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Stories: Cracking the language code

A stroke robbed Nicole of the ability to express herself. At Bloorview, she’s finding her voice again

Nicole, 8 (left), with Bloorview School teacher Cathy Smart, writes math equations with her left hand following a stroke that paralyzed her right side.

Angel girl.

It’s written on Nicole’s shirt and it’s a perfect description of the eight-year-old, says her father Michael. “She was a leader in her class, a straight-A student who was highly sociable and loved to dance, play soccer and ride her bike. ”

But on Canada Day – while playing in a swimming pool – the unthinkable happened. Nicole sustained a massive stroke that paralyzed her right side and stripped her of language. “The doctors can’t say why, but they believe a viral infection she had six months earlier attacked an artery in her brain,” Michael says.

For three weeks, Nicole was unable to utter a word. When she was transferred to Bloorview Kids Rehab for rehabilitation, she arrived in a wheelchair – able to speak a couple of single words that began with D. One of those words was Dad.
“I had great expectations for Nicole’s future and to be taken into this world of unknowns – where no one could tell us to what degree she might recover – was devastating,” Michael says.

Nicole was diagnosed with expressive aphasia, “a language disorder typically seen in adults with stroke,” says Bloorview speech-language pathologist Kim Bradley. “Nicole’s ability to think is intact, but her ability to use language to express thoughts is affected. Nicole understands an idea, but doesn’t have the words or grammar to code the idea.”

Kim began therapy by getting Nicole to focus on a familiar object – an animal or favourite book – and encouraging her to name it. When Nicole got stuck, Kim would give her the first sound of the word, describe the object, or encourage her to produce any associated words, such as its colour. “Words are stored by sound and meaning so the more words she can produce in the same semantic field, the closer she will get to the word she wants,” Kim says.

After a week Nicole was able to produce single nouns and soon after to combine them with a verb. But problems with grammar, tenses, word order and the use of small words – such as in, on and is – persist. “She’ll get the big part of a sentence – the noun and verb – because they carry a lot of meaning, but the little words and word endings have less meaning” and don’t come automatically, Kim says.

When Nicole struggles to construct a sentence, Kim encourages her to produce the main words, then put together the other pieces, much like a puzzle.

Word order is also an issue, and was evident during an exercise when Nicole had to pull two words out of a box and combine them into a sentence. When Nicole picked “want” and pen,” her response was “I please want a pen” instead of “I want a pen please.” Other times when the two words were presented in one order, she couldn’t produce a response until they were physically switched. Before working on grammar, Kim had to assess – by getting Nicole to point at pictures – whether she understood the concepts of past, present and future. She did.

And it’s that huge gap between her cognitive ability and expressive language that is most frustrating for Nicole, who was highly verbal before her stroke, her father says. The elaborate, adult-like conversations she was known for have been replaced with shorter, simpler, sometimes choppy sentences.

An advantage Nicole has over adults with aphasia is that her young brain is more plastic and “open to learning new strategies,” Kim says.

Kim describes Nicole’s progress in three months as remarkable. “She’s dogged and bright and works her butt off.”

She’s also blessed with a sense of humour. When asked to compare her abilities now to when she arrived with no speech, Nicole’s face lights up. “Chatterbox,” she says.

To be connected with expert sources, contact:

Louise Kinross, Manager, Communications
Tel: 416-424-3866
Pager: 416-589-8826
E-mail: media at bloorview dot ca

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