March 23, 2016 | Erin Bluvas, bluvase@sc.edu 

Although the technology for evaluating and treating stroke survivors has advanced significantly over the past several decades, the ability of scientists and clinicians to offer personalized prognosis and treatment plans for individual patients has remained stunted. Researchers just don’t know how factors, such as age, gender and brain fitness, impact rehabilitation outcomes. Julius Fridriksson aims to change this with a five-year, $11.1 million grant from the National Institute on Deafness and Other Communication Disorders (NIDCD) that will create the Center for the Study of Aphasia Recovery.

“This is a remarkable accomplishment for a faculty member who throughout his career has been steadfast in producing impactful science, quality mentoring, quality classroom teaching and demonstrating model faculty citizenship,” says Thomas Chandler, dean of the Arnold School of Public Health. “I am really, really proud of him.”    

The purpose of the grant is to better understand individual responses and recovery following stroke for patients who have acute/subacute (i.e., first days and weeks) or chronic aphasia—a communication disorder resulting from stroke or injury to the brain that impacts patients’ ability to speak, listen, read, and/or write but not does not affect their intelligence. With half of stroke patients in South Carolina under the age of 60, aphasia is not a condition that is limited to the elderly population. Recruiting patients through print media, television and radio, the Center will evaluate and treat a wide range of participants while collecting data on a multitude of factors that influence recovery.

“Clinicians have to end every appointment by telling the patient, ‘everybody’s different and I can only speculate on how you will recover,’” says Fridriksson, who is a USC Health Sciences Distinguished Professor in the Arnold School of Public Health’s Department of Communication Sciences and Disorders (COMD). “I don’t want to do that anymore. I know for certain that the patients and their families don’t want to hear that anymore. They need something more concrete.”

According to Fridriksson, stroke survivors have specific questions regarding their recovery—ones that lead to anxiety and depression if left unanswered. What will my future be like? When will I be able to work again? Will I be able to communicate exactly as I could before?

“There is so much variability among the patients, and we don’t know what the crucial factors are that affect prognosis,” he says. “For a while we were only able to look at the amount of damage the stroke caused for patients. Now we know that there are other factors that influence recovery, but we don’t know which ones matter most or what roles they play.”

One of the primary factors the Center will look at to predict prognosis is brain fitness—an umbrella term that includes many different measures of brain integrity, such as residual cerebral blood flow, intactness of brain connections, and location and size of brain damage. They will also assess variables such as age, time-post stroke, gender and neuropsychological status.

“Previous research has yielded small data samples that often lead to more questions than answers,” Fridriksson explains. His new Center will revolutionize treatment for aphasia patients by collecting and analyzing data from hundreds of individuals through collaborations among the Center’s four sites: Fridriksson’s Arnold School-based Aphasia Laboratory, which works closely with USC’s McCausland Center; the Medical University of South Carolina; Johns Hopkins University; and the University of California, Irvine.

Each site will be run by locally based co-principal investigators. USC contributors for the project include Fridriksson’s COMD colleague, Dirk den Ouden, and psychology’s Rutvik Desai. Also joining the project from psychology is Fridriksson’s closest collaborator, Chris Rorden. “Chris is just as important as our MRI scanner,” he says warmly. “He provides expertise that I don’t have and is known worldwide for his data analysis.”

The 2010 Arnold School Faculty Research Award Winner first conceived of the idea for the Center three years ago, emphasizing that a collaboration of this scale begins long before the funding is announced. “There must be a lot of synergy for a project like this—even beyond the immediate area,” he says. “We have a very strong core of scientists here in Columbia, but we need to work with an even broader group of experts with different resources and strengths that compliment ours.”

Funded with one of the largest research grants ever received at USC, the Center is the result of countless collaborations and Fridriksson’s personal dedication to aphasia research that began 15 years ago when he joined the Arnold School as an Assistant Professor—still finalizing his dissertation research. His interest in aphasia began even earlier, however, when he was studying economics as an undergraduate in his native Iceland.

Fridriksson’s uncle, an Ear, Nose, and Throat physician, encouraged his nephew to study speech-language pathology. Because Iceland did not have any master’s programs in this area at the time, Fridriksson moved to the United States to earn his degree at the University of Central Florida. “After meeting my wife there, who is originally from Puerto Rico, I knew that we would not be returning to Iceland,” he says, laughing.

After graduation, Fridriksson’s work with stroke survivors as a speech-language pathologist at a nursing home in Florida steered him toward aphasia. “I found it fascinating that the ability to communicate could be selectively impaired,” he says.  “You can’t talk and you don’t know what others are saying. Most of the patients told me that they lost most of their friends within a year or two. Their intellect is intact, but it’s difficult to maintain social support.”

That’s when Fridriksson knew that he wanted to study aphasia so he went to the University of Arizona to work with the world-renowned researcher, Audrey Holland. Holland specializes in the effects of stroke on psycho-social aspects of aphasia, and Fridriksson forged a new path for himself in the under-researched area of neurophysiology of aphasia recovery.

When he interviewed at Carolina, Fridriksson immediately felt at home in the COMD department and connected with his future colleagues and then-chair Elaine Frank. “I canceled my other interviews because I knew that USC was it,” he says.

“I first met Julius Fridriksson while recruiting him to become a professor in the Arnold School of Public Health,” says USC President Harris Pastides, who was the dean of the Arnold School at the time and offered Fridriksson the position. “He was fresh out of his doctoral program but I saw in him the potential to become a scientist and scholar of the highest order, and who would not only have impact but could also serve as an excellent mentor. What a great decision that turned out to be.  I couldn’t be prouder.” 

In 2001, Fridriksson arrived at the Arnold School and established his then-modest Aphasia Laboratory. His compassion for the uncertainty and lack of social support that many stroke survivors face led him to create free Stroke Recovery Groups in 2002 within COMD’s USC Speech and Hearing Research Center.

Over the next decade and a half, Fridriksson rapidly built his research portfolio, often with support from the 2000 endowment gifted to the Arnold School by Gerry Sue and Norman J. Arnold (their collaborations will continue with the Arnolds’ 2015 $7 million gift to establish an Institute on Aging at USC). He became a recognized authority and pioneer in aphasia research, concurrently developing the critical connections within the field that would make a Center of this magnitude and impact a reality.

Today, Fridriksson remains as grounded and enthusiastic about his work as he was on his first day at the Arnold School. “Sometimes I can’t believe they pay me for this job,” he says. “Working as a scientist is not just very rewarding but also a lot of fun!”

Though Fridriksson enjoys his role as a researcher, his end-game stays squarely focused on the patients and how his work will improve their quality of life—a priority that is shared by his entire department of researcher-clinicians and one that is integral to the Arnold School’s mission. “A project this size will help us contribute not only to the literature but also to the clinical side,” he says. “That’s always the ultimate goal—to improve their care, to improve their lives.”

This person-centered philosophy is a common thread among public health practitioners and scholars, and Fridriksson’s commitment to it is apparent to everyone who works with him. “Julius’s work is so important because of its emphasis on people,” says COMD Chair Kenn Apel. “Since his first days here in the department, he has had a laser-like focus on understanding how to help people with aphasia improve their communication abilities. Our graduate students benefit from his research because they can implement his latest findings as interventions in our Speech and Hearing Research Center. More importantly, our clients at our existing center and the ones who will join his new aphasia-focused center will gain much from receiving those interventions.”

And even though Fridriksson’s Center for the Study of Aphasia Recovery was a long time coming, he assures us that he’s just getting started.

Read more: UofSC press release