APHASIA AND SPEECH LANGUAGE DISORDERS – INVESTIGATING THE HIDDEN POWER OF INNER SPEECH

Dr. Turkeltaub and his colleagues conducted a preliminary study of a small sample of patients with promising results: Nearly 80 percent of those surveyed experienced the phenomenon. Also, their reports about inner speech were related to the particular part of the brain affected by the stroke, and even predicted which words they would relearn during speech therapy.

September 9, 2015

Dr. Turkeltaub - Aphasia

WASHINGTON, DC – Sept. 9, 2015 – “On the tip of my tongue” is a much-used phrase—and familiar experience to many. For most of us, this momentary search for a word is a simple annoyance.  For those suffering from aphasia, it’s a frustrating and isolating, everyday reality.

Millions of Americans suffer from aphasia—an acquired impairment of language and communication as a result of stroke or another type of brain injury.  While current therapies can be effective, they have limitations.  So when MedStar NRH Researcher Peter Turkeltaub, MD, PhD, observed a phenomenon while treating patients, he recognized a potential for progress.

“Many people with aphasia describe experiencing inner speech. While searching for a word, they will say it to themselves. They hear the ‘inner speech” in their heads, but can’t say it aloud.  Some patients experience this all of the time—some feel it only occasionally,” says Dr. Turkeltaub, director of the MedStar NRH Aphasia Clinic.

“When we think of aphasia, we think of people struggling, but failing, to find the right word. But those people with inner speech experience something different. They find the word—and go a step further. They hear it spoken in their minds, yet can’t say it aloud,” Dr. Turkeltaub explains.

“The problem may be that the mouth can’t move properly to form the sound.  We want to know why some people experience this phenomena—while others do not.  Ultimately, we want to understand how this might impact future aphasia therapy.” 

NIDCD Grant

Dr. Turkeltaub and his colleagues conducted a preliminary study of a small sample of patients with promising results: Nearly 80 percent of those surveyed experienced the phenomenon. Also, their reports about inner speech were related to the particular part of the brain affected by the stroke, and even predicted which words they would relearn during speech therapy.

Now Dr. Turkeltaub has been awarded a three-year grant from the National Institute on Deafness and Other Communication Disorders (NIDCD) to explore the concept further.*

“Successful inner speech is hard to verify,” Dr. Turkeltaub says.  “It hasn’t been investigated at all in aphasia—except for a study published in 1976 that examined self-reporting of ‘tip-of-the-tongue’ sensations. We hope this new study will build on this and on our own preliminary research,” he adds. 

This new investigation has three key objectives:

  • Understand how common the sense of successful inner speech is among people with aphasia and who is most likely to report it;
  • Examine the relationship between the sense of successful inner speech and the psychological processes of word-finding; and
  • Examine whether brain activity patterns during word-finding reflect the perception of success or failure of inner speech.

Dr. Turkeltaub and his team hope to recruit approximately 50 men and women who have aphasia as a result of a stroke.  Participants will first be surveyed about their inner speech experiences and information will be collected about their diagnoses and the location of their strokes.

A subset of participants will also be asked to participate in a series of tests of inner and out loud word recognition, while undergoing functional MRI. Imaging will examine brain activity when patients are calling these words to mind.

New Therapy Approaches

Investigators hope that results will help to clarify if patients who are more likely to experience inner speech share certain characteristics—information that may help to identify a subset of patients for whom a modification in traditional therapy might enhance recovery. 

“Aphasia is very difficult for patients and the people around them,” says Dr. Turkeltaub.  “We have made progress in therapy in recent years. There are also medications we prescribe that may improve memory and language.  At MedStar NRH, we’re looking at the use of transcranial direct current stimulation to increase recovery for people with aphasia. And we are studying other ways to boost brain plasticity, as well.

“Still, this research could provide us with a new way to guide individualized aphasia therapy, and could fundamentally change the way we understand the experience of having aphasia,” Dr. Turkeltaub adds.

*This is the third grant the lab has received from NIDCD on inner speech in the past year. Two of Dr. Turkeltaub’s graduate students, William Hayward and Mackenzie Famahave, won National Research Service Award training grants from NIDCD to study inner speech in aphasia.

 


 

About MedStar National Rehabilitation Network

The MedStar National Rehabilitation Network (MedStar NRH) is a regional system of rehabilitation care that offers inpatient, day treatment and outpatient services in Washington, D.C., Maryland and Northern Virginia.

The Network’s interdisciplinary team of rehabilitation experts provides comprehensive services to help people recover as fully as possible following illness and injury.  Rehabilitation medicine specialists, psychologists, physical and occupational therapists, and speech-language pathologists work hand-in-hand with other rehab professionals to design treatment plans tailored to each patient’s unique needs.  Rehabilitation plans feature a team approach and include the use of state-of-the-art technology and advanced medical treatment based on the latest rehabilitation research.  

The Network provides comprehensive programs specifically designed to aid in the rehabilitation of adults and children recovering from neurologic and orthopedic conditions such as amputation, arthritis, back and neck pain, brain injury, cancer, cardiac conditions, concussion, fibromyalgia, foot and ankle disorders, hand and upper extremity problems, post-polio syndrome, stroke, spinal cord injury and disease, and sports and work-related injuries.

Inpatient and day treatment programs are provided at MedStar National Rehabilitation Hospital located in Northwest Washington, DC and at more than 40 outpatient sites conveniently located throughout the region.  MedStar NRH is consistently ranked by physicians in U.S. News & World Report as one of America’s “Best Hospitals” for Rehabilitation, and is fully accredited by The Joint Commission,  the Commission on Accreditation of Rehabilitation Facilities (CARF), with CARF accredited specialty programs for Amputations, Brain Injury, Spinal Cord Injury and Stroke.

For more on MedStar NRH and to find a location near you, log on to MedStarNRH.org.