Wednesday, August 29, 2007

Sen. Tim Johnson second chance at life and work

Sen. Tim Johnson's Second Chance at Life and Work
Bob Woodruff Follows the Remarkable Recovery and Return of the South Dakota Senator
Senator Tim Johnson, who returned to South Dakota today for the first time since suffering a brain hemorrhage last December, says he plans to run for re-election in 2008. "I expect to run and to win," he said. (Office of Senator Tim Johnson)
From Nightline

Sen. Tim Johnson, D-S.D., addressed a crowd today in Sioux Falls, S.D., "Wow. You guys are a sight for sore eyes. It's good to be home."
It's been a long road home for the senator in the eight months since the brain hemorrhage that nearly killed him in December. In that time he's had to learn to walk again and to cope with speech slowed by aphasia.
Related Stories

"I am back and I promise you all that I will work harder than ever for you and for our state," Johnson said.
One thing Johnson, who will return to the Senate on Sept. 5, hasn't lost is his sense of humor.
"I will promise you that when my speech is back to normal, I will not act like a typical politician and overuse the gift."
"Of course, I believe I have an unfair edge over most of my colleagues right now — my mind works faster than my mouth does," he said. "I'm hoping that folks will focus more on my work than how quickly I walk these days."
Johnson has always been a straightforward, moderate Democrat from a mostly Republican state. He is a man so respected by his colleagues that they made him chairman of the Senate Ethics Committee. He is also the only senator with a son who has served in Afghanistan and Iraq.
When Johnson fell ill with what appeared to be a stroke, the outpouring of concern from both sides of the aisle was heartfelt and genuine.
White House Press Secretary Tony Snow told reporters, "This is a time to pray for Tim Johnson's health, and I'll leave it to others to start doing political calculations."
Dec. 13, 2006
Shortly before noon on Dec. 13, 2006, Johnson was conducting a telephone news conference when his words began to falter.
"I looked at him and kind of gave him a sign like wrap it up. And he said, 'Frustrating.' He said frustrating, I think two times," Johnson's communications director Julianne Fisher said. "And I turned and looked at his scheduler and pulled her aside and said, 'I think he's having a stroke.' … By 12:15 he was probably in the ambulance and gone."
Johnson only recalls part of that day.
"I remember that time, and all the way to the emergency room— ambulance ride, the emergency room. And then I become vaguer. I don't remember anymore," he said.
Johnson was unaware that the scene outside George Washington Hospital quickly became a media circus, much to the dismay of his worried family and staff inside.

Monday, August 27, 2007

Joseph Chaikin

Joseph Chaikin (September 16, 1935June 22, 2003) was an American theatre director, teacher and playwright. He suffered from heart complications as a child, and was sent to a children's hospital in Florida the age of five. It was during this period of isolation that he began to experiment in the theatre.

He briefly attended Drake University in Iowa, and then went on to work with The Living Theatre before founding The Open Theater an experimental theatre co-operative that progressed from being a closed laboratory to performing devised work to an audience. In 1970 they performed Endgame by Samuel Beckett, with Chaikin playing the role of Hamm, at the Grasslands Penitentiary, a fulfillment of his desire to experiment with audiences who would be fundamentally different to the ones they were playing for. In 1970- 71 they performed Terminal by Susan Yankovitz in many maximum and minimum security prisons on the East Coast of the USA and Canada. The Open Theater ran for about ten years. Chaikin wound the company up to avoid its institutionalising, since it achieved critical success, something which he spurned saying, "I have rarely known a case where a critic's response to actors, directors or writers has expanded or encouraged their talent- I have known cases where by panning or praising, the critic has crushed or discouraged creative inspiration".

He then formed a company called The Winter Project, whose members included Ronnie Gilbert and Will Patton. Chaikin had a close working relationship with Sam Shepard and together they wrote the plays Tongues and Savage/Love, both of which premiered at San Francisco's Magic Theatre. They were commissioned to write When The World Was Green for the 1996 Olympics in Atlanta, Georgia. Beyond performing in his plays, Chaikin was an expert on Samuel Beckett, directing a number of his plays including Endgame at the Manhattan Theatre Club. Beckett wrote a poem for Chaikin entitled What Is the Word?. He received six Obie Awards, including one for Lifetime Achievement, and two Guggenheim Fellowships.

