Alexia, Aphasia, Agraphia - Reading, Talking & Writing

Alexia is an acquired reading disorder with difficulty seeing and reading words or understanding the meaning of written words. "Agraphia" is the loss of a previous ability to write. 

Angie discovers new terms related to her aphasia and the connection in the brain. 

Dr. Seles shares clinical stories on navigating alexia in therapy and the role speech-language pathologists play in helping survivors reintegrate into the community.

https://www.cognitiverecoverylab.com/seles

https://aphasia.org/stories/announcing-the-davetrina-seles-gadson-health-equity-grant-program/

Our beloved colleague, Dr. Davetrina Seles Gadson, passed away January 11, 2025. Dr. Gadson was an extraordinary speech-language pathologist and neuroscience researcher who devoted her energy to studying health disparities in aphasia recovery. She was a fierce advocate for improving services for individuals with aphasia, particularly Black Americans. Her research transformed our understanding of these health disparities and shed light on how we can address them. We were privileged to have Dr. Gadson as a cherished member of our lab community for four years, first as a postdoctoral fellow and then as an Instructor of Rehabilitation Medicine. She was still a close collaborator and friend to many of us at the time of her passing. Dr. Gadson was an incredible person—compassionate, inspiring, and full of life. Her dedication to advancing equity in aphasia recovery and her profound impact on our community will never be forgotten. We are committed to honoring her memory by continuing to push our field forward and fight for equitable services for all people with aphasia. 

Transcript

Copy Transcript Copied

SPEAKER_00 0:00

Welcome to Brain Friends, where two neuronerds talk all things aphasia, language recovery, culture, and community. I am Dr. Datrina Celeste Gatson, a clinical speech language pathologist and neuroscientist.

SPEAKER_01 0:13

And I am Angie Cawthorn, stroke survivor and aphasia advocate. Welcome to our show.

SPEAKER_00 0:21

Welcome to Brain Friends. We want to thank all of our listeners for downloading the podcast. We appreciate everyone listening. So please tell a friend to tell a friend that we are here. And we are.

SPEAKER_01 0:52

So I'm happy.

SPEAKER_00 0:54

Yeah. Yeah. What's going on with you? Well, the weather's nice here in DC. Um, I'm on a 70 degrees. Everyone's out. I've been invited to uh gatherings, and I'm like, I gotta get home. Let me record my podcast, then I'll meet y'all out.

SPEAKER_01 1:15

Oh, words. And we where we go with we uh is it uh brown liquor Friday night or is it a wine night? I don't know.

SPEAKER_00 1:23

It depends on how good our time goes.

SPEAKER_01 1:28

I love it, I love it. Listen, so what have you been up to? Have you read any good books lately?

SPEAKER_00 1:36

I'm actually reading a book right now. It's called The Color of Law by Richard Rothstein, and it's basically about the forgotten history of how our government segregated America.

SPEAKER_01 1:52

It is so baked in. That is so baked in, it's so baked in. Right.

SPEAKER_00 2:00

And this type of book, I have to like pick it up and then I'll put it down because I get, you know, one, I'm an 80s baby, so some of these things I remember, but I just didn't know kind of like why this was the way it was. I just felt like mom's telling me I can do and be anything, but over here it seems like I can only do this type of stuff.

SPEAKER_01 2:28

And so it sounds like it feels like she's gassing me up a little bit. Somebody, somebody's not being a hundred percent.

SPEAKER_00 2:36

I don't know, and I trust moms, I trust mom. But it's things like that I didn't know, which was how you know, individuals that would participate that were in the military after they came home, the government would say, like, oh, okay, we're gonna give loans to the veterans to be able to secure housing, but then the banks wouldn't lend to black people. And so you have this deficit because you I study health disparities, and so now I think I'm starting to really, besides just saying their health disparities really start to peel back on that onion, why there are health disparities. And so if people are playing catch up in housing equity, there's a disparity right there.

SPEAKER_01 3:27

Yeah, yeah.

SPEAKER_00 3:28

What about you, lady? What books, what book are you reading? What what books are you into?

SPEAKER_01 3:34

Well, actually, I I I can't read that well. The uh aphasia, my stroke, um has um my ability to read is diminished a lot. Um, I can see the words, I know what they are, but they don't they have I know what they mean when I see them, but they don't connect all the way. Like it's word, word, word, and now that first word is already gone. And like, so it's almost like I'm reading a different language. If I especially if I see a whole lot of text. But one of my favorite books was How to Win Friends and Influence People by Dale Carnegie. When I was when I I used to read all the time, and I read um, I used to read uh by all graphice of um I had a I um and uh Think and Grow Rich by Napoleon Hill.

