Saturday, September 22, 2007

Speech Class Diary, Part 5

This part of the diary covers 2/06 through 3/06.

2/15/2006, Spring Semester
Ma and Pa Kettle go to Speech Class

Don had his first speech/language pathology evaluation at the college yesterday. He’ll get two undergraduate student clinicians this semester and they’ll be supervised by the same professor we’ve had in the past. I love our professor. She’s really good with Don, pushes him hard, and she’s a thorough teacher with the students. She also gives me the same in-depth, quality answers to my questions as she gives to the students. The plan, this semester, is for me to be in the observation room instead of the treatment room. Hallelujah! It’s dark in there and I can relax more without worrying about being caught on camera or being observed picking my nose---not that I would, but I’m old and who knows when that ‘grown-up filter’ gives out on you and you start doing quirky, senile old people stuff.

The girls did the standard auditory comprehension tests and the oral motor test. I’ve seen these tests given so many times, I could give them myself. In the comprehension portion, Don did much better than I’ve seen him do in the past. He was up to doing four part instructions, for example, before he wiped out and he breezed through the some of the simpler ‘naming’ and ‘finding’ tasks. The oral motor test is done more for the student’s benefit than for Don’s. It’s an opportunity for them to learn to identify and evaluate the asymmetry of the face, mouth and tongue of a real stroke survivor. He got a tongue depressor shoved down his throat, looking for a gag reflex, and both students and the professor each found one. Yippee I O, gagging is good! After poking inside of Don’s mouth and having him make silly faces---tongue up, tongue down, smile, blow a kiss, etc.---it was determined that Don still has mild weakness on the right side thus the reason why he still occasionally chocks on thin liquids if he isn’t careful.

The goals set for this semester are two-fold. One is the same as last semester: to get Don to jump from one or two-word responses to full sentences. The second goal is to get Don to interact more with his Lingraphica machine, to help with conversation. All-in-all it was good to be back in the speech therapy frame of mind again even though I don’t look forward to being locked into that rat race schedule again. Hop on the Endy 500, honk-honk! Weave and dart. EEEEEKKKeeee! "Naughty" Toyotas better stay out of my way. (Don says 'naughty' whenever he sees foreign made cars on the road and does sound effects with my driving.)

I have to go now. I have to contemplate why I keep putting off buying new clothes! I felt like a bag lady on campus yesterday and I had stood in my closet for a full five minutes trying to find something decent to wear that day. My wardrobe consists of sweats, Champion brand jersey knit outfits, and tennis shoes---not that the kids on campus dress much different. But they have color, jewelry, real shoes and the layered look. I look like I got my color palette from a mortuary handbook. Someone should give caregivers Welcome-Back-to-Life showers!! I feel like I’m a zombie on auto-pilot who is just waking up and realizing that I’ve lost five and a half years of fashion savvy.

Jean Riva ©

Testing, Part II

Don’s second speech class of the new semester consisted of more testing. The professor was absence and I shared the observation room with one of the other students. They only have nine girls in the clinic classes this semester---down by about half their normal number---so we’ll get to know this crop quite well. The girls working with Don today started him out with an exercise where he was supposed to fill in the missing word at the ends of ten sentences. “The sky is ____.” “I like bread and ______.” “I would like a piece of _______.” I held my breath on that last question hoping that Don wouldn’t come out with, “I would like a piece of ass.” I could read that humorous retort in his eyes and I was thankful that the gods of aphasia didn’t kick it out of his mouth.

The next testing set consisted of Don being asked to make a sentence out of a single word. For example: give me a sentence that contains the word ‘house.’ Don didn’t do well at all. He wouldn’t have gotten any of the ten if the girls hadn’t queued him all the way. Had the professor been there, I know she would have corrected them for doing that. Testing is different from teaching. It really doesn’t matter for Don’s purposes but if this were an insurance covered therapy where the importance of documented progress were critical to keep that coverage coming what you don’t want a speech therapist queuing during the opening testing phase.

They did the Boston Naming Test, too, and Don breezed through that which was so different from the every first time I saw him take this test. The only ones he got wrong today out of a hundred were he said “steak” for a paring knife and “tree” for a leaf. The first time he took this test at the college four and a half years ago, he could only put a name to a few of the pictures.

Next came a bunch of facial movement tests: rounding lips, touching the tongue to the nose, etc., etc. Don got pretty silly with the puckering-up-for-a-kiss command. He had everyone laughing. To round out the hour, they gave him the reading comprehension battery of tests and he really did very well with them. The only disappointment of the day, for Don, was that no one noticed his ‘Re-elect Hillard’ bummer sticker on the back of his wheelchair. Oh, well, tomorrow is grocery shopping day and he’s sure to reel someone in while he’s out trolling for friends at Starbucks' coffee shop.

