Learning > Health

Living with lost words

Brain injuries such as a stroke may lead to aphasia, a condition which robs a person of the ability to speak, write and understand language

Amrita Kaur on 26 Oct 2020

The Straits Times


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Former physical fitness trainer Sherwin Tang was conducting a workout session at a gym in 2015 when all of a sudden, he had trouble speaking in a coherent manner.


Thinking he was tired, he decided to drive home to rest, but along the way, he felt a sudden weakness in the right side of his body.


His wife took him to Changi General Hospital, where they found out he was having a haemorrhagic stroke, which happens when a blood vessel breaks and bleeds into the brain. The next day, he had an operation to relieve the swelling and bleeding in his brain.


Since then, the 57-year-old has been unable to recall certain words and often struggles to find the right words to use in conversation.


He has a condition known as aphasia. It is a communication disorder that results from damage to the regions of the brain responsible for language after an injury, most commonly from a stroke.


Ms Jamie Yin, a senior speech therapist at Outram Community Hospital, said about 30 per cent of stroke patients in the hospital have aphasia.


Those who have it have difficulty speaking and understanding speech, reading and writing, or a combination of these.


Any disease or damage to the parts of the brain that control language can cause aphasia. These include brain tumours, traumatic brain injury and degenerative neurological disease.


Though there are no official figures, it is estimated that nearly 3,000 individuals here are diagnosed with the disorder every year, according to Aphasia SG, a non-profit organisation that supports people with aphasia and their caregivers.


This number is expected to rise as more people fall prey to strokes, mainly because of an ageing population.


Based on the Singapore Stroke Registry Report 2018, there were about 8,300 stroke cases admitted to public hospitals here, a 5 per cent increase from about 7,900 cases in 2017.


World Stroke Day falls on Oct 29 every year, while Speech Therapy Week is from Nov 2 to 8 this year.


Speaking in short phrases, Mr Tang told The Straits Times in a video interview: "Initially, I couldn't speak at all. I used to draw things or point to objects to communicate."


His wife and caregiver, Madam Patricia Tan, who is an assistant teacher, said it was like "playing charades" with him. "He was like a young child learning the names of objects all over again."


Mr Tang, whose right arm is still weak from the stroke, said: "I knew the words I wanted to say in my mind, but I just couldn't seem to say them."


For two years after the stroke, he visited Changi General Hospital and St Andrew's Community Hospital for speech therapy and physiotherapy. Now, he practises speaking and reading on his own using a free aphasia therapy resource called Aphasia Therapy Online.


Mr Tang, who has four children aged between 20 and 27, also uses his smartphone to type the words he wants to convey when he speaks to people.


Ms Kathleen Tan, a speech therapist at the rehabilitation departments of Ng Teng Fong General Hospital and Jurong Community Hospital, said a common misconception of someone with aphasia is that he is unable to speak because he does not know what he wants to say.


She said: "A person with aphasia often has the same thoughts and knowledge that he had before he developed language difficulties. He knows what he wants to communicate, but has simply lost the language ability to do so."


Ms Gan Hui Hui, a principal speech therapist at Singapore General Hospital's department of speech therapy, called aphasia "an invisible impairment".


She said: "There are many things that happen to the body after a stroke, such as muscle weakness and paralysis, which are more visible compared with aphasia. If one doesn't interact with a stroke patient, chances are he won't know of such a condition."


Freelance creative designer Nazri Razak suffered a haemorrhagic stroke in October 2018. He was unable to speak after his stroke and later found it difficult to recall certain words as well as the names of people.


The 49-year-old bachelor said the recovery process was "disheartening". "It made me feel like I was learning a new language all over again and I felt like a child in kindergarten."


He recalled: "I could say words like 'water' and 'flow', but I couldn't say 'dripping', though I knew it in my mind."


He has since made much progress with the help of speech therapy and can now hold a conversation independently, though he occasionally finds it difficult to remember some words when he is tired.


Recovering through speech therapy and support


Senior speech therapist Weng Wanxin at Alexandra Hospital (AH) said the extent of recovery differs for each person.


"Some with aphasia who achieve good functional recovery may still complain of functional impairments such as difficulties in finding certain words to say in a conversation."


Last year, aphasia made up 40 per cent of speech-therapy cases at AH's rehabilitation ward.


The condition cannot be treated with surgery or medication, but speech therapy can aid in recovery.


Therapy sessions involve tasks that train auditory and reading comprehension, as well as verbal and written expression, or the training of alternative modes of communication such as gesturing and drawing.


To help a person with aphasia participate better in conversations, Ms Tan advised people to use simple words and short sentences and ask yes or no questions instead of open-ended ones.


Outram Community Hospital's Ms Yin said a person's recovery from aphasia depends on factors such as age, the extent of the stroke, other medical conditions and how early speech therapy is started, as well as the intensity of the therapy.


Having a network of support including family, friends and colleagues who are encouraging and understanding is also important for recovery, said speech therapists.


For example, Aphasia SG brings together people with the condition to practise talking to and socialising with one another.


The sessions, called Chit Chat Cafe, are held twice a month and facilitated by healthcare professionals such as volunteer speech therapists.


It also organises singing sessions and aphasia-friendly games and craft activities. These have all moved online since the circuit breaker in April.


Mr Tang and Mr Nazri have taken part in Aphasia SG's activities and said the sessions have encouraged them in their recovery process.


Myths about aphasia


Ms Jamie Yin, a senior speech therapist at Outram Community Hospital, shares four common misconceptions about aphasia.


1. Misconception: You can be born with aphasia.


Fact: Some people are born with communication disorders, but aphasia is an acquired communication condition resulting from damage to the brain. The causes include stroke, traumatic brain injury, brain tumour, brain infection and degenerative neurological disease.


2. Misconception: People with aphasia have a lower IQ.


Fact: Aphasia affects a person's communication abilities, but not intelligence.


3. Misconception: People with aphasia cannot express themselves.


Fact: People with aphasia may sometimes not be able to speak. However, they may be able to communicate through other ways such as gesturing and writing.


4. Misconception: Aphasia can be cured with medication.


Fact: The condition can be improved with speech therapy.


People with aphasia due to strokes may take medication, which can help alleviate the risk factors for further strokes, such as high cholesterol and hypertension.


Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.



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