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Program Holds Hope for Stroke Patients Who Have Lost Ability to Speak, Write

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DETROIT - In three years, Dr. Kenneth (Casey) Engles has achieved substantial progress. At times, he wasn't certain he'd get this far.

He had to relearn how to walk and how to pick up writing and eating utensils.

His speech was a jumble of undecipherable sounds, mixed with medical terms.

Now Engles, 53, a one-time radiologist in a successful New Jersey practice, faces a challenge as great as the physical limitations he has overcome.

He is reclaiming his speech and communication skills from aphasia, a language disorder that affects a person's ability to produce and comprehend speech, as well as reading and writing.

Aphasia is a common complication of stroke, head injuries, tumors and infections. There are one million Americans who share the diagnosis. Poorly understood, aphasia may leave a person unable to talk or capable only of short utterances. Others, like Engles, search long and hard for the right words.

Asked where he lives, Engles, for example, replies: "I've had the place individually since 1991. It has a top, second floor and bottom floor. You couldn't put it on many properties. It was hard to get any film. Radiography. You got to go out and buy them."

As confusing as the sentence might sound, it's progress to Engles and his wife. He could barely talk three years ago.

Engles has gotten as far as he has through several stroke rehabilitation programs. He also sees a personal trainer who specializes in stroke patients and works out at a gym three times a week.

His greatest progress came this year when his doctor changed his anti-seizure medications and adjusted doses of three other medicines he takes to promote his speech.

It encouraged the couple to learn that Engles might be able to push his recovery further.

This summer, Engles enrolled for six weeks of intensive therapy at the University of Michigan Medical Center's Residential Aphasia Program. Recently, he enrolled for another six weeks.

The program, known nationally as one of the few places providing intensive aphasia therapy, offers 23 hours of individual and group therapy a week. Eight or nine residents are accepted for each $25,000, six-week session.

The University of Michigan offers scholarships, as well as other less expensive programs, including a popular weekly Language Enrichment Group.

"A lot of rehabilitation programs are very limited because of insurance reimbursement," says Mimi Block, a speech and language pathologist who heads clinical services for the program.

"People need the intense programs, but most hospitals can't afford it. A lot of people who come here tell us we are their last resort."

Residents come with moving stories. Some, like Engles, have survived comas, several weeks on mechanical ventilation, repeated surgeries and more.

Diane Pyrz, 39, of Lansing, Ill., a bodybuilder and mother of four, awaits more surgery to reattach part of her brain. She was in a coma for 35 days, and doctors twice told her husband, Peter Pyrz, they expected her to die. She came to the residential program last month determined to move ahead.

"She's been here two days, and she's already saying sentences," Peter Pyrz said. "It's very encouraging."

Engles' health challenge dates to Oct. 20, 2000, when he and Debbie, his wife of 34 years, treated themselves to a New Mexico vacation after the youngest of their five children left for college.

Engles, once a radiologist with a busy practice in Normandy Beach, N.J., felt sick while showering. He had a series of seizures then developed an aneurysm that burst as he boarded a plane to return home for treatment.

The next day, Engles had a stroke that left him paralyzed on his right side. He was in and out of a coma for nine weeks.

When he regained full consciousness, he could not speak beyond an occasional "Hi."

He spent three months in a Massachusetts stroke program before a doctor recommended that Engles be discharged to a nursing home. It made Debbie Engles angry. "I just didn't want to give up," she says.

"My husband is a tremendously determined person. I felt if anyone could do it, he could."

Casey Engles turned to three-times-a-week workouts to bolster his weekly speech and occupational therapy. One therapy used a neurostimulator device to help regenerate nerve impulses in his hands.

The workouts helped Engles walk more steadily. By January, he was able to walk without fear of falling. By spring, Engles was ready for more.

Engles' day in the program begins with 9 a.m. individual therapy. This day, Klye Teichow, a speech and language pathologist, starts by asking Engles to write answers to questions about whether the sentences she reads are similar or different.

She begins: "I always walk home from school." Then she reads: "I never walk home from school."

Same or different? she asks Engles. Once, he succinctly uttered, "There is no difference." Other times, he answers: "It's too high. It's a negative. That's twice."