1st Group Speech Class of the Semester

When we woke up this morning it looked like Hollywood had turned a snow machine on outside our bedroom. It was coming down so thick we could barely see the pine trees just twenty feet from the window pane. The individual flakes were as big as dinner plates. Well, that’s a slight exaggeration, but they were huge and their laciness could be seen with the naked eye and it looked like a bunch of scissor-cut paper snowflakes were fluttering from the sky. I thought for sure we’d end up having to cancel going to Don’s speech class and I’d be spending the afternoon shoveling white stuff that was so fluffy it would have been akin to shoveling goose feathers with a soup spoon. But the Hollywood snow machine turned off and the sun turned on bright and beautiful before we had to leave and by the time we had gotten a quarter of a mile away, the snow on the roads had conveniently melted. Sometimes life is good!

On the drive through town, Don was in his “Chatty Kathy” mode naming things along the way and making little boy motor sound effects as I drove. EEeeeeKKKKK for the when I applied the brace. Grinding gears sounds for when I take off from a light....and I drive an automatic! Go figure that one. At one point---after he had named the yes/no houses (don't ask), the trees, buildings and a lake---I asked him if he was a tour guide. “Yes,” he answered, and I told him he’d missed the hot babe we’d just passed.

“Hot babe?” His aphasic brain processed the words.

“She wasn’t a shy virgin type dressed the way she was,” I said. “Want me to turn around so you can check her out?”

Don hesitated but finally answered, "No."

The group speech class---the non-verbal clients---has grown to six guys this semester, four of them in wheelchairs. Four of six guys have been together for several semesters now. Another guy who had attended two classes at the end of last semester was back again and the newest kid on the block will fit in well personality wise. His speech is at the REALLY-struggle-to-get-out-single-nouns stage. But he worked hard, wasn’t shy about feeling his way through his mispronounced attempts and he looked comfortable interacting with the others. We all laughed a lot. Group class is fun.

The two student teachers spent the entire hour on having the guys introduce themselves and their wives to each other and doing a word finding exercise. For the word find, they only had time for three categories: finding words that relate to baseball, then breakfast and finally to transportation.

We’re all going out to dinner after next week’s class, which is nice but to be honest if it weren’t for the guys in the group all having had a stroke Don and I would have very little in common with the others. We’re all in the same age bracket but our life experiences are a big gulf between us. Don and I don’t have kids, grandkids or a church family to chit-chat about and the rest all do. They say that snowflakes and people are all different, but in groups like this I often feel like a lump of coal in a sand pile.

Today’s Highlights….

It was barely past noon when we had our first emergency here on Elm Street. Yes, it WAS an emergency-type scream I heard coming from the bathroom. I wasn’t wearing my running shoes—or any shoes for that matter---but it didn’t matter. I went flying, old-lady style, to the other end of the house where I found Don was sitting on the toilet. Yup, he was sitting, not lying on the floor. There was toilet paper on the roller. I checked it twice. No pee was evident where it wasn’t supposed to be. There weren’t any cuts or bruises in sight and the exhaust fan was turned on. “What the bloody hell is the matter?” I asked Don in a kinder, more Miss. Manners tone of voice and with nicer word choices. (I was having a good day.) He pointed to his watch.

“Your watch battery quit working?” I asked.

“NO!” Don said, touching his watch again. Then he pointed to the television in the bedroom.

“Oh, my God!” I gasped. “You’re having a Bold and the Beautiful soap opera emergency!” The TV set was not turned to the right channel and today, at twelve-thirty, was Ridge’s wedding day to what’s-her-name---Brook---who he’d been married to twice before. No wonder my little groupie was screaming bloody murder.

The next big little event here on the Planet Aphasia happened as we were on the way to speech class. Just about everywhere we have to go takes us past the yes/no houses. These are two houses that we had looked at back after the stroke when we thought we might be able to find something that could be remodeled to suit a wheelchair. Both of these houses turned out to be wild goose chases that a relative had sent us on, but every since the first time we saw them Don never fails to grade their “suitability” as we drive by. The “no” house also gets the middle finger treatment---much to my aggravation. (I keep visualizing a beefy guy seeing it and wanting to stop our car to throw a few punches.) Anyway, today an aphasic miracle happened. The yes/no houses got upgraded to the good/bad houses. That mental dictionary in Don’s head that produces speech is getting closer to the right pages!

