The Tradaphasia project seeks to develop solutions to restore communication to non-francophone or bilingual stroke patients who have lost their capacity for speech. The beneficiaries will be patients hospitalized in neurovascular emergency units during the critical phase at admission. Our goal is to provide medical and paramedical staff with free online access to innovative, digital tools to help patients regain speech based on neurolinguistic research and speech therapy.
Aphasia Translate : The issues encountered by the non-English speaking aphasia patients
Genesis of the project
The idea of using verbal sequence recordings in the patients’ native language came into being in February 2011 when a 46-year-old Polish patient was treated. This patient arrived in our service, mute, apraxic (loss of voluntary gestures), in a stunned state (fixed eyes, distraught gaze), following a large left superficial sylvian infarction (occlusion of the end of the carotid). She had been living in France for two months, was isolated from the family and did not know the French language. The only contact I could have was a co-worker, Polish like her, with significant time constraints during the day.
In order to be able to start the Speech Training for Ms S. with twice-daily sessions, I decided to have her colleague translate in Polish the automatic series, object names and some tests to check for the existence of dysexecutive disorders or not.
These translations allowed me to stop a stereotypy that my patient had developed on the word « glass », to work on the designation, the manipulation of objects, on oral instructions and to reintegrate it into the verbal language (on the expression and the comprehension).
Mutism and Speech Training
Speech training is an emergency speech-language system in the medical emergency care. It must intervene as soon as possible and the speech therapists working in USINV are required to be present by the patient’s bedside as soon as he or she arrives in the service.
In Speech-Language Pathology, we use several techniques:
Either, going through the automatic way by relying upon the procedural memory (for example counting from 1 to 10, the recitation of the days of the week, the end of automatic sentences …)
Either, by using singing (popular nursery rhymes) to activate also the right hemisphere which will come to solicit the left hemisphere.
To cure a patient’s mutism, it is also necessary to have a kinesthetic approach : to press on his chest, on his throat, to make him take again his breathing loudly and to obtain even a laryngeal vibration on which we try to cling a sound vowel.
In view of Michel Paradis’s work, if we start from the assumption that Speech Training is important in the patient’s mother tongue, how can we work with the patients? Two axes of approach are possible: the phonetic translation and / or the work performed in the presence of the family with the patient’s active collaboration.
Why use recordings?
The phonetic translation is very difficult to use, because of the lack of control on the part of the therapist, the lack of fluidity that implies the slowdown of the rhythm which is induced.
How to rely upon memorizing a rhyme to use procedural memory?
How to use the emotion that these songs arouse (limbic subcortical structures may also have a role in the recovery process) ?
Working with families is also very difficult to put into place. The Speech Training sessions are grueling sessions for the patient, but also for the family. The emotional charge is high. So, it is sometimes necessary, at the same time, to take care of the patient and manage his or her family, which can disrupt the synergy set up by the willingness to perform well and to provide an answer, sadly which is not implementable due to the non-responsiveness, to the simulations, of the patient’s family. How to manipulate a larynx to try to bring out a sound of discomfort which will be the sound of a return to vocalization, to pursue on singing, in the presence of the family which is struck by the suddenness of hospitalization, the anxiety of losing a loved one, and who will live these interventions as a physical and psychological aggression?
We must treat the patient and, at the same time, create contact with him or her, manage the relatives who sometimes only perceive failures while we, Speech Therapists, see the beginning of a labial or lingual movement on which we can rely upon during a next session.
I request users of this website to refer to my University diploma thesis where several chapters depict the notions of language, language, aphasia, mutism, speech training, bilingualism and recovery of bilingual patients in acute and chronic phase.
For long-term care, I refer to the Bilingual Aphasia Test (B.A.T) report, the references of which are available in the Bibliography tab.