In another exercise, Teichow reads a sentence to Engles and asks him to record on a sheet of paper its subject, verb and direct object.

"We use this exercise a lot," Teichow says. "It gives structure to the sentence."

Engles' initial answers are painstaking. He takes two lines to write a word. The letters are capitalized and angled upward to the right at first. But in a few minutes, his writing gets more legible and is limited to a single line. That's what keeps Engles going.

He leaves the session for the weekly one-hour support group meeting. There, sitting around the table, some for the first time, people take time recounting some story or recent experience. "Share something," says Cambria Reading, a volunteer speech and language pathologist who leads the group.

Ray Goodrich, who has been coming to the weekly group since he had a stroke in 1981, brought pictures of a trip to Italy to show the group. He checks notes to help him recount the trip. "Wednesday, we had pizza," he says. "And wine," he adds quickly.

Asked how long he was there, he says, "Friday, Saturday, Sunday, Monday, Tuesday, Wednesday and Thursday." He laughs again at his preference for the lengthier but still correct answer about his one-week vacation.

Asked his favorite dish on the trip, he says, "I guess soup." More laughter.

When Casey Engles' turn comes, he talks about a recent trip to see his daughter. "I went to visit my daughter in Minnie-soy. Minn-E-soy. Minnie-so-tah," he says persistently.

He goes on. "My eldest son is five months married. She likes the life she has now. She lives in a beautiful house. Plastic. No. Not plastic. It's three levels high." Someone asks in what city the daughter lives and Engles stumbles for the answer before saying, "To be honest, I don't remember."

James Goodwin, a North Carolina man who is new to the program, tries to talk but gets frustrated and breaks down crying when he can't speak about his three dogs. Bob Arbour, a Belleville man coming to the group with his wife, Mary, a stroke patient, for three years, intercedes. His asks his wife to tell Goodwin: "We've all been there. You just keep trying."

He says of his wife: "This group has done more for her than any of her therapies. It's the most positive thing she's done." Indeed, hearing the stories of people around the room gives hope to some of the newer families like the Goodwins and Engles.

"There's something to learn almost every day," Casey Engles says.

Residents get personal binders and picture dictionaries to help them communicate. The binders have alphabet letters and numbers to help them save time when communicating easy concepts like ages of their children. They swap stories over lunch, then head to computer class.

Numerous programs have been developed to meet the varied abilities of people with aphasia, Block says.

One program shows a shopping cart and asks the computer user to spell out the word using alphabet letters. Another uses a fill-in-the-blank word exercise.

Some computer programs allow first-timers to touch the screen to record their answers. Another, called Speech Practice, was developed by a resident, Winston Jerome Lindsley. It hones in on a person's lips to show how sounds are formed.

Engles' computer program is more ambitious. It's a synonym and antonym exercise. He sorts though lists of words that are the opposite and later the same. He picks a few wrong words, then plugs away at another exercise. "I want to do it again," he tells therapist Louise Peelle, a senior clinician in the program.

She and the other therapists are working to help Engles focus on word selection, improve his ability to construct sentences and write more legibly. Their tips include using fewer words and shorter sentences, and reading as much in his spare time.

Engles likes to simultaneously read a book while listening to it on tape. "They leave me with an exuberant knowledge of the story," he says, wincing later at his choice of words.

Through a Library of Congress program, he gets large-print magazines and newspapers delivered to his home. "They said he'd never read again," his wife says.

By day's end, the Engleses are tired and ready to have a quiet night at their hotel in Ann Arbor.

Wished good luck with his recovery, Engles turns and says, "Perseverance. That's what's cooking. That's the slow boat."

It might not be exactly the words he wanted, but Engles' thought was very clear. He expects to get there just the same.



For more information about the University of Michigan's Residential Aphasia Program, and others offered by its Center for the Development of Language and Literacy, call 734-764-8440.

For general information, call or visit the National Aphasia Association, 800-922-4622,

For computer programs, visit Parrot Software, a West Bloomfield, Mich., firm, at


(c) 2003, Detroit Free Press. Distributed by Knight Ridder/Tribune News Service.

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