Wednesday, September 19, 2007

Speech Class Diary, Part 2

Speech Class Diary--- Part 2

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 to Read my Yahoo! 360 page and blog Yahoo is were all my current blogs will be from now on. This part of the diary covers speech classes that took place between October 19th, 2004 through November 20th.

Jean Riva ©

October 19, 2004

Going from one end of town to the other with an aphasia and apraxia affected person is quite an adventure. Trying to drive, watch the road, and figure out what my husband is gesturing and making sound effects about really tests my power of concentration. "Eeeeeeeeeeeeeeeekk!" could mean anything from, "that other car is going to hit us!" to "step on the brakes!" "Geehs!" usually means a foreign-made car came into view. "WoooooOOO!" today meant, "look at the huge field of pumpkins!" but in the past it has been used to point out cool classic cars. Don's gesturing in the car drives me crazy. Does he mean, "turn here," "change lanes," "what does that vanity plate mean?" or "I used to go to school with the guy whose father started that business"---gestures have been used for all these things. Someday he's going to gesture us right into an accident. Then there are the car sounds he loves to vocalize, the kind little boys make when they are playing in a sand box pushing toy trucks around. He either enjoys our drives down to class or he sleeps through them. Today was one of those gesturing, sound effects rides. He had a good time. I was a nervous wreck. But today he also came up with two new words: "bothers me" he said about bird poop on the window. Who would ever had guessed that bird poop could inspire speech.

Out in the waiting area, before class, one of the professors came out to announce that the girls were running late because she had given them a test. "C," a patient who has a lot of trouble with words containing the letter F, said to the professor: "Are you going to F#ck them all?" meaning flunk them. God, I laughed so hard and the professor was doing an admirable job keeping a straight face as she explained how hard "C" works on the 'F' sounds. Many times, speech classes are anything but boring.


In Don's individual class Thursday, the girls had him bring in the words to some songs he used to like to sing. We brought in Fats Domino's BLUEBERRY HILL. It was almost his theme song back when we first met, and over the years I've heard him sing many times, especially when he was in a good mood. Gene Autry's BACK IN THE SADDLE AGAIN was a choice from the days when we used to go back and forth to Colorado every fall. YOU ARE MY SUNSHINE Don says he's been singing it since he was five years old and Irving Berlin's BLUE SKIES was another song from way back. I tried so hard to find our theme song on the internet, but I must have had the title wrong because I couldn't find it. We used to sing it a LOT in the truck: "Oh, we ain't got a barrow of money, and maybe we're ragged and funny but we're rolling along, singing a song, side by side." The singing went okay in class but it could have been better had they girls let Don look at the lyrics I'd printed out. Next week, I'll print out a set for each of them. The generational thing really showed up in class during this section as the girls didn't know most of these songs.

The rest of the class was pretty much a repeat of the same exercises that they did last Tuesday: 1) The Say and Do Verbs Bingo cards--"J" is going to photo copy them for Don to have at home, which really pleases me; 2) The Don's-a-waiter game; and 3) picture bingo with Don calling the pictures. i.e. "Do you have a ________?" Early into this exercise the professor told the girls to back off from giving Don so many queues (let him struggle a bit) and after that he really did much better. Once he got into the rhythm of it, he was getting out, "you have banana?" and "you have star?" sentences one after another. I was impressed.

October 23, 2004

After the lights are turned off, and we’re all snuggled down for the night, out of the darkness comes the words, “Hereeeee’s Johnny!” I would have thought by now that Don’s little bedtime ritual would have worn itself out, but he’s been doing this since mid summer and no amount of trying to teach him to say goodnight in the traditional way does any good. When asked if he’s quoting Ed McMann from the old Tonight Show or Jack Nicholson from the horror movie, The Shinning, he usually just laughs as if it’s the funniest joke in the world. Wednesday night I woke up in a cold sweat after having spent my dream life running away from the madman from the Chainsaw Massacre.

