Speech Class Diary, Part 1
Speech Class Diary--- Part 1
These speech class entries were moved from a message board to protect them from being deleted for being too old. For entries made after May 2007 you can visit my Yahoo 360 blog at: Click Here! Yahoo is were all my current blogs will be from now on. This part of the diary starts with August 27, 2004 and ends with October 14th.
August 27, 2004
Don is getting ready to go back to speech therapy classes in a few weeks, and today we went to the last of the support group days that were offered during the summer. For those of you who don't know this by now, when the semesters are in session, we go two days a week to a local college for speech therapies where Don is more or less a guinea pig for the students. One day a week is an individual session and one day is a group class. The student, future speech pathologists plan the lessons and teach the classes while a professor oversees everything, and they do a good job. We've been doing these classes for three years and the cost is only $20 a session. It is my intent, this year, to do a running speech class diary so that anyone who may be interested in speech issues can to follow along.
In the meantime, I posted an article in this Language Disorders forum that I found while I was looking for information on 'telegraphic aphasia'---a term my husband's speech professor used today to describe Don's inability to use the little words such as "to" "is" "the", etc. She said that he thinks he is saying them because he hears his inner voice saying them in his head. For example: He was saying, in an intense exercise between three speech patients, these words, "store gone" and the professor says the reason he can't understand what we want from him when we tell him to expand his sentence is because he THINKS he is actually saying, "the store is gone." From what I've gathered from reading on the internet tonight, telegraphic aphasia is a part of Broca's aphasia, but I plan to verify this when classes start.
The speech support group was so much fun today that I nearly peed my pants laughing as everyone was teaching each other swear words. This swear-fest came about after one young lady (40ish) was telling that for the longest time all she could say was "yes, no and fu#ker." Well, that opened up the floodgate and we were all rolling on the floor before it was closed again. This young lady had a stroke from an accident that occurred during getting a face lift. People, when they learn her age, always tell her how young she looks and I've often wondered if it hurts to be reminded so often of how she got her stroke. Is it like having someone call attention to an AFO brace?---which I know negatively effects so many people.
August 27, 2004
So many times I'd just like to take a vacation from dealing with speech issues, but for Don to keep making any progress at all, we can't let a day go by without the constant battle to get more and more words out of him. Dozens of times a day, it's the same thing over and over, day after day. "Not TV. Turn on the TV. Say it. Now say it again!" "Not pee. I need to pee? Say it. Now say it again!" Repetition is the only way to unlock the door to his semi-silent world.
Oh, but when I step back and look without the emotional drain obscuring my view, I can see the progress he's made these past four years. There's no more all-day marathons to get out just one word which, in the end, meant absolutely nothing to me--no bell going off in my head to let me know what that one word was suppose to communicate to me. Now, those single words come out in under two minutes for most nouns. No more do we have to sing nursery rhymes and Happy Birthday day in and day out, trying to get that automatic speech to kick in. No more days of total silence.
Now, he sings the tunes of many songs...his latest fixation is the Camp Grenada song where a kid is writing a letter home to his parents. But I can't remember the words to help him, so he just vocalizes the melody...often at the top of his lungs, picking up a word here and there.
I'm both excited that classes will start soon and dreading it at the same time. Excited because I've seen a lot of progress this summer for the girls to work on and dreading it because it's been nice having the two extra days a week in my schedule.
August 29th, 2004
Don's next speech therapist will ask how he's done over the summer. So, I'm starting to log all the spontaneous words that he gets out each day. I'll do it for several days, then take an average. He'll get the two hour evaluation testing done, as they do at the beginning and end of each semester, but his ability to get out speech in everyday situtations is what really counts. At least to me.
Don's first words this morning were: "Hello muddah," hello faddah," and then "Camp Grenada"---all in sang several times during his 'Celexa Happy Hour.' Next came his greetings at the farmer's market: "fine" in answer to "How are you today?" and "see you," a parroting of something said to him. On the way home from the market he got out, "Eat?" and "pee" for obvious reasons. And later on at the pizza place he said, "decaf coffee." It was the very first time he's got the 'decaf' out without prompted!! He also said, "thank you" to the waitress when she refilled his cup.
