Fetterman’s use of captions common in stroke recovery, neurologists say

In his first on-camera interview since his stroke, Democratic Senate candidate John Fetterman stumbled over words and used closed captioning to read interview questions, prompting Republicans to raise concerns. new questions about his health.

Disability advocates, however, say the response shows a lack of understanding of the accommodations that are often made after a major health event such as a stroke.

“I sometimes hear things in a way that’s not perfectly clear,” Fetterman told NBC News, in an interview Friday, which aired Tuesday. “So I use captioning, so I can see what you’re saying on captioning.”

While neurological experts said they couldn’t offer a specific diagnosis about Fetterman’s health, they did note that closed captions are a common tool for people with auditory processing or hearing issues, conditions that have nothing to do with global intelligence.

“It’s not about intelligence, it’s not about cognition, but unfortunately how we get in and out of information tends to impact how people perceive it,” said Brooke Hatfield, associate director of the American Speech-Language-Hearing Association. .

Fetterman’s health has become a major issue in the tight Pennsylvania race against GOP nominee Mehmet Oz. Republicans attempted to use the interview to discredit Fetterman’s cognitive abilities.

The Republican National Senate Committee tweeted that Fetterman was not “transparentabout his health. The Senate Republican Report tweeted which NBC reported that it was difficult to speak with Fetterman without captioning.

Sound processing issues can occur for a number of reasons. Hearing is a particularly unique sense because, unlike sight or smell, sound is processed before it even reaches the brain. There are a number of areas where understanding can be impaired even if someone doesn’t have hearing loss or intellectual disability, said Borna Bonakdarpour, associate professor of neurology at Northwestern University Feinberg School of Medicine.

Jenna Beacom, 51, a deaf media critic living in Columbus, Ohio, said she was surprised at how well Fetterman was able to follow the interview even though he seemed to rely on automatic captioning or real-time captioning. She sometimes uses this type of captioning, but says it’s often riddled with errors or has significant lags.

“The purely mechanical issue of late captions was played in a way that made Fetterman seem slow to absorb, in an unfair and inaccurate way,” she said.

Beacom said she faced similar criticism when she was slow to respond to someone when they were speaking. “I have all kinds of mechanisms to calm hearing people down because I’m aware of that,” she said.

Fetterman suffered a stroke in May and neuro-audiology experts said they believe he showed signs of a specific type of acquired communication disorder called aphasia, which is caused by damage to the regions of the brain responsible for language. According to the National Aphasia Association, aphasia affects approximately 2 million Americans and is common after a stroke, but can also be the result of head trauma, brain tumor, or infections that damage the brain. brain.

Importantly, aphasia does not affect intelligence, decision-making, planning or other cognitive functions in the brain, experts said. And it can be treated and improved over time with therapy.

Darlene Williamson, President of the National Aphasia Association, believes Fetterman displayed behaviors consistent with aphasia based on his interview with NBC News. She applauded his use of closed captioning and said his use of strategies to help with communication “shows his ability”.

Aphasia can affect a person’s ability to process language visually or aurally, said Pelagie M. Beeson, professor of speech, language and auditory sciences at the University of Arizona.

When people have trouble choosing the right word to say or write, this is a form of expressive aphasia. Fetterman stumbled into the interview saying the word “empathetic,” when he meant “empathetic.” (He corrected himself.) Stumbling over the word could be a sign of minor expressive aphasia, Beeson said.

When people have trouble processing other people’s sound, either translating a sound into a word or connecting a word to its meaning, it’s called receptive aphasia. This is why people may need closed captioning.

“If you say to someone with significant aphasia, ‘Can you give me the pencil?’ They say, ‘a pencil… a pencil… I should know what it is,’ she said. “They heard it and put it together, but they don’t connect the meaning. It is a serious deficiency. He didn’t have that level of impairment.

Beeson said Fetterman can have mild cases of both types of aphasia, but saw no behavior that would lead him to believe that Fetterman struggles with the meaning of words, as he was able to answer questions during the interview appropriately.

A person with a mild auditory processing problem would typically need more time to process sounds and might have trouble following long sentences, fast speakers or lectures, said Sarah Lantz, a speech pathologist at Magee Rehabilitation Hospital, who is part of Jefferson Health. in Philadelphia. A person with more severe auditory processing problems may struggle to understand just one word at a time, she said.

There are exercises people can do with speech pathologists and rehabilitation specialists to help overcome auditory processing issues, Hatfield said.

When a person has problems with auditory processing as a result of a stroke, the usual pathways for linguistic information have been interrupted and signals may have to take a detour. But luckily, there’s a lot of redundancy in the brain, which means healthy parts of the brain can support an injured part of the brain as it heals, she said.

“You always get where you’re going, but it might take you longer to get there,” Hatfield said. “The problem with speech is that people can speak very quickly, so the brain has to process a lot of things at once.”

As people strengthen new connections and pathways in their brains through speech therapy and rehabilitation, they can begin to connect sound to meaning more quickly and understand people better, she said. declared.

Other people talking to a person with auditory processing problems can help improve understanding by adding extra context when they repeat themselves, slowing down when they speak, eliminating background noise, or giving the person visual context clues such as captions.

In stroke recovery, people can expect to see the greatest improvement with symptoms like auditory processing within the first year after stroke, said Swathi Kiran, founding director of the Center for Brain Recovery. from Boston University. After that, people may continue to improve, but the rate of recovery may slow down. In Fetterman’s case, it’s only been about five months since his stroke, so it’s likely he’ll continue to improve with speech understanding, she said.

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