On the way to class on Thursday, Don was pointing out various things that caught his attention. At one point he kept saying “top staff” and that started the ‘guessing game’ we always go through when he wants to tell me something and I can’t figure it out. “Red, white and blue” came out, too, and from that I was guessing it had something to do with the political signs plastered everywhere and that ‘top staff’ was the president and vice president. Wrong. After 15 minutes of guessing and twisting my brain in ways it didn’t want to go, I was able to figure out that he was talking about a flag pole with the flag at half staff. Sometimes it makes me feel SO stupid that I can’t make the connection right away between Don’s clues like ‘top staff’ for half staff. I don’t know of any other way to explain it other than to say that it wears me out to have my thoughts always interrupted to have to stop and figure out what thoughts are in someone else’s brain. It must be the same way young mothers feel when their little kids are constantly saying, “What’s that?” or “Why, mommy?”

The tasks in class today were all word retrieval exercises starting out by the student teachers asking the patients to name sports while they gestured the actions in various things like bowling, archery, fencing, basketball, etc. It was surprising how many sports there were to name. The second activity was a take off on the Family Feud. The girls would ask patients to call out the name of things like pets, colors, beverages, holidays, etc. The last exercise was picture bingo. One interesting thing that I picked up about “S” today is that when she is pressed to try to say a word, with a student sitting near-by to give mouth queues, she is able to say, “I don’t say.” When she is saying this, she often puts her hands next to her mouth, then points to her forehead. It’s the first time I’ve heard clear-cut words out of all her garbled speech. Most of her speech sounds like Yiddish---fast, fluid and animated and totally a mystery.

At one point in the class Don got side-tracked by the student sitting next to him and out came his classic "cute." The professor would like him to quit saying this altogether, probably because she views it as a stroke related impulse issue. And when he says 'cute' 5 or 6 times a class (or hugs too much at family functions), I have to agree. However, asking Don to quit saying 'cute' or hugging would be like asking him to change his personality. He's been complimenting girls since he was old enough to notice them. Instead of banning the word from his limited vocabulary, which isn't fair to Don, I'm working on the once-per-visit rule and saying cute in a complete sentence. I don't think the professor really understands my logic in this, but I'm holding my ground. I chalk up it up to a woman-thing as some women wouldn't like their husband's saying things like that in front of them. But it's never bothered me in all the years I've known him, so why start now? Don's always been as loyal as they come.

No class on Tuesday! Hurray! Maybe we can go on a mini-color tour if there’s any color left by then.

October 28, 2004

While Don was getting dressed today, he did an amazing thing. He held up the stretchy liner he wears under his AFO brace, which was getting a little frayed, and he said: "Cut." Unprompted verbs have been sneaking out of his mouth on rare occasions lately and while it pleased me to hear him say 'cut', it didn't surprise me. But what he said next sure did. After telling him I needed a sentence, he said--- without even the slightest hesitation or queuing---"I want cut [in] half." Not exactly a correct sentence to describe what he wanted, but it was a sentence! A whole sentence!!! Only someone who struggles with speech would understand the benchmark importance of getting the verb out first, then building his sentence from that. It was truly a first for him.

In group class today I came to the conclusion that just about everything the girls have been doing so far this semester is about word retrieval. And that makes sense with the mix of patients in this class. The students are really pretty creative in the way they plan their tasks to motivate and keep the patients on their toes.

The students started the group out by asking the four patients to name hobbies, but the little twist was that the hobbies were all turned into verbs: drawing, fishing, collecting, hunting. Before the exercise was over they had come up with 21 hobbies listed on the board. At one point, the professor told the girl working with "S" to tell "S" what she was doing when she was trying to get her to watch her mouth queues. ("S" doesn't seem to get what they want her to try.) And "L", who really studies the mouth queues given to her, is just the opposite. She works so hard at getting her mouth and lips pursed right. After 5-6 tries at saying a word, it usually comes out correctly, too. When Don does get a word out, it usually sounds right, with the exception of some of the 's' words.

The next task reminded me of a game that ladies play at bridal and baby showers. The students put three items on the table, then they had the patients close their eyes. While their eyes were closed they removed one item. The word retrieval task was for the patients to name the missing object. After a few rounds, they added another object and kept adding objects, after several rounds, until they got up to six things on the table. "S" got out 'boo' for book. Don did reasonably good and so did "V" and "L." Picture bingo took up the rest of the class.