SPEAKER_00 4:38

Ooh, okay. I have both of those. I haven't finished them, but I have to. Those are my jams. Those are my jams.

SPEAKER_01 4:44

I'm not gonna hold you.

SPEAKER_00 4:45

Now what about podcast? Like, do you do you listen to podcasts?

SPEAKER_01 4:53

None of that.

SPEAKER_00 4:53

Besides Brain Friends. Hello. I'm sorry, I didn't mean podcasts I meant audio, um, audio books.

SPEAKER_01 5:00

I did, but they were um I am uh I listened to Will Smith's book before the slap that was heard around the world. Um, shout out to Will and uh Jada thinks she fish from Gotham. I don't like her anymore. So anyway, I may or may not take that out. Help lady. Lady So anyway, what was the question? Do you listen to audiobooks? I I do. I listened to Will Smith's book, which was excellent. And as a kid from Philly, and uh we're part of that same class. Did I ever tell you I rapp with Will? No, I never told you that.

SPEAKER_00 5:41

I know, right? See, you should use that as a two truth and a lie. I won't remember.

SPEAKER_01 5:47

Yes, you will. But anyway, um that would have been a good one. Yeah, yeah, yeah. That was a thousand years ago. Oh my gosh. Yeah, it was class 87.

SPEAKER_00 5:58

West Philadelphia.

SPEAKER_01 6:01

Uh would you wait for me to back you up?

SPEAKER_00 6:04

Oh, man raise, yes.

SPEAKER_01 6:06

On the playground is where I spend most of my days. Yes, there's my aphasia coming out. I used to rap all the time now. When I I used to practice rapping to work on my cadence for my aphasia. Oh, that's good. Music helps. Music is so good, and I would go in the mirror and I would do um I'm your idol, your highest title, numero uno. I'm not a Puerto Rican, but I'm speaking so that you know, and understand I got a gift, a speech, and it's a blessing. So listen to the record I preach. Special ad. Anyway, that's my books. We just out here, but yeah, I used to um I used to love reading, and I would read literally a half an hour a night. And of course that turns into longer, but I was all about it because I was, I wanted, I I loved reading.

SPEAKER_00 6:59

Now, when you were in therapy going through your process, did anyone talk to you about what that difficulty in reading is called? It honestly, it really didn't even come up.

SPEAKER_01 7:11

I had such bigger problems, I guess. It the fact that I couldn't read, um, was she was like, say pancake. Say pancake. Say this. It was a lot of that.

SPEAKER_00 7:28

Okay.

SPEAKER_01 7:28

And but she didn't really have me read things or make sure that I understood them to the point where they all connected. They were all here, but they never did this. There was no closing.

SPEAKER_00 7:40

Mm-hmm. Mm-hmm. Well, that difficulty in reading is called Alexia. And Alexia A-L-E-X-I-A is the difficulty with seeing and reading words. Um, it affects reading aloud and understanding the meaning of written words. And so it's most often caused by a stroke. You often see it accompanied with aphasia. And so, oftentimes, kind of like what you mentioned, because you have bigger fish somewhat to fry, reading usually takes the back burner.

SPEAKER_01 8:19

And it's not even that you have bigger fish to fry, it really is, actually, it's 100% that, but it's like, oh yeah, I can't read either. But because I can't talk, it's just a bigger issue. And I can't speak. I can I know what I want to say, and so even that becomes when you're mid-stroke, um, that even that I can't open my hand is a bigger issue, or I can't move my arm is a bigger issue than I think okay, but I can't talk that good. But I believe that will fix itself versus I can't open my hand. Therefore, I oh I can't move my foot, therefore I can't drive. Now I can't get to the store. Those are the bigger issues that, and so it it does go in the back burner. And this is why a lot of people maybe go out of therapy or don't continue with therapy because they don't realize that it's a big of a problem that as it is, and that there is truly help available. Mm-hmm. Mm-hmm.

SPEAKER_00 9:22

And I stand, I I want to make sure I said stroke and aphasia, which obviously it occurs in those, but individuals that have traumatic brain injury or even Alzheimer's disease can also experience Alexia, the the difficulty of reading.

unknown 9:39

Wow.

SPEAKER_01 9:40

Are there any like cures?

SPEAKER_00 9:43

Well, like aphasia, you know, there isn't a cure, but there are strategies and ways to support, depending on, you know, what your area of deficit is or what your challenges are. I always like to start with an individual's strengths and use those strengths to support the weaknesses. And so one thing with Alexia oftentimes is people would or therapists would try to get the individual to read aloud, read aloud. And so I personally now I'm not submerged in the Alexia literature, but I personally would sometimes feel like that would create an extra pressure because you have the aphasia, you're having your word-finding difficulty, and now you're trying to read these words aloud. Where when we think about naturally reading, you read to yourself. Right.

