If You Can Speak, You're an Author

[#1]

Hi llana!

What a sad, but eye opening story.  I can't say I've every thought about what my life would be without words.  Language has always been for me a catharsis for the feelings inside of me clamoring to get out.  If it was something that upset me, made me happy or just a jumble of feelings that I couldn't sort through, words and paper were waiting for me to disclose these expressions.  Although, not a writer, when I'm overwhelmed with something that can't be expressed through speaking how I feel, the instruments of pen and paper are waiting.

I've never thought of how important words are to me ... but they are.  I love learning new ones and am always fascinated that they mesmerize me so.  It's like being hypnotized.  Sometimes they are easy for me to say.  Easy for me to use in the context of a sentence.  Words I've never saw or shouldn't be easily pronounceable just seem to ring a bell inside my brain.  If there are ones that I can't pronounce at first, I keep trying until I've got it.  I never give up!  There seems to be something within me that doesn't permit me to do that.  Once, I've gotten the pronunciation, I'm happy as someone whose just gotten a million dollars!  I can't explain it!  I'm sure only those who love words as much as I do understand what I'm saying.

What's inside evolves slowly.  Their just my feelings from the pictures I see in my head or what's in my heart translated into words on paper.  It is the most wonderful thing in the world to see that emotion transformed into words from what's inside of me.  I count myself extremely lucky to have been given this love of the language of words. 

For your patient I hope he regains as much of what he's lost as the Heavens grant him in every aspect.  If I couldn't enjoy this language of words in reading books, hearing them or feeling them, I'd be lost and my world would indeed be lonely! 

[#2]

I'm curious.  Has your patient retained the cognitive ability to sequence a story non-verbally?  Like putting a sequence of cartoon pics into a logical chain of events?   

I ask because I would think that having a personal story would require the abilty to order the events of one's life in a logical way even more than words.

[#3]

Thanks for the comments, 1lovealways and Psychee.

Psychee, this is a pt who (I changed details in the story, so tiptoeing around HIPAA here), scores in the bottom percentile in Picture Arrangement of the WAIS, but high on Block Design.  So, it seems that he's able to organize purely visual information (the blocks) but is less able to synthesize more complex information or narratives, like human scenes.  That said, you're right that his visual, internal experience of the past might be far more rich than the narrative he can tell us.  I welcome your insights.

[#4]

Actually, I would surmise that the higher block design score -- which also requires complex visual-spatial processing at the adult level -- tells you nothing about the internal narrative he may or may not retain, other than a good possibilty that he still retains the ability to recognize faces (that's not always the case, though).

Having an emotional reaction to internal picture memories of scenes would require, I think, the ability to know that one event led to another, then another, and so forth, in sequence.  If he retained in memory the scary picture of a guy holding a gun, for example, he may not associate that man with his subsequent brain damage or condition.  The two things may just seem like discreet things - like two things from different movies.  That might explain why you are seeing the blankness in his expression.  His appreciation of cause and effect relationships might be severely impaired. In that case, unfortunately, his internal experience would not be rich at all.

Does that make sense?  

[#5]

I'm currious, not knowing the details of his case. Has any language reteach method been tried, or even have they seen if he's capable.

I've met a few severare brain injury survivors who lost words and with a lot of effort, were able to relearn. Something to do with other parts of the brain compensating for the damaged parts. Even a young girl who lost close to 50% or her brain. 6 years later if you didn't know, you'd think she was just a might slow.

My uncle after being kicked in the head by a horse when he was three. Lost all language skills and all his learned skills completely. Had to relearn how to walk and talk form scratch. He ended up designing microchips.

[#6]

Llana can tell us for certain, but if he's in a rehab hospital, he received a full speech eval and is no doubt getting speech therapy right now.   Depending on how deep his head injuries are there is reason to hope for other brain cells to kick in and take over the work of the damaged ones, just like you describe, TB. 

But his prognosis is not as good as that of a six or three year old, whose brains are still rapidly developing.  The term used is "neuroplasticity".  No matter what our age, we have some degree of neural regeneration and reorganization ability, but young children have the most.

There's a lot of hope that in the future stem cells might be used in cases like this.

[#7]

Well I've seen stoke victims of considerable age with resulting brain damage, relearn so.... While I agree a child has a edge, a 19 year old isn't far off.