In 1984, a stroke suffered during open-heart surgery left Chaikin with partial aphasia. Despite this barrier to communication, Chaikin continued to direct and to create plays collaboratively with other writers, including John Belluso, whose disability-themed plays were produced at the Mark Taper Forum, Trinity Rep, Pacific Repertory Theatre and the New York Shakespeare Festival. Chaikin was also a lifelong teacher of acting and directing, and lived in New York's West Village until his death.

In 1972 his book, "The Presence of The Actor" was first published with a second edition in 1991 published by Theatre Communications Group. It includes exemplar notes, photographs and exercises from several Open Theatre productions as well as presenting Chaikin's philosophy on how theatre can bring about social transformation.

Chaikin was born and died in New York City. His son, Mauricio, now resides in Deer Park, New York.

Tuesday, August 21, 2007

Language Evolution’s Slippery Tropes

This view now faces many rivals. The big-bang theory has been countered by linguists who believe that just as the eye evolved to meet a need for vision, language evolved to meet the need for communication. Ms. Kenneally ushers onto the stage researchers who have discovered that many animal species possess languagelike skills previously unimagined and, without benefit of syntax or words, have a complicated inner life. They believe that the study of animal language and gestures could shed light on a possible protolanguage stage in human development.

The idea that language is restricted to a specific area of the brain has been more or less discarded. Brain researchers now believe that language tasks are assigned throughout the brain. Moreover, some linguists now believe that language is a two-way street. It’s not something emanating from the brain of a communicating human. It actually changes the processes of the brain. Stroke victims suffering from aphasia, a condition involving language loss, do not simply find it difficult to communicate, they also find it more difficult to categorize, remember and organize information.


Dr. Ronald Cohn/Gorilla Foundation/PBS

Koko, a gorilla with a vocabulary.

Assessment Aphasia

Book Description:
Spreen and Risser present a comprehensive, critical review of available methods for the assessment of aphasia and related disorders in adults and children. The authors explore test instruments and approaches that have been used traditionally for the diagnosis of aphasia, ranging from bedside screening and ratings, to tests of specific aspects of language, and to comprehensive and psychometrically standardized aphasia batteries. Coverage of other methods reflects newer trends, including the areas of functional communication, testing of bilingual patients, psycholinguistic approaches, and pragmatic and discourse-related aspects of language in everyday life. The authors also examine the expansion of language assessment to individuals with non-aphasic neurological disorders, such as patients with traumatic brain injury, lesions of the right hemisphere, the healthy elderly, and invidulas with dimentia. Taking a flexible and empirical approach to the assessment process in their own clinical practice, Spreen and Risser review numerous test instruments and their source for professionals and students-in-training to choose from in their own use. The introductory chapters cover the history of aphasia assessment, a basic outline of subtypes of aphasia- both neuro-anatomically and psycholinguistically-, and the basic psychometric requirements for assessment instruments. The final part discusses issues in general clinical pracitce, specifically questions of test selection and interpretation.L The book is a thorough and practical resource for speech and language pathologists, neuropsychologists, and their students and trainees.

A Novelist in Shadowland

I knew that the left hemisphere processes positive feelings, the right negative ones; unopposed, the remaining right hemisphere could spark dark angry emotions for the rest of his life.

"Mem, Mem, Mem.

" After a stroke, a prolific novelist struggles to say how the mental world of aphasia looks and feels. [Via ectoplasmosis.]

Exactly the same thing happened to me. Apart from the bit about being a famous writer & poet.

This is a great link, and very sad. My great-grandmother had aphasia after several strokes and it was so hard to see her frustration when she struggled to say something and could only produce random syllables.

velvetrabbit's link about Edwyn Collins from earlier this week is interesting in this context.

Great link and inspiring story.

He sounds like someone interesting to talk to, and the process of his writing while coping with aphasia is compelling, but I just couldn't get into his new writing.

All of his writing can be fairly opaque.

What an absolutely riveting read!

I'm also reminded of my grandmother - she was in and out of it at the end. In one of her lucid moments she found out that my no-good cousin was in jail and insisted on dictating a letter to him. It read much like West's aphasic memoir.

