For the past few years as a Duke undergraduate student, Nana Osaki has studied the brain, focusing on how language changes after a stroke. During her sophomore year, she became the Blue Devil mascot - a role that depends entirely on gestures.
Together, those experiences have shaped how she understands communication and how a stroke causes language to break down.
"I think a large part that was really interesting to me is I'm a Japanese woman, but as a Blue Devil, I'm a white man," Osaki says. "There are times when … people be like, 'bro,' and dap me up, which would never happen in my real life."
Her life as the Blue Devil, along with her research in associate professor Jamila Minga 's lab, has broadened her view of communication. She's interested not just in what people say, but also in how they say it and how meaning is conveyed beyond words.
Not All Strokes Are Alike
Strokes occur when blood flow to a part of the brain is blocked or a blood vessel ruptures. It can occur on the right or left side, and each impacts the patient differently.
As part of her undergraduate research, Osaki studied right-hemisphere stroke survivors under the mentorship of Minga, focusing not on whether they could speak but on how they used language in context. Unlike left-hemisphere strokes, which can impair speech, right-hemisphere strokes often don't impact a person's ability to speak but affect what researchers call pragmatic language.
"That means that those individuals may have challenges producing language that is appropriate for the communication context, like saying the wrong thing for a particular situation or saying the right thing but at the wrong time in a conversation," says Minga, associate professor of head and neck surgery & communication sciences at Duke University School of Medicine and a speech-language pathologist.
Language-use challenges after a right hemisphere stroke are "most apparent when things don't happen as expected," Minga says. Conversations with right hemisphere stroke survivors can have long periods of silence and may end abruptly. They struggle to ask questions. When survivors are the ones answering, their responses can come after the conversation has moved on from a topic.
"I've noticed that oftentimes it's a lack of eye contact," Osaki says. "Their speech isn't slurred … It's just a little awkward."
Still, because these patients can produce fluent speech, their condition is often overlooked.
For survivors and their families, it can prove to be devastating.
"It affects their life in many ways," Minga says. "Many of the survivors are unable to maintain healthy personal and professional relationships. They're not able to maintain their employment. Many become socially ostracized and lonely."
Shining Light on a Hidden Issue
With May recognized as Stroke Awareness Month, researchers such as Minga are working to bring more attention to these less visible effects of stroke.
The research is both clinically significant and rare. Minga is among the handful of researchers in the U.S. studying right-hemisphere stroke and one of the few federally funded investigators in the field.
That funding comes through a K23 grant from the National Institutes of Health, which supports junior faculty as they develop independent research programs.
The goal is to link lesions visible on brain scans to patterns of language use in the hope that one day clinicians can predict language use disorders more effectively.
Another key development of Minga's work in the field is the creation of an ICD-10-CM diagnostic code for apragmatism, the technical term for the acquired pragmatic language difficulties that right hemisphere stroke survivors can experience.
The code allows health care practitioners not only to bill for language use disorders after right hemisphere stroke but also to obtain epidemiologic information, Minga explains. The code was approved by the National Center for Health Statistics and the Centers for Disease Control and Prevention in January 2026 and should be available for use in October 2027. Minga added: "It's another way for us to acknowledge the very real language use impairments that right hemisphere survivors experience."
Nana Osaki spent years anonymously representing Duke as the Blue Devil mascot. Credit: Nat LeDonne
That recognition also allows for better tracking, more research funding, and greater awareness of a condition that has long been misunderstood.
Connecting the Dots
The research also reflects a change in how scientists understand the brain, from two strictly divided halves to an interconnected network.
"I think it's really important to think of the brain as a network," Osaki says. "The brain does a little bit of everything, everywhere."
That perspective has implications beyond stroke, opening avenues for studying other neurological conditions and deepening understanding of how people communicate.
As Osaki prepares to graduate, she reflects on her experiences.
"I observe a lot more what people are doing with their hands, how they communicate," she says. "This comes from not only my research but also from being a mascot. And I think that has to do with when that sense has been taken away - you rely on your other senses, like sight or body language."
About what it's like inside the suit, she added: "When I'm in the suit, I am Duke, and I think that's a very cool experience that I'll really treasure for the rest of my life. And, you know, nothing beats a courtside seat," Osaki says.
Learn more about how federal funding supports groundbreaking research while training the next generation of scientific thinkers at Duke Research Saves Lives .
