CAROL KOSCHAK OF PLANO IS A WISPY, brown-haired woman whose face seems frozen in an expression of childlike surprise. This is partly because of her girlish features: wide, animated eyes and an easy smile that allow her to look much younger than her 49 years. But largely it is because most everything Carol has heard and read and said recently has literally come as a surprise.
Carol suffers from aphasia, a disturbance in the ability to comprehend and formulate language that is a result of a massive stroke she suffered two years ago. About 100,000 of the nation’s half a million stroke patients are afflicted with the disorder each year; head trauma causes it in another 200,000. In each case, a disruption of the blood flow to the brain—whether caused by vascular occlusion, hemorrhage, tumor, or intracranial swelling—cripples or kills brain neurons responsible for everything from simple motor tasks to complex cognitive faculties. When the disruption occurs in the left hemisphere of the brain, the locus of language proficiency, the patient’s ability to read, write, and speak is frequently impaired.
The problem is not intellectual: Carol’s thinking and most of her memory are just fine. But the mechanisms that translate her abstract thoughts into concrete verbal expression aren’t functioning normally. So when she attempts to articulate a thought or commit it to paper, it comes out incomplete or off-target; she can’t retrieve the word her thoughts are instructing her to say or she selects the wrong one or she butchers the pronunciation of the right one. And sometimes what she hears or reads, she misinterprets or simply cannot understand at all. “You know what it’s like to have a word on the tip of your tongue, or just when you go blank and can’t remember a place or a name?” asks Delaina Walker-Batson, an aphasia expert on the team treating Carol at the Texas Woman’s University Aphasia Center in Dallas. “That’s what it’s like for an aphasic patient most all the time. The thoughts we automatically render into language get lost in the translation.”
On a Tuesday morning in early December on the TWU campus, Carol seems nervous but eager to show me the progress of her therapy thus far. I first ask her what she felt when she realized the nature of her affliction. Her eyes crease and her lips purse in concentration. “It—was—bad!” she intones haltingly. As our chat continues, her words come laboriously, as if hauled up from a deep quarry by heavy machinery, and many times not at all. She frequently grabs a pencil to scrawl her reply on a sheet of paper, as writing has come back to her more quickly than speaking, and seeing a word on paper can help her say it. When she needs to tell me a number, she uses her fingers. Mostly, though, she communicates with her face, having perfected a vast vocabulary of nods and shakes of the head and cues with her eyes, eyebrows, and the corners of her mouth.
Through it all, that perpetual look of surprise is present: when she uses a word correctly or when the wrong one comes out, when her listeners seem to understand or when they are perplexed by what she has said. It must be terrifying to have such a vital, instinctual faculty suddenly rendered inaccessible from what might be referred to as your brain’s hard disk. And it must be maddening to have retained the acuity of thought to understand the nature of the handicap, yet to be capable of making only plodding progress at regaining skills that were once second nature. “Imagine the blow to your self-esteem,” says Walker-Batson, an intense, voluble woman who heads TWU’s efforts in researching new remedies for aphasia and other post-stroke impairments. “It’s a very isolating disorder. For many years the belief was that there really wasn’t much you could do about it except attempt to reteach the language, as with a child. But now we know different. Most of it’s still in there. It’s getting to it that’s the problem.”
To that end, Walker-Batson says she and her colleagues in TWU’s Department of Communication Sciences and Disorders (in collaboration with the University of Texas Southwestern Medical Center in Dallas and Baylor College of Medicine in Houston) have been conducting a series of experiments aimed at “accessing the brain’s parallel circuitry” for language. The most promising of them—and the first of its kind in the nation—involved dosing post-stroke aphasic patients with dextroamphetamine (similar to the Dexedrine some of us took in college to study all night for exams) during the first few weeks of their physical and speech therapies. Firm conclusions can’t be drawn yet, but initial tests on patients like Carol have suggested that the drug’s excitatory effect on brain neurons, when combined with rigorous therapy, helps restore some basic language skills. “It may not seem like much to the layman,” says Walker-Batson, “but Carol’s increased comprehension and three-word sentences are monumental progress compared with where she came from.”
Indeed, when Carol had her stroke on February 20, 1995, she was at ground zero, Walker-Batson recalls, and it came completely out of the blue: Like many Americans who suffer an attack of this underpublicized killer and disabler—the third leading cause of death in the U.S. and the number one cause of adult disability—Carol had been pronounced healthy during her last physical and felt no symptoms of the impending vascular disruption other than a little queasiness the afternoon before. When her husband, Karl, found her in a lifeless, fetal heap on the bedroom floor that night, the idea that it could be a stroke never entered his mind. “I thought maybe it was some kind of bizarre food poisoning,” he says. The EMS paramedics never mentioned a stroke when they rushed Carol to Columbia Medical City Hospital, and the doctor who first examined her, Karl says, “either didn’t think it was a stroke or wasn’t telling me. They kept saying her vitals were fine,