June 2023

REHABILITATION

REHABILITATION AT THE APHASIA CENTER: A PHYSICIAN'S JOURNEY TO RECOVERY

Featuring: ​Harish Shownkeen, MD, ​Michelle Armour, MS, CCC-SLP
In a remarkable tale of resilience and rehabilitation, Eric Werner, MD, walked out of Northwestern Medicine Central DuPage Hospital mere days after surviving a stroke. Despite his apparent physical recovery, this 62-year-old physician faced an unseen consequence of his stroke: aphasia, a language disorder commonly resulting from such neurological events, affecting his ability to communicate effectively.
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The incident unfolded in June 2022 when Dr. Werner, an anesthesiologist, found himself alone at his St. Charles, Ill., residence, suddenly collapsing to the ground. Weakened and unable to reach his phone, he drifted in and out of consciousness, struggling to grasp the gravity of the situation. Approximately two hours later, his wife returned home, immediately dialing 911. Dr. Werner received advanced medical intervention through the Northwestern Medicine Mobile Stroke Unit, an ambulance equipped with a state-of-the-art 16-slice CT scanner and specialized stroke medications.

He was swiftly transported to the Interventional Lab at Northwestern Medicine Central DuPage Hospital, where a 4.5-millimeter blood clot in his brain was successfully removed.

“With the Mobile Stroke Unit, we can take the hospital to the patient and provide treatment right away in the field,” said Harish Shownkeen, MD, medical director of the Stroke and Neurointerventional Surgery Programs at Northwestern Medicine Central DuPage Hospital. “This early intervention leads to better outcomes, as every second counts when you are treating a stroke.”

Dr. Werner's physical recovery was nothing short of miraculous. He was walking unassisted the day after being admitted to the hospital, and within a week, he was discharged to his home.

“It felt like a miraculous recovery. The same day I got home, I cut down a small branch of a tree just to see what I was capable of,” said Dr. Werner. 

However, alongside his physical progress, Dr. Werner faced a new challenge—expressing his thoughts verbally and comprehending spoken language. His struggle included difficulty distinguishing certain letter combinations, such as "th" and "sh," leading to challenges in understanding specific words. His diagnosis: aphasia.

“Aphasia results from damage to the language center of the brain. Intellectual skills are perfectly intact, but there is a disruption in the ability to communicate,” said Michelle Armour, MS, CCC-SLP, founder and program lead clinician of the Northwestern Medicine Aphasia Center at Marianjoy Rehabilitation Hospital. “It may impact listening, speaking, reading and writing. Every individual is different, however, so not everyone experiences changes in all of these areas.”

To regain functional communication and language skills, Dr. Werner embarked on outpatient speech-language therapy at Northwestern Medicine Marianjoy Rehabilitation Hospital. This therapy addressed both receptive and expressive language abilities, emphasizing education, retraining, and the implementation of compensatory strategies. 

“With Dr. Werner, we specifically focused on verbal expression, thought organization, auditory processing and motor speech skills,” said Amy Nourie, MA, CCC-SLP, speech-language pathologist at Marianjoy Rehabilitation Hospital. “Dr. Werner demonstrated exceptional effort and follow-through of completion of home exercise programs, which positively affected his recovery.”

The primary goal of therapy was to stimulate the brain's language center, promoting neuroplasticity—the brain's capacity to establish new pathways. Patients also acquired alternative communication methods, such as gestures, visual aids, or electronic devices.

“At first, the recovery is remarkable, but then it slows down, and over the next year, there is a gradual improvement,” said Dr. Werner. “I’m a type-A personality, and I’ve faced this like a mountain to climb. If I feel like I’m hitting a wall, I try something new. Recovery has become a full-time job.”

In addition to individual therapy, Dr. Werner participated in an eight-week program at the Northwestern Medicine Aphasia Center at Marianjoy Rehabilitation Hospital. In this small group setting, participants engaged in real-life activities, including conversation, games, mathematics, writing, music, technology, and book clubs. Each session aimed to enhance language functioning, promote socialization, foster independence, and improve overall quality of life.

Dr. Werner emphasized the substantial advantages of group therapy, particularly the opportunity for social interaction—a crucial aspect for individuals recovering from strokes, who often tend to isolate themselves. He actively maintained connections with friends, recognizing the value of conversational opportunities and the understanding and support of others.

“People with stroke tend to self-isolate,” said Dr. Werner. “I’ve made a big effort to not do that with my friends. The more opportunities I have to speak with others, the better. People are very supportive and understanding.”

Today, Dr. Werner's aphasia is rarely noticeable to others, but he remains acutely aware of the additional effort required during fast-paced conversations. With boundless enthusiasm and optimism, he dedicates several hours daily to enhancing his speech and communication skills.

“For some patients, aphasia may never completely go away, but they can make amazing progress as they learn new skills and keep practicing,” said Armour.

While aphasia may not completely dissipate for some patients, remarkable progress can be achieved through skill acquisition and consistent practice. Dr. Werner's journey serves as an inspiring testament to the resilience and determination of individuals confronting aphasia, offering hope and inspiration to his fellow physicians and healthcare professionals.
Harish Shownkeen, MD, medical director of the Stroke and Neurointerventional Surgery Programs at Northwestern Medicine Central DuPage Hospital.
Michelle Armour, MS, CCC-SLP, founder and program lead clinician of the Northwestern Medicine Aphasia Center at Marianjoy Rehabilitation Hospital.

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