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!