Accommodating the Communication Disability Associated with Aphasia in the Courtroom

Many people in the aphasia community have heard about the case of a Massachusetts woman with aphasia who had to fight a battle to testify in a court case filed against a certified nursing assistant she had accused of assaulting her in her living facility. An earlier posting related to this case can be found at: “National Aphasia Association Update on the Case of Ruby McDonough”.

As stated in the earlier post: “The judge essentially ruled that because the basis for the earlier decision on competency had failed to recognize Ruby’s capacity to testify with accommodations, she had a right to take the stand at trial and utilize all reasonable accommodations to facilitate her communications as a witness against her assailant.”

Last week on March 10th the trial began and concluded the following day. Ms. McDonough was able to testify in the courtroom and pointed out the defendant as the man who had assaulted her. She was asked a number of questions by the attorneys from both sides. The trial was a bench trial which means that the judge and not a jury determined the outcome of the case. After listening to all of the cross-examination of witnesses and the arguments of both sides, the judge found the defendant not guilty.

I was at the trial and in this posting I would like to address some of the issues I see as important to accommodating those with aphasia in a courtroom. I was asked by Marian Ryan to assist in the case by conducting an evaluation of Ms. McDonough and I was also called as a witness to testify about the disability of aphasia itself.Before the trial began, attorneys from both sides asked me questions about aphasia and about what kinds of accommodations I thought might be useful in the case. Just as every case of aphasia is unique, so are the accommodations required unique to each. Unfortunately there is no simple way to provide an aphasia-translator in the courtroom. Some people will need assistance in expressing themselves in the courtroom, some will need assistance in understanding the language used in the courtroom and many PWA will need assistance with both. The first step therefore in each case must be a thorough assessment of the communication abilities of the PWA, so that person-specific accommodations can be determined.

In this case, it was argued to the judge that Ms. McDonough should not be required to answer open-ended questions such as “Where were you living?” but rather she should be given questions requiring only a “yes” or “no” answer.

For a PWA who has relatively intact auditory comprehension, this may be a good solution. However, what should be done for those who have significant problems understanding spoken language? In clinical practice we try to accommodate this disability by using multi-modality input (gesturing, pointing to pictures, writing down key words) to accompany our spoken words. Sometimes we also use extra verbal context to set up a topic, e.g. “Now I will ask you questions about your job? (pause). Did you work in an office?” However, in a courtroom, some of these accommodations may be considered to be “leading the witness” and may not be allowed. Furthermore, some questions just cannot easily be translated into other multi-modality means of expression, without in some way altering the content. This is a dilemma that does not have an easy solution.

Also in clinical practice, when we ask yes/no questions we often ask them in pairs and only when both are correctly answered are we certain that the PWA understood the questions. The reason for this is that people have a 50% chance of responding correctly to a single Yes or No question. In a courtroom should the accommodation allowing yes/no questions also require that they be presented in pairs?

Furthermore, should all of the attorneys have to equally abide by the same accommodations? In the trial last week, this is not what happened. The assistant district attorney used pictures and a series of yes/no questions in her questioning of Ms. McDonough. She stayed away from asking open-ended questions because she knew these would be difficult for her. She also allowed Ms. McDonough to use gestures to express herself.

But when the defense attorney questioned Ms. McDonough he did not use these accommodations and in fact asked her many open-ended questions. When he did ask her yes/no questions he often asked them in such a way as to lead her to give a “Yes” response, by nodding his head in the affirmative and ending his question with “…. yes?” This part of the trial succeeded only in demonstrating to all in the courtroom that, in fact, Ms. McDonough did have aphasia!

Since PWA may produce words in error, what we call paraphasias, it is also important that the court recognize that these errors are not intentionally produced to be misleading, nor should they be over interpreted as intended answers. This became an issue in the trial when earlier testimony was recounted that contained words Ms. McDonough had said in attempting to talk about the person she claimed had assaulted her. Because she was not able to say the name correctly, the defense attorney tried to make it seem she had named someone else. I felt it was likely she had merely made a paraphasic error in saying the name.

For a PWA, a much better way get this information across is to show a set of pictures and have her point to the picture of the person she meant to talk about, rather than requiring her to respond verbally, and, as happened in this case, using her own verbal response against her in subsequent testimony.

While the outcome of this trial was not as she would have hoped, Ms. McDonough was pleased to have the opportunity to present her testimony. There were many other individuals in court, including the judge, who hopefully learned something about aphasia that will benefit the next PWA in the courtroom. It will be a struggle, but one that is certainly worth it, to determine the exact accommodations and make them available in the courtroom for each person with aphasia.

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#104 
Written By viagra on April 9th, 2014 @ 12:48 pm

How long after drinking can I take ativan?

#105 
Written By viagra on April 9th, 2014 @ 6:05 pm

I would question as to why Ativan for anxiety. There are separate drugs for antidepressants and or anxiety. I would talk to your Dr. before making any changes.

#106 
Written By Viagra on April 10th, 2014 @ 2:07 am

How can I make my comments appear on blogger?

#107 
Written By viagra on April 10th, 2014 @ 12:00 pm

Drug Test result will show it up as Opiates. Not all tests would find it, it will depend on the cut-off the drug test they do but still you would show as positive. And unless you have prescription for it, it can be a problem.

#108 
Written By Viagra on April 10th, 2014 @ 3:35 pm

Check out my blog at jessicaflachner.wordpress . com/. I’d really appreciate? your feedback? on my posts!. Thanks!

