Aphasic Victim as Investigator
Dorothea Wender, PhD

\s=b\ The author (a classics professor) suffered a cerebrovascular accident, resulting in aphasia. In order to learn whether
speech therapy helps aphasic patients to
recover, the patient worked on Greek
vocabulary and grammar and ignored Latin. (Both languages were equally well\x=req-\
known before the accident; skills in both
languages had been totally lost afterward.) This case demonstrates the value
of retraining an aphasic. After three
years, testing demonstrated a professorial level of the Greek language, but Latin
was essentially still missing.
(Arch Neurol 1989;46:91-92)

fter a cerebrovascular accident this
investigator, a classics professor,
had lost a large number of English
words, some syntax, and the ability to
read and write. In addition, ancient
Greek and Latin, the two languages
she had taught for 20 years, were
totally missing, except for a scant
knowledge of some letters of the
alphabets and a small number of
names like Zeus and Caesar. Having
heard from her speech pathologist the
belief that working hard on relearning words would help her immensely,
and then having heard the opposite
from several neurologists, the patient
proceeded to investigate. Her experi¬
ment was to study ancient Greek
grammar and vocabulary and to leave
Latin, as the control, completely
alone. After three years an examina¬
tion made it clear that her knowledge
of Greek was very good and her Latin
Accepted for publication Jan 25, 1988.
From the Classics Department, Wheaton College, Norton, Mass.
Reprint requests to 109 E Main St, Norton, MA
02766 (Dr Wender).

still mainly missing; therefore, this

report seems to prove that working,

either alone or in combination with
volunteers or professional therapists,
does seem to improve at least some
aphasie victims.
REPORT OF A CASE

The patient, a 45-year-old right-handed
classics professor, suffered an onset of
darkening vision, with right-sided hemiparesis and aphasia of jargon type. A com¬
puted tomographic scan showed a hemato¬
ma in the left temporal lobe, extending
from the left temporal tip in the vicinity of
the left middle cerebral artery back to the
area of the trigone. It extended deeply to
the level of the internal capsule (Figure).
Arteriography showed a large avascular
mass in the left temporal lobe without
abnormal vessels or evidence of tumor.
Steroid therapy left the patient with only
mild hemiparesis and some speech
improvement. One week later, the patient
was fully ambulatory, with minimal weak¬
ness of right grip and homonymous hemianopia on the right side. A month later, the
patient showed intelligibility of speech
(70% ), but with some naming defects, alex¬
ia, and agraphia. The patient received
approximately 30 hours of formal speech
therapy, in addition to help from her
daughters, previous students, and col¬
leagues; mainly, however, she taught her¬
self.
Two months after the cerebrovascular
accident, the patient began to relearn
Greek while ignoring Latin. Her idea came
from the disagreement between her neu¬
rologist and her speech pathologist: the
latter begged her to spend as much time as
possible at home working on relearning to
speak, read, and write English; the former
said, "Don't bother working so hard; just
wait; either your language will come back
spontaneously or it won't." It occurred
to the patient that she (as the subject)
could perform an unusual experiment,
since she could try to relearn Greek (or
Latin), using Latin (or Greek) as an excel...

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lent control. She would, of course, work on
English at the same time, but that would
not be part of the study. (It is perhaps
interesting that, although the patient
thought of the experiment in precisely the
way described above, she did not at the
time "know" the words "control," "idea,"

"language," "Greek," "Latin," "English,"
"experiment." In fact, it was three years
later when she relearned the words "exper¬
or

iment" and "control" for the first time
after her stroke; she needed the words for
the first draft of this article. She had,
obviously, originally thought without

words.)

Ten months after the accident the

patient had relearned enough Greek, with
the help of a textbook and intensive study,
to be able to teach elementary Greek again.
Two years after the accident, with further
study every day, the patient taught two
advanced Greek courses. By the end of
1982, three years after the accident, she
felt ready for an examination.
Although her command of Greek was
still not as good as before the cerebrovas-

Computed tomographic scan of patient show¬
ing hematoma in left temporal lobe, extending
from left temporal tip in vicinity of left middle
cerebral artery back to area of trigone.

cular accident, the patient's efforts
resulted in a marked discrepancy between
her ability in Greek and that in Latin. In a
vocabulary test administered by a col¬
league she correctly identified 35 out of 41
Greek words, vs 12 Latin words out of 41.
In addition, and more strikingly, her trans¬
lation of a passage of Plato was marked by
the examiner (Eva Stehle, PhD, Classics
Dept, Wheaton College, Norton, Mass) as
"almost totally correct," but that of a
passage of Cicero "only a few words right.
She was not able to translate any complete
sentence."
A well-known aphasiologist (N. Gesch¬

wind, MD, personal communication, 1982)
was contacted in December 1982, and, after
reading the patient's first draft of this
article, commented in a telephone call
(January 1983) the following: (1) one rea¬
son for her surprising recovery came from
the fact that her father and one daughter
were ambidextrous; (2) her idea for the
experiment was interesting and could be
repeated, as she suggested, with bilingual
aphasies (eg, patients in Québec); and (3) it
was possible (not likely, but still possible)
that the patient's recovery in Greek had

been spontaneous, while her poor Latin
recovery had not.
In reply to the third statement the
patient asked another colleague who
taught classics (Keith Dickson, PhD, Clas¬
sics Dept, Wheaton College, Norton, Mass)
to perform a simple experiment, in which
the patient was given ten Greek and ten
Latin words, all ones she could not remem¬
ber. During the next week the patient
studied the Latin words and not the Greek
ones; after the one-week period she was
administered a quiz. The result of the quiz
was obvious; she correctly identified all ten
Latin words, but was still mystified by the
ten Greek words. Therefore, the patient
could have relearned Latin rather than
Greek; her recovery in Greek was even
more