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Aphasic memoirs

'Mem, Mem, Mem' -- After a stroke, a prolific novelist struggles to say how the mental world of aphasia looks and feels, by Paul West; introduced by Diane Ackerman. American Scholar, Summer 2007.

from the introduction: "'You know, dear,' I said to him one day, about two months after the stroke, when he was feeling mighty low, 'maybe you want to write the first aphasic memoir.' He smiled broadly, said, 'Good idea! Mem, mem, mem.' And so he began dictating, sometimes with mountain-moving effort, and at others sailing along at a good clip, an account of what he’d just gone through, what the mental world of aphasia felt and looked like. Writing the book was the best speech therapy anyone could have prescribed. For three exhausting hours each day, he forced his brain to recruit cells, build new connections, find the right sounds to go with words, and piece together whole sentences. Going over the text the next day helped refine his thoughts and showed him some of aphasia’s fingerprints in the prose." [More] (via Arts & Letters Daily)

(Post a new comment)

2007-08-18 03:09 pm UTC (link)
That's a fascinating piece, and I find it ultimately very encouraging. I hope one doesn't have to be a novelist to work through aphasia! I think there may be hope for those of us who talk and blog almost incessantly (like me!).

(Reply to this)

Wednesday, August 1, 2007

ravel and the third stream cont.

We know now that Ravel first began to show signs of neurological problems in 1927, and over the next several years, he experienced progressive muscle problems and aphasia, or the inability to speak. Neuroscientist Daniel J. Levitin has written that Ravel suffered brain damage that impaired his ability to hear pitch*. He began to show signs of dementia, worsened by a car crash he suffered in 1932. Over the next few years, he became unable to understand the written word, and he lost all ability to communicate through speech or writing. Finally, after an unsuccessful brain operation, he died in Paris on December 28, 1937, one week prior to my six-month birthday.

*Interested in the neurological and psychological aspects of music and composers? Check out This is your Brain on Music: The Science of a Human Obsession by Daniel J. Levitin.

thoughts about tiantan puhua

alright, now that i have a good internet connection outside the hospital, i can give you all my thoughts on my stay at the hospital.

first of all, it was difficult communicating with the nurses because many of them do not speak english. it was difficult talking with them at first. some of the nurses in the south ward speak a bit of english (like ally who’s no longer working there and jingjing who replaced her) but MOST of them do not. unfortunately my chinese isn’t good enough to really talk with them, so oftentimes, no communication went on…but i do miss seeing the nurses. many of them were very attentive and i can tell you that there were a few gifted in searching out my small, non-existent veins for my IVs. irene and shirley were very good! i miss them dropping off my 9am, 12, 4, and 8pm medicines, telling me, “9-clock…12-clock, 4-clock, 8-clock.” i miss them. hahah
second, i was lucky considering that many other patients had all sorts of problems. for example, some people had diarrhea and others had bacteria infection in their brains due to their brain surgeries. it’s funny that as soon as i check out of tiantan puhua, i get sick. i had a fever of 37.8 C and it lasted for 3 days. i got home on saturday and i started feeling sick the next wednesday. luckily by friday, my fever had lowered and by saturday, i was fine! whew!
third, let me tell you, don’t have high expectations for therapy at this hospital. for me, the most important therapies were speech and physiotherapy. i did NOT have a real speech therapist until basically a month after i checked in! i had lily for a little while who was such a great speech therapist! but turns out that her boss zhou comes into my room during our therapy session, starts yelling at her in chinese for a while, and then leaves. poor lily was crying and i asked her what was wrong. it basically was about how she spent too much time on this one patient during february and march because they did not have a lot of patients then. i’ve heard different stories since, but nonetheless, zhou is a poor manager which is why she is no longer the therapy manager. mark became the manager a few days before i checked out of the hospital.
granted, they understand they do need to work hard at improving the therapies, but i was disappointed because the most important part of getting stem cells is also working them so they know what their new role’s/job’s supposed to be! dr. wang and dr. wu, the” directors” of my case constantly stated this: stem cells plus therapy produces the best results!! well, obviously i got 4 stem cell injections as i’ve said on this blog, but therapy? quite lacking. so you know what? i was in the hospital for a total of 66 days and i had 19 days of speech therapy sessions. yes, that’s right. ONLY 19. that’s all. so yes, the hospital knows their therapy is lacking and they told hubby and me that they are working hard to improve them.

