Saturday, September 22, 2007

Speech Class Diary, Part 7

This part of the diary covers 2/07 throught 5/07, the spring semester. 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 February/07 through May/07.

Feb 14, 07, New Semester

Don started back to speech classes again this week. The two student clinicians he’ll be working with at the college have good personalities to mesh with Don’s which I always sweat each semester for naught. The plan, this semester, is to target verbs (actions words) which totally elude Don and all the testing they did on the first day of class reflected that plan of action.

You can show Don a picture of something like a hand cutting a piece of paper and he can name the nouns---‘hand’ and scissors’ and ‘paper’---but ask him what the hand is doing with the scissors and even torture couldn’t get the work ‘cutting’ out of him.

Wish us luck, gang! Without those verbs there is no hope of every getting full sentence.

Jean Riva ©

Teaching the Teachers

Don’s first session with his new student therapies was interesting, mostly because the professor did a lot of teaching on how to administer the therapy tasks leading up to getting verbs out of a patient.

The first task involved showing Don three photographs and he was suppose to point to the right photo to match a single word that the student ST would say. Verbs like: eat, drive, and tie. This task was easy for Don---got 100% right---but was leading up to harder tasks.

The second task was the same principal except using five photographs instead of three and since that, too, was easy for Don it was deemed he was ready to step it up. The rule is 80% correct before going to something more difficult.

And for the third task they would lay one card down at a time (the same photos they’d just used) and ask Don to name the action/verb. For example, "What is the girl doing?" for a picture of a girl lying in bed with her eyes closed. The expected word would be ‘sleeping.’ Out of ten photos, Don could only get out three verbs. They just don’t want to come out of his aphasic brain and haven’t for the past almost seven years.

This is where it got interesting—at least for me watching from the observation room. The professor stepped in and said concepts/verbs are harder for people with aphasia to name than nouns/object. And since Don has spent so long trying to name objects (nouns) in his post-stroke life that it’s going to take some hard work to get him to understand that it’s a concept/action/verb, not just any word relating to the picture, that they want from him. She didn’t want the students to give him the correct words when he comes out with something wrong. She wants him to struggle harder, to keep trying until he finds it for himself.

For example, for a photo that the professor showed Don of a man watching TV, Don’s first try was ‘smelling’ [the TV]. The professor then used her voice in an exaggerated question to say back to him: “He’s SMELLING the TV?” It was giving him a queue of without giving him the correct word or the first part of the word. When he’d come up dry for another try, then the professor would go back to laying three photos down and asking him to point to the card that matched the word ‘watching.’ Easy. He could do it and it was back to the single card again of the man at the TV and he couldn’t name what the man was doing. Back and forth they went between the three card task and the one card task. At one point there was a break through and we all saw Don struggle through a dozen words that all sounded similar to ‘watching’ until he FINALLY said watching.

It’s okay, the professor said, to let Don get a little stressed in the process and to urge him to keep trying to come up with words. It’s the TRYING that’s going to make it click in his brain. She said she will always jump in when she thinks the student ST’s are doing Don’s work for him and giving him the queues/words too early. It’s a fine line to walk, she said, because it’s a natural pressure for clinicians to want to give just the right queue to get the words out of a client but by giving too much he isn’t attempting to make the new pathways in his brain. Just remember, she said, who is supposed to be doing the verbal work here.

So after that teaching mini session, the next time the professor demonstrated the three card/one card task using a photo of a guy riding a bike it went text book perfect. Don came up with the words: running, wheeling, walking first and with each word the professor would repeat it back with the huge question in her voice. Then came ‘riding’ out of Don. All this in about a quarter of the time it took for the word ‘watching.’

And that ended the hour session. Don was exhausted as he always is after a good speech session. He often sleeps on the way home as if he’d just spend a hour shoveling dirt instead of shoving words out his lips.