The word "stoned" came out next---another parroting of a word. It was in a Bob Dylan song that was playing at the restaurant. Thankfully, Don didn't take a likely to THAT song, or he'd be trying to sing, "everybody needs to get stoned" for the next three weeks. I can just picture me trying to prompt those words out of him in the grocery store. I'd be pushing my cart down the isles, with him trailing behind in his wheelchair, both of us singing, "EVERY body NEEDS to get STONED!" And if anyone asked about what happened to earn Don the wheelchair I'd respond, "It was a bad LSD trip, man! Just bad!" When we first met 34 years ago, I had Don believing that I raised topical fish for a living. With a wheelchair and a happy old man as props, I could pull it off a joke like that.
What?" "Man!" "Welllllll!!"---all additional words that came out today in reaction to something said to Don. Then tonight, one of his favorite jokes was predictably on schedule: "TV, right now!"---always said with a big smile on his face---to which I give him my standard answer of: "Turn on the TV. Say it. Now, say it again."
Twenty spontaneous words in 14 hours. It was good speech day for Don!
August 30th, 2004
Don's summer homework for speech class was to use complete sentences. My homework was to accept nothing less. A typical conversation at our house, as per the therapist's instructions on my part, goes like this:
Jean: I need a complete sentence. I.....
Don: I want TV.
Jean: I want TV? I....
Don: I want a TV.
Jean I want a TV? You have a TV. I want to wa.....
Jean: Complete sentence please. I...
Don: want to watch TV
Jean: Complete sentence. Say it with me. I want to watch TV.
Don: I want to watch TV.
Jean: Now, say it again.
Don: I want to watch TV.
Jean: Bingo! Now, what channel do you want?
Jean: Western? I....
Don: I want western.
Jean I want western? I want to....
Don: I want to western.
Jean: I want to western? I want to wa....
Don: I want to watch western.
Jean: I want to watch western? I want to watch a...
Don: I want to watch a western.
I'm often amazed that Don has the patience to go through all this every day, day in and day out for most of the things he wants. It's only because he has that kind of patience that he's gotten past the single word vocabulary that he had for so many months. I just know all this repetition is going to pay off in the coming semester!
September 2, 2004
This morning we got the official letter from the college inviting Don to take part in the fall speech classes. It says, "...therapy services will be provided by undergraduate student clinicians under close professional supervision by a certified Speech/Language Pathologist. Treatment will focus on the development of functional communication skills." That sure sounds better than me says that Don is a guinea pig for the students.
This college is a Christian based college and girls in the speech program are a little less worldly than most college-aged kids. This is the aspect of going to classes that Don has the most fun with. i.e. he was a big (harmless) flirt before the stroke and he still is. What he used to do with words, he now does in non-verbal ways that can get the girls red-faced and with dimples showing in seconds. We actually drilled with cards this summer trying to teach Don to say things like: "you have pretty eyes" and "I like your ring" and "you have pretty hair" so maybe he'd stay out of the personal space of some girls who, at first, don't know how to take him.
Even though Don works with only one student per semester, the professors tape all his sessions and the tapes are used in classes as training material. So, all the girls in the whole department know all the patients really well by the ends of the semesters. (I say 'girls' because in the three years we've been doing these classes there's only been one male in the program.) In the waiting area before and after classes the patients and these speech students often interact, and this is when Don does his best flirting. In class, he works very hard.
Today, Don came up with a couple more words he hasn't said since the stroke. I was telling him why we couldn't do something and I guess I dwelled on the subject a tad too long for his tastes because he came out with, "enough said!" Just as clear as a bell, not once but two times. One of these days we'll probably have genuine argument and I'll probably be grinning from ear to ear.
Another thing that happened today in Don's speech world took place at the bookstore where we go near the first of each month to get a copy of "Cowboy & Indian" and "Southwest Art" magazines. They have a Starbucks inside the store and Don usually sits there with a cup of coffee while I browse the store. On this trip a lady who works at the coffee shop approached me out in the bookstore and said she had been talking to my husband and wanted to know if she got his "communication" right. He was able to convey that we were staying home for the weekend and having company from Georgia! Roaming the neighborhood on his electric wheelchair has really increased his ability to get his thoughts across. Without me to lean on, to fill in his gaps, I think he tries harder.
I don't often loss my temper when Don is trying to talk, but yesterday morning I blow my cool and yelled at him. Then I felt like such a witch (spelled with a 'B") for having done so.