[#8]

I think there would be a big difference in the rate at which a 19 year old would recover from aphasia versus a 3 year old, mostly because the processes of that recovery would be different.   The three year old is still building original neuronal and dendritic connections at a rapid rate, while the 19 year old's rate of such new development is slower.  It's still happening, mind you, but not at the incredible rate of a 3 year old. 

On the other hand, because brain areas develop both physically and functionally like an onion, with a great deal of redundancy occurring as higher cognitive functions overlap and take over for lower ones, the 19 year old has something that the 3 year old doesn't have -- unless the gun shot wound wiped out all the levels, his brain already had built an alternative to use for the speech function -- he just needs time, motivation, and stimulation to get that region connected again.

The same is true of the elderly stroke patient.  But the elderly stroke patient has other factors related to age that the 19 year old does not- changes in blood flow rate and degenerative changes in general.

In truth, though, prognosis about cognitive rehab is always a guessing game -- every injury is different, every brain is different, and the guesses we make are more often wrong than right.  

There's one thing I can say for certain, though.  Unless the patient has lost brain function as a result of an ongoing progressive deterioration, such as what happens in Alzheimer's disease, there is always hope for recovery.  And year by year that hope seems to get better as technology allows us to see more and more examples of plasticity at the cellular level, even in the elderly.

[#9]

If we have no words, but only visions, can these visions be put down on paper as images, or in sculpture with clay? 

Do you think this story can be told by this 19 year old, in this way?

[#10]

Good question, Kathy!  llana would have to tell us what his other disabilities and abilities might be.   There's a good chance, though, that the bullet that affected his speech also affected the use of his right hand, as the brain regions controlling those things are near each other.   So, it might be difficult for him to draw or sculpt, but aside from that, it would be worth a try, I think, if he was motivated to express himself himself that way. 

[#11]

They've even got image flash cards for that. They allow the unartist (not that the art itself wouldn't be therapeutic) to communicate without words.

In truth, though, prognosis about cognitive rehab is always a guessing game -- every injury is different, every brain is different, and the guesses we make are more often wrong than right. 

Oh absolutely. I'm just always leaning more towards the hopeful side. Seen too many good recoveries not to.

[#12]

Sometimes the loss of function is not due to brain damage at all, but rather, generalized pressure effects from injury in another part of the brain not related to the function in question.  Those recoveries are pretty fast once the swelling goes down.  It's hard not to do a "happy dance" when I witness that!  

I think you're referring to "communication boards", aren't you, Tigger?  

[#13]

Nope, flash cards with picture made for people who have lost the ability to speak. They pick them out and line them up into kind of sentences. Or they can nod for the word picture they want if they can not hold them them self; you hold it up, did you mean? or? or? and they nod to the one they want or blink or....

They are called image cards or word picture cards.

[#14]

Ok, I get you.  Same general principle as the communication board. 

The thing is, he hasn't really lost the ability to speak.  He can speak four or five word sentences, according to what Llana wrote above.   At face value, his problem seems to be more one of accessing his larger vocabulary, but that sequencing deficit might also play a huge role in his communication difficulties. 

We also don't know if he can still read. 

In fact, now that I read it all again, it seems like he had a traumatic injury to the head some time ago and is only in the hospital now becaue he got shot in the stomach.  I was merging the two with the idea that he got shot in the head.  Makes a big difference! 

[#15]

Important point, difficult to tell from what I get from the article. Is his loss of talk from a head injury or because of shock for another injury?

But so If he has a limited verbal vocabulary from his injury, flash cards could fill out the blank spaces that's if "his brain still see a dog and reconizes it as a dog but just can remeber how to say dog".

[#16]

But so If he has a limited verbal vocabulary from his injury, flash cards could fill out the blank spaces that's if "his brain still see a dog and reconizes it as a dog but just can remeber how to say dog".

Absolutely!   Sorry if I neglected earlier to say so!

[#17]

Excuse me -- newcomer here, but does he have any ability to draw, or make shapes or use color?

[#18]

We'll have to wait for Llana to tell us, Jules.  Thus far, all we know is that he has a normal ability to arrange blocks to match a pattern.

[#19]

This story is a metaphor, as I see it.  We are all stuck, inside of ourselves, with no past, no future, unless we can hear our words, experience our emotions, feel words of others, and make sense of them all by projecting this in ways for others to see, and react to. 