SPEAKER_01 10:41

And that's an internal dialogue, and that right, I understand. And that that is a different, and if you didn't like reading aloud, pre-stroke or pre-brain injury, and now, and maybe I had anxiety with that just normally. And now you're telling me to do this in when I'm at a deficit, it's just layer on top of layer.

SPEAKER_00 11:06

I was gonna say, I remember working with a client who, I mean, she was just so amazing. And we had did all a good bit of therapy. You know, she was back to a level to where she felt comfortable. And she turned to me before, you know, we were ready to discharge, and she said, you know, I want to be able to read aloud, read the scripture aloud at Bible study. And I was like, okay, great, let's let's work on that. And so then our therapy went to reading the scriptures and you know, standing up and reading them, because she said that that was something that they would have to do, you know, when you, honey, you stand, give given honor and respect. Let's stand for the reading of the word. Right, right. So, with that, of course, there would be anxiousness and anxiety, like what if I stumble on the word? And so, of course, there was some memory that came just from you know her hiding the scripture in her heart. But she was so grateful when she was able to go back to Bible study and read, stand up and read aloud the scripture.

SPEAKER_01 12:21

Oh, that is so dope.

SPEAKER_00 12:23

And you helped her with that. Well, but I love that because I feel like sometimes as practitioners, we're having individuals just read whatever, like whatever's convenient for us to get you to read.

SPEAKER_01 12:40

Oh, yeah, yeah, read this.

SPEAKER_00 12:41

Exactly. Where you know, when these individuals are leaving, they want to be able to do something like for her, that's what she wanted to do. So she had done well with all of the little words and pancake. She got pancake okay. She was saying pancake, could spell pancake, could write pancake, but when it came to saying the scripture along with the numbers, and then doing the whole process, um, you she had trouble. And so I think that kind of goes back to some of the things we were talking about earlier, which is checking in with the individual before just discharging them, or because you've completed the things that I've had, or I'm like, oh, that's just anomia. Right.

SPEAKER_01 13:32

She made her appointment for for next week pretty good. Exactly. She's obviously fine. Exactly. Exactly. But that doesn't make you fine, that just makes you able to string a few words together. Has nothing to do with the blockages that I have. You know.

SPEAKER_00 13:50

Um and the idea with the Alexia is that there is an interruption in the connection from your visual cortex, your visual part of your brain to your language part. And that's why some of that difficulty occurs. You mean the obsipial lobe? Yes, okay, girl. Okay, yes. The occipital lobe for those individuals that have like really strong alexia.

SPEAKER_01 14:20

That might make sense because my two strokes, one was um frontal and occipital.

SPEAKER_00 14:29

Oh, well, there you go. Kudos to science, y'all right. It is in the occipital lobe and the disconnection between that and the right.

SPEAKER_01 14:38

So when you said that, I'm like, because every it's so funny because I would read up, read up on what uh the occipital, I'm like, well, I don't have any eye problems, I can see okay, and it's not blurry or whatever, but that's what they said, and I've always kind of questioned that. But now what you're saying is, no, that makes perfect sense, and which is why I have my problems with that are even though I am a gnomic in mild aphasia, it the second stroke is what makes me um Alexa. Alexia.

SPEAKER_00 15:16

Have Alexia. Did you have both of your strokes at the same time? Yes. Okay. Same night, same time. Now, what about writing? Do you have any trouble with the writing?

SPEAKER_01 15:28

I do. It's um it starts out okay, and then it um it it it it goes into third grade quick. It it it looks like it's gonna start out pretty strong. Like I can write the title of what I want to say, and then I don't have the what what's required and the spelling, like nobody could read it. You know, it's it's pretty it's it's a personal journey.

SPEAKER_00 16:00

And that's called a graphia. Have you heard that word before? A graphia?

SPEAKER_01 16:04

No, I haven't.

SPEAKER_00 16:06

So a graphia is the difficulty with writing that can co-occur with Alexia or aphasia.

SPEAKER_01 16:15

Sounds like a bunch of Amazon products, but okay. I listen, I'm just gonna say this. I I felt like aphasia should have been called a communication.

SPEAKER_00 16:34

Ooh, communicasia. That sounded like Asia. What's her name? Her name communicasia. This is like the little community. Come here, Communication.