#109 
Written By Viagra on April 10th, 2014 @ 5:17 pm

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#110 
Written By Viagra on April 10th, 2014 @ 7:01 pm

Can you still earn money from adsense through Bloglovin?

#111 
Written By Buy Cialis on April 11th, 2014 @ 5:18 am

I recently created a cooking blog. I will be adding recipes and other stuff on a regular basis. Do anyone of you have a cooking blog and would like to share your experiences on building readership?. . A link to my blog is included on my profile page.. . Cheers. spoon-and-chopsticks (dot) blogspot (dot) com.

#112 
Written By viagra on April 11th, 2014 @ 2:36 pm

What are some of the best blog sites to use?

#113 
Written By viagra on April 11th, 2014 @ 8:52 pm

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#114 
Written By viagra on April 11th, 2014 @ 9:38 pm

My husband was on Lipitor for a couple years and he had cramping and muscle spasms from the drug. It is listed as a precaution to the medicine.

#115 
Written By Viagra on April 12th, 2014 @ 1:55 am

how long is prescription for alprazolam good for?

#116 
Written By Viagra on April 12th, 2014 @ 6:17 pm

If I eat healthy and do blogilates every day will it help me lose weight and get toned?.

#117 
Written By Viagra on April 13th, 2014 @ 12:26 am

I am an aspiring advice columnist. I am starting a small one for myself using my own personal blog. But I am having trouble with the promoting part of it. Any help would be appreciated..

#118 
Written By Viagra on April 13th, 2014 @ 6:12 am

No, I do not blog or journal, but I disagree with your friend’s idea that personal feelings shouldn’t be expressed. The whole point of a blog or a journal is to express your personal opinion and your feelings to others who will listen and be affected by them. Your feelings involve everything – otherwise you would just be listing off things you have done or seen, and not why they were meaningful. . . Face to face expression of feelings is sometimes better – since you can’t see the other person’s actions through written communication, it’s harder to know what they actually think by looking at their body language. Written communication is much easier to do although, and you’re able to think about what you want to say and how to say it in a (in my case) non-offensive way.

#119 
Written By Viagra on April 14th, 2014 @ 10:54 am

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#120 
Written By Viagra on April 14th, 2014 @ 3:20 pm

Possibly because it was a word invented by the author and thus novel. Possibly quite simply to give it added emphasis ( the usual reason for using italics). A frightening book isn’t it ?

#121 
Written By Viagra on April 14th, 2014 @ 8:48 pm

How much blog traffic will affect to my blog if I convert my blog name with different domain name?

#122 
Written By Viagra on April 14th, 2014 @ 10:45 pm

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#123 
Written By Viagra on April 15th, 2014 @ 6:13 am

It doesn’t work. there are no magic pills to lose weight just old fashioned had work and eating the right foods. Don’t waist your time or money when your going to end up having to start over again eating right and exercising.

#124 
Written By Buy Cialis on April 16th, 2014 @ 2:21 pm

I’m doing a research paper where I have to convince my company that blogging can be beneficial to it.I have to decide a real-life company to “work” for. Which company do you think can actually do good from corporate blogging?.

#125 
Written By Viagra on April 16th, 2014 @ 3:44 pm

How to administer Oxycontin if the patient have difficulty swallowing?

#126 
Written By cialis on April 16th, 2014 @ 8:02 pm

I have a blog on blogger and I want to put an outside banner on my blog but I do not know how to do it, when I choose add the html gadget it does not work, please help..

#127 
Written By viagra on April 17th, 2014 @ 10:29 am

Why would hydrocodone being Schedule III? result in higher prescription rates compared to Schedule II drugs?

#128 
Written By Viagra on April 17th, 2014 @ 8:57 pm

I see a lot of websites offering incredible deals for generic Propecia. Does anyone have any experience ordering this stuff? Are they all scams? Any info would be greatly appreciated. Thanks..

#129 
Written By Viagra on April 18th, 2014 @ 3:52 am

The use of MERIDIA in combination with other CNS-active drugs, particularly serotonergic agents, has not been systematically evaluated. Consequently, caution is advised if the concomitant administration of MERIDIA with other centrally-acting drugs is indicated . . well bupropion is not a seratonergic drug but. it has been shown to indirectly enhance the firing of serotonergic neurons, via activation of downstream norepinephrine flow. . . well seems confusing..ask ur doc……

#130 
Written By cialis on April 18th, 2014 @ 4:14 am

What is the best way to override the effects of Percocet?

#131 
Written By viagra on April 18th, 2014 @ 11:43 am

What kind of things could get you prescribed Valium in Canada?

#132 
Written By Viagra on April 18th, 2014 @ 11:41 pm

Just saw several? FOX NEWS REPORTS on the PERMANENT SIDE-EFFECTS on Propecia !!!

#133 
Written By Viagra on April 19th, 2014 @ 7:30 am

How long do I have to charge a Sony bloggie touch and no when its fully charged?

#134 
Written By viagra on April 19th, 2014 @ 6:13 pm

should I try to come off Klonopin and Epilim and try taking Valium just when I know i’m going into an unfamiliar situation to make me less paranoid and anxious about my dystonia, so I won’t be taking it every day as I don’t get into unfamiliar situations everyday, so i’m wondering if that would be a better choice for me… And plus the effects on the meds i’m on are knocking me for six, i’m a mum? and finding it hard to cope being constantly doped! I don’t want to miss out on them growing up :(

#135 
Written By Viagra on April 19th, 2014 @ 7:48 pm

Whats the difference between oxycodone and hydrocodone? And will it show up different on a drug test?.

#136 
Written By Viagra on April 19th, 2014 @ 10:04 pm

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