Spring 2000 (8.1)

What the Azeri Language Tells Us
About Stroke Victims and Vice Versa

by Gulmira Sadiyeva

Brain injuries occur in numerous ways and are much more prevalent than most people think. In the United States alone, nearly 1 million people suffer from brain injury to a greater or lesser extent every year, according to statistics gathered by the Brain Injury Association. Rehabilitation services are required for more than half of such victims.

But what about Azerbaijan, where services are not as available? Linguistics researcher Gulmira Sadiyeva has been studying language patterns in stroke patients in Azerbaijan for the past year. Her work has convinced her that there is hope for much recovery, given the correct approach and understanding of the problem. Here she describes her findings on aphasia, a speech disorder caused by injury to the brain. She concludes that understanding the structure of the Azeri language can be an integral part of the therapy.

I'll never forget the first patient I started working with when I began my research into aphasia. He was a man about 45 years old by the name of Vagif. Highly intelligent, he had graduated from two Institutes and had held very high positions before he suffered a stroke. When we met, he could not utter a single word, although his comprehension had not been damaged. When his wife began telling me about his past, he became very excited and couldn't hold back his tears. He wanted to add something, but it was impossible for him. All I could do was encourage him and give him hope that one day he would speak again.

One day when he seemed to have given up all hope, he somehow manage to blurt out, I cannot speak (Danisha bilmiram). The cliché-type phrase had somehow been retained in his memory and was more easily accessible for him to reproduce. He kept trying to say other words, but completely failed.

One day, I remember it had been raining all day long. When he tried to say the word for "rain" (yaghish), he couldn't, though he managed to say similar words, like "shashig" or "lalish". He got very frustrated that he couldn't say the correct word.

Photo: Because Azerbaijan has changed its alphabet four times in the 20th century, many grandparents know the Latin script that their grandchildren are studying despite the fact that their own children grew up learning Cyrillic. Photo: Chris Cannon.

However, when I asked him the simple question: "It snows in winter, but what about in autumn?" he answered me spontaneously: "Yaghish" (Rain). He had answered correctly. In other words, when presented with a situation where he could concentrate on what to say rather than how to say it, he was successful.

I began to incorporate basic questions like this one as well as proverbs into his therapy. By the time he was ready to leave the hospital after three major courses of treatment, he had recovered nearly 70 percent of his speaking ability. By then he could express many of his thoughts and wishes once again and was very grateful to be almost back to normal.

What is Aphasia?
For my research in linguistics, I work with patients like Vagif who suffer from aphasia, a speech disorder caused by a stroke, brain tumor or brain injury. In the case of a stroke, brain cells die when blood circulation is cut off, because they stop receiving oxygen and nutrients. Since the left side of the brain is responsible for language, damage to it can impair one's ability to speak or comprehend.

There are at least seven different types of aphasia. The degree and type of speech disorder varies from patient to patient. One type of aphasia patient forgets the names of objects. For example, show him a comb and ask: "What's this?" He will answer: "This is something we use to brush our hair. Hairdressers use it, too." But he can't say the name of the object because he doesn't remember it.

With another type of aphasia, patients forget time and space notions. For example, they don't understand basic concepts like "tomorrow" and "yesterday" or what it means to put something under the table, or on top of it.

A different type of stroke patient can speak, but can't comprehend what others say to him, a condition known as Wernicke's Aphasia, or fluent aphasia. Take the case of Yoghunali, a 62-year-old patient. He was very talkative, but his speech was disordered and didn't make any sense. Plus, he couldn't understand even the simplest of commands, like: "Show me your head" or "Close your eyes."

In very rare cases, I found that he could catch the meaning of a sentence and answer it. For example, once I asked him: "How are you?" (Nejasiniz?) He answered immediately: "I'm fine, thank you. And you?" (Chokh sagh ol, yakhshiyam, san nejasan.) Fortunately, by the end of a month of treatment, his ability to comprehend speech was mostly restored.

Another common type of aphasia is Broca's aphasia, which is caused by damage to the left frontal lobe of the brain. Patients with Broca's aphasia can understand what's being said but have trouble speaking. Often, they have to talk in short, choppy sentences and often leave out small connectives such as "and", "as", and "the". Like Vagif, they tend to get very frustrated because they can no longer express their thoughts.

In many cases, aphasia may not be completely curable. A patient may only be able to recover 60 to 70 percent of his speech, since the speech center of his brain has been permanently damaged.

A New Field
You might ask: why is a linguistics researcher studying stroke patients? I believe we can learn a great deal about the Azeri language with such research which, in turn, will also benefit aphasic patients. Before I began my study, I was working on a completely different dissertation topic, studying infinitive sentences in Azeri, Russian and English. During my reading on the subject, I came across an article by Roman Jacobson that talked about patients with aphasia. I became interested in the topic, so I went to several different Baku hospitals and found out that there were many patients with aphasia, but their language patterns had never been investigated.

I decided to change my dissertation topic to be "Linguistic Analysis of Speech Disorders in Aphasia." Once the dissertation was finished, I received the degree of Candidate of Philology (equivalent to a Ph.D. in the U.S.). My work with aphasia patients continues as I work on my doctoral dissertation, "Neurolinguistic Questions of Language and Brain Problems." No one else is working in this field in Azerbaijan.

For my Candidate dissertation, I worked with 25 patients in the neurological department at Baku's Republican Clinical Hospital named after Academician Mirgasimov. Each patient went through three sessions of treatment that were each about 20 days long. While they were there, I worked with them for an hour every day. In a typical session, I would try to have a conversation with them about their family, work or interests, using my own strategies and techniques to help them speak.

