I ran into Matthew at the shopping mall about 3 years after I first met him. I was so happy to see him and I noticed that he was using his wheelchair and I asked, “Matthew! How are you?”. He said with slow careful cadence, “I-am-fine-how-are-you?” His face was lit with triumph like he knew that I would be shocked. I stood with my mouth agape; feeling that familiar tightness in my chest that I feel when I tear up.

I met Matthew about 6 months after a stroke affected the left hemisphere of his brain while I was working in an outpatient rehabilitation service. His right arm and leg were still completely paralysed. He could stand with assistance and was just beginning to take a few steps with a cane. He seemed to understand simple sentences but was only able to utter one word, “yes”. The inflexion of his voice and his facial gestures were very expressive so there were many times that even though Matthew said “yes” I knew he actually meant “no”. We got to know each other very well over the 6 months we worked together and I admired his smile, his positive attitude and the loving relationship he had with his wife. Matthew had just retired from a senior sales position with a large company and it was not hard to imagine that he was superb at his job.

We worked on standing balance, stepping and walking and when he finished his physiotherapy he could walk unaided with a cane for short distances. Despite weekly speech language pathology sessions though, his speech had not changed. We said goodbye and he and his wife had an
extensive home exercise program to continue to work on.

So what happened in those few years? Where did those words come from? At the mall, I asked Matthew, “Your speech, it has improved! How did that happen?” His wife did not fill me in but patiently waited for Matthew to explain, “My-friend-visits-we-talk-a-bout-the-news”. Matthew’s wife told me that shortly after he left our rehabilitation service, his buddy would drop by his home. Every day Matthew’s friend would help Matthew work on his exercises but then they would sit and debate news and politics which they both loved. In their conversations, Matthew’s friend would not ‘fill in the blanks’ for Matthew but instead would encourage Matthew’s attempts at new words. Over months and years of almost daily practice, Matthew added to his word repertoire to the point that he could speak phrases of about 5 or 6 words and have a telephone conversation with his children and grandchildren who were living away. His wife related that now she felt that Matthew could be left home alone because
he could use the phone as well as get around the house with his cane.

If we were able to image the cortical activity of Matthew’s brain, I think we would find that the stroke severely and permanently damaged the centre for speech production, Broca’s area, in his left hemisphere. Since gestures and voice inflection are stored in other areas of the brain, they were spared. It was likely that with encouragement and repeated practice along with Matthew’s intelligence and motivation, other parts of the brain, either adjacent to the damaged area or in speech support areas in the right hemisphere, began to ‘take-over’ for the damaged speech areas. Obviously this took time because silent or latent synapse became active, new dendritic branches developed in response to new requirements and finally new speech pathways were developed in secondary speech centres in the brain. I think these new pathways are like paths in the forest. When they are new, they are narrow and difficult to navigate but as they are used more often, the path gets well-worn and easier to pass. I think that neuronal pathways get laid down more firmly with time, like the saying goes “neurons that fire together, wire together”.

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