“I sometimes will hear things in a way that’s not perfectly clear,” Fetterman told NBC News, in an interview Friday, which was aired Tuesday. “So I use captioning, so I’m able to see what you’re saying on the captioning.”
While neurological experts said they could not offer a specific diagnosis about Fetterman’s health, they noted that closed captions are a common tool for people with auditory processing or hearing issues, conditions which have nothing to do with overall intelligence.
“This is not an issue of intelligence, it’s not an issue of cognition, but unfortunately how we get information in and out tends to impact how people perceive that,” said Brooke Hatfield, an associate director for the American Speech-Language-Hearing Association.
Fetterman’s health has become a major issue in the close race in Pennsylvania against GOP candidate Mehmet Oz. Republicans have tried to use the interview to discredit Fetterman’s cognitive abilities.
The National Republican Senatorial Committee tweeted that Fetterman is not being “transparent” about his health. The Senate Republicans’ account tweeted that NBC reported that speaking with Fetterman without closed captioning was difficult.
Issues with processing sounds can happen for several reasons. Hearing is an especially unique sense because unlike sight or smell, sound gets processed before it even reaches the brain. There are a number of areas where understanding can be impaired, even if someone has no hearing loss or intellectual disability, said Borna Bonakdarpour, an associate professor of neurology at Northwestern University Feinberg School of Medicine.
Jenna Beacom, 51, a deaf media critic living in Columbus, Ohio, said she was surprised at how well Fetterman was able to follow the interview even though he seemed to be relying on auto-captioning, or real-time captioning. She sometimes uses this type of captioning but said it is often riddled with mistakes or has significant lags.
“The purely mechanical issue of lagging captions was played in a way that made it seem like Fetterman was slow on the uptake, in a way that is unfair and inaccurate,” she said.
Beacom said she faces similar criticism when she is slow to respond to someone when they are speaking. “I have all kinds of mechanisms intended to calm down hearing people because I’m aware of this,” she said.
Fetterman suffered a stroke in May, and neuro-audiology experts said they believe he was showing signs of a specific type of acquired communication disorder called aphasia, which is caused by damage to regions of the brain responsible for language. Aphasia impacts about 2 million Americans, according to the National Aphasia Association and is common after a stroke, but can also be the result of head trauma, a brain tumor, or infections that damage the brain.
Importantly, aphasia does not affect intelligence, decision-making, planning or other cognitive functions in the brain, experts said. And it can be treated and improved over time through therapy.
Darlene Williamson, president of the National Aphasia Association, believes Fetterman displayed behaviors consistent with aphasia based on his interview with NBC News. She applauded his use of closed captioning and said his use of strategies to help with communication “demonstrates his capacity.”
Aphasia can affect someone’s ability to process language either visually or auditorily, said Pélagie M. Beeson, a University of Arizona speech, language and hearing sciences professor.
When people have issues with choosing the right word to say or write, this is a form of expressive aphasia. Fetterman stumbled in the interview by saying the word “empethic,” when he meant “empathetic.” (He corrected himself.) Stumbling over the word could be a sign of minor expressive aphasia, Beeson said.
When people have issues with processing sound from others, either in translating a sound into a word, or with connecting a word to its meaning, it is called receptive aphasia. It is the reason people may need closed captioning.
“If you say to someone with significant aphasia, ‘Can you give me the pencil?’ They go, “pencil … pencil … I should know what that is,’” she said. “They heard it, and put it together but they don’t connect the meaning. That’s a severe impairment. He didn’t have that level of impairment.”
Beeson said that Fetterman may have mild cases of both kinds of aphasia, but did not see any behavior that would lead her to believe Fetterman is struggling with the meaning of words, since he was able to respond to questions during the interview in an appropriate manner.
Someone with a mild auditory processing issue would typically need more time to process sounds, and may struggle to keep up with a long sentences, fast speakers, or lectures, said Sarah Lantz, a speech language pathologist at Magee Rehabilitation Hospital, part of Jefferson Health in Philadelphia. A person with more severe auditory processing issues may struggle to understand a single word at a time, she said.
There are exercises people can do with speech therapists and rehabilitation specialists to help overcome issues with auditory processing, Hatfield said.
When someone has auditory processing issues from a stroke, the usual pathways that language information takes have been interrupted, and the signals may need to take a detour. But luckily, there is a lot of redundancy in the brain, meaning healthy parts of the brain can support an injured part of the brain while it heals, she said.
“You still get where you’re going, but it might take you longer to get there,” Hatfield said. “The problem with speech is that people can talk really fast so the brain has to process a lot of things at once.”
As people reinforce new connections and pathways in their brains through speech therapy and rehabilitation, they can start connecting sound to meaning faster and understanding people better, she said.
Others speaking to a person with the auditory processing issues can help boost understanding by adding additional context when they repeat themselves, slowing down when they speak, eliminating background noise, or giving the person visual context clues such as captions.
In stroke recovery, people can expect to see the most improvement with symptoms like auditory processing within the first year after the stroke, said Swathi Kiran, founding director of the Center for Brain Recovery at Boston University. After that, people can continue to improve, but the rate of recovery may slow down. In Fetterman’s case, it has only been about five months since his stroke, so it is likely he will continue to get better with understanding speech, she said.
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