I found out from researchers in other countries that proverbs and targeted questions can be very useful in helping aphasic patients who have trouble uttering specific words. As with the "rain" example mentioned above, the patient must be asked a question that only has one answer, without any alternatives. He or she must think about what to say but not how to say it. Familiar proverbs that have two parts with a causative clause and a consequence clause are particularly successful as well.

For example, I might begin a proverb for a patient and have him finish it. I say: "Ozgaya guyu gazan..." (He who digs a hole for another man...), and he continues: "Ozu dushar" (will fall into it himself).

Or "Ishlamayan dishlamaz" (The one who doesn't work, doesn't eat). Then there are other familiar proverbs that I have used like: "Bala baldan shirindir" (a baby is sweeter than honey) or "Aslanin erkayi dishisi olmaz" (Lion is neither male nor female).

I also use famous poems that patients have known since their childhood. Samad Vurghun's poem "Azerbaijan" is one that nearly everyone in Azerbaijan knows, regardless of the level of their education. I find that stroke patients can recite it automatically, since they know it so well.

Folk songs also work well, especially for elderly people who come from villages in Azerbaijan. One example is, "Almani atdim kharala galdi sarala sarala..." (I threw an apple into a big bag, it remained there and got yellow).

Patients respond well to questions that only have one answer. For example, a patient can be asked: "Balig uzur, bas gush?" (A fish swims - what about a bird?). The patient will automatically answer: "Uchur" (It flies). Or the question can be continued: "Gush uchur, bas dovshan?" (A bird flies - what about a rabbit?). The patient answers: "Gachir" (It runs).

Often patients with aphasia, especially elderly ones, are very sensitive. Even a little success - like being able to finish a proverb - can make them well up with tears and cry. Patients must have a strong belief that they will recover. If they don't have this confidence, they won't even want to try. When they see that they are able to say the ends of proverbs or sing some songs, they get encouraged. Though these words are not always remembered after the first correct attempt, it does help to boost their confidence that they will be able to speak again.

It's curious the role that clichés and expressions serve in helping patients reclaim their language. For example, various blessings or wishes such as "Allah sani sakhlasin" (May God save you) or "Allah balalarini sakhlasin" (May God bless your children") or even the simple phrase, "Inshaallah" (If God wills) are also very effective.

One hypothesis explaining this phenomenon suggests that fixed patterns are saved in the right hemisphere of the brain. Stroke patients draw upon the reserve of patterns that has been stored there.

Lost Sounds
In my studies I've noticed that aphasic patients are much more likely to have trouble pronouncing consonants than vowels. Often, consonants are replaced by other consonants, while vowels don't seem to be altered as much. The tendency is to say words like "totur" instead of "tokur" (pouring), "alaggabi" instead of "ayaggabi" (shoe). ("Totur" and "alaggabi" are nonsense words in Azeri.)

Patients often confuse voiced and unvoiced consonants, such as k with g, t with d, s with z, sh with j as well as r with l. The word "kartof" (potato) might be pronounced as "taltop", "kalam" (cabbage) as "taram". "Yumurta" (egg) may come out as "dumumda", and the word "gullar" (flowers) may sound more like "durrar".

My research confirmed the existing hypothesis that stroke patients' speech corresponds with children's speech. By that I mean that the first sounds to be acquired by children (b, m, p, t, d) are the last to be lost in the case of aphasia. Conversely, the sounds most difficult to pronounce for children (such as r, s, sh, z, j) are among the first to be lost by aphasic patients. You can make a general assessment of the severity of the damage to the brain simply by studying which letters have been lost.

It's particularly interesting what effect the agglutinative nature of Azeri has on aphasic patients. I discovered a tendency for them to leave off the affixes of words and preserve only the root. For example, the affix "-ma" indicates negation in Azeri. Instead of using the words "danishma" (don't speak) and "yema" (don't eat), many aphasia patients say "danish yokh" (speak-no) and "ye yokh" (eat-no) instead. This is also the way many children begin to learn these negative constructions.

Of course, in non-agglutinative languages like English, stroke patients display different characteristics. In the 1970s, the British scientist Lee pointed out that stroke patients whose mother tongue was English would exhibit differently than someone whose mother tongue was German, for example. There are some fundamental differences between Azeri and English, especially when it comes to word order. English has a fairly fixed word order, but in Azeri, this is not the case. Since word order doesn't matter as much in Azeri, when stroke patients mix up the order of words, it doesn't matter so much. It's the loss of affixes that causes the most trouble in Azeri.

As a member of the International Association for the Study of Child Language, I brought up these similarities in a presentation at the Association's Eighth International Conference held in San Sebastián, Spain in July 1999. It was a good opportunity for me to talk to other researchers about the subject and find out how research is being conducted in other countries.

Looking Ahead
I plan to continue doing research on this problem for my doctoral dissertation, studying speech disorders of aphasia as well as schizophrenia. With aphasia, the problem occurs in the pronunciation and comprehension of words. In schizophrenia, the problem revolves around content and meaning of the patient's speech.

My work is mostly descriptive. I'm hoping my research can serve as the basis for a methodology to treat and cure stroke patients. In the meantime, my preliminary observations can help neuropathologists and speech therapists who work with stroke patients.

Unfortunately, in Azerbaijan there are not enough books on this subject and we don't have broad ties with other countries. My book, "Aphasia: A Neurolinguistic Investigation," came out in December 1999 in Azeri Latin, published by the Academy of Science. I hope that it will begin to provide the basis for the initial development of this field in Azerbaijan.

For more information about Aphasia in Azerbaijan, email Gulmira Sadiyeva at <gulmira@lan.ab.az>. Those who deal with other questions of neurolinguistics are also invited to contact her. Farida Sadikhova also contributed to this article.

Azerbaijan International (8.1) Spring 2000.
© Azerbaijan International 2000. All rights reserved.

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