also i wrote many patients who had been treated at tiantan puhua and nanshan stem cells therapy hospitals to get an overall view of the treatments/therapies. i found that at nanshan, they have the vocastim collar which actually would’ve been EXCELLENT in my healing process, especially because it helps people with ataxia, dysphasia, and dysarthia problems. i have all 3 of those!!! it’s basically Electric Current Therapy of larynx paresis, aphasia, dysphasia, dysarthria and dysphagia.
i put a picture of christine with the vocastim collar on in a previous blog so you can check it if you want to see it.

you can read about vocastim here:

you can see more here:


not sure you could read that so i copied it here:

Electric Current Therapy of larynx paresis, aphasia, dysphasia, dysarthria and dysphagia
(as published by Johannes Pahn, Martin Ptok, Hans-Joachim Radü, Gabriele Witt in: “Interdisziplinär Jg. 11, August 3, 2003, p. 176 – 178)
electrotherapy, larynx pareses, aphasia, dysphasia, dysarthria, dysphagia
In Germany, about 100.000 goiter surgeries are carried out annually. It is assumed that 1,000 - 3,000 patients are suffering from larynx paresis as a consequence, with unreported numbers probably ranging much higher. As registration is not compulsory, an additional number of larynx pareses caused by surgeries of head, cervical spine and throat with different indication can be assumed. Additionally, it is estimated that cerebral damage triggers another 10,000 – 20,000 cases of vocal and speech deficiency or loss. This is caused by cerebral insults or infarcts, aneurysms, tumors, meningitis, encephalitis, neuritis and generalized affections of the nervous system. In Germany, it is estimated that about 100 people suffer severe skull-brain-trauma caused by accidents in a day. Reporting such cases is also not obligatory. The total number of patients suffering from respiratory and phonatory damage triggered by pareses of cerebral nerves is thus an estimated 20,000, at the least, with a large portion suffering from dysphagy as well. This figure, however, comprises only the newly affected patients per year.
The medical and neurological acute care and subsequent attendance of a rehabilitation clinic is followed by so-called practicing exercises. This is what ambulant therapy of vocal, phonatory and swallowing dysfunctions concentrates on. A sensible selection of exercises is promoted by diverse tests as well as diagnostic measures.
The combination of practicing exercises and electric current, however, is used to a very small degree, although electrotherapy is extensively applied in the fields of orthopaedy and physiotherapy in the context of motoric damages with identical etiology (Edel, 1983). Such treatment has proven to be extremely successful in these fields.
What are the reasons for neglecting electrotherapeutical treatment of vocal and phonatory irritations including swallowing dysfunctions triggered by pareses of cerebral nerves?
First, we may assume that patients without proper experience are somewhat reluctant to handle a stimulation current unit. This obstacle however, could be eliminated by special education in the course of the training. This is hardly advisable for physiotherapists, as training for vocal and phonatory treatment would be much more of an effort than for the vocal and speech therapist to read the user instructions of the stimulation current unit.
Other reasons for reluctance have to be considered:
Several expert fields cover the diagnosis and therapy of diseases of the cerebral nerves V, VII, IX, X and XI. Both interdisciplinary contact and knowledge are presumably not sufficient to cross the border to close cooperation. Due to this, problems in competence, terminology, the interpretation of diagnostic procedures and different therapy conceptions are likely to occur.
Obviously, distinctions of the pareses of the cerebral nerves have to become more sophisticated. In most cases, the knowledge on nervus vagus impairments is very much restricted on the recurrent nerve paresis. The diagnosis for any damage to all nerves connected with swallowing and articulation is most frequently sensoric and motoric aphasia and dysarthria. The subtle motoric movements are full of antagonisms however, which can
only be avoided by synchronizing the electric current impulse with one single and separate performance intended by the patient in each case. Simultaneous stimulation of both agonist and antagonist will block any form of regeneration. This principle also applies for the skeleton muscles. The size of the individual muscles, however, already facilitates the isolated stimulation of the agonist. When dealing with phonatory, articulatory, resonance forming and swallowing subfunctions of a muscular system commonly used, you fall into the trap of antagonism quite easily. The success of muscle training depends on the small border between too much and too little demand. Crossing this border is dangerous in both directions. Sports trainers create fine-tuned individual training schedules to avoid making mistakes. This principle has an even higher significance for pareses and the effects on muscles as well as possibly the impaired regulation of the function.
This concerns:
1. The frequency of the stimulation. It must be applied several times a day.
2. Pauses for the affected system to recover between each phonation or articulation as well as between the daily applications.
3. Adaptation of the requirements to the performance to the state of regeneration
4. Adaptation of the stimulation current properties to the reacting capabilities of the neuromuscular units. They continually change in the course of the regeneration. The actual state can be determined by electrical measurement of the accommodation and a subtle vocal status. In case of pareses with difficulties in breathing, spirometry with differentiation of the expiratory and inspiratory dyspnea must also be included.
