause, too. There are a number of other possible reasons, but they impact the brain’s processing centers where language is processed. When something affects these language centers, then the person can’t speak or they can’t understand. It’s a really severe illness and it’s hard to interact with the world if there’s an issue with communication, right.
Alex: You explained about speech and language, but for anyone who uses sign language such as Deaf people or CODAs, is there any difference? Would it help a person with aphasia to learn sign language? Would a deaf person who has aphasia not be able to sign or understand sign language? I’m curious how it would impact a deaf person.
Dr. IV Mirus: That’s a fascinating question. There’s really not a lot of information on that, but there are many case reports on that and it’s really fascinating. So, for some hearing people who can’t speak but understand others fine, due to Broca’s aphasia, who were taught signs, some did pick up some things - closer to gestures, not ASL - and it did help them a little bit. There are some reports about deaf people who use ASL as their primary language who had a stroke and aphasia, and their signing and ASL skills declined to the point where they can’t sign anymore. Or they can’t understand sign language. It’s unfortunate, but in another perspective to me is that it’s more proof that ASL is a living and breathing language, right? It lives in the language-related parts of our brain. That’s proof that ASL is a language, and our brains process ASL the same way as other people process spoken languages. So I think that’s really cool, but we need more research to find better ways to identify aphasia in people who primarily use sign language. There’s still so much to learn about that.
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Alex: This is similar to research conducted at Gallaudet University. I forgot the name, but they did find that speech develops in the brain in the same place that deaf people learn sign. It’s in the same language center, so that aligns with what you said.
Dr. IV Mirus: Yes. I know that lab, it’s called Visual…
Alex: VL2 (Visual Language and Visual Learning).
Dr. IV Mirus: That’s right. They do research about developing language process centers, and it’s almost the same, but on the other end, we have evidence — that’s unfortunate — that if aphasia happens to a signing deaf person, but it does show that our brains process ASL as a language the same way as hearing people process spoken language. I think that’s really cool.
Alex: Understood! Do you have anything to add to this topic?
Dr. IV Mirus: I’d like to share some information about the concerns of strokes, because aphasia does happen often and I see it in the ER. It’s really important to catch it right away, because the biggest concern is if you are speaking or signing just fine in one minute then in the next minute something happens to you that concerns you, go to the emergency department, or call 911 right away. Because that’s a concern for a stroke. An easy way to identify it is F.A.S.T. F stands for “face” as in facial droop, which means half of your face will droop and you won’t be able to smile properly. A stands for arm weakness but it can happen to your leg, too. It doesn’t matter, it can be your arm or leg that feels weak. S stands for any issues in speech (aphasia.) This can apply to sign, too. Then T is for time. Time is really important. The faster we can intervene to fix the problem, the better chance you have to go back to 100%.
Alex: F.A.S.T. is a good way to review. I’ve seen that on a billboard before, and that applies to both deaf and hearing people even though many focus on speech, but the same concern applies to signs and understanding signs. And deaf people might be more impacted because it impacts their hands and arms. It seems like it might be easier for hearing people to “beat” aphasia because it’s just voice, but it impacts speech too. It’s fascinating, for sure.
Dr. IV Mirus: We still have a lot to learn about that process, yeah. It’s really fascinating.
Alex: I really appreciate your time as always, Dr. IV Mirus!
Dr. IV Mirus: Anytime! Take care and be well.