We were watching the hurricane coverage on CNN and he wanted to ask me something---what I still don't know. After several tries, I said, "Stop, I'll tell you everything I know about the hurricane." But my account of what I'd just seen on TV didn't stop him from still trying to ask me something. After 15-20 minutes of his unsuccessfully searching for words and pointing to the television, I lost it and yelled, "I can't tell you what I don't know! All I know is what we just saw on TV!" It's like he's so focused on what he wants to say that he doesn't hear what I am saying. And I hate to watch him struggle for words when I know I won't have answers for him if and when he does get them out.
Well, I apologized five minutes afterward and he was quick to forgive me, but this whole business of not being able to talk is just so damned unfair!
September 9, 2004
Handicapped, handicapped, HANDICAPPED!
Over and over again that harsh word
Came out of Don's aphasiac brain
And passed his lips like a dirty curse.
Handicapped, handicapped, HANDICAPPED!
Repeated with varying accented syllables
Like someone learning a foreign language.
From soft to loud, said in different volumes
Like he was playing with the knob on a radio.
"Only a word," I tell myself as this goes on
But it's cutting, cunning and condemning
And I do not know what it means to him!
Is it word of sudden sorrow or deep pain
Or a word of grief, or of finding acceptance?
Handicapped, handicapped, handicapped
Aphasia, apraxia, stroke, wheelchair, caregiver,
Survivor---they're only words. ONLY WORDS!
And, God, how I wish I'd never heard them!
by Jean Riva
This was written in response to an hour long incident that happened this morning. He's said the word "handicapped' since the stroke but this time it was a chilling recital. And very much out of character for him this far out from the stroke. It also led him to saying the words: dead and die. All I was really able to get out of him in way of explanation is that he wants us both to die together. To which I said, "Okay, but not for 20 years." He agreed.
September 21, 2004, First day at school.
Don will be working with two student pathologists instead of the usual one. Both J. and N. (as the girls will be known from here on in) were friendly and not so shy that Don will be able to fluster them easily. The professor is good at matching up personalities of the students to patients.
The room they'll be using all semester for these Tuesday one-on-two treatments (plus the professor) is small, about 8' x 8' with a round table and four chairs. One wall contains a small counter with a sink and the door. Another wall is all one-way mirror. A camera is trained on the place where Don sits in his wheelchair. And next door, I will sit in a room of equal size and furnishings, plus the recording equipment and a large TV that feeds from the camera. Today, three other students watched with me in this observation room.
Before the testing got started, the girls engaged Don in a conversation about the things he likes to do and he was able to get out 22 assorted, unconnected words. Knowing him as I do, I know he was trying to tell about his yearly vacations out west, his die making job and the parking lot maintenance business he ran on the side in his pre-stroke days.
Then the hour and a half testing began. For anyone who has a copy of the 'Minnesota Test for Differential Diagnosis of Aphasia,' Don was given tests 1, 2, 4, 5, & 6 of section A: Auditory Disturbances. And in section C, Speech and Language Disturbances, he took tests 3, 4, 5, 6, 8, 9, & 13. The girls also gave him the Oral Motor Test For Nonverbal Apraxia.
What does all that mean? First, they had Don pointing to yes/no cards while asking trick questions. (He got 2 of 20 wrong.) Then a serious of mouthing sound effects: Ah, EEE, etc., and following commands like: stick out your tongue, round your lips, blow, etc. Standard tests. The third test was repeating words like: pie, boy, two, day, see, zoo, show, go stay, pray, etc. Don predictably screwed up all the words starting with "S". The forth test was easy for him: repeating phrases like 'man & woman,' 'all ship shape,' 'sing a song.' He only screwed up 1 of 20 of these: 'a kitchen chair' became 'a chicken chair.' Counting: he did a perfect 20. Days of the week: perfect. But the alphabet was a washout at "e" and he got a little frustrated. (He always pushes his wheelchair back when he's frustrated.) Then came a test where the girls would say: "what do you do with a hamper?" with soap? with money? This went well except for one interesting answer. When they asked "what do you write with?," expecting the answer of pen, Don said "left"---he used to be right handed before the stroke.