In speech class, all the tasks were reruns of things that were done last semester---sentence building from pictures, a listening task consisting of following three-four part directions using objects on the table, and naming words in categories.

The only notable thing that occurred in class happened when the student teachers showed Don a picture of a hunter pointing a rifle at an elephant. When one of the girls directed his attention to the hunter and asked him what that was Don-the-clown says, “Bad!” Then he put a little-boy-pouting look on his face, pointed to the elephant and hotly bellowed out “Baby!” Next thing you know he slammed the picture face-down on the table. “Bad!” he repeated. One of the student teachers turned it back over---they were both trying hard not to laugh at this point---and somehow they got through the process of pulling words out of Don, writing each one on a separate index card as he named them.

“The hunter is shooting the elephant,” the girls kept queuing him to say all together in a sentence, once all the words were written down. However, every time they got to the word ‘elephant’ Don would insert the word 'baby' with total disgust in his voice. Finally, they added an index card with the word ‘baby’ on it and Don was appeased. I was cracking up in the observation room. Don the hunter who always had the greatest respect for the ethics of good sportsmanship, and following the hunting laws, would not condone this hunting poo-haw, speech or no speech.

Simple Pleasures

We have a new word here on the Planet Aphasia: booger. “Thank you very much, dear,” I gushed as Don ceremoniously presented me one on end of his finger. And so my day started out with a ten yard sprint to the Kleenex box. You’ve gotta love a word like ‘booger,’ said with a beaming smile and a booming voice as if presenting a bodily fluid were a diamond on a silk pillow.

Then the dog found another kind of gift on the deck: a black cat who probably out weighed Cooper by at least two pounds. The he-haw square dance that transpired upon their meeting got the dog’s blood pressure up, his tongue hanging down and it put a smile on his silly canine face. Ah, the simple pleasures of life---nothing says spring is in the air more than yucky boogers and black cats.

Thinking it might make a good topic for an essay, I made a mental note to look for more simple pleasures through out the rest of the day. I knew there will be some because: 1) it was a bright sunny morning after a long dreary winter. And, 2) I might be old but I’m not a horse that can be taken out behind the barn and shot or pranced off to a dog food processing plant. I would not let our dog eat horse meat! If I did, how could I hold my head up high while walking through our living room? That herd of forty wild mustangs galloping across the wall would never forgive me if I turned our sweet little gourmet cheese eating poodle into a horse flesh eating wolf.

As we were getting ready to go to speech class I plucked a whisker off my chin and I wondered it this act was just a little too simple for my ‘Simple Pleasures’ list. I concluded that although getting rid of the annoyance gave me pleasure it also falls in the category of things that make a woman feel old. “Well, hells bells,” I reconsidered my thoughts. “At least I still find the image in the mirror vaguely familiar. It’s another good day here on Elm Street.”

Arriving on campus before my husband’s speech class, I pulled the Blazer to the back of the parking lot next to a little tree where Don likes to use his urinal. We’ve had a lot of time to ponder the beauty of that tree since his stroke. Today, the new growth branches were turning red and budding out and the bird’s nest that’s glued in a forked branch was still in tact, waiting for the return of its architects. Yup, who could not gush mushy platitudes about mating birds and apple blooms in the spring?

Watching Don’s speech class from the observation room today was more than a simple pleasure. It was huge, rent-a-billboard-for-the-front-yard amazing. Only someone who has watched a spouse struggle for speech can truly understand how exciting this is.... Today---five years and ten months post-stroke---Don jumped from a nouns-only vocabulary to saying a complete six word sentence, properly canted and without queuing. Of course, it took nearly a whole hour of working with pictures and index cards to get that sentence out of Don, but everyone in the observation room did a virtual standing ovation.

Yup, a booger on a finger tip, a black cat on the deck, the wonders of nature and hearing Don say, “The elephant is chewing the grass” makes for a great day here on the Planet Aphasia.

Jesse Crust

Don came rolling out of the bathroom this morning singing “pretty!” in an aphasic operetta. Silly me, I thought he’d found a pair of rose colored glasses and was making a statement about my looks. Wanting to milk a compliment a little bit, I asked, “You think I’m pretty?”

Don stopped singing and answered, “Me!”

On the Planet Aphasia words like ‘me’ and ‘you’ in addition to he/she, them/us, mine/yours, and girl/boy are usually used in the exact opposite way as they are on earth. So I had to get a clarification because, as you know, I’ve been trying to teach my husband Earth English. “You mean Jean is pretty?” I asked. Using the words ‘Jean’ and ‘Don’ for ‘you’ and ‘me’ keeps us from talking around in circles for ten minutes before we get things straighten out.

