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Aphasia Recovery: Motivation and The Little Engine That Could (6-1-2021)
Dear AHA Friends and Colleagues,
I had a stroke and aphasia on September 26, 2011. I was an associate dean at The Heller School at Brandeis University when I fell down on Main Street, Waltham, MA. I lost my language and could not read, write or speak well. I started speech therapy in October 2011, and that was the beginning of seven months of formal therapy with one therapist plus an aphasia group at Boston University. At the start, people with aphasia (PWA) have a hard time talking with anyone never mind their family and friends. We can see the damage of our language and are just too scared to talk about it out loud and hear how bad it might sound.
It was years later when I learned about something called “learned non-use,” when PWA avoid verbal communication and “retreats from social interaction” as a result of a stroke (Pulvermuller, 2008). The behavior of learned non-use in language is linked at the cellular level as well; the less stimulus on the outside, the less activity, plasticity & learning on the inside. It turns out that socialization is a highly therapeutic factor in helping avoid behavior such as learned non-use in language. Of course, I didn’t know any of that at the time even though I had been applying it (as many people with aphasia do) as a matter of course.
Thanksgiving that year was the first time I had seen my extended family since my stroke. It was also their first time seeing me with a stroke and this thing called aphasia. No one knew anything about it other than our daughter who was a neuroscience major in college. Our family has had Thanksgiving dinner together for over 35 years and I was quite nervous to see everyone. I didn’t talk much and I don’t remember much about it either!
It was over nine years since then and we have moved back to Maine from St. Augustine, FL. While unpacking, I found this little book, The Little Engine That Could. It is a famous folktale to teach children the value of optimism, hard work, and motivation. In the tale, a long train is being pulled over a big mountain until its engine broke down. Other engines were asked to pull the train but for various reasons they refused. But a small engine agreed to try. The engine succeeded repeating its motto: "I-think-I-can, I-think-I-can" and then on the other side of the mountain saying, "I thought I could, I thought I could."
The brain, not unlike the little engine, has incredible power even after it has been damaged from a stroke. It has the capacity to rewire the brain and regain its language (depending on severity notwithstanding). Recovering one’s language from a stroke and aphasia can seem like an impossible task. I got (mostly) better but without knowing how it happened. It wasn’t until much later, when I heard about the five rules of aphasia recovery; motivation, and practice, practice, practice, and more practice! In my case, I think my lifelong helpful habits pushed me to do more “I think I can” than “I think I can’t” thinking.
As I read The Little Engine That Could again, I saw an inscription on the inside cover that I hadn’t noticed before. It said, “Thanksgiving 2011, To Uncle Tom, Keep on chugging! Love, Mike Coe.” Mike is my older sister’s older son. He must have given it to me at Thanksgiving at a time when I couldn’t even remember getting it.
It was clearly a message in a bottle that had come full circle. Whether I knew it or not, or whether I read it or not, the message and the motto of The Little Engine That Could urged me to climb my own mountain. It took nothing more than realizing that the little engine had believed that the “I think I can” thought was more than half the battle.
Please see the full article and associated video, https://youtu.be/618Qu6bfUfs
Thanks again and have a great Aphasia Awareness Day!