Speech-Language Pathology/Aphasia and sign language?

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Question
I was asked to tutor a man in sign language who had a stroke and was diagnosed with aphasia. His friend hired me. I'm trying to find out if sign language can be helpful and how.

Here's more information about this situation:

His friend apparently didn't know him really well until after the stroke and then he decided to be a closer friend and helpful, because he was not getting the help he needed to improve. It turned out he lived with his parents who took his disability insurance for the first two years after the stroke. He's now living in a group home and trying to become independent. The friend thinks sign language will help, but hasn't been able to tell me why he thinks that except that he has remembered a couple of signs he taught him from learning it online.

The symptoms/abilities/challenges of my student:
* He says he had a stroke which affected his left brain
* He says his left arm and hand has no feeling (these two things seem contrary since I believe the brain affects the opposite side)
* He has a lump on the back of his head near his neck on his left side which he thinks causes him to lose consciousness occasionally
* He has to check his blood sugar occasionally and apparently it's sometimes high and sometimes low (don't know if he had this problem before the stroke)
* He can communicate fairly well, but then seems to become confused
* His friend says he can't say some things, like certain words and names, though he believes he knows them and sometimes thinks he's saying the right thing when he's not
* I witnessed him calling his friend the wrong name twice
* He is very willing to learn sign language and thinks it will help him to show that he's capable of learning and communicating so he can go to college
* His friend thinks he can't pass a competency test now, but with sign language they would probably have a different way of testing him and then he would pass.
* They both believe that he'll never recover (like Jill Bolten Taylor did) because he had no therapy during the first two years and now it's too late.
* He "loses consciousness" so he can't be independent in case that happens. They say it's not epilepsy and don't know why, so I'm guessing it's his sugar (diabetic shock - don't know if it could be relate to the aphasia or stroke).

I've only given one lesson. It looks like he'll be a slow learner, though I can't tell how much he'll remember between sessions. I am giving them a reduced rate due to financial difficulties and don't want to continue if it seems that teaching someone with aphasia is not prudent due to a low probability of it being able to help him.

Any thoughts on this situation or information I seem to be lacking that you might be able to give me?

Thanks for however you might be able to help!

Answer
This is a great question and I have encountered it a few times in my career. The short answer is that no, I don't think it will be beneficial. There have been a few old studies of gestural use or Amer-Ind training in aphasia, but it would have limited use and generalization.

The long answer (because you are going to need it)--the fact that he didn't get therapy right after the stroke has no real bearing on his recovery. Yes, there is a spontaneous recovery period within the first two years that maximizes neural re-organization, but he can still make improvements daily with intensive aphasia treatment. Jill Bolte Taylor is an anomaly--very few people will recover like her in that time period. Aphasia recovery is typically slower and the majority never come back to pre-stroke levels.

Aphasia is a disorder of speech and language after a brain injury to the left hemisphere. It affects reading, writing, speaking, and understanding as well as gestural use. Language is a symbolic representation of a concept that is expressed in words and sounds and gestures. ASL is a language. There are different types of aphasia, but they all have all forms of language affected to varying degrees. The common denominator of all types of aphasia is anomia--inability to access a word/concept when needed in any form.

Taking away that he won't be able to make the precise movements for ASL physically, anomia will still be there. It's very difficult to teach gesture to someone with aphasia--they can do it sometimes in therapy but then can't carry it over to real life easily. They have frequently lost the ability to problem-solve communication ("Oh, I should just make the gesture since I can't say the word"). ASL is fast and a language. Testing him in ASL will not go well. You cannot replace one language with another and expect the aphasia to disappear. You cannot teach someone Chinese and expect that the aphasia will disappear.

I would recommend that they put their resources towards actual aphasia therapy. If they cannot afford it, there are online programs (www.aphasiatoolbox.com, bungalowsoftware.com), most universities have supervised student clinics, he should have Medicare and can go to outpatient therapy. My facility specializes in intensive aphasia treatment, which is costly but takes the place of years of therapy. There are student intensive programs (university of Central Florida for example). There are workbooks he can order online to work himself.

I hope this helps. Thank you for the excellent question and for the insight that this may not be the best method of treatment. Also, if I may offer you some advice--don't ever discount your services. You are skilled in this area and deserve to be paid what you are worth. I have learned the hard way that people do not appreciate your discount and will always try to get more for less.  

Speech-Language Pathology

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Lori Bartels-Tobin, Ph.D., CCC-SLP

Expertise

My speciality is aphasia and cognitive disorders from stroke or brain injury. I can also answer questions regarding adult swallowing, caregiver information and support, oral motor disorders, augmentative and alternative communication technology, communication technology, and general adult speech therapy questions

Experience

I have conducted multiple research studies in the areas of adult neurogenic disorders, as well as published and presented frequently on these topics. I have experience in multiple therapy environments and I understand insurance reimbursement challenges.

Organizations
American Speech-Language and Hearing Association, American Neurological Communication Sciences and Disorders, Adult Neurologic Disorders, ASHA Special Interest Division on Neurophysiology and Neurogenic Speech and Language Disorders

Publications
Journal of Neurolinguistics, Brain and Language, Medical Speech-Language Pathology: A Practitioner's Guide, Therapy Times newsletter, MS Focus Magazine, StrokeSmart magazine

Education/Credentials
I have a Ph.D. in Speech-Language pathology.

Awards and Honors
September 2010 received Top Ten Blog April 2008 served on committee for paper acceptance for Language Disorders in Adults for the American Speech-Language Hearing Association. December 2006 recipient of $200 Publication for Doctoral Student and Faculty Mentor Award from the University of South Floridaís College of Arts and Sciences. January 2006 to July 2006, recipient of $25,000 Pre-Doctoral Associated Health Rehabilitation Research Fellowship at the Bay Pines Veteranís Healthcare Administration in Bay Pines, Florida. October 2005 recipient of $350 research travel award from the University of South Florida to present research at the Academy of Aphasia conference in Amsterdam.May 2003 recipient of $1500 travel award from the National Institute on Deafness and Other Communication Disorders to attend Clinical Aphasiology Conference, May 2003, in Orcas Island, WA. November 2003. Recipient of University of South Florida research travel award, $300, to present research at the American Speech-Language & Hearing Association conference in Chicago, IL. January 2001 and 2002 Recipient of a Sertoma scholarship for graduate speech-language pathology students August 2000 and 2001 Recipient of AMBUCS Scholarships for Therapists awards

Past/Present Clients
Due to privacy laws, I cannot reveal client names. There are, however, some testimonials on our website at www.stepstherapy.net

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