Foreign Accent Syndrome

Sharon Campbell-Rayment had a fall from a horse that knocked her out cold. Her recovery from that injury was complete with one small exception. For the past decade, ever since her accident, she's spoken with a Scottish accent.

In July 2008, Campbell-Rayment was initially diagnosed with a mild concussion. After about 10 days, the former self-described Type A personality was back at work.

"I woke up one morning and thought, 'Oh, I'm going to call one of my employees.' And when I called her I was unable to say anything," Campbell-Rayment recalled.

An MRI showed bruising to the frontal lobe of her brain that controls important cognitive skills, as well as injury to areas of the brain involved in speech. When she started to speak again, she stuttered and had trouble putting words together. 

This led to speech therapy where she progressed well. But weeks into her recovery, both her speech therapist and Campbell-Rayment were puzzled to hear her speaking with a thick, Scottish accent that she later learned was "right out of Inverness." 

Campbell-Rayment grew up in southwestern Ontario and has Scottish ancestry, but no accent before her accident.

She was a rare case of a strange disorder known as "foreign accent syndrome," or FAS.

This spring, researchers published what they called the largest case series to date in the Journal of Neurology, Neurosurgery and Psychiatry to outline what can trigger FAS in people like Campbell-Rayment.

Sharon Campbell-Rayment is told she sounds like Mrs. Doubtfire. Here she gives another idea of why she developed the accent. 0:21

Their analysis of speech samples also suggested that what we hear isn't really an accent at all. 

Is this for real?

Foreign accent syndrome is a rare and surprising outcome of a brain injury.  As a result, one of the problems people with FAS often encounter is it isn't taken seriously.

Dr. Laura McWhirter of the Centre for Clinical Brain Sciences at the University of Edinburgh co-authored the study on people with foreign accent syndrome. She recruited people for the study from online support groups. 

"I think we need to be much more open about accepting these disorders as something we have to deal with in neurology and psychiatry, and that we can really help people," McWhirter said in a conversation with CBC Radio Quirks & Quarks host Bob McDonald. 

"I think sometimes people are getting a bad experience. They are feeling dismissed or not listened to by doctors."

One of the reasons for this is that the accent can seem to be fake.

In fact, according to linguist Sheila Blumstein, it's not really a foreign accent at all. Rather, it's a change in speech patterns that listeners interpret as an accent — though sometimes a bad one.  

Blumstein is a professor emerita of cognitive, linguistic and psychological sciences at Brown University in Providence, Rhode Island. She's seen four people with FAS in her career, which is an unusually large number of patients, considering how rare the condition is. Typically, listeners aren't unanimous on what they think the accent might be, she said. 

Blumstein recalled one female patient who she thought sounded French because the melody of her speech had a big rise. But the woman was raised in Boston and didn't know French.

"We believe that it's largely a change in the melody of speech, the intonation," Blumstein said. "That has an effect on what we call the rhythm of speech, it's prosody."

Breathy voices and vowel variations

McWhirter's study of nearly 50 cases includes examples of foreign accent syndrome that are thought to have a structural cause, such as from a stroke or a brain lesion. The damage often occurs to the left side of the brain that affects motor areas. She classified those as a "hardware problem" with the brain where physical damage causes messages to become scrambled.

But the majority of FAS cases McWhirter's team found were what she called functional neurological disorders, in which patients have symptoms such as weakness after migraine or injuries to the face or mouth. She characterized these functional disorders are more like "software problems" with the brain. In this way, it might be closer to some cases of late onset stuttering or other speech difficulties.

Dr. Laura McWhirter said this woman with foreign accent syndrome originally had an English) accent and a French/Italian accent subsequently. McWhirter said she likely has functional FAS. 0:11

Co-author Nick Miller of the speech and language sciences department at the University of Newcastle, studied speech samples provided by participants. He found those with the functional form tended to have variations in how hoarse or breathy their voices were, along with producing vowels in a particular way.

In contrast, McWhirter said those who developed a foreign accent or dialect after a stroke showed other speech problems, such a difficulty coordinating their words and speaking with an accent that's hard to pin down to, say, purely Italian.  

Sheila Blumstein said the melody of speech is affected in foreign accent syndrome. (Brown University)

McWhirter said giving people with a functional FAS a clear explanation of the diagnosis can be reassuring because clinicians may be able to show inconsistencies in their speech that demonstrate the brain is working. For others, symptoms such as pain, stress, depression or anxiety may need to be addressed. 

Sounds 'like a foreign enemy'

Blumstein also gave a historical example to illustrate how difficult it can be to suddenly speak with what seems to be a foreign accent. 

"In 1941, there was a woman from Norway who was wounded with shrapnel during the war and as a result, she develops a foreign accent syndrome and she sounded German. She was speaking from what sounded like a German accent to people in Norway speaking Norwegian. She was shunned by her compatriots essentially because she sounded … like a foreign enemy." 

So far, scientists know frontal areas of the left hemisphere that are involved in production and articulation — and sometimes subcortical areas — are involved in FAS. 

Sharon Campbell-Rayment and her horse, Malachi. (Submitted by Sharon Campbell-Rayment )

Blumstein said that by doing functional MRI to see what areas of the brain are activated when a person speaks and comparing that to someone who does not have foreign accent syndrome who says the same words or sentences, researchers hope to find underlying neural differences. Doing so could open a window into what the underlying problems may be. 

As for Campbell-Rayment, she now embraces her Scottish brogue. The former nurse and minister works as a motivational speaker. Campbell-Rayment said the story of how she acquired the accent often hooks in an audience to hear about the more serious side of recovering from a brain injury, as well as how she's learned to slow down and heal with her horses. She documents the journey in her book, Falling into the Rhythm of Life: Life Lessons Straight From the Horse's Mouth.

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