Stroke changes Southerner's speech Patterns into something a bit more exotic
Berley Stabler had always fancied himself something of a romantic, a fighter in the world of sales, but more so a lover of the trumpet.
These days, though, the home-theater sales rep, a Simpsonville resident born and bred in rural St. Matthews, S.C., is no longer a lover.
He's a "lah-vah." And, playing the "trom-PET" is his "lahv."
Stabler went to bed the week before Christmas a Southerner, and by the time he came home from the hospital on Christmas Eve, he had become a Frenchman.
Or at least, a Southerner with a French accent.
Stabler's sudden change in accent is the result of what he learned later was a stroke.
His new speech pattern is described by doctors as an extremely rare condition known as "foreign-accent syndrome," a phenomenon that has been documented only a little more than 20 times worldwide since 1919, experts say.
So, when Stabler talks about grits and lightnin' bugs, he sounds like an emigrated Frenchman learning alien Southern terms.
And, despite the difficulty in getting strangers to believe he is a native South Carolinian or convincing family that it's not all a joke, his new dialect is fine by him.
"I feel like one of those European romanticists," says Stabler, 45. "I enjoy things more. It doesn't particularly bother me. At first, I couldn't speak, so I'm glad the good Lord allowed me to."
Overnight, a stroke
Indeed, at first, Stabler was speechless.
He had finished an evening of reheasal with the Hosanna Brass, a small orchestra he plays in as a hobby and an expression of his love for music.
He had suffered headaches off and on for a week, and that night it was particularly bad. He went to sleep only to awaken at 5 a.m. with a strange feeling in his face.
His wife, Shari, told him he was simply tired and needed to go back to bed. At 7 a.m., he awoke again and stared into the mirror in amazement. His speech was nothing but indecipherable slurring.
His wife called an ambulance, and as paramedics treated him, he noticed that his speech was returning but sounded different. By 9 a.m., his speaking pattern was completely transformed. Those who knew him before were baffled.
When Stabler's family practice physician, Dr. Larry Berglind, first saw the patient he has known for more than 10 years, he asked, "Berley, why are you talking like this?"
It wasn't until his neurologist, whom Stabler hadn't known before his stroke, asked where in Europe Stabler was from that he was diagnosed with foreign-accent syndrome.
Although the accent has presented challenges, Stabler knows he's lucky. Stroke is the third-leading cause of death in the United States, behind heart disease and cancer, according to the American Heart Association.
In Stabler's case, stress from the holidays, a death in the family and beginning a new job after a layoff had contributed to high blood pressure, 218 over 146. Stabler also had a history of hypertension, and it didn't help that he has diabetes.
He is working to strengthen muscles on the right side of his face, but otherwise, his accent is about the only noticeable sign of the bullet he dodged. Doctors termed his stroke "mild."
Six days after his admission to the hospital, Stabler was back home, with a new way of speaking … and a lot to explain.
A new Berley
"The way he was talking just flipped me out," Shari says. "So many people think it's a put-on, because it's such a good accent."
His longtime friend, Brian Beam, owner of Cinema Quest, where the two now work together, says he wasn't sure at first if the whole thing was a practical joke.
The two have been known to call each other when one is at a house installing a home theater, playing the part of an angry homeowner who questions why someone is in his house.
The accent, Beam soon learned, was no joke.
"It's this new accent with the old way of saying things," Beam says.
The easy part for Stabler was convincing those closest to him that his French accent was real. The challenge has become selling it to those strangers he meets and the old clients he comes in contact with.
"When I call old clients, they have no idea who I am," he says. "I find myself trying to speak distinctively with my old clients, but then I just have to let it go."
Speech therapy has done little to change his accent. Rather, it serves more to help strengthen the muscles on the right side of his face.
He hasn't suffered major paralysis of the face and limbs as many stroke victims do, but he does have a little trouble playing the trumpet, though that is improving.
"Speech therapy is 'TOHR-cha,' I tell you," Stabler says.
