The question seems simple enough. “So what’s this?” Melissa Richman asks as she sets a cup on the conference room table one afternoon in April. After a few minutes of silence, Carol (not her real name), one of three older adults at the table, blurts out, “Cup.” Her classmates, Bill and Rilla, nod their heads and repeat the word. Then Richman hands them three flash cards with a letter on each—C, U, P—and asks them to spell the word. Bill struggles: P-C-U, U-P-C, then C-P-U. He peeks at the others’ work and sighs heavily.
Richman, a speech-language pathologist at the Stroke Comeback Center in Rockville, works to give survivors of stroke and traumatic brain injuries a voice by helping them regain the communication skills they’ve lost or master the use of gestures or symbols to compensate for their deficit. A few of those survivors are wheelchair-bound and unable to utter more than a word or two, while others can convey their thoughts without any obvious sign of impairment. The common denominator they all share is aphasia, a communication disorder resulting from damage to the left side of the brain, which, for most people, controls speech, comprehension, reading and writing. The most common cause of aphasia is stroke, according to the National Aphasia Association, which estimates that at least a third of the 655,000 people in the United States who survive a stroke each year suffer from the disorder.
As Richman, the center’s program director, tells it, a healthy brain operates like a sophisticated filing system that organizes words and accesses them quickly to construct sentences. But for people with aphasia, “it’s as if someone took all their files and dumped them on the floor,” she says. “The words they want are there, but they have to dig around to find them. Sometimes the files are only mildly disorganized. Sometimes the files are a huge mess and the pile is so big that they just can’t find what they want.” Aphasia can also cause a “word salad,” Richman explains, when words are mixed together in a sequence that doesn’t make sense. The challenge for speech therapists is figuring out a way to help people work around these issues. At the center, they do that by working with small groups of three to six people, a setting that’s meant to produce instant community and a shared sense of purpose while providing a more natural environment for dialogue and feedback.
When the cup exercise ends, Richman dangles a key in front of her three students. “OK, what’s this?” she asks. “Cup,” Carol says, then she furrows her brows. “Seeee,” Bill says, repeating the sound a few times.
“Close,” Richman assures him, before offering the class a hint: “You open the door with the…”
Then Carol gets it: “Key.”
Richman then pulls out a tennis ball. Bill calls it a cup. Rilla says: “Cup. It’s a cup. Yellow. Throw. What is it?”
The Stroke Comeback Center is designed to feel like a home away from home. The front door opens into a spacious room with a kitchen and dining table to one side and a seating area with cozy chairs and a flat-screen television to the other. Staff and clients congregate in the communal area between classes, as do caregivers—family members and health aides—who often mill about during group sessions. Each treatment room has a table and chairs facing a TV screen that’s used for interactive games and exercises. A wall decal in one room reads: “Aphasia—loss of language, NOT intelligence.”
The idea for the outpatient center took flight around 2000, soon after speech-language pathologist Darlene Williamson opened her own private practice in Fairfax, Virginia. By then, Williamson had worked in hospitals for more than two decades and spent seven years as clinical director of George Washington University’s Speech and Hearing Center in Washington, D.C. She’d had her fill of dealing with insurance companies. “I was the person telling the family, ‘I’m sorry, but we’re going to have to wrap it up next week—your insurance company is no longer going to cover this,’ ” Williamson says. “The families were always flabbergasted. I knew they needed more than what insurance would pay for. The first thing out of their mouths was, ‘now what?’ ”