A New Approach to Treating African Americans with Aphasia

Three minute thesis from an advocate for African American stroke patients.

On December 16, 2012 Binti Lee was taken into Houston Methodist Hospital after she had collapsed in her home. She had lost the ability to speak and use the right side of her body. The doctors, believing she was having a mental breakdown, prescribed her an anti-depressant, and discharged her. 36 hours later, she was informed that she had had a stroke, but was denied the care she needed to properly recover for one simple reason: she was an African American woman.

This is a reality faced by many African Americans. They are 50% more likely to have a stroke and 3 to 4 times more likely to die from it. African American men and woman are often muted when attempting to voice their healthcare concerns. Now imagine how Binti felt physically being incapable of communicating that she was suffering. This is also the reality for the one million people with a diagnosis of aphasia. Aphasia is an acquired loss of ability to understand language, reading, writing and producing speech fluently after a brain injury or stroke.

People with aphasia tend to have difficulty in reading, writing, understanding language, and producing speech fluently. On aphasia tests, African Americans consistently score lower on producing fluent speech than their White Counterparts. The majority of African Americans speak an ethnic dialect known as African American English in their homes, while a majority of Americans speak a general American English dialect —the dialect you see on television or read in textbooks. African Americans often have to negotiate between these two dialects.

Have you ever been out with your friends and your boss calls? You automatically turn on your professional voice.  This is called code-switching. African Americans frequently have to code-switch, often subconsciously, to General American English dialect in school and professional settings. But what if when you have a stroke, code-switching is not so automatic?

What if this is the reason African Americans are scoring lower on fluency tests? Speech language pathologists treat individuals with aphasia but only 3% of said speech language pathologists are black and likely to use the dialect.

Research has shown that African Americans with severe aphasia who use more features of African American English produce more speech. My research aims to answer these questions. Are we making it harder by using a different dialect than the one with which a person is most comfortable?  And maybe we could make it easier if we encouraged AAE dialect? I believe that there is a direct correlation in the amount of speech you produce based on your natural American dialect.

My study involved prompting a 44 year old African American male with aphasia who self-reported speaking in a general American English dialect and an African American English. I collected 4 language samples. Two personal stories (one where the examiner prompted him in AAE, and one where the examiner prompted him in GAE) and a story retell task (one where the examiner prompted him in AAE, and one where the examiner prompted him in GAE). The samples were compared for conditions (AAE and GAE) and sample type (formal language samples and the personal story). The samples were compared for the quantity (amount of words, amount of different words, the mean length of each utterance, and repetitions) and quality (the cohesion of the narrative and how well the narrative was put together).

The results indicated there were no different in the quantity of verbal output but a difference in the quality of the verbal output. The participant produced a more cohesive narrative when being spoken to in AAE, as opposed to GAE. This could be due to the control process model. The control process model states when someone is bidialectal when they are speaking they activate two “codes” (AAE and GAE) depending on the speaker one code is chosen, and the other code has to be inhibited. It is possible after stroke or brain injury it becomes more difficult to activate and inhibit selected codes? More research is needed to completely clarify this answer, this study was conducted as a pilot study

Imagine if Binti Lee had an advocate there who could communicate in her dialect and voice her experiences. 2020 has a brought a lot racial inequality to America’s forefront and health concerns should not be left out of the conversation. My goal is to turn those conversations into research that supports and enhances the African American community.