All the tests that involved matching pictures with words were easy for my husband. Then came the questions designed to test his listening abilities: "Does the sun rise in the west?" "Should parents spank their kids?" "Does everyone put money in the bank?" Then, last but not least, came the 2, 3, & 4 part instructions test (as I call it) where Don is expected to move objects around on a table. He was actually able to do some of the 4 part instructions for the very first time! For example: pick up the key, pen and flash light and put them in the box.
I was pleased with how he tested today. He did well and his antics had the girls in the observation room and me laughing quite often. He really is a clown.
September 28, 2004
When our poodle, Cooper, was still in puppyhood he had several sessions with a doggie psychologist. Yes, you read the right. He'd been taken away from him mother at five weeks old and to say that he was trouble with a capital "T" would be an understatement. He missed a few of the lessons that dog mom's usually teach their pups and the theory was that we would have to teach him that I (not him) was the alpha leader of the pack...a title he wanted with a vengeance. And, yes, this is leading to a speech story.
The psychologist (a.k.a. elite dog trainer) told us to have Cooper work for everything we give him. So, a pattern of making Cooper do a series of commands like 'sit' 'stay' 'down' 'up' and 'shake' to get daily treats became a ritual for Don and Cooper. But aphasia took that ritual from their lives over four years ago...until Sunday when it came back without fanfare or labored sessions with a speech therapist. I was sitting at the computer when I heard Don telling Cooper to 'sit' and 'up.' I could hardly believe it! There was poor Cooper doing his best to figure out why the hand signals didn't match the voice commands coming out of Don's mouth. This was another one of those "Wow, speech moments!" that I've learned to treasure.
Today was the first individual class of the semester and this time the professor was in the observation room with me for part of the session, letting "J" and "N" do the first half hour by themselves. These classes usually start out with a ten minute "conversation" and that went well. The girls were able to pull an assortment of words out of Don that (sort of?) told them about his collection of antique gas pumps, signs, cans and other gas station memorabilia from the 1910s to the 1940s. I know they didn't get it all, but it's an odd ball collection so they were at a disadvantage for queuing questions. And Don still tries to tell the same elaborate stories he did before the stroke so he was all over the place trying to tell them about our auctions, our booths in antique malls, and our vending at antique gas station conventions.
Simple sentence construction of 3 to 4 words is what they worked on the rest of the session. Subject, verb and object. To do this they showed Don pictures of things like a girl closing a window, a man watering plants, etc. He'd name the subject and object in the pictures and they'd write them on a post-a-note and then have Don move them around until they were in the right order. At that point, they'd work on pulling the verb or action out of Don. Of the 14 or so pictures they worked on, I found it interesting that he actually came out with three actions words without queues or prompting. It's rare for him to say verbs.
There was one sticky point of the session where the girls lost control of the class. It happend when Don called a bicycle an Oldsmobile and he got the girls side-tracked trying to tell a complicated story about his '67 Olds that a friend was going to restore. I was getting frustrated because I knew they'd never figure out what he was trying to tell them. Don did his characteristic roll-back that he does when he is frustrated. And the professor seemed to be frustrated, too, I assumed because the girls didn't guide Don back to the exercise they were suppose to be working on. It was at this point that she left the observation room and went to sit in the treatment room.
Over the course of the rest of the session the professor told the girls things like, "There is a delicate balance between giving queues and doing Don's work for him." (A good thing for me to remember, too.) And, "When giving queues, don't change Don's intent because you think another word would be easier for him."...I think I have that right. And, "give enough clues for Don to do word retrieval but not to bail him out."
On the way home, I asked Don if he felt like he had worked hard in class and he said "yes" in that emphatic way he does when he wants to express complete agreement. All in all it was a good first class.
October 1, 2004
It wasn't all that many years ago that I used to think that old people who didn't want to wear their hearing aids were either in denial or just plain vain. Then a few years back Don's ears were tested at the college where we go for speech therapy and it was decided that his hearing was bad enough to impede his efforts to learn to talk again. $3,000 later and a lot of trips back and forth to the hearing center, I need to apology to all those old people who I misjudged! We never seem to go for very long with both hearing aids working at the same time. One or the other is always back at the hearing center to get the wax sucked out of the digital components. And then there was the time when Don put a hearing aid on an end table and the dog snatched it up as if it were a tasty prize. Crunch. Crunch. On the way to class today we stopped at the hearing center. Again.