Visual language grows with internal images.  But there is only growth, if that form of language is acted out, in some form, and then returned. Whether written in a novel, or in real life. 

In my teaching children art, part of that time was spent in having them act out what they saw.  I wanted them to feel art.  Visuals became more than one dimensional on a piece of paper.  They became real.  We tell stories in words, pictures, three dimensional images, and action.  Performing.  We need to find that depth of meaning that is called reflection.

Isolation without human contact, with only another person's stories or suggestions, or pictures, to tell us what was, or is, is meaningless, unless we can compare that knowledge to our own; if we haven't experienced it for ourselves, individual growth doesn't exist.  We are, as stated, "suspended in space"; someone else's space.  Emotions can't exist in a vacuum.

[#20]

Hmm not that reminds me of a conversation back 8 months ago.

If one has read about the ocean, heard about it from others, seen pictures, watched films with oceans. But has never actually been to one, set foot on a beach to feel the sand benieth the toes and the smell on the breaze, swam within the crest of waves. Can one really know what the ocean is like?

[#21]

But so If he has a limited verbal vocabulary from his injury, flash cards could fill out the blank spaces that's if "his brain still see a dog and reconizes it as a dog but just can remeber how to say dog".

Absolutely!   Sorry if I neglected earlier to say so!

No apology nessisary, was just trying to clarify.

[#22]

But so If he has a limited verbal vocabulary from his injury, flash cards could fill out the blank spaces that's if "his brain still see a dog and reconizes it as a dog but just can remeber how to say dog".

Absolutely!   Sorry if I neglected earlier to say so!

No apology nessisary, was just trying to clarify.

[#23]

Heavy thoughts there, Kathy.  Very poetically expressed!

And yet, after contemplating on your words, it occurred to me that some of my most profound personal experiences are those for which I have never found words to describe to others, and thus far have not had any need to.  These experiences are keenly felt on a deeply personal level and remembered and valued.

Could we allow that as an exception to your "rules" ?  (Sorry about the word "rules" - I just can't think of a better term -- but maybe "truisms" is better? )

[#24]

Tiggerbear wrote:  If one has read about the ocean, heard about it from others, seen pictures, watched films with oceans. But has never actually been to one, set foot on a beach to feel the sand benieth the toes and the smell on the breaze, swam within the crest of waves. Can one really know what the ocean is like?

Certainly not at a sensual level!   My own experience of the ocean is so inextricably tied to the invigorating smell that when I've gone to the beach with a cold I've felt like I was not there at all! 

[#25]

Psyche wrote:  And yet, after contemplating on your words, it occurred to me that some of my most profound personal experiences are those for which I have never found words to describe to others, and thus far have not had any need to.  These experiences are keenly felt on a deeply personal level and remembered and valued.

Could we allow that as an exception to your "rules" ?  (Sorry about the word "rules" - I just can't think of a better term -- but maybe "truisms" is better? )

P - You are more than welcome to have an exception to what I've just said.  I welcome it.  I agree with it, too!  But...(smile)  only profound personal experiences come from, or have originated from, previous experiences...the profoundness comes from weighing the emotional past to the present....I think. 

If you've applied that experience to yourself, you inadvertently, not consciously, perhaps, will transfer it in some way to people around you.  I can't imagine not feeling that deeply about something, and hiding it.  In your smile, your frown, in your anger, your hurt, your joy, or your love...facial expressions change...body language changes....voices change, mannerisms change.....interactions with people change.. You change.  It's all growing deep inside of you.  You may not speak the words, but it's there.  Whether these are rules, or truisms...I don't know...just observations that I believe happen.

I feel the same way about the ocean...but there is more than one sense that you use, when you're around your environment.  Visual, tactual, audio, taste, smell....imagination.... If I can't smell the ocean, I can imagine from my past experiences.  I feel it.  I can always hear it in my mind...tasting it's saltiness, or feeling its grittiness...all I have to do is touch the water, or look at it, and feel it's coldness...see the waves breaking, to hear its sound and see its blueness.  All from my past interactions with being there, within it, once.  Of course the joy of our feelings are heightened when we do have all of these senses working at once....no doubt about that...!

[#26]

Another very poetic response! 

But I think I might have lost your train of thought there.  Weren't you originally talking about words themselves as being necessary for one to have a meaningful experience?   Non-verbally reacting to those experiences doesn't require words, right?