The Myth of the Aphasia Recovery “Plateau”
by Nancy Helm-Estabrooks on August 4, 2010
Perhaps one the most frustrating things that happens to people who are dealing with aphasia is hearing from clinicians that they’ve reached a “plateau” in their recovery; a mythical place where no further improvement is to be expected. Often they hear about the “plateau” from their physicians who, in the earliest period after onset of aphasia, tell them that they can expect recovery for X number of weeks or months before they reach a plateau.
Let’s explore the “geographic” landscape of aphasia recovery and see if we can identify some truths.
It is true that following sudden onset of aphasia, a period of spontaneous, natural healing occurs. During this “period of spontaneous recovery”, structurally undamaged portions of the brain, temporarily influenced by such factors as swelling and abnormalities of blood flow and metabolism, resume function. Depending on site and extent of brain damage that remains, the person may have to deal with ongoing aphasia. This may seem like a leveling off because rapid changes may have occurred early on and now things have slowed down. Aphasia recovery, however, is far from over.
Natural recovery continues indefinitely at a slower, less dramatic rate. And, if the person with aphasia receives well-founded treatments, notable improvements may occur at any time after onset of aphasia. It is important to note, however, that for maximum recovery to take place, individuals with aphasia must maintain their general health and continue to have dynamic interactions with their environments.
Aphasia recovery studies that have followed people over long periods show that slow, natural recovery often occurs in such language skills as word- retrieval and understanding what others are saying. Aphasia therapy studies show that with the right treatments, great gains can be made in such skills as producing sentences, reading and writing – even many years after onset of the aphasia.
It is also true that too few longitudinal studies of aphasia recovery have looked at recovery of all aspects of communication. Yes, language use (speaking, listening, reading and writing) is the primary way we communicate. Yet, we also communicate through non-linguistic modes such as gestures, drawing, facial expression, emotional tone, and the ways we socially interact with others. Most people with aphasia get better and better at using the full spectrum of communication options as they learn to compensate for their remaining language problems.
One of the crimes (misdemeanor or felony?) committed against people with aphasia is to discharge them from any further therapy because they have “reached a plateau”. I suggest that it is the clinician that has reached a plateau in her or his aphasia treatment repertoire. When clinicians have reached the limits of their treatment repertoire, why not say just that? Why blame it on the person with aphasia? It’s not surprising that we don’t have all the answer to aphasia – one of the most challenging and complex disorders known to humans.
Treating aphasia is like scaling a mountain but, unlike Everest, no one has been able to reach the peak. Still, let’s not any of us talk about “plateaus”. Let’s all just keep on climbing!
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Reader Comments
What wonderful, insightful and true comments about the fantasy of patient plateau in aphasia rehabilitation. In our opinion here at the AphasiaSolutions Network you are 'spot on'. I emphasized during my presentation at the recent international aphasia conference this same point and the logical followup of examining what treatment outcomes truly interest people with aphasia: employment, conversing with friends, independence, reading stories aloud to grandkids, screen literacy, and of course chatting with a spouse. Thank you Nancy for this realty check and thank you for all of your very creative and useful work over the years for people with aphasia.
It is always heartening to have professionals debunk the plateau theory! Thank you.
My husband and I were fortunate in his early stroke recovery to be given this advice: 'beware of the clinician using the word plateau'. So I learned right away as soon as someone said The P Word, to stop them, and say, there is no plateau in recovery. It usually made them a bit more careful in their statements. Our first neurologist saw my husband regularly for 2 years after his stroke and resulting aphasia. After one year, we were pleased to hear the neurologist say, Wow, you are still making improvements. We were always certain to tell the MD what we were doing at home to help recovery, what was working and what was not. We CAN educate the professionals!
Two years ago, I listened to an accomplished artist and psychotherapist Ruth Resch who was the keynote speaker at Speaking Out in NYC. She told the audience, she was 28 years post aphasia and continues to see improvements in her communication and life. As an aphasia therapist, I hear it and see it all the time. Be it language gains,communication improvements, or a new venture in life with greater confidence and satisfaction, PWA reveal their resiliancy. With the right support (fellow PWAs, family and SLP), along with ST interventions that are personally significant and innovative for that individual; the ongoing evolution of successful living with aphasia continues on.
Marilyn Certner Smith
Speaking of Aphasia
Debunk the "Plateau." I don't hear it anymore. Here I stand: shoeless and dancing. (okay… my ankle brace… but, I will be back for more!)
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Thank you Nancy,
I have thought the same idea. With my aphasia (in 9/11/06) I have said myself I am working up a mountain like your idea there is no peak yet, but sometime it will be there with research!
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