Overcoming the sound of silence

Silence is golden — unless it’s your own tongue that has become mute as the result of brain injury or stroke.

Jessica D. Richardson believes more can be done through health care and by society to help those affected by aphasia to overcome their communication limitations and live fuller lives.

“I have a desire to bridge the gap between what stroke or brain injury survivors were able to do before with what they are able to do now,” says Richardson, an assistant professor in the University of South Carolina's Arnold School of Public Health. As one of 13 speakers slated for the Jan. 19 Tedx Talk in Columbia, she plans to discuss her research and potential steps toward improving outcomes for individuals with aphasia.

With researchers at UNC Chapel Hill and the Triangle Aphasia Project, Richardson is assessing screening scores of stroke and brain injury survivors and their family members and caregivers to gain a better understanding of their paths to recovery and their participation in family, civic and community activities and other aspects of life participation. The research involves gathering data points, such as the locations of brain lesions caused by stroke; mood (i.e., depression or confidence levels); speech-language and cognitive limitations; physical limitations and other disease conditions; and, previous abilities.

“We’re hoping to be able to more accurately predict the level of recovery a person can expect to achieve after a debilitating event such as stroke or brain injury,” says Richardson, a faculty member in the communication sciences and disorders department.

Normally, health care professionals provide treatment and speech therapy after a stroke, then discharge the patient after he or she has reached certain levels of basic functioning, primarily because of limited insurance coverage. Additional therapy or services usually must be paid for by the patient, which is difficult or impossible for many individuals and families because of hospital bills and lost wages.

But treatment and insurance coverage should also cover a patient’s life-participation limitations, Richardson says. “Someone might do well on an aphasia test but be unable to participate in a conversation or return to life roles as a father, mother or working person,” she says. “We want to use our findings to galvanize the health care community into action, to raise the bar for treatment and improved outcomes.”

It turns out that a person’s ability to express the main concepts of a story very often parallels their ability to participate in normal life activities. “And that ability to tell a story and express the ‘gist’ can be trained or taught, or we can come up with techniques or gestures that can help them,” Richardson says. “We want to help restore their ability to converse and potentially increase the chance that this will restore their participation. My goal is to create new tools for clinicians to test and treat the discourse and conversational abilities of persons with aphasia.”

Help also needs to come at the community level, Richardson says. Restaurants provide ramps for the physically disabled, for example, but little or no accommodation is made for those with impaired communication. “We need to use the information we’re gathering from patients and their caregivers to identify the barriers to their life participation,” she says.

What inspires Richardson in her research is the human brain’s plasticity — its ability to adapt to injury and change in response to therapy. “That’s how treatment can maximize and increase the brain’s plasticity, but we still have much to learn about how this occurs, when it should occur and exactly what treatment can make it occur,” she says.

If you're going

What: TedxColumbiaSC

Where: Harbison Theater at Midlands Technical College

When: Jan. 19 (all day)

Tickets: Visit Tedx Columbia

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