clearly not simply spontaneous.
COMMENT

This case supports the concept that
speech therapy is of value. The value
of speech therapy has been widely
investigated. Many clinical neurolo¬
gists believe that some spontaneous
improvement is often attributed to
speech therapy, and that was indeed
the author's experience, since some
Latin words (mainly nouns) returned
to her without effort. It was not, how¬
ever, enough to be considered knowing
Latin.
The two most important medical
articles concerning aphasie therapy,
are by Lincoln et al1 and Wentz et
al.2
Lincoln et al concluded that therapy
does very little for aphasie patients.
(Most neurologists, compared with
speech pathologists, have already
believed this for a long time; see Har¬
rison's Principles of Internal Medi¬
cine,1 which asserts that "speech ther¬
apy is of questionable value but

should be tried. At least it is of value
in improving the morale of the

patient.")

The article by Wentz et al strongly
disagreed with the conclusions of the
article by Lincoln et al, and is, I
believe, much more carefully re¬
searched, using many more subjects
who were helped for a much longer
period of time. Furthermore, several
different types of therapists were
used (including some volunteers who
worked better with the patients than
did some professionals).
One of the problems with the article
by Lincoln et al was that the patients
had therapy only a few hours a week,

for half a year, in the first year after
their strokes. I would like you physi¬
cians to consider an equivalent exper¬
iment. If we were trying to find out
whether ordinary 6-year-old children
could learn to read, and the investiga¬
tor spent a couple of hours each week
with a 6-year-old child for half a year,
and, furthermore, his test was to ask
the child to write a page criticizing
King Lear, do you think we would
know whether normal children could
learn to read, ie, should we have
schools? English is a rich and compli¬
cated language, and many aphasies
(like myself) will need thousands, not
hundreds, of hours before improve¬
ment will be clear to normal speakers
of English. Volunteers, therefore,
seem to be extremely useful. An
example of this is the New Haven,
Conn, Volunteer Stroke Rehabilita¬
tion Program Inc.
Literature concerning aphasie vol¬
unteers is not common, perhaps, since
most books on aphasia are written for
and by speech pathologists. For exam¬
ple, Adult Aphasia? which is generally
careful and scholarly, has a last chap¬
ter titled "Family Therapy." That
chapter, however, is not really what it
sounds like; it is mainly a description
of the psychological problems the
aphasic's family is likely to face. On
the other hand, I would like to men¬
tion that my family (three daughters
in high school) helped me very much
to relearn English, as did many col¬
leagues who also volunteered. Of
course, the most useful "textbook"

concerning neighbors as therapists,
even though it is a badly written
("Tinseltown" style) biography, is Pat
and Roald,5 which was the most
important document in persuading

the British government to establish
the "volunteer scheme" to help apha¬
sies.
In addition, it is also quite possible
that the therapists used by Lincoln et
al were not good teachers. (I fired my

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first speech pathologist because she
made me miserable; my second thera¬
pist did help, mainly by suggesting
ways to try relearning words at

home.)
Spontaneous improvement seems to
be agreed on by all articles; however,
different authors feel that the sponta¬
neity returns after 2, 3, or 6 months,
or one or two

years. I, however, am

still improving (both in Greek and
English) nine years after my accident.
After my first year after the stroke, in
which I improved the most strikingly,

perhaps partly by spontaneous recov¬
ery, I still could not read or write, ie, I
was literally an illiterate professor.
After three years, I finally was able to
read a complete adult book, but I feel
that I relearned the largest amount of
English vocabulary in my sixth year,

when I wrote and sold a murder mys¬
tery and finished the scholarly book
about Plato that I had started before
my accident. I do not believe that my
improvement that year was spontane¬
ous; I feel that it came from my time
for writing: it was my sabbatical year.
This year (the ninth) has also been
excellent; nevertheless, I still cannot
multiply or divide and do not want to
relearn it, since I bought a calculator
after my stroke. Many other aphasies
have written me letters with very
similar anecdotes, which seems, to
me, to indicate that at least some
people may improve from working or
from long periods of therapy, not sim¬
ply from the early healing of the
injured brain.
The following people have helped me prepare
this article and are now thanked: Wayne D.
Miller, CCCSP/A, Bojan Jennings, PhD, Eva
Stehle, PhD, Keith Dickson, PhD, Stephen W.
Parker, MD, Norman Geschwind, MD, Emmett
V. Schmidt, MD, and Kathleen Francis. I partic¬
ularly wish to thank Maurice H. Charlton, MD,
who has kindly helped me many times during my
revision of this study and who was especially
helpful in obtaining a copy of the computed
tomographic scan from Massachusetts General
Hospital, Boston.

References
1. Lincoln NB, McGuirk E, Mulley GP, et al:
Effectiveness of speech therapy for aphasic
stroke patients: A randomised controlled trial.
Lancet 1984;1:1197-1200.
2. Wentz RT, Weiss DG, Aten JL, et al: Comparison of clinic, home, and deferred language
treatment for aphasia: A Veterans Administration cooperative study. Arch Neurol 1986;43:653\x=req-\
658.
3. Wintrobe MM, Thorn GW, Brauwald E, et al
(eds): Harrison's Principles of Internal Medicine,
ed 7. New York, McGraw-Hill International Book
Co, 1974, p 1764.
4. Eisenson J: Adult Aphasia. Englewood
Cliffs, NJ, Prentice-Hall International Inc,
1984.
5. Farrell B: Pat and Roald. New York, Random House Inc, 1969.