Aphasia 99To confront Roy with his disabilities, an aphasia therapy session was videotaped. During the
session, Roy was asked to name body parts, pictures of family members, and objects placed on a
table. There were close- ups of Roy erring, denying, projecting, and refusing to comply with the
requests. After the session, the videotape was edited and reduced to about 10 minutes of relevant
close- ups to be used during the confrontation session.
A few days later, Roy, his wife and his oldest daughter, the psychiatrist, the speech- language
pathologists, and several other members of the rehabilitation team met in the conference room to
view the videotape. The atmosphere was one of support and encouragement. After the reason for
the viewing was explained, the tape was played. Roy became angry and agitated, often turning
away to avoid the screen. After the viewing ended, the psychiatrist asked Roy several questions
about the videotape. Using convoluted jargon, Roy explained that he was not the person video-
taped, and that even if he was, there was no abnormal communication whatsoever. The attempts
to jar him from denial were unsuccessful. Eventually, Roy was discharged home. Over the years his
comprehension improved somewhat and the jargon speech partially diminished, but he was never
able to return to his previous job and his position in his family.
Case Study 5-2: An 86- Year- Old Woman With Moderately
Severe Predominantly Expressive Aphasia and Perseveration
The residential wing of the luxurious retirement center is cozy and comfortable. The three-
story building is nestled in rolling hills surrounded by acres of oak and maple trees, with mani-
cured lawns and shorn shrubs blending into the nearly rural suburban landscape. The aff luent
owners of each apartment have used their retirement savings to buy lifelong leases guaranteeing
them the good life. Lush carpets, blooming f lower bouquets, and expensive original paintings
adorn brightly lit halls. Each f loor has an oak- paneled library and a sunny solarium, and there are
spas and recreational centers on the first f loor. Three gourmet meals are prepared daily, and wait-
ers serve the residents on linen table cloths with expensive silverware. A doorman greets visitors,
and there is valet parking in the underground garage. Eighty- six- year- old Helen has lived here for
9 years.
The source of Helen’s vast wealth is unknown. According to some residents and staff, the
seeds were sown in the crime- ridden Chicago of the 1920s in a family business Helen ran after
her husband’s suspicious death. Others believe that her money is simply the result of wise
investing and several bull markets. What is not debatable is that Helen is the consummate lady.
She is thoughtful, polite, considerate to all, and generous to a fault. Few people know that she
anonymously pays the hefty medical bills for a gardener’s daughter stricken with cancer. Two
months ago, she had a stroke that robbed her of language. Still, Helen has maintained her grace
and dignity, and she is transported to the attached rehabilitation center for daily outpatient
aphasia therapy.
Helen is brought to your office by a volunteer who locks her wheelchair into place at the
therapy table. Helen is dressed in a tasteful business suit, her hair is styled impeccably, and
you detect a slight whiff of perfume. After sharing a few pleasantries about the weather, you
get down to work. Today’s session is devoted to sentence completion exercises. For Helen, the
most frustrating part of aphasia is the word- finding prob lems, especially the perseveration.
Sometimes her mind locks on a word and she cannot shake it. As usual, she earnestly attempts
to complete the frustrating tasks.