For the entire hour I only heard Don tell his student teacher "cute" three times. She seems to have a good sense of humor and handled him well---told him he was over his quota and to hush up.

Don looked like a walking election billboard today. Five political pinbacks, a logo baseball hat, denim logo shirt and a dog tag. Instead of donations this election, he bought a political wardrobe instead---two shirts, a jacket, 12 pinbacks, a coffee cup, a hat and several cut-out tie tacts. He's had fun with it all but, at times, I haven't and I'll be glad when the election is over. I've never liked talking/debating politics with causal acquaintances and I've been forced to do just that with people we've come in contact with.

November 2, 2004

Over the weekend, we went to Applebee's with close friends. As usually when we go out to restaurants, we had Don practice what he wanted to order before the waitress came back with our drinks and he did reasonably in this practice session getting out "Bourbon Street steak, medium rare." But when the waitress came back, she took my order first and you could almost see the wheels turning in Don's head as I told her I wanted a Bourbon Street steak, medium rare. Then she turned to Don and much to everyone's surprise, he put a big grin on his face and said "ditto!" We all burst out laughing. It was the first time he's said that word since the stroke.

On the way home, we had 'The Talk' about giving the young waitress too many "cute" compliments. I went over the fact that this is an impulse control issue due to his stroke and that too many compliments from an older guy can take a nice compliment and turn it into a situation where the girl feels uncomfortable, wondering if he isn't a dirty old man. Don said, "yup" and then said the last name of a friend whose house we had been to last summer for a high school graduation party. At that party, Don REALLY lost impulse control and he said "cute" at least a hundred times to various young ladies. And I'm not exaggerating.

This is where this "cute" story is going... As we were leaving the dentist office today, Don rolled up the the receptionist (who is a real knock-out in the looks department) and Don said: "Teeth." I knew what he meant, she's got the most perfect set of teeth in the most perfect face you can ever imagine. So I said, "Sentence please. You have pretty teeth." Don says, "You've pretty teeth." Another speech first for Don---a contraction of 'you have!' Then I said, "I know you want to say something else. Get it out of your system" to which he leaned towards the girl and said, "cute." To cut this story short, as he was rolling away, Don turns back and whispered to the girl, "cute." (Only the second 'cute' of the visit.) I was elated that he whispered! To me, it's a sign that he checked himself and even though he didn't NOT say the word, he at least thought about its appropriateness before saying it! This young girl is really used to his teasing. She's very good natured about it.

For the benefit of family and friends who may be reading this diary, I've decided I should include a definition of apraxia and aphasia. So, here it goes. Apraxia: "A movement planning problem involving a disruption in the sequencing of voluntary muscle movements. A transmission problem between the brain and the muscle. This would be similar to a transmission problem in a car where the engine (the brain) works well and the wheels (the mouth) work equally well. The breakdown is in the transmission between the engine and the wheels. This disruption is not associated with weakness, slowness or dis-coordination of the muscles." From APRAXIA; A GUIDE FOR THE PATIENT AND FAMILY.

Aphasia as defined by APHASIA: A GUIDE FOR THE PATIENT AND FAMILY---"Aphasia can be defined as a loss or reduction of language skills due to brain injury. Lanugage is the mental process which makes speech 'sounds' or written configurations become meaningful words. This involves understanding, thinking, talking, reading, and writing. The person who has aphasia has suffered a breakdown in the ability to use the representations or symbols of language in any number of ways. It must be made clear that the breakdown in language is not intelligence. The person may still be able to get the thought across using other forums of communications."

And from the National Aphasia Association's website: "Broca's Aphasia - This is a form of aphasia in which speech output is severely reduced and is limited mainly to short utterances, of less than four words. Vocabulary access is limited in persons with Broca's aphasia, and their formation of sounds is often laborious and clumsy. The person may understand speech relatively well and be able to read, but be limited in writing. Broca's aphasia is often referred to as a 'non fluent aphasia' because of the halting and effort-ful quality of speech."

