Feltman’s use of subtitles common in stroke recovery, neurologist says

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

However, disability advocates say the response shows a lack of understanding of the adjustments typically made after a major health event such as a stroke.

“I sometimes hear things in a way that’s not very clear,” Feltman told NBC News in a Friday interview that aired Tuesday. “So I use subtitles so I can see what you’re saying on the subtitles.”

While neuroscientists say they can’t provide a specific diagnosis about Feltman’s health, they point out that closed captioning is a common tool for people with auditory processing or hearing problems, which are not related to overall intelligence.

“It’s not a matter of intelligence, it’s not a matter of cognition, but unfortunately, how we input and output information often affects how people perceive it,” said Brooke Hatfield, associate director of the American Speech-Language-Hearing Association. .

Feltman’s health has become a major concern in Pennsylvania’s tight race against Republican candidate Mohamed Oz. Republicans tried to use the interview to discredit Feltman’s cognitive abilities.

The National Republican Senate Committee tweeted that Feltman was not “transparent” about his health. Senate Republicans’ accounts tweet NBC reported that it was difficult to talk to Feltman without closed captioning.

Problems dealing with sound can have several causes. Hearing is a particularly unique sense because, unlike sight or smell, sound is processed before it reaches the brain. Borna Bonakdarpour, an associate professor of neurology at Northwestern University Feinberg School of Medicine, said there are many areas in which understanding may be impaired even if someone does not have hearing loss or intellectual disability.

Jenna Beacom, a 51-year-old deaf media critic who lives in Columbus, Ohio, said she was surprised by how well the interview was capable, even though Feltman seemed to rely on automated or live captions. She sometimes uses this type of subtitle, but says it’s often riddled with errors or has noticeable lags.

“The purely mechanical issue of lagging subtitles plays out in a way that feels like Feltman’s absorption is slow, which is unfair and inaccurate,” she said.

Beacom said she faced similar criticism when she was slow to respond when others were speaking. “I have all kinds of mechanisms to calm down people who hear it because I know that,” she said.

Feltman suffered a stroke in May, neuroaudiologists say they believe him Showed signs of a specific type of acquired communication disorder called aphasia, which is caused by damage to the area of ​​the brain responsible for language. Aphasia affects about 2 million Americans and is common after stroke, but can also be the result of head trauma, brain tumors or infections that damage the brain, according to the National Aphasia Society.

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

Darlene Williamson, president of the National Aphasia Society, Feltman is believed to have exhibited behavior consistent with aphasia in an interview with NBC News. She praised his use of closed captioning and said his use of strategies to help communicate “demonstrates his ability”.

Pélagie M. Beeson, a professor of speech, language and hearing sciences at the University of Arizona, said aphasia can affect someone’s ability to visually or auditorily process language.

It is a form of expressive aphasia when people have problems choosing the right words to speak or write. Feltman inadvertently uttered the word “emethic” during the interview, when he meant “empathetic.” (He corrected himself.) Stumbling over the word could be a sign of mild expressive aphasia, Beeson said.

When people have problems processing sounds from others, either translating the sounds into words, or associating words with their meanings, it’s called receptive aphasia. This is why people may need closed captions.

“If you say to someone with severe aphasia, ‘Can you give me a pencil?’ they say, ‘Pencil…pencil…I should know what that is,'” she said. together, but they don’t connect the meaning. That’s a serious injury. He didn’t have that level of damage. “

Feltman may have had two mild cases of aphasia, Beeson said, But seeing no behavior would convince her that Feltman was struggling to understand the meaning of words because he was able to answer questions in an appropriate way during the interview.

People with mild auditory processing problems often need more time to process sounds and may have trouble keeping up with long sentences, fast speech or lectures, said Sarah Lantz, a speech-language pathologist at Magee Rehabilitation Hospital, part of Jefferson Health. in Philadelphia. A person with more severe auditory processing problems may struggle to understand one word at a time, she said.

Hatfield says there are exercises that people can do with speech therapists and rehabilitation specialists to help overcome auditory processing problems.

When someone has auditory processing problems due to a stroke, the usual path of verbal information has been disrupted and the signal may need to take a detour. But luckily, there’s a lot of redundancy in the brain, which means the healthy part of the brain can support the injured part as it heals, she said.

“You can still get where you’re going, but it may take longer to get there,” Hatfield said. “The problem with speaking is that people speak very fast, so the brain has to do a lot of things at the same time.”

If people strengthen new connections and pathways in the brain through speech therapy and rehabilitation, they can begin to associate sounds with meaning faster and understand people better, she said.

Others who talk to people with auditory processing problems can help improve understanding by adding extra context when they repeat themselves, slowing down when they speak, removing background noise, or providing people with visual contextual cues such as subtitles.

When it comes to stroke recovery, one can expect to see the greatest improvement in symptoms such as auditory processing within the first year after a stroke, said Swathi Kiran, founding director of the Boston University Center for Brain Recovery. After that, people can continue to improve, but recovery may be slower. In Feltman’s case, she said, he was only about five months after his stroke, so it’s likely he’ll continue to get better at understanding speech.

Sign up for the Well+Being newsletter to get expert advice and simple tips to help you live your day

Source link