The mysterious brain
The accent — and possibly the heightened senses of vision, smell, hearing and taste he reports — are a result of the brain reorganizing its circuitry to heal and perform old tasks, says Jack Ryalls, a professor of neurolinguistics at the University of Central Florida who has taken a lead role in studying foreign-accent syndrome.
Ryalls likens the way a brain works after a stroke such as Stabler's to that of a lamp that flickers: It still illuminates, but in a different way than when the circuitry was wired correctly.
"The brain reorganizes after a stroke, tries to find new pathways to accomplish old motor tasks like speech," he says. "Sometimes, it overcompensates or does it imperfectly."
Ryalls, who recently worked with a woman in Sarasota who awoke with a thick British accent, says speech impediment in stroke victims is a mysterious hurdle, as are many phenomena of the brain.
Therapists, he says, have been known to hold up a card with the word "blue" on it, only to have the patient unable to speak it and give up trying.
However, when the patient gets upset, oftentimes he will blurt out: "Darn it, I can't say 'blue.'"
Since 1919, about 20 cases of foreign-accent syndrome have been documented, Ryalls says.
Stabler's case is the first that Berglind, the family physician, has ever seen.
"It's probably something I will never see again," he says.
After recent media exposure of the Sarasota woman with the British accent and a Philadelphia woman who appeared on numerous television talk shows, Ryalls says 10 more possible cases have come to his attention, which he says demonstrates that the syndrome is woefully underreported and seldom diagnosed. In so many ways, the medical community doesn't fully agree about what foreign-accent syndrome is, how to diagnose it or why exactly it happens.
In many cases, he says, doctors are simply shooting in the dark.
However, there are four basic criteria — simple criteria — that neurologists follow to diagnose the syndrome: the patient must sound foreign, have suffered a brain injury, sound unlike his or her previous accent and have no background or significant exposure to a foreign country.
And, Ryalls says, there seem to be, in the limited number of cases reported, more women (68 percent) diagnosed than men.
Those who exhibit symptoms have damage to the left side of the brain (where the mind performs speech functions); left-side brain damage affects the right side of the body.
In Stabler's case, a lesion on the brain caused by the stroke affects his speech pattern. Stabler's particular lesion is small, Berglind says.
In trying to break down the various accents that manifest themselves through the syndrome, experts are finding that the accents might be nothing more than a listener's perception.
In other stroke cases in which speech is affected, the same part of the brain is damaged. The only difference, says Jennifer Tooley, a speech-language pathologist with the Greenville Hospital System who is working with Stabler, is that most stroke victims' slurred speech doesn't sound "normal."
It's more likely, she says, that a foreign accent is only a particular kind of slurred speech — a sound that is picked up by the listener as an accent when it is nothing more than a change in pattern unrelated to culture.
"It's very exciting to study," Tooley says.
From German to Greek
Sometimes, Stabler's voice sounds German, other times Greek. One person told him he sounded like an Iraqi.
But for the most part, he's told he sounds French ("oh-kai" for OK; "BUH-lay" for Berley).
"I tell people I'm working my way across the continent, back to America," he says.
In describing what he thinks a German accent sounds like, he seamlessly alters his accentuation to sound distinctively German.
He's at a loss for why he can force himself to speak a convincing German accent and not speak common American English.
Speech therapists seem to agree that Stabler's accent is German. When he's tired, and his speech slurs more than during the morning, Stabler's voice sounds more Greek, his Greek clients say.
Ryalls says that French accents are more common, and he believes the sound is a result of timing and irregular accentuation on syllables.
When such aberrant accents are broken down to their smallest parts, linguists find that the speech pattern is more an odd mixture of sounds than anything else. Stabler, in some sentences, unconsciously speaks a few words that sound Southern.
"If you look at the detail of it," Ryalls says, "it's not really a French accent. Some people believe it's partly in the ear of the beholder."
