Wednesday, September 19, 2007

Speech Class Diary, Part 3

Speech Class Diary, Part 3

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 covers therapy classes that took place between November 6, 2004 through December 8th.

Jean Riva ©

November 26, 2004

Some times it's hard to see progress in speech when it comes on so slowly. But something happened this Thanksgiving that really pointed out the contrast between now and a year ago.

Don likes to eat, and using food to help him with word search exercises was something we did a lot back a year ago because we had the most success getting language out of him when he worked on naming categories like: vegetables, meats, fruits, etc. And back then, I wouldn't let him have seconds of any food unless he could name it. At Thanksgiving dinner last year, a relative was starting to tick me off because she kept naming the foods that Don would point to, not giving him a chance to come up with them on his own. She also called me "mean" for not just giving him what he wanted.

Well, guess what! This year he not only could name most foods without queues or prompting, but the best part was that when Don said, "pie" all on his own, and I said, "complete sentence, please" he quickly answered, "I want piece pie." It surprised everyone but me! It just feels like there is a switch in his head that is ready to quit flickering and stay on---like he just needs to get past the point where it takes me prompting him to speak in sentences.

Class last Tuesday started out by reviewing Don's homework assignment. He'd been given 10 words like, "I" "she" and "it" and he was to complete the sentences. It only took him about 15-20 minutes to do this assignment at home with me writing down the sentences he came up with. Reading them out loud to the girls was a real struggle, and they had to help a lot. Some of the sentences he comes up with make me laugh and wonder, "where in the heck did that come from!?"

About 3/4 of the class was spent on an exercise that built on one that was done last week: coming up with adjectives to describe objects. But the new twist was that all the objects were so weird that even I couldn't have found a noun to pin on the objects. As before, Don was expected to come up with three adjectives and the girls would write them on a dry wipe board along with the transient words like "it" "and" "is" etc. Sentences would form. i.e. Don's words of "small," "yellow" and "round" became, "It is small, yellow and round." Then he'd have to read the sentence off the board. To see the process of building sentences like this, was actually exciting to watch!

The rest of the class was spent on audio comprehension. The student teachers loaded up the table with all the weird objects and they would have Don sort them by color, textures and shape, then progressively, their instructions to got more complicated as they went along. Near the end of the exercise Don had to start asking them to repeat the instructions quite a few times. By then a set of instructions would go something like this: Put one pink and one blue object over here, put all the smooth things over there, and then put all the round things and two yellow objects right here.

It was a good class!

December 2, 2004

Tuesday was the last individual class of the semester, so the girls gave Don an informal testing to track his progress. They started out with the Boston Naming Assessment Test for Aphasia. It's a book of drawings of things like a broom, comb, ladder, tree, house, etc. The professor, in the observation room with me, said it was a test that had been given to Don when he first started classes at the college 3+ years ago and she wanted to see how far he's come since then. Her exact words, when Don was finished with the test was, "Holy Cow! He did the whole book!" The first time he had taken the test, he only got through the first 20 pages before it was plain that he was struggling too much to name the pictures. She pointed out how he had lots of attempts and false starts at finding the right words, and self queuing, all of which pleased her. For example, for octopus he moved his fingers in and out (self-queuing) and said, "wiggles" (false starts) before saying, "octopus." She explained that for anyone to learn to talk again they must have the ability to hear when they are making errors. And they must try words out, over and over until they come out with the right ones, the right sounds. "No one can give them the right words. They have to find them for themselves," she said.

The professor thinks that Don is ready for the next step in trying to get sentences out of him. At home I'm to no longer say the words, "complete sentence." I need to make a flash card that says, "complete sentence" and show that to him instead of giving the verbal queues. Also, I can try just showing him two fingers to represent, the "complete sentence" or even try not responding to him in any way if he doesn't get out a sentence. We're to also continue working over the holidays to have him describe objects several times a day.

I asked the professor if anyone with as severe of a problem as Don's ever gets to the point where they can talk in complete sentences again. At first she said, "yes," then she qualified it by saying that he'll never be as fluent as he once was. But being able to carry on a simple conversation should be an obtainable goal for Don.