March 1, 07
Individual Class, Week Two

Part of this class was a continuation of the same tasks they were working on as described in my blog entry titled “Teaching the Teachers.” The student giving Don the task had done her homework. I could really see the different in the way she came out of the gate to administer the therapy and when she asked Don to name the verb/action of the photos she’d set down in front of him, he spit out five of them in a row so quickly that it blew my mind---eating, drinking, sleeping, brushing and shaving. The next photo of someone washing their hands, he said ‘soap’---reverting back to naming a noun---but it only took a queue from the professor or, “I am ______my hands” to get ‘washing’ out of my husband. The next photo to correspond with the word ‘pouring’ took a gesture of the action to get the correct word out of Don. All and all, this therapy went extremely fast compared to last week tracking through ten photos. I was amazed.

For the next therapy involved showing Don a sentence and two similar pictures. He was to read the sentence to himself and point to the correct sentence. The first sentence, for example, was “The monkey is in the tree.” Both pictures had trees and monkeys but only one monkey was in the tree. Then he was queued through reading the sentence out loud. At one point early on the professor stopped the task and told the girls that they were allowing Don to take his queues from reading their mouths and he really wasn’t reading the actual words on the paper which wasn’t helping him accomplish the whole point of this therapy. They had to be sure, to keep their clients focused visually on the paper. After that, the exercise got hard and frustrating for Don and the students got uncomfortable. The professor again stopped the task and asked Don if he was frustrated. “Yes,” he answered. “Do you want to give up?” He replied an emphatic, “NO!” I’m guessing this was done for the girls because the professor made a remark about getting used to clients struggle and to a certain amount of being uncomfortable watching that.

While I was in the observation room another professor came in with a woman who was applying for a job as a speech pathology professor. They started talking about how Don was the only client they’ve ever kept so long. Most are discharge after two years. But, she said, they keep Don to teach the girls that progress doesn’t have to end even when things look hopeless in the beginning of working with a patient. She say he helps them understand that cutting a client off from therapist should be a very difficult decision for them, not to be taken lightly. Wow, I thought, he came into the program with cognitive issues and extremely severe aphasia and apraxia and they’ve documented on tape every step until now when he clearly shows his keen intelligence, good sense humor, etc. I can see how those tapes would be a good teaching tool to get this message across to future speech pathologist.

It was another good session.

Annoyances and Accomplishments

This was a weird sort of day. It started out with me wanting to kill my husband. Yes, the man was trying to wear out my name this morning. Don was suppose to be getting himself a sponge bath and then dressed for his speech class while I was trying to get some important work done behind the scenes here on the site. Every five minutes I heard bellowing from the bedroom, “JEAN! JEAN!”

As all caregivers know you can’t ignore a call like that, even if you’re pretty darn sure your mate isn’t on his death bed or that a gun toting robber hasn’t entered the house. And it was true today. Nothing justified the urgency in his voice. Once there was a little piece of paper on the floor. “You aren’t helpless,” I told him. “Pick it up.” Once he couldn’t decide between black pants or blue pants. “You’ve got three hours before we have to leave,” I told him. “You’ll figure it out.” Once he wanted the channel on the TV turned and I again I told him that he is perfectly capability of changing the channel. “Oh,” he cheerfully said as he reached up to push the button. Duh, he’s been doing this for at least a year! Several times he called but couldn’t tell me what he wanted and I couldn’t guess.

Then while I was in the observation at the speech clinic this afternoon Don, the same man who nearly drove me as batty as a bat in a belfry just blew us all away! He breezed through the therapy tasks that just two weeks ago were painful to watch. He was reading one, two and three letter words which is the first time ever he could do that. He was naming verbs related to pictures so fast he looked like he was trying to beat the clock in a game show and he was canting the sentences he was reading out loud like a norm speaking voice. We were literally all watching with our mouths wide open---the professor, Don’s last semester student clinician and three other students. I told the professor I’ve been riding Don hard all week, requiring him to name every action I do all day long and forming a sentence out of every noun he says and making him repeat those sentences several times. She said “keep it up!” He is close to having a break through to thinking in verbs and that would be a HUGE step to learning to talk again.

Another interesting thing happened in the clinic waiting room. A student clinician who Don had several semesters ago came back for a visit. She’s in grad school and she was all excited about a treatment she is learning for the treatment of apraxia. (This is a major part of Don’s speech issues.) She told us that this treatment has been used with children for a while and they are just recently experimenting with using it on adults. If I understand it correctly---and I make no guarantees that I do---it’s sort of a reverse approach. Currently therapies work to try to get the thoughts that form in the brain to send signals to the muscles in the mouth and tongue to form the words. This other therapy is done by having the clinician working their hands on the face and tongue to try to get the muscles there to send signals to the brain that correspond with the sounds they are helping the client make.

It’s called PROMPT which is an acronym for Restructuring Oral Muscular Phonetic Targets. At a site on the internet it defines the therapy as follows and I haven’t got a clue what this really means: “PROMPT is a tactile based treatment method for reshaping individual and connected articulatory phonemes (sounds) and sequences. The system uses a different prompt for each English phoneme. This type of therapy approach is used with children who have motor based speech disorders such as Developmental Apraxia of Speech.” The girl who was telling us about it offered to work with Don next summer if she thinks she’s learned enough about doing it to help and our professor thinks the therapy would probably help Don and is worth a try.

Anyway, for a day that started out with such petty annoyances it sure ended up with some exciting accomplishments.

He, She and It

Such little words they are---he, she and it---but what a huge huddle they are for Don. This semester in speech class he’s been doing fantastic getting verbs out but in order to jump him into sentences he’s got to get past what is turning out to be a major stumbling block. He gets the ‘she’s’ and ‘she’ right when he’s looking at a picture of a woman or girl and is suppose to say something like: ‘she is reading’ or ‘she’s watching’ but when it comes to a man in a picture, he says ‘it is reading’ or ‘it’s watching’ far more often than he gets it correct.

Today was the second speech class he’s had where they worked on nothing but ‘he, she and it’ and I’ve been drilling him three times a day with flashcards that say: he’s he, she, she’s, boy, man, girl, woman, object, it, it’s, me, and you. There was progress today because sometimes he’d self correcting with the word “no” when he’d hear the wrong thing come out of his mouth. That’s auditory comprehension which is absolutely necessary for anyone with aphasia to have in order to learn to talk again i.e. if you don’t recognize your mistakes---then you can never word search in your brain to get the right words out. Auditory comprehension was also a hard-earned jump forward in progress for Don and its gotten better and better as time goes on. I can remember a time when he tested out at around 10% and I’m guessing he’d test out around 70% now.

He, she and it---I just want to get a hammer and beat those tiny words into his head one letter at a time. But I’ll resist the temptation---I hope! The professor says when it finally clicks in his head it will be like flicking a switch and it will stay on. Me being me, I wanted to read some psychological mumble-jumble into Don’s it-man hang up. I thought maybe he calls men ‘it’ because he sees the stroke as emasculating him/men. Nay, the professor says, tiny words are a huge problem for people with Don’s type of aphasia. Okay, I trust her expertise.

End of the Speech Semester

Today was a mixture of sad and happy. Don was sad that speech classes have ended until next fall. He always misses the energy that goes with being on the college campus where he goes for therapy. I was happy because speech classes have ended until next fall. Having two days a week tied up for classes keeps us on a rat race and I need the summer breaks and change in routine. There will be a summer social hour once a week for all the clients and we may try to go to some of those events. Don thrives being around all the people we’ve met through the language disorders clinic.

Here’s today’s evaluation report. Drum role, please. Don had a 60% improvement in the work he did on verbs since the beginning of the semester to the end. He barely scored at the beginning of the semester testing. Of course, he’s no where near fluent with verbs now. It takes a great deal of queuing to get them out of him but even so, he’s made remarkable progress this semester---beyond what the student clinicians and the professor had hoped for. And another drum role, please….when Don was testing he FINALLY self corrected himself when he called a guy in a photo “it” instead of “he.” He said, “it, no, he” not once but several times during the testing. Funny how so many people can get so excited about something like this, but we were. God, how we all take language skills for granted when we have them!

You wouldn’t believe the amount of homework Don was given for the summer. And it goes without saying that he was invited back for next year. He always sweats these evaluations because there is always a chance he won’t get invited back.

It’s been a good few days. The party after the evaluations today was fun.

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