A Frenchman at heart
The ear of the beholder is all that matters in the world of Berley Stabler, because that's why he must answer question after question about his new voice.
No matter how hard he tries, Stabler can say only two words in his native, Southern vernacular: "Marvin" and "aunt" (pronounced "ant").
He has no idea why those two words come to mind.
To speak them, he must concentrate, closing his eyes for about five seconds before he blurts out an eerie "typical-Southern-white-guy" accent.
His change in speech has had one particular side effect that has helped him: His singing voice is purer.
As he sings in the Simpsonville Methodist Church choir, Stabler has amazed choir director and voice coach Elaine Fowler.
In working with most Southern-accent speakers and those from the Northeast, Fowler says, she must train them to enunciate "pure vowel sounds."
People with distinct regional American accents need coaching to sing differently than they talk, she explains.
However, Fowler says that Stabler suddenly gained the ability to speak and sing pure vowel sounds almost flawlessly.
While his speech pattern will fade over time, Berglind says, his odd, blended European accent likely will never disappear. If his speech hasn't cleared up in two weeks, the change probably will be permanent, he says.
Ryalls, however, believes that because Stabler has recovered so quickly thus far, his accent eventually may fade.
Either way, Stabler has begun a new regimen of walking — both to improve his cardiovascular health and to create endorphins to help his brain heal. Doctors tell him the exercise will help immensely with health and speech.
Even so, Stabler's not sure he's ready to yield his exotic brogue just yet.
While his wife quips that her husband's appetite for French or European cuisine isn't any different than it was before, Stabler says he can't help but think his trumpet playing will take on a more romantic tone.
He says he will embrace whatever voice he's left with, as long as he can talk … and play the trumpet.
And if the voice that speaks to his romanticism is to fade, well, he says, that's life. Or, as his newfound countrymen might say, "c'est la vie."
—
February 28, 2004
Scientists study stroke victim's brain
Berley Stabler's stroke-induced venture into the French dialect has taken the good ol' country boy on an unlikely journey.
First, it was waking in a hospital with a French accent, then convincing family and friends he wasn't faking, and all along the way enjoying the novelty of it all.
Now, Stabler – who, as the result of a stroke, has been learning to deal with an extremely rare condition called "foreign-accent syndrome" – is contributing his experience to science.
The home theater sales rep from Simpsonville recently traveled to Charleston to undergo a brain scan that experts say reveals groundbreaking information in determining what causes foreign-accent syndrome.
"What everybody is trying to figure out is, what is this?" said Dr. Julius Fridrikson, a communication and disorders scientist in the University of South Carolina's public health department who headed the research effort.
"What we found, nobody has ever found," said Fridrikson, who along with colleagues is rushing to get the findings published in medical journals.
Using functional magnetic resonance imaging – a type of MRI used to determine brain function – Fridrikson said he was able to confirm finally, what researchers have long thought about the syndrome.
Scientists have theorized that a lesion on the brain caused by stroke, and the location and severity of the brain damage, is what causes someone like Stabler to suddenly develop a foreign accent.
Now, Fridrikson said, that has been confirmed, and with more study, he and collaborators from Nottingham, England, who were present for the scan, hope to gain more insight into exactly how victims recover and why some don't.
A new way of talking
Stabler suffered a stroke the day before Christmas.
While he escaped some of the more debilitating after-effects of stroke, such as full-scale paralysis and memory loss, the stroke immediately affected his speech pattern. His normal Southern drawl was replaced by what sounded like a French accent.
The accent is actually a mix of the typical slurred speech stroke victims suffer and a change in verbal accentuation.
Since 1919, only about 20 such cases have been reported in the United States, said Dr. Jack Ryalls, a University of Central Florida neurolinguistics professor who is a nationally recognized expert on the syndrome.
Ryalls, who learned about Stabler during an interview for a story that appeared in The Greenville News last month, encouraged him to undergo the scan.
Brain 'working overtime'
During the MRI, Stabler was asked to identify pictures and to recite words on command. The test showed how increased blood flow to a certain section of the brain helped him speak.