Conditional reflexes only function in case of undamaged reflex arcs. This includes sensor afference, center, efference and motor. Speech requires a multitude of conditional reflexes, which form automatisms, combined to dynamic stereotypes. No damage to a peripheral neuron only concerns efferent nerve fibers. It always also affects the afferent fibers morphologically positioned in the same nerve with the efferent fibers. The lack of a sensorial information of the center in the medulla oblongata and in the cerebrum blocks any motorial reaction. This means that the motors are not regenerated without regeneration of the sensors, which gives the stimulation of the sensors the same significance as that of the motors. A normal regulation depends on deep and superficial sensitivity. The sensors of the surface are positioned in the mucous membrane. Every acute or chronic inflammation of the mucous membrane not only damages its power of resistance, but also its embedded sensors. However, it is required that the sensors function to make electrostimulation successful. An acute inflammation is found to be painful. A slowly developing chronic inflammation, in contrast, is hardly recognized, or only as globus sensation. The causes for chronic inflammations are nicotine, alcohol, allergies and, above all, reflux. In most cases of chronic pharyngo-laryngo-tracheo-bronchitis caused by reflux, symptoms such as heartburn or pain are missing. Consequently the reason for starting a therapy is missing.
Every patient with dysphagia, bilateral laryngeal paresis and frequently only unilateral paresis suffers from chronic inflammation of the mucous membrane through reflux. The inflammation is significantly more serious as the one frequently found among all people. The reason, for central etyology via the cerebral nerves IX and X, is believed to be damage of the plexus pharyngicus, which innervates the sphincter pharyngis inferior in the esophagus entrance in addition to its function for articulation, resonance formation and swallowing. In case of central and peripheral lesions, impairments of ventilation, arytenoid movement to open the lower hypopharynx and sensor failure must also be taken into account. The success of an electrostimulation therefore strongly depends on a successful reflux therapy, among other things.
Very frequently, any therapy is postponed in expectation of a spontaneous remission. However, it cannot be predicted. At least, it is frequently expected after goiter surgery.
This problem lies in the interval between damage and remission. If it takes commences too late, fibrosis of the joint capsule of the arytenoid has already started. This means ankylosis, which in case of a bilateral paresis can lead to tracheotomy and lateral fixation of a vocal chord.
But even a unilateral paresis with a milder dyspnea frequently impairs physical stress and the vocal functions. Exercises don’t help much in these cases. Electrostimulation is not taken into consideration, because it is known not to be very helpful with the modalities of the application used until now. Prerequisite to an effective stimulation of the stiffened arytenoids is a manipulative relaxation of the capsular fibrosis in combination with several applications of stimulation a day. A suitable manipulator is manufactured by Storz. The goal of every therapeutical measure is facilitated by exact knowledge of the pattern of paresis. Neither central nor peripheral pareses affect the nerves in question in the same way with respect to distribution and seriousness of the damage. Even a recurrent paresis may have a quite diverse pattern. Precise information connects electromyography with speech and vocal status. The muscles used for articulation can be easily measured electromyographically using superficial electrodes. The muscles of the larynx, however, can only be measured adequately using puncturing electrodes and exercise. The procedure depends on the availability of equipment and required expertise. The problem is situated within the competence of three fields, phoniatry, neurology and logopedics. But it could be solved by special training for interested specialists.
Therapy results
The diagnosis and therapy for pareses of the voice and the articulation performed at the university clinic for otorhinolaryngology currently has experience with more than 1,000 patients. In most cases, these are referred patients with long intervals with damage of up to six years. Even in cases of bilateral recurrent pareses that have existed for several years, decannulation can be achieved in approx. 50% of all cases. Between 1992 and 1998, the tracheal cannula could be removed in six out of eleven cases. This number is limited by neurological and medical diseases, threat of relapses and old age. In cases of a short interval after the damage has taken place, we estimate that regeneration is reached in 80% of all cases. Remission takes places sooner and faster than we would expect without stimulation current. In total, partial or complete regeneration in cases of delayed treatment can be achieved in 62% of all cases.
Dysphagia existing for several years respond astonishingly well to stimulation current. The remission of every aphasia, dysphasia and dysarthria is accelerated considerably in combination with standard therapeutic measures, which do not lose their significance at all. The results are confirmed in Bochum (Radü), Hannover (Ptok) and Brügge (van Gompel).
Based on the results and practical experience, the stimulation current device VOCASTIM was developed by Physiomed. In combination with 4 CDs, it features an extremely safe standardized procedure of electrophonatory and articulatory stimulation (NMEPS/NMEAS Pahn, 2002).
The device is manufactured in two versions. The master version for therapists features excitability measurement, programming a chipcard with the respective stimulation current properties and control of the therapy time already used. The more basic version was developed for the execises carried out by the patient at home. The chipcard prevents from any wrong operation.
Still, it is required that the patients see their phoniatrist/speech therapist regularly to check the progress and adapt the stimulation current properties as well as the vocal/speech performances to the state of the regeneration. Exercises besides electrostimulation are also necessary.
Even if the number of laryngeal pareses after goiter surgery slowly decreases through neuromonitoring recently applied (Neumann, 200), the total number of all pareses with a
vocal/speech background is not likely to change in the near future. Traffic accidents alone cause a large number. It should be rewarding to do away with prejudices against electrotherapy and again start using this therapeutic method almost forgotten since Gutzmann in phoniatry and speech therapy. (Kruse, 1989). The results when expertly applied speak for themselves.

