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Thursday, May 12, 2011

Aphasia: Perseveration & Apraxia

Big words, those. And something that we've been dealing with a lot in Speech Therapy. A year ago, I would not have known their meanings, so here's a brief definition for those who don't:

  • Aphasia: inability to communicate due to brain injury or disease.
  • Perseveration: continued repetition of a word or phrase
  • Apraxia: loss of motor planning
Even knowing the definitions, I'm still confused. I wish there was a way to get inside of Bob's mind, to see things exactly as he does...

Although, I certainly see the "perseveration". He tends to get stuck on a word or phrase and keeps repeating it. Especially when we use flash cards. He'll identify a picture correctly as a "monkey", then when he's shown the next flash card, a picture of a fish, he'll tell you it too is a "monkey". And three cards later, he is still saying "monkey".  It's almost as if he's stuck in loop.

As far as "apraxia" is concerned, the therapists seem sure that Bob suffers from this, but I'm not so sure. By demonstration, they will ask him to "put your finger on your chin" or "point to the floor", to which Bob will just stare at them blankly. "Motor planning" is the ability to follow commands. The therapists tell me that although Bob "knows" what they mean, he cannot make his hand move to his chin or his finger point the floor. But then, if they demonstrate the action to him, i.e. the therapist puts her finger on her chin, he can mimic her.... so what's with that? I wonder if it's that he doesn't understand what the words "finger", "chin", "point" and "floor" mean. I point this out to the therapist, and I'm told that it's probably a combination of both not understanding the words and the inability to motor plan.

He can count to ten. He can sing the ABC's. However, if you show him ABCD etc. written down, he cannot identify the letters. He is anomic, meaning he has difficulty naming objects. He can't seem to remember the days of the week, except for Monday & Friday. He can't remember his own birthday, or the address of our house, however, lately, he's become a backseat driver in the wheelchair transport, shouting out directions to the driver: i.e. "Left! Left!" Which is a very good thing!

I think, in a way, the Speech therapy is the hardest of all three therapies. I asked the therapist if the goal here was to "relearn" everything, i.e. reading, writing, speaking or are we looking for a "magic key" