Elke dag praten we met elkaar: een 'goedemorgen', een flauwe mop of een praatje met de buurvrouw over het weer. Taal lijkt zo vanzelfsprekend dat we er zelden bij stilstaan, totdat het plots niet meer lukt. In onze hersenen zijn verschillende gebieden verantwoordelijk voor onze taal. Maar waar zitten die precies? En wat gebeurt er als er net in die gebieden iets misgaat?
Beeld je even in dat je bent zoals Mia. Mia weet precies wat ze wil zeggen, het ligt op het puntje van haar tong, maar toch kan ze de juiste woorden niet vinden. Ook een simpel woord als ‘boek’ komt haperend uit haar mond. Of stel je Mark voor. Voor de buitenwereld lijkt hij vlot te praten, maar af en toe slaat hij de bal mis. Dan zegt hij bijvoorbeeld ‘stoel’ terwijl hij eigenlijk ‘tafel’ bedoelt of wordt een ‘trein’ plots een ‘bus’.
Zowel Mia als Mark hebben afasie, een taalstoornis die meestal ontstaat na een beroerte. Spreken kan dan moeizaam verlopen of woorden raken zoek. Ook het begrijpen van wat een ander zegt of lezen en schrijven kunnen stroef verlopen. Alledaagse activiteiten kunnen plots een enorme uitdaging worden. Afasie komt bovendien vaker voor dan je denkt: ongeveer één op de vier personen met een beroerte krijgt ermee te maken. Het zou dus goed kunnen dat je zelf ook iemand kent met afasie.
Maar waarom maken Mia en Mark dan niet dezelfde fouten? Dat komt omdat de beroerte schade heeft veroorzaakt in andere gebieden in het brein. Je kunt het brein zien als een drukke stad vol kruispunten en snelwegen, waar informatie razendsnel van de ene plek naar de andere reist. Afasie is alsof er in die stad plotseling een brug instort: de boodschap wil wel op weg, maar raakt niet op de juiste bestemming. Wij gingen op zoek naar waar in de hersenen precies die bruggen instorten bij afasie, welke straten van het brein afgesloten zijn en wat er gebeurt als we die blokkades leren kennen en misschien zelfs kunnen omleiden.

Onze eerste stap was opnames maken van gesprekken met personen met afasie die enkele maanden geleden een beroerte doormaakten. We probeerden echte, herkenbare situaties na te bootsen zodat we konden horen hoe iemand taal in het dagelijkse leven nu écht gebruikt. We vroegen bijvoorbeeld: ‘De kinderen op straat voetballen vlak voor uw voordeur. U heeft dat al vaker verboden. U gaat naar buiten om de jongens toe te spreken. Wat zegt u?’. En geloof ons, wat daarop volgde was zeer uiteenlopend. Van lang vervlogen jeugdherinneringen tot dagelijkse frustraties. Je kan het je vast wel inbeelden.
Het resultaat? Uren en uren aan opnames. Elk woord, elke pauze, elke zucht moest hierbij uitgeschreven worden. De moed zonk ons al in de schoenen bij de gedachte dat we dat allemaal handmatig moesten uitschrijven. Gelukkig bestaat er tegenwoordig artificiële intelligentie (AI) die de gesproken opnames automatisch kan omzetten in een geschreven tekst. Een snelle, handige en vooral tijdbesparende tool waarbij technologie en taal op hetzelfde pad komen! Nadat we deze AI-gegenereerde teksten hadden nagekeken, konden we beginnen aan het echte werk, namelijk de analyse van onze resultaten.
Het is natuurlijk niet genoeg om alleen te kijken naar welke taalfouten personen met afasie maken. We willen ook weten waar precies in het brein de schade zit die deze fouten veroorzaakt. Daarvoor bekeken we de hersenscans van alle deelnemers, gemaakt juist na hun beroerte. Urenlang zaten we achter een gigantische tablet vol hersenbeelden, alsof we een ingewikkelde stadsplattegrond probeerden te ontrafelen, en kleurden we zorgvuldig alle beschadigde gebieden in.

Daarna gingen we op zoek naar verbanden tussen die ‘ingestorte bruggen’ in het brein en de taalfouten die de mensen met afasie maakten. Denk even terug aan Mia en Mark. Zij maakten niet dezelfde fouten. Mia worstelde vooral met het vinden van de juiste woorden en het vloeiend uitspreken ervan, terwijl Mark vaak een ander woord gebruikte dan hij eigenlijk bedoelde. En dat verschil zagen we ook terug in de hersenscans! Bij Mia lag de schade eerder vooraan in de hersenen, zoals in het blauw wordt weergegeven op de figuur. Meer specifiek vonden we letsels in de insula, een gebied aan de binnenkant van de hersenen, en de precentrale gyrus en orbitofrontale cortex, gebieden die zich eerder aan de buitenkant van de hersenen bevinden. Bij Mark daarentegen lagen de letsels eerder achteraan, namelijk in de gyrus supramarginalis, gyrus temporalis medius en superieure laterale occipitale cortex. Deze gebieden bevinden zich eerder aan de buitenkant van de hersenen. Dit wordt in het groen getoond op de figuur. De verschillende letsellocaties verklaren dus waarom Mia en Mark andere taalfouten maken. Bij Mia en Mark gaat het dus om twee verschillende bruggen die zijn ingestort, elk met hun eigen gevolgen voor het verkeer.

Met dit soort onderzoek kunnen we steeds beter voorspellen welke hersenschade welke taalproblemen veroorzaakt. Deze informatie helpt de logopedist om sneller én gerichter een behandeling op te starten. Daarnaast kunnen we met deze gegevens beter inschatten hoe personen met afasie zullen herstellen. Rond de ingestorte brug in het brein wordt als het ware een omleiding aangelegd. Soms gebeurt dit herstel spontaan doordat onze hersenen heel flexibel kunnen omgaan met de hersenschade. Ook kan logopedische behandeling helpen om de omleiding aan te leggen.
Voorlopig moeten we de voorspellingen over de taalproblemen en het taalherstel nog met de nodige voorzichtigheid benaderen. Er valt namelijk nog veel meer te ontdekken. En hoe meer we ontdekken, hoe beter we de stad van het brein leren kennen. Zo ontrafelen we beetje bij beetje hoe we de onderbroken wegen van de taal weer kunnen herstellen.
Bronvermelding figuren:
Figuur 1 gegenereerd door AI via ChatGPT
Figuur 2 door Cottonbro studio via https://www.pexels.com/nl-nl/foto/medisch-anatomie-hersenen-examen-5723883/
Figuur 3 gegenereerd via BioRender
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