ok i could go on and on about how much that vocastim collar could’ve helped me improve. unfortunately i didn’t push them enough to get it. i bugged them about 3 weeks before i checked out of the hospital which was plenty of time to get it but the higher-ups didn’t want to spend the money to get it since it is very expensive. sigh, so that’s very disappointing for me.

luckily hubby told kotan before i checked out of the hospital that they should’ve charged the first few people who need to use it a bit more for their therapy so then actually, the collar would’ve been paid for in absolutely no time! i think he said why not charge the first 5 people an extra $500 so after 5 people use it, it’s all paid for!!! sigh. it’s just disappointing that the one thing that would’ve added so much benefit to my therapy sessions wasn’t bought when i was there.
but the good news for me is that my tongue has fattened out and it actually can move a bit to the right, the first time that has happened since i was misdiagnosed in tokyo, japan in june 2003!!! that was 4 years ago and from the stem cells and therapy i’m doing on my own, my tongue now is looking more normal and actually moving to the right!! YEA!!!

Old brains, new ideas

Category: History of neuroscienceNeuroscience

Posted on: July 16, 2007 9:22 PM, by Mo

The French anatomist, anthropologist, and surgeon Pierre Paul Broca (1824-1880, left) is best remembered for his descriptions of two patients who had lost the ability to speak after sustaining damage to the left frontal lobe of the brain. Broca's observations of these patients, and the conclusions he reached after his post-mortem examinations, would lead to major advances in the understanding of the brain, and laid the foundations for modern neuropsychology.

In 1859, Broca founded the Societe d'Anthropologie de Paris. Two years later, several heated debates had arisen there: one was about the relationship between brain size, race and intelligence, and the other about the localization of cerebral function. In the latter, one of the main proponents of the localization theory was Franz Joseph Gall (1758-1828), the founder of phrenology. Gall and others believed that the faculty of articulate speech resided in the anterior lobes of the brain, but most members of the scientific community were cautious; some argued that Phineas Gage provided strong evidence against the theory that speech was localized to the anterior lobes. Gage, a railroad worker, had suffered severe frontal lobe damage in 1848 when a tamping iron was propelled through his skull, but had retained his ability to speak after the injury.