SPEAKER_01 16:51

Communa, communication, come here, baby. I felt like I'm like, why are we calling this aphasia? Like, I ain't making no sense to me at all. But that's not mine. I heard that on a podcast when I first had my stroke, somebody from England said that. But if I said I have a communication, you would know it. A communication's in the room, like graphia is like writing. I I get that, like a graphia. That checks out. That's all I'm saying. Yeah. So when you learn about these things in school, what's the like I don't like the importance of it?

SPEAKER_00 17:53

Uh well, the important first of all, I kind of feel like in school, and I mean, come for me. Leave look, leave us a comment, a review if you disagree. It's a little controversial. No, I feel like in school, it's so much information that you learn. And I often feel like speech pathologists are the jack of all trades and the master of none because it's a lot of information. And so when you learn about aphasia, which is more so heavily taught, and then you'll have a chapter on Alexia or a graphia, and a lot of that is just saying that it can co-occur. Then sometimes you meet individuals that have what we would call like a pure alexia or pure graphia, meaning that aphasia-wise, they're fine, they're able to communicate, there's no anomia, no other language disorder. Their only disorder is the ability to read. And when you have those individuals, it's pretty neat to work with because I think it really shows you how challenging reading can be without the aphasia and how important it is. And then you start to look at breakdown certain types of materials because certain types of materials can be easier, uh, such as reading street signs, newspapers, magazines, versus reading a book or reading or an application, or even an application.

SPEAKER_01 19:31

When you go to the doctor's office, there is nothing worse for me personally than going to the doctor's and having to fill out that form. I just hand it to Charles. But maybe if I don't have a Charles, yeah, you know, everybody don't have a Charles or somebody that can even go, maybe that he's at work that day. And now I have to tell this lady behind the desk that's like, what you need? Right? Right. Hi, I have aphasia. And I I'll tell you in a heartbeat, yeah, I had two strokes, I have aphasia, I need help with this. And usually um, I always try to make sure I say aphasia because I think if I just say stroke, they'll be like, okay, fine, they kind of get it, but I want to keep replanting that seed of aphasia.

SPEAKER_00 20:17

Right. I think the other thing that's important when we think about Alexia is meeting the individual where they're where they are. I remember when I was working clinically, I had a gentleman who was young, he had to be like in his mid-40s, and he was a hospital transporter. So his job was to get people from their room and take them to surgery. And so for me, I was like, okay, bing, we got to make sure your reading's okay. And when we went to read, he I was so glad that he felt comfortable enough to share with me that he also didn't really know how to read. And I was like, what do you mean you don't know how to read? You read the patient's names in order to make sure that they're the right person for therapy. And he said, I match the letters. He said, I look and I match the letters, and that's how I know I have the right person. And I said, Well, what about other documents or anything like that? And so he had formed a community of people to where if it was something that he needed to read in depth, rather, you know, something that required a signature or something that was out of his norm, he would have someone that would read it to him or tell him like what it was. But I mean, he was functional. He was able to get around, he had had had this job for a while, he loved this job. And so then my role was not to try to teach him how to read now at this age. Right. It was to make sure he could match those letters and make sure that he could match. All of the information to deliver the right patient to the right operation.

SPEAKER_01 22:06

Wow. Wow. So he's collecting letters rather than reading the word. Exactly.

SPEAKER_00 22:14

Wow. So it was making sure that he had the letter identification. So a lot a lot of times I might do something like mix up, not mix up, but purposely do um like a Johnson and a Jackson kind of deal. So there might be only one or two letters that was off. And so our therapy was making sure numbers was another thing, making sure that everything he could match because that was his pre-morbid level in reading. Wow. Language was great. It was just the reading part that he had the trouble with.

SPEAKER_01 22:49

And because he had he didn't have uh a solid foundation previous. Exactly.

SPEAKER_00 22:58

Wow.

SPEAKER_01 22:59

Yeah. I've often wondered if a person comes in and they have a stroke and you already had certain um uh problems, how does that fit in? You know, like I mean, I was I was I could feel my drop off. I was I was pretty smart. Uh I wasn't, you know, setting the world on fire, but I I was I was like that hard to believe you weren't setting the world on fire, but be modest, go ahead. I was only the finance manager for the largest killer in the country. I mean, what? I mean everyone doesn't do that, no. So you're saying, uh I mean, I was the mortgage director for the state of Pennsylvania. I am a banker, not a broker. A broker is a smoker, you heard it here first, guys. Oh my god. Anyway, but I can actually feel like physically feel the drop off. And that's the part that hurts your feelings. Like you can, and I don't, I'm wondering is if he didn't have the drop-off, how did he feel? You know what I mean? Like, I I've the the depression that I feel that I felt uh before I got on that good stuff, um is listen, it's listen, I got prescriptions. Pharmaceutical pharmaceuticals, I'm sorry, pharmaceuticals that's about that that that that Walgreens, shout out to Walgreens. But um no, I'm wondering, like I can feel I could feel mine, and that's what kind of would when if I got depressed, that's what I was feeling. It was from a root of my pre-stroke self. But if my pre-stroke self, it wasn't that far of a drop, I couldn't read before. So the fact that I can't read now, or I can read less now, I guess it would still be the same.