There are many types of aphasia and most people with stroke related speech problems have more than one type of aphasia and/or apraxia, in varying degrees. But for the purposes of this diary, the above definitions should give a little over-view to our family and friends.

I did learn something while trying to find these definitions. "S" from Don's group speech class probably has what is known at Fluent Aphasia. One of the books mentioned up above says this about fluent aphasia: "Verbal communication is easily produced but sounds like 'double talk.' There is little meaning or content and the person with fluent aphasia tends to talk non-stop." I can think of at least two patients at the college speech clinic who fits this description. "V" from group probably has the same comb as Don. I can't figure out the technical name for the type of speech problem "L" is dealing with, but she's pretty fluent with most parts of speech. I'm guessing it's mainly the nouns she struggles with pronunciation on, I'll have to pay more attention.

November 6, 2004

Don has a different sound effect for each of his toes. When I'm helping him with his shower, and I have to put medication on his toenails, each one I touch gets a 'zoom', 'boom', 'ecck', or swishing sound. It's not like regression-to-childhood sounds, more like he gets into what I call his "entertain the masses" mode.

Don had a good class on Tuesday. It started out with a review of his homework. He'd been asked to build a sentence with 10 verbs the girls had given him. "Eat" became "I eat Pizza"---stuff like that. When he did this homework, he was able to come up with the sentences rather fast (15 minutes) but reading them out loud was a lot more difficult. And with each sentence he was asked questions to expand his speech like, "What toppings do you like on pizza?"

The next task involved showing Don photographs and he was asked to give the girls two words about the pictures, then after a half dozen or so pictures he was asked for three words per picture. At one point Don had said, "scissors, man, pieces" and the professor, who was in the observation room with me, got really excited and animated while declaring that Don was doing "an awesome job."

Next came a task for practicing audio expression, audio memory and audio sequencing, the professor said. The girls would lay down three photographs with very subtle differences in them. Don was to pick out the photo that best fit a sentence they would read. For example: "The man shaved and wiped his face with a towel" or "The man picked up a towel and then shaved his face." Eventually, the girls worked their way up to five photos on the table, and the sentences got longer. Surprisingly, Don did well with this task and the professor was pleased again. At one point, Don got distracted by a crooked part in "N's" hair but the girls got him back on point very quickly. They are learning how to handle him well.

Playing a simplified version of 'Concentration' took up the rest of the hour. The professor said it would be a good game for us to play at home. Then she joked, "As if you've got all kinds of time on your hands." She had been working with speech patients, in the field, for 16 years and if my memory serves me right, she's been teaching 5-6 years at the college. She's a good instructor.


On Thursday we got another new patient in the group class, a man who is 18 months out from his stroke and he is still on pureed foods. "JM" as he'll be known from now on, was sent home from the hospital with no swallowing therapies and no follow-up on this aspect of his stroke! His daughter didn't even know there are therapies to help with swallowing and eating.

The girls started the class by having the five patients try to name as many food and cooking related words they could come up with. Then they wrote a bank of words and a recipe on the board and had the patients try to give them step-by-step directions on making chocolate chip cookies. Both of these tasks took the better part of the hour and the cookies that came out of their pretend oven were pretty good.

Playing 'Go Fish' took up the last ten minutes. While watching this particular game, I decided that I really like "S" even though I rarely understand any of her many words. She's quick to laugh, seems to have a keen sense of humor, and is a smart lady. She's gotten over her shyness that she exhibited the first few classes.

November 11, 2004

Over the weekend we went to the first antique show we've been to since Don's stroke. It was a large one and I couldn't walk it all, so Don rolled around on his own while I waited in the concession area. At one point he came back all excited that he'd found something for me to look at. It was no surprise that it turned out to be a one gallon Otis Elevator Oil can that he didn't already have in his collection of gas station memorabilia. The dealer was asking $40.00. The funny speech part was that Don was able to say to the dealer,"Ten percent?"---meaning will you discount your price. No one who knows the wheeler-dealer side of Don's personality will be surprised that "ten percent" is a phrase on his short list of spontaneous words.

