In 2008, Joanne Coggins had surgery to remove an infection from her heart valve. Some of the tissue came loose during the procedure and ended up in her brain, causing a stroke and leaving her with with aphasia, a condition that makes it difficult for people to use and understand language.
At first, Coggins could only use a few words to communicate, said her daughter, Karen Kelly, who is her mother’s caregiver and founder of the American Aphasia Society. But after three semesters with Emerson College’s Motor Learning Guided (MLG) Treatment for people with aphasia, under the direction of Dr. Joanne Lasker, associate professor in the Communication Sciences and Disorders Department, Coggins can now tell her daughter what she needs and what she wants to do.
“She has really regained a lot of her speech,” Kelly said.
Aphasia is a neurological condition, usually brought about as the result of a left-hemisphere stroke, that affects more than 2 million people in the United States, Lasker said. It’s not reversible, but it is treatable, and people can improve and regain some of their language, she said.
Aphasia is separate from, but often seen alongside, apraxia of speech, which is a motor disorder. The two are often paired, as in Coggins’ case, because the areas of the brain that handle language and speech are close together, Lasker said.
“It’s a little confusing, because speech and language are two different things,” she said. “Speech is the ability to make your mouth move in a certain way, and language is the ability to think of the words you want to say and understand what other people are saying.”
Coggins is one of ten clients in the MLG Treatment study, which operates outside of, but collaborates with, Emerson’s Robbins Speech, Language, and Hearing Center, Lasker said. Clients meet with clinicians at Emerson twice a week, typically over Skype, where they practice saying the words and phrases they need to be understood.
Clients are shown flashcards of phrases and practice saying them repeatedly. Then they are given feedback from the clinician.
The method uses the same principles used in learning a new motor skill, Lasker said.
“So the example I usually give is if you’re trying to learn how to hit a tennis ball over a net…you would learn to do that well by practicing that and being given a lot of opportunities to practice that, and by being able to modify your stroke based on results,” she said.
Lasker’s treatment varies from traditional aphasia treatment in two important ways. One is that the clinician, whether Lasker herself or an Emerson graduate student, only gives feedback on what she or he hears (“I heard the first part of the sentence clearly, but I had trouble making out the last word.”), not what the clients do or should do (“Put the tip of your tongue farther behind your teeth.”). In other treatment settings, patients frequently would be given explicit directions, Lasker said.
“We believe that our brains learn to do what they are being asked to do, so we provide feedback to enable the client to come to the ‘correct’ intelligible production by virtue of his or her own brain, thereby re-acquiring the lost motor patterns/capacity to create these words and phrases,” she said.
The other major difference is the actual practice phrases themselves. They’re all things that the clients want to be able to say for their own reasons, as opposed to sentences from a children’s book or devised by the clinician.
“I had one client who wanted to say, ‘Get me a Bud Light, please,’” Lasker said.
Kelly said she really appreciates that her mother is practicing saying things that are relevant to her life. For example, Coggins loves to garden, Kelly said.
“She can say, ‘I plant vegetables,’” Kelly said. “And ‘vegetables’ is a three-syllable word, and my mom before couldn’t say three syllables. It’s not totally clear, but you know what she’s saying.”
Kelly also helps her mom with her “homework.” Kelly took photos of the phrases her mom was learning and recorded herself saying the phrases on her mother’s iPad, which Coggins uses to practice when she’s not Skyping with Lasker.
And because Kelly lives in Braintree, Massachusetts, and Coggins lives in Hull, Massachusetts, the fact that the sessions can be done over Skype is a huge convenience, Kelly said.
Lasker said Coggins has made “excellent progress” during the course of the three semesters.
“She’s learned to say, I would say about 60 phrases that she hadn’t been able to say before. And it’s in large part due to the fact that she’s such a motivated hard worker and truly self-driven,” Lasker said. “This process of the the study is hard work, and I compare it to going to the gym, because you’re not getting a lot of feedback…you basically just have to do your leg lifts.”
Before Coggins developed aphasia, Kelly said she had never heard of the condition. She’s been active within the aphasia community since 2008, when her mom had her stroke, but after about five years, she decided that the wider world needed to know more about the disorder.
She formed the nonprofit American Aphasia Society, and since 2013 has hosted Aphasia Awareness Days each June—Aphasia Awareness Month—at the Massachusetts State House. Every year, groups of Emerson CSD students, led by clinical instructor Laura Glufling-Tham, volunteer at the event, which draws 200–300 people, including students from Boston University, Northeastern University, and the Massachusetts General Hospital Institute of Health Professions, all of which have communication disorder programs. They guide people to booths, escort attendees with disabilities, and keep the morning running smoothly, Kelly said.
This year, the event is being held on Thursday, June 30, 10:00 am–12:00 pm. In addition to information and resource tables, aphasia patients will share their stories, and the BU Aphasia Chorus will perform. (Some aphasia patients are unable to speak much but can sing normally, Kelly said.)
An Emerson graduate student, Lauren Gallagher, has volunteered to help publicize the event this year on social media, which Kelly hopes will draw in even more people who could benefit from the services available like her mother has.
“Having the opportunity to participate in this study has changed my mom’s life,” Kelly said. “It has given her back important communication that she needs for everyday life.”
To register for Aphasia Awareness Day, email firstname.lastname@example.org.