The room we'll be using for Don's weekly group speech class holds a large oval table that seats 20 people. One long and one short wall of the room are all windows that look out over the parking lot and the other long wall has a dry-and-wipe board plus the door. The fourth wall is all one-way glass behind which is the audio testing room that doubles as an observation room.
From a selfish point of view, it was disappointing to learn that a couple of the guys who'd been in Don's classes in the past have graduated to the middle, more verbal group. They made the classes fun. Left behind was Don and "V." Like Don, "V's" language has improved since last spring. He was quicker getting his single word responses out, and his emotional lability didn't show up today. The only other patient in class was new to the program and she'll be known as "S" from now on. When she first came into the room she almost went into panic mode because it was suggested that her granddaughter sit at the other end of the room---which is customary for the spouses/family to do---so they ending letting her granddaughter sit beside the woman. For this reason, I was surprised to learn that she lived alone and that she had had her stroke way back when her college-aged granddaughter was a little girl. I was even more surprised when "S" spoke out loud and a stream of undecipherable words came out, along with sound effects and gestures. The professor asked her granddaughter if "S" had ever spoken a second langauge when she was younger. "No," she answered, but it sure sounded like she was speaking one now!
The girls got the class started in the usual way: introductions where the patients are to say their names, name a hobby, and tell who came with them. Don was able to get out his first and last name and the professor kidded him that he was being a show-off. The rest of the class was spent playing charades. One patient-student team would act out a simple picture like a man shaving while the other two patient-student teams tried to guess what they were doing. This activity is designed (I think) to teach them to use gestures while doing word retrieval. It's one of my least favorite activities that they do in these classes. Don's one-handed gestures never match what he is trying to talk about, which frustrates me to no end, plus I've always hated the game of charades.
On the way home, we went to storage to check on things and Don predictably got on the "corvette debate" that we've had off and on for the past few years. It eventually will be moved home, but the bone of contention comes from Don wanting me to get it licensed and insured and drive it home instead of trailering it. But after being in storage for over five years, our mechanic says it's not safe to drive and that if we're not going to drive it once we get it home (which we're not) there is no point to replacing the brakes because it's the nature of corvettes in storage to have their brakes dry out. Every time this debate comes up, it feels like I'm taking Don's dream of walking away from him again because we have to get into the fact that he'd not be able to get in and out of the '78 vette for us to drive around. And where would we put the wheelchair? The "corvette debate" always ends the same way: with me fighting back the tears and him going into a state of melancholy. Without speech it's so hard to figure out how he really feels! Am I the bad guy in the scenario? Am I the messenger he wants to shoot? Does he really understand my reasons for not wanting to spend the money on getting the car repaired, insured and licensed again? Does he really think he's going to be able to drive the car again someday? I hate not being able to talk out our feelings the way we used to!
October 7, 2004
Class on Tuesday began with a conversation where the girls would expand Don’s single word responses into full sentences, then have him repeat them. He’s getting pretty good at getting through a whole 6-7 word sentence after only hearing it once or twice. One funny point came when they got on the topic of politics and Don blurted out, “bull sh#t!” It cracked everyone up and embarrassed him. He hasn’t said that since the stroke. His diction still reminds me of a little boys at times, but it's getting better. His voice is deep and full, the way it was before the stroke, but he sometimes accents things differently. He has a voice like the singer, Roger Miller, and every one used to love it.
Next the girls did a variation of the exercise they’d done last week….showing Don pictures in order for him to build simple sentences based on what he saw. But this week the pictures were not of a person doing an action. They were of things like a mop head standing next to a can of wax or a hand petting a dog. These were obviously more difficult for Don and after he’d struggled with a few pictures the professor left the observation room, and in the treatment room she told the girls that they needed to stay with the other level of pictures they’d used before until Don could do them with an 80% accuracy, then bump him up.
The rest of the session was spent playing Go Fish, a game that encourages getting repetitive sentences out in same way in which the game of Uno was used to get colors and numbers out of Don when he was still struggling to say any words.
Thursday's group class consisted of five exercises:
1) The patients had to call out words that were associated with fall.
2) The students had a pumpkin and the three patients had to instruct them how to carve it.
4) The three students acted out things like eating and writing while the patients guessed what they were doing.
