What the Azeri
Language Tells Us
Stroke Victims and Vice Versa
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
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
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
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
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"
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
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.
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
<email@example.com>. Those who deal with other questions
of neurolinguistics are also invited to contact her. Farida Sadikhova
also contributed to this article.
From Azerbaijan International (8.1) Spring 2000.
© Azerbaijan International 2000. All rights reserved.
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