Finding the Words
Speech therapists at the Stroke Comeback Center in Rockville are helping survivors recover their communication skills—and connect with others facing similar challenges
The class is watching an episode of The Good Place, an NBC comedy that weaves philosophy, ethics and existentialism into its plotline. Brooke Hatfield, a speech-language pathologist who is leading the class, has handed out a sheet with each character’s name and photo. She engages the class in a recap of the previous episode, and pauses the show during commercial breaks to regroup. When the episode ends, Hatfield asks if everyone agrees with one character’s assessment that all humans are a little sad because they’re aware of their own death.
“Yes. It’s in the back of our minds,” says Foley, a librarian who retired from the Library of Congress four years ago. “It’s there. I know it’s a reality.” Hatfield then turns to Quinnan, a physician by training who served for 13 years as chairman of preventative medicine at the Uniformed Services University of the Health Sciences in Bethesda. She asks Quinnan, an infectious disease specialist, if he’s ever broached the subject of death with patients. Quinnan leans forward, seemingly eager to address the topic. “I…I…I can,” he responds. Then he pauses, unable to finish his thought. “I don’t know.”
Chances are that Quinnan does know. Aphasia does not erase information or rob people of their intelligence. It prevents a person from using language to say what they want to say, which is why doctors often compare aphasia patients to tourists in a foreign land. But because public awareness of the disorder is limited, many people form false impressions of aphasia sufferers. In a recent survey by the National Aphasia Association, about 85% of those questioned said they’d never heard of aphasia, and 31% agreed or gave a neutral response when asked if difficulty with speech suggested an intellectual deficiency.
Dr. Peter Turkeltaub, director of the Cognitive Recovery Lab at Georgetown University Medical Center, says the aftermath of a stroke is largely determined by the precise location of the damaged brain tissue, how much of the tissue was affected and whether tissue elsewhere in the brain can compensate for the parts that were destroyed. Genetic factors can influence the extent of recovery. Some experts even speculate that an avid reader might be able to recoup his or her reading skills more quickly after a stroke than someone who didn’t read much, says Turkeltaub, who is also director of the Aphasia Clinic at MedStar National Rehabilitation Hospital in Washington, D.C.
Foley has no trouble reading, and her communication skills appear intact. “You may not know I have limitations, but I know I do,” she says. Vivacious by nature, the Rockville resident has noticed that carrying on a conversation, staying focused and remembering takes more out of her now. “I get mentally tired,” says Foley, who has three grown children. “My brain shuts down, I don’t want to say much or interact.”
Immediately following her stroke, Foley began one-on-one outpatient treatment with a speech therapist. Back then, her vocabulary was far more limited. When the therapist showed her pictures of animals and objects, she could correctly identify them about 30 percent of the time. As the treatment progressed, Foley improved much faster than her therapist expected. But she began to tire of the repetitive drills about 10 weeks into therapy and her progress slowed. That’s when the therapist recommended the Stroke Comeback Center, where Foley attends two classes a week.
Quinnan also ended up there at the recommendation of a speech therapist at a local hospital. But he needs far more support than Foley. Quinnan suffered two strokes. The first most likely occurred on the night of June 8, 2018, after he went to bed. He’d undergone elective surgery related to a digestive disorder the previous day, and he was experiencing abdominal and esophageal cramps before going to sleep. When he woke up the following morning, his eyes were glazed over. He wasn’t speaking.
“He just kept stroking my face,” says his wife, Leigh Sawyer, who called an ambulance. The emergency room doctors at MedStar Montgomery Medical Center in Olney diagnosed the stroke, and for more than a month Quinnan was transferred from one hospital to another for treatment. The initial imaging showed a blood clot in one of the major blood vessels in his neck. A few weeks later, he suffered another stroke, which his neurologist says may have been due to residual plaque from the clot in his neck traveling to the back of his eye and blocking blood from flowing to the optic nerve. Days later, his condition was exacerbated by bleeding around the area of the initial stroke.
Quinnan now suffers from a partial loss of vision in his right eye, some numbness from his right ankle to his foot, and some loss of feeling in his right arm. He also struggles with apraxia, a neurological disorder that sometimes exists alongside aphasia and makes it difficult to initiate the muscles in the mouth, lips and tongue that are needed to formulate words. Quinnan, who was working as a medical officer at a Rockville firm that helps clients conduct clinical trials and research studies around the world, has not returned to his job since the strokes. “He would have kept working and working as long as he could,” Sawyer says.
In class, Quinnan can usually string together short sentences, augmented by gestures, to relay his thoughts. Sometimes he uses an electronic touch screen device that generates spoken messages and organizes words and other relevant information into folders for his reference. Writing and typing are tough for him, but he pores over the newspaper every morning. “Reading, I understand it,” he says during an interview at his Rockville home, and he pulls out a book he’s just started, Bill Bryson’s A Short History of Nearly Everything, which is anything but short.
By contrast, Chris Vincent, 35, can’t read a novel or a newspaper to himself. Small snippets, like text messages or road signs, are more manageable. Reading aloud is even more difficult. The neurological processes needed to scan and understand a written sequence of words are different than the ones needed to do all of that and then say the words. But Vincent is a testament to the progress that can take place for people suffering from aphasia years after its onset. Seven years ago he suffered a life-threatening traumatic brain injury when he was hit by a car while riding his motorcycle in Darnestown. He was airlifted to a shock trauma center in Baltimore with a broken leg, a broken ankle, a few broken ribs, a collapsed lung and brain damage so severe that a portion of his skull had to be temporarily removed to make room for the swelling.
Three years later he could only say about 60 words, most of them profanities, as his parents, George and Kathy Vincent, recall. His speech therapist at MedStar National Rehabilitation Hospital in the District eventually suggested that he go to the Stroke Comeback Center, and he’s been attending classes there ever since. Now, despite his aphasia, Vincent can easily recount his ordeal. “It was bad, but I obviously regained a lot of my words and phrases,” says Vincent, who lives in Rockville with a roommate after spending several years recuperating at his parents’ Potomac home. “I’m at the center for classes two or three times a week. It has changed my life.”
Gone are his days as a safety officer at his family’s commercial office-cleaning service in Bethesda. He still volunteers at the fire department in Rockville—preparing meals at the station and attending meetings—but he can no longer fight fires. He’s wiped out by evening and his speech starts to deteriorate, so late-night outings with his buddies are out of the question, he says. “But that’s OK,” he adds. “Rehabilitation is my full-time job.”