In class Tuesday, when the girls tried to pull the story out of Don about our going to the antique show, he gave them the misguided impression that he had bought me a gift at the show. And who knows, maybe he DID think of that Otis can as a gift for me. After all, he did once buy me a 50 gallon gas tank for my pick up truck as a Valentine's Day present. Mr. Romantic, that's my Don.

The first task in class was similar to one they'd done last Tuesday. The girls would show Don pictures and ask him to give them 3 words about what he saw. For Example, one picture generated the words, "comb, hair, teeth" and another picture generated the words, "priers, no, scissors, china"---that last word said with a snarl because he hates foreign made tools.

The second task involved point at things in pictures as the girls read sentences like: "The car making tracks in the snow," "The car pushing another car in the snow," or "the suitcase in the trunk of the car," "the teddy bear sitting on a suitcase." I'm not entirely sure what this task is suppose to accomplish but I'm guess it's to build listening and cognitive skills. I couldn't really see if his pointings were accurate. The observation room was really full. The Juniors have to have 25 hours of observation time in before they can get their first patients as a seniors.


Today's group class: The first 1/2 hour of class involved having the patients try to name adjectives for the things the girls would hold up---colors, shapes, size, texture. For the second task of the class they girls had put all the objects they'd just used in a bag and they passed the bag around. Each patient would pull out an object and they had to come up with an adjective to describe it. Around and around the bag went until each patient had seven objects in front of them. For the third task, the girls reversed the process and would name an adjective and the patients had to pick an object off the table that fit that description. And for the last 15 minutes, the group played a version of 'Go Fish' using the numbered cards from a Uno game.

Don came up with a one funny thing the other day. When we're out and about, it's our routine to go to the back of large parking lots where he can use a urinal rather than struggle in handicapped bathrooms that are not always set up right and to go through the progress that is extremely time-consuming to do. But I always make him ask first. Today after he said "pee" and I said, "complete sentence" he said, "I need to pee. Move it!" The "move it" was a brand new expression for him and it made us both laugh.

November 20, 2004

Don didn't have a group class this week. But in the individual class on Tuesday, the girls continued working on getting adjectives out of him. They'd show Don objects and he'd have to name a color, texture or shape to describe what he saw. This went fairly well, I thought. Don was able to self-correct on several occasions, especially when he was trying to name colors.

The second task was for Don to find objects on the table that fit the descriptions the girls gave. Again, texture, color and shape questions. At one point the rhythm of the task got off pace when they showed Don a coaster with a picture of the college on it. He got all excited and kept saying, "keep" and "me!" I knew that what he wanted to say was, "I want one, where can I get it?" Well, the girls walked all around the subject and they never did figure it out, and he gave up trying to make them understand. Guess I can put that on the Christmas list.

Task three was along the same lines as the last, with one exception. Instead of using only one word to describe an object on the table, the girls used two. For example: "Show me something metal and round." This exercise was much harder for Don and his success rate showed it. The forth and last task involved using a table full of objects and having Don name a missing object that they'd removed while he closed his eyes momentarily. He didn't get any of them without prompting.

As I've watched these exercises the past few weeks, I can really see how they are all working up to building sentences. Even the parts were they have him close is eyes and then name an object that is missing from the table fits in to being able to word search without the physical queues in front of him. It's quite amazing, how it all works together. But, it's a slow process! No wonder so many people give up on speech therapy.

While we were out to lunch today, Don couldn't help himself from rolling over to the next table to try and talk to a stranger. God, that can get annoying! The guy was really nice but I'm the one who ends up in conversation, because of Don's limited vocabulary, and I've always hated talking with strangers. I liked it so much better in the pre-stroke days when I'd just listened as Don struck up these conversations every where he went. As the guy was leaving Don was able to get out his famous, "come over!" Well, this guy says, "sure, give me your address." So, there's another stranger with our contact information. Don wants company so badly! It breaks my heart that he doesn't get as much socialization as he wants and needs. I take him every where I go and we go out often. But running our lives and our house all by myself wears me out...I just can't do any more than I am!

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