SPEAKER_00 24:56

Yeah, no, it's still a drop because before you were able to identify letters and match letters and you know have this successful job to where now you're literally having to take more cognitive energy to make sure you don't mistake Jackson and Johnson.

SPEAKER_01 25:16

And that sounds exhausting anyway. Like they have to match letters to everything.

SPEAKER_00 25:22

Well, not if you're used to it.

SPEAKER_01 25:25

You're so nice, Dr. Celeste.

SPEAKER_00 25:27

You're so sweet. And so I think sometimes when we think about older individuals that may not be able to have a strong reading piece, like a you know, skills, I think we just can't assume that one that is normal. I mean, that that's not normal. Right. Yeah, I don't think that we can assume that that is not normal because of where individuals grew up, of you know, if your mama didn't read well and her mama didn't read well, and you're in a class and the teacher is just kind of like, you know, get it together or not as supportive, you're not going to, and I'm sure there's somewhat of an embarrassment, maybe, or shyness that comes with it. So you just make do and try to go under the radar. Cause I know even my mom shared stories with me about she was the first, uh, she was the first group, her class to integrate her high school, high school or middle school, one of those schools, she was like the first to integrate. And the teachers were like, I got mine, you get yours. Right. You know, and so even in that space, when you're going to school to learn, depending on your environment, right?

SPEAKER_01 26:53

So we're chicken, real quick. I know we gotta wrap up. Tennessee, Tennessee, Tennessee. I got the song in my head, but I can't sing it. I got it though. Ah, but I want to say this my mom w grew up in uh North Carolina again. Shout out to Wilson, and she went to an all-black high school, Darden, Charles Darden High. I went after my mother passed away, and I was obviously depressed, and I went to her class reunion because I just missed my mom so much. So I wound up going, but I walked out of there feeling like you know what, maybe we shouldn't have integrated these schools because their pride, their smartness, their swagger was just on uh just on tilt, and Darden High, specifically, I can speak of and attest to just some phenomenal teachers, phenomenal black children coming out of Wilson, North Carolina, they were just a cut above. And I'm not just saying that because it's my mama and my daddy, maybe a little bit, but the point is that school has produced many, many great Americans, smart kids that were um truly products of their environment, but they were allowed to um, they were poured into in a way from their black teachers. And it was just a different level of how we're gonna get you up to up to speed and on point.

SPEAKER_00 28:31

So which from what my mom shared with me that she felt that love all before the integrated before they before they integrated, and then as soon as they integrated, it was just kind of like I'm not helping you with this, you get yours. And back to the the young man with the difficulty in reading. I wonder if part of why he felt comfortable sharing it with me was because we looked alike. Wow. Because I was giving him my regular test, bringing out these words, like, oh, okay, I know your job, let me give you this. And because he was open to say, like, no, that's not how I would read that before I match the letters, I was able to shift my whole therapy approach. Right.

SPEAKER_01 29:19

And no, and you're right, and I think seeing, and that's where diversity, and this is why it's important to be in a space where you see people like that look like you and not just be in a homogeneous situation, and it allows for some diversity and for you to open up and maybe say something that you wouldn't have said to quite frankly, um, some old white lady. Shout out to uh old white ladies uh so peace. But you know what I mean? You don't still want to be, he might not feel that comfortable, some 47-year-old man, and he she might remind him of the third day grade teacher that didn't help him read.

SPEAKER_00 30:03

Or try to make me lose my job, like I'm gonna, you know, intentionally deliver somebody to get the wrong limb amputated. But listen, it is, I think we're out of time. We're out of time. This is so good. Thank you. I always enjoyed talking with you, Angie. You're the best brain friend ever.

SPEAKER_01 30:22

Brain friends! Listen, this merch is on the way. We have a YouTube channel, Brain Friends, the podcast. Ow.

SPEAKER_00 30:32

Okay, no way. Bye. See y'all. We hope you enjoyed this episode of Brain Friends. Please leave us a five-star review on Apple Podcasts or your favorite streaming platform. Also, make sure you subscribe to our YouTube channel.

SPEAKER_01 30:54

Brain Friends the Podcast.