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Aphasia: Background information when reading Lean Fall Stand

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Lean Fall Stand

A Novel

by Jon McGregor

Lean Fall Stand by Jon McGregor X
Lean Fall Stand by Jon McGregor
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  • First Published:
    Sep 2021, 288 pages

    Sep 2022, 288 pages


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Book Reviewed by:
Peggy Kurkowski
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This article relates to Lean Fall Stand

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Cartoon drawing with speech bubbles showing how a person with aphasia struggles to communicateIn Lean Fall Stand, the main character suffers a massive and debilitating stroke during a whiteout storm in Antarctica. After being rescued, he returns home to England to begin the long, arduous task of learning to speak again. The medical term for the loss of the ability to understand or express speech is aphasia. It is usually caused by a neurological insult, such as a stroke, brain injury or neurogenerative disease like dementia.

According to the Mayo Clinic, "The most common cause of aphasia is brain damage resulting from a stroke — the blockage or rupture of a blood vessel in the brain. Loss of blood to the brain leads to brain cell death or damage in areas that control language." With certain forms of aphasia, it is not uncommon for some people to retain their intellectual and cognitive abilities, while at the same time being unable to communicate.

How do you recognize aphasia? It is helpful to look for the following signs, as the person may:

  • Speak in short or incomplete sentences
  • Speak in sentences that don't make sense
  • Substitute one word for another or one sound for another
  • Speak unrecognizable words
  • Write sentences that don't make sense
  • Not understand other people's conversation

In the United States, more than two million people are living with aphasia in one of its three forms: Broca's (also called expressive aphasia), Wernicke's (also called receptive aphasia), and global aphasia. The main character in Lean Fall Stand falls under the Broca's spectrum, as he struggles to express himself using only a few words and has difficulty finding the right words for what he is trying to convey. Sometimes called nonfluent aphasia, people with this form may understand what others say better than they can speak themselves. This struggle to communicate and find the right words for things often leads to frustration.

While people with Broca's aphasia can only speak in short sentences of a few words, those with Wernicke's aphasia are fluent, speaking long and complex sentences; however, the sentences often do not make sense and might contain incorrect, unrecognizable or unnecessary words. And while they can speak more fluently, they are less likely to understand spoken words and might be unaware that others cannot understand them.

The most severe form is global aphasia. People with global aphasia struggle with both comprehension and expression, and while those afflicted with the other two forms tend to retain some ability to read and write, those with global aphasia can do neither. This is usually caused by damage to the perisylvian cortex, which is the brain tissue dividing the frontal and temporal lobes of the brain.

How do people with aphasia recover their ability to communicate? A speech-language pathologist is usually assigned to work with a patient diagnosed with aphasia. Speech and language therapy is a necessary component to rehabilitating the brain's ability to form and identify the right words to match what a person is attempting to communicate. This is often a slow process that only rarely returns the person to their pre-injury abilities. Speech and language therapy also looks to supplement a person's communication experience, i.e., people are taught other ways of conveying information beyond words. In Lean Fall Stand, the therapy group Robert attends uses innovative ways to encourage people to tell their stories through movement and dance. This is an approach that is used in real life to successfully treat aphasia.

Broca's aphasia graphic by Pereoptic

Filed under Medicine, Science and Tech

Article by Peggy Kurkowski

This "beyond the book article" relates to Lean Fall Stand. It originally ran in October 2021 and has been updated for the September 2022 paperback edition. Go to magazine.

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