Fridrikson said he found that the section of Stabler's brain that helps control motor and speech function is "working overtime" to compensate for brain matter that was destroyed as a result of the stroke.
Much like an inexperienced runner receives more blood flow to his muscles than is required for a marathon runner, the speech section of Stabler's brain is receiving markedly more blood flow than in people with normal speech.
"This process can tell us which telephone lines are in place," Fridrikson said. "His brain is compensating for this stroke by increasing its effort."
The functional MRI scan has been used in brain research to study everything from schizophrenia to blindness. This is the first time it has been used on someone with foreign-accent syndrome, Fridrikson said.
Recovery coming, slowly
In the time since his stroke, Stabler's voice has gradually begun to return to normal. His voice sounds, here and there, more akin to his background as a lifelong South Carolinian.
Fridrikson said Stabler is recovering well because his lesion is small and because, at 45, he is relatively young for stroke victims.
Because Stabler is recovering so well, Fridrikson said a follow-up scan in late June could make headway in determining exactly how those with foreign-accent syndrome recover.
Stabler said he learned something valuable.
During the testing, Fridrikson showed him a scan of a woman who had suffered a similar stroke in the same part of her brain.
But instead of a change in speech and mildly decreased motor skills in the face, as Stabler has, her injury has left her severely debilitated.
The change in accent has been kind of fun, Stabler said, but "this made me really take hold not only how precious life is but how fortunate I am to be showing good recovery. I guess it hit home even harder."
—
February 18, 2005
Berley Stabler strives to stay fit while battling new obstacles
Berley Stabler is a Southerner once again; his flirtation with life as a Frenchman is but an exotic, bittersweet memory.
A "trom-PET" is again a "TRUM-pet"; "JEH-zus" is "JEE-zus."
Stabler has returned to his native South Carolina accent after a strange, yearlong odyssey during which he spoke with a French accent as the result of a rare, stroke-induced condition known as "foreign accent syndrome." Only 20 cases of the syndrome have been reported since 1919.
Rarely does Stabler miss the French accent he acquired after suffering a mild stroke in December 2003 and the attention it brought him initially from friends, family, the media — and physicians across the globe who were fascinated at the prospect of studying his case.
Soon enough, the novelty wore off.
After all, the Simpsonville salesman is still, at the core of the whole ordeal, a stroke survivor.
He had to endure rigorous speech and physical therapy, reverse a lifetime of poor eating habits and take a daily cocktail of medicine for the purpose of lowering his blood pressure (medication he no longer has to take thanks to improved health through exercise and diet).
But his trying experience could provide a substantial benefit for other stroke patients.
Stabler's foreign accent syndrome has now faded almost completely as a result of his brain's successful mending, and doctors hope that the studies they have conducted on his brain over the past year will yield new knowledge about how to help other stroke victims recover.
A University of South Carolina neurology professor has been studying Stabler's brain with a powerful MRI device in Charleston, tracking how the brain heals the damage a stroke inflicts and how that healing process could lead to better treatment methods.
And a British medical journal is set to publish Stabler's case history to document the rare syndrome.
Two British neurologists as well as a foreign accent syndrome specialist from the University of Central Florida will meet Stabler in Charleston in March for one last scan.
A trying time
Where once he quipped about a latent romanticism unlocked and reveled in the new-found ability to sing whole vowel sounds in the church choir, Stabler now is ready to put the whole accent thing behind him.
There was something intriguing at first about waking up after a nighttime stroke with what sounded like a French accent.
Of course, it wasn't actually an accent of any nationality, but rather the ear's interpretation of a distinct form of the slurred speech that most stroke victims exhibit.
Either way, Stabler says he soon tired of speaking so slowly.
"It was fun at first," he says in an unmistakable Southern drawl. "But it started getting frustrating."
Eleven months after his stroke and the onset of the French accent, around Thanksgiving, Stabler's voice began to return to normal.