“Me!” Don said again, this time while thumping his chest with the palm of his hand. Well, I’ll be damned, I thought, he’s speaking Earth English without us dancing words back and forth like we’re doing an old Abit and Costello comedy skit. And I knew another good speech day was on the horizon.

“Yup, Don,” I agreed, “You’re the prettiest guy in the room.” He beamed---no low self-esteem issues on his plate.

Don’s been making great strides lately learning how to swear. As I was driving on the expressway today another driver ticked him off and he tried to say, “Jesus Christ” only it came out “Jesus Crust.” He knew it sounded wrong but he couldn’t figure out how to say it correctly. I wasn’t in the mood to do queuing for profanity, since we were on our way to a Christian college, not to mention the fact that I was laughing so hard it’s a wonder I kept the Blazer from driving up the butt of the car in front of me.

Don rolled the words ‘Jesus Cuss’ around on his tongue a few times and finally went back to ‘Jesus Crust’ all the while giving me ‘The Look’ that says, “Help me out here, woman!”

“Don’t look at me, Buddy-Boy,” I told him. “I’m not helping you get kicked out of speech class for swearing.” Finally, without a translation from my Aphasia Decoder Ring, the conversation and laughter faded away.

We got to the college campus, I unloaded the wheelchair and got my husband transferred and off we went to the elevator. As I stood there waiting and waiting for the slowest elevator on the face of the planet, I remarked to Don, “Boy, is this elevator slow.”

“Jesse Crust!” he swore, a look of total agreement and disgust on his face. And that was only the beginning. Group speech class today was an hour-long laugh-in starting with one of the other clients greeting another guy named Tim as, “Hi, Tit!” You have to see the humor of living on the Planet Aphasia. Otherwise the tears mess up pretty faces.

Comic Book Kisses

I woke up this morning, as I have on several occasions, with a conversation going on in the bedroom. Yup, Don was talking in his sleep again and not just a few random words. He was talking in full sentences and it lasted for several minutes. Intelligently, I understand how a person with severe apraxia and aphasia can talk in his sleep yet not be able to get the words out at will when he’s awake, but it still ticks me off. Mostly because he was talking so fast while I was half asleep and the words didn’t register in my brain so I have no idea what he was saying. It’s like climbing a mountain to hear Gandhi speak only to find out that someone glued marbles inside your ears and you can’t understand the wisdom he’s sharing with everyone who clawed their way up to the top. It’s not fair, not being able to process Don's conversation after all the speech classes I've attended! I’m going to get a voice-activated tape recorder for his bed stand so I can catch the next one on tape.

We have a new guy in group speech class and all his attempts to speak sound the same---like he’s saying the letter O. The professor was telling us that he’s got great potential for improving diction if he starts working on inside-of-the-mouth tongue exercises; he’s only been doing outside-of-the-mouth tongue exercises. All of these exercises are suppose to be done in front of a mirror and involve doing things like putting the tip of the tongue on the roof of your mouth, moving the tongue from side to side, etc. Don’s never had a problem with diction on the words he’s able gets out so, other than for testing purposes, he’s never had to do these exercises.

It’s fascinating, the range of language disorders that all get lumped under the heading of aphasia from brain processing issues to facial or tongue muscle control issues to transmission problems between the brain and the mouth. The latter of which is Don’s problem. To make it even more complicated, a stroke survivor can have problems in all these areas in various degrees. Plus there’s the whole category of language disorders called ‘dysarthia’ which involves damage to any of a variety of points in the nervous system.

The professor says it’s a good sign that in the past six or so months Don’s been talking in his sleep again, as he did in his pre-stroke days. He must have been telling a great story this morning because his conversation came laced with a lot of laughter. At least in another plane of existence motor-mouth Don still lives. But I gotta tell you…if I find out he’s wining and dining another woman in his sleep he’s going to wake up with his head in my personal waffle warping grip. Just kidding! If I were going to abuse my husband, I'd want him to be fully awake.

It seems silly now but a hundred years ago I stayed mad at Don for an entire day because he said another woman’s name in his sleep. Men, poor babies, can’t even get a break when they’re dreaming. In typical Don fashion, he thought it was the funniest thing in the world that I was sputtering and spitting over him waking up with the taste of reporter Lois Lane’s kiss on his lips. What? I’m a woman, aren’t I? And PMS knows no boundaries. Everyone knows that.

P.S. Don was going through a phase, then, where he was wearing a superman t-shirt underneath all his other clothes and he would make a silly production of revealing it.

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