5) The patients took turns acting out pictures like brushing their teeth.
All of these exercises were designed to practice word retrieval and to hone gesturing. Don did well and got quite a few words out today. He also won a round of Go Fish that had him gloating in a very mischievous way. He can sure put a lot of different emotions into a word with the way he pronounces, "well" and "oops"....two of his favorites.
On the home front, we got rid of the digital cable box and we're going with straight cable now. I no longer have to operate the remote for Don because the new one is so much simpler to operate! The down side is that it cuts down on our most repetitive conversations.
October 14, 2004
In Tuesday's individual class the girls had Don bring in some photos to talk about in their opening "conversation." True to form, Don brought in pictures of the dog, his Vette, and part of his collection that we'd just hung up in the garage.
Then they brought out a bunch of plastic food. A hamburger and sandwich that came apart, a slice of cake, a variety of fruit, etc. Don had to pretend to be a waiter and the girls were the customers. It started out simple---asking for one item at a time working their way up to asking for two items at a time. Then three and variations on the sandwiches. It was an exercise in listening and the only language required of Don was to repeat the item asked for and saying "your welcome" to their "thank yous." Don didn't get these last two words out without prompting until the last few minutes of the exercise.
The next exercise was a verbal expression task. The girls wrote out a bank of words on a dry/wipe board for Don's reference. Then they brought out a loaf of bread, peanut butter and jelly, a knife and plate. The task was for Don to give the girls instructions on how to make a sandwich. The girls were instructed by the professor to only use gestures as queues, no words. Don actually did quite well, I thought. He got out the words: "bread, one bread, take bread, plate, peanut butter, open it, pour it, knife, slice. " He worked hard at getting out "spread" but he couldn't do it but then he said, "jelly, open it, and knife." Trying to say "spread" again got him confused but finally he said, "more [jelly], close and eat."
Thursday's group class was interesting and there was a new addition, a patient who'd been in class with Don in the past but who had been assigned the medium, more verbal class last week. Either she or the professors must have decided she wasn't ready for that step. "L", as she'll be known from now on, is a single women in her late 40s or early 50s who used to be a surgical nurse. She has the sweetest, retired parents who drove almost 35,000 miles last year coming up from another state each week to take their daughter to these classes and to help her with errands. The first time I met "L" I couldn't understand why she was in a speech class. You have to be around her for awhile to see that she struggles with the correct pronunciation of many nouns.
"S's" daughter came with her today, instead of her granddaughter. We learned that "S" is in her 70s and she had her stroke 10 years ago. Back then, she'd had some speech therapy but it didn't help and insurance quickly ran out. She lives alone, drives, shops and is quite independent. You've got to give her a lot of credit for being willing to try speech therapy again after all these years.
For the first exercise, the girls put on some silly animal hats (a bear, moose and racoon) that really loosen everyone up. The task was for the patients to call out the names of, or gesture, different animals. Don got out: deer, antelope, elk and bear. "S" gestured fish and crab, with the help of photo cards to look at, and she actually said the beginning sound of Dog. It was the first sound she's made that I could actually understand! "L" really worked hard at getting the right pronunciation of fish. I was also impressed at how she self-queued herself by using her fingers to form the letter C to get to the word, Cat.
Next, the group played three rounds Bingo with picture cards, four across and four down. The professor told me this was another verbal expression, word recognition and word retrieval task. "S" got out the B sound when she won a round. And Don was so geeked up playing this game! He was in full, entertain-the-masses mode with his sound effects and enthusiasm.
Two card based games came next. Webbers Photo Phonology, another task in gesturing with the patients looking at the photo cards. And then Verbs Bingo by Say & Do. The verbs Bingo was really quite good for Don because it's the verbs he has the most trouble getting out. The girls would read a short poem like, "take your hands and make a wack. It is time to cheer and ______ " and the patients were to fill in the blank. This game was so perfect for Don that I looked it up on the internet, hoping to buy a set. But it costs $59.96! It contains 240 cards with riddles/poems for: 1) present verbs, "In a boat, you can go, when you use the oars to ______; 2) past tense verbs, "Today I wash the dishes. Yesterday I _____ dishes;" and 3) irregular verbs, "Today we ride our bikes. Yesterday we _____ our bikes."
Today's class seemed quite successful for everyone---patients and student teachers alike.