Today, he is a man determined to avoid another stroke. That means a regimen of walking — three miles each day at the Simpsonville Activity Center — and weightlifting to build on the past year's rehab work.
He's lost 46 pounds since he suffered his stroke Dec. 18, 2003, and his blood pressure readings are right in line with what defines a healthy cardiovascular system. He's found himself renewed — and the stroke isn't the only force that has driven him.
In April, Stabler's wife, Shari, passed away suddenly. About the same time, the home-electronics business he helped run with a longtime friend folded.
It was a difficult, painful time, a period in which he says he had to reach deep down for faith in order to press on.
Over the summer, Stabler decided to honor Shari's life by working in a nursing home, remembering how fond of the elderly she had always been. Just before Christmas, he was laid off from that job.
Out of work, Stabler entered 2005 hoping for a better year than the one that had just passed. Yet, only a few days into January, he found himself suddenly paralyzed.
Steadily throughout that day, Stabler lost feeling in his limbs and soon had trouble breathing.
The doctor told him he had a burst blood vessel on his upper spine (not the result of a stroke) and gave him a choice: life-threatening surgery that might or might not work, or spending the rest of his life as a quadriplegic.
He had two minutes to decide. He thought of the late Christopher Reeve. He prayed: "I said, 'God, if you're ready to take me, I'm ready to go.'"
His decision is clear in the thick, 6-inch-long scar scaling his lower neck and back and the furious power-walking he engages in every day.
Lying in the hospital bed, though, he got a call on his cell phone. It was a job offer to get back in the home-entertainment business at Tweeter Home Entertainment Group. Stabler told the prospective employer he was in the hospital, that it might be a few weeks before he could clock in. They held the job for him.
This week, he started his new job … just as he returned to work mere weeks after he suffered his stroke.
The Hosanna Brass ensemble Berley plays trumpet in has joked with him that he should change his middle name from Jacob to Job, says Terry Layne, who has played tuba with Stabler in the brass band for five years.
"I've never met anyone like him," Layne says. "How many people do you know who could do or would do what he's done? For someone who has lost as much as he's lost, he's retained the very best human traits."
An opportunity
Stabler's recovery from the stroke was an opportunity that researchers couldn't pass up, not only because of the rare chance to study a patient with foreign accent syndrome, but also because of the ease with which they could watch how his brain recovered.
The stroke left a small, conspicuous lesion on the part of the brain that governs speech, making healing easy to monitor, says Dr. Julius Fridriksson, a neurology professor at the University of South Carolina's Department of Communication Sciences and Disorders.
Stabler's peculiar side effect — the accent — was the type of symptom that was easy to compare alongside the improved blood flow in the damaged area of the brain, Fridriksson says. That made it so that doctors could distinctly link healing to improvement.
"It's a clearer picture," Fridriksson says.
Dr. Jack Ryalls, a professor of neurolinguistics at the University of Central Florida who has taken a lead role in studying foreign accent syndrome, says Stabler's is the first case that could be studied in such detail.
What researchers found, Ryalls says, was that Stabler's brain was routing blood flow to the damaged area of the left frontal cortex (where speech is generated), overcompensating so that he could speak.
Over time, the damaged area healed and blood flow began to work more conventionally.
Ryalls recently has studied a Sarasota, Fla., patient whose stroke led her to speak with what sounds like a British accent. Her damage was more extensive, and her speech hasn't recovered at nearly the rate Stabler's has, making his case all the more rare, Ryalls says.
In the last brain scan in March, Fridriksson says he and British doctors expect to find Stabler's brain has reorganized its circuitry and reached equilibrium. Studying Stabler's recovery, Fridriksson says, is a valuable piece of the puzzle in trying to develop new drugs to heal the damage from strokes.
Stabler couldn't be more pleased.
"That was the whole reason I participated in the study," he said. "It was all worth the effort if other people are helped. We made lemonade out of a lemon."