Thursday's class was a strange one for me. In the waiting area, before classes got started, one of the other patients showed a video of a brand new treatment for strokes involving a tiny little cork screw device that is threaded through the groin up to extract a blood clot out of an artery that had caused a stroke. The woman in the video was right side paralyzed and couldn't speak from a very recent stroke. But within hours of this processor, that all changed; she would talk and move her limbs!! Seeing her laying in the bed with tubes running every which way bought back such a wave of emotion over me and I couldn't keep the tears from flowing down my face. It was such a surprise to me to go from feeling nothing in particular to being over-whelmed with anger and grief that something like that wasn't available back when Don had his stroke. I don't even know how experimental the tiny cork screw device is because I was so self-conscious of trying to hide my tears that I really didn't hear the ending of the video. I know at least one student teacher saw me. I felt like a fool; I didn't see anyone else crying like a baby and we've all been on the same stroke roller coaster.

From one emotion to another---in the group class, we laughed so hard that tears were rolling down my face. AGAIN! It was such a relaxed class, with everyone---including spouses, students and the professor---cracking jokes. All of the tasks were word retrieval exercises like finding every word that is associated with Christmas. Then they played a card game where the girls would give the clue of cavity looking for "tooth" or the clue of scrambled looking for "eggs." The professor also interrupted the class to talk about us attempting to get complete sentences out of Don by using a card instead of the verbal queuing. So far, it isn't working at all. She said not to continue with it if he doesn't catch on soon as to what the card is suppose to represent to him.

Next Tuesday we'll get the evaluation results from last Tuesday, and the speech department always has a little party for all the patients and graduating senior students.

December 8, 2004

One day over the weekend, I kept track of all the sentences that Don was able to get out. Six in all! This is a vast improvement in language skills since I started this diary. The sentences were: "I want shirt," "I want cut it off," "Clean teeth?", "I want pizza," "I want to [re]lax," and "I want dinner." More importantly than the number of sentences is the fact that one of them was totally unprompted, and one other one was only prompted with a gesture. (The gesture is one the professor taught me to do where I put my fingers together and then draw them out to the sides, as if to say, "make your one word response into a sentence.") The other four sentences were prompted verbally with me saying, "complete sentence, please" when he'd said one word.

Tuesday was Don's last day at the college speech classes until the patients come back in February for a new semester. Don's student teachers are recommending him to come back again, Thank God! I dread the time when they tell us it's time to give his space to someone new. There is always a waiting list and not everyone is asked back. We've seen people come and go, many from my observation aren't asked back because the families don't help with least this is my theory.

As far as the evaluation went, they gave Don high praise for his cognitive skills, reading comprehension and social pragmatic communications. They also said he worked hard at verbal expression and expanded his vocabulary a lot. In fact, they gave us a list of all the words he was able to get out during the semester: a total of 288! I was blown away by that! The weakest note on the discharge paper was in auditory comprehension where they pointed out that although Don listens well, when the sentences get longer he has to ask, "repeat" often. On the Boston Naming test, he scored an awesome 53 out of 60. The first time he was given that test back when he first started these classes they had to quit at 20 pictures because he couldn't do the test, they said. And another time when he took the test over the past three years he only scored 34 out of the 60.

For homework over the break, Don and I are to continue drilling verbs, adjectives and sentences the way we learned in class. We also can use pronoun flashcards and have Don read out loud from the word list he generated in classes. But my personal homework should be interesting---"To facilitate the used of complete sentences by not responding to Don unless he uses a complete sentence."

At the discharge party, all the students got up and told little anecdotes about their patients. It seems like just about every student mentioned that they appreciated their patient's good sense of humor. I personally think having a good sense of humor---being able to laugh at your mistakes, instead of claiming up when they happen---is an extremely important element in learning to talk again. All in all, it was a great semester!

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Blogger Unknown said...

Hi Jean,

I've been reading your blog. I've recently become interested in Aphasia due to a student. I'm trying to learn more about it through personal accounts.
I'm enjoying your blog but was wondering - generally of course- where you are located?


2:31 PM  
Blogger Jean R. said...

Thanks for the comment. I am in West Michigan. I have another blog about speech class issues, too. It's called "From the Planet Aphasia" if you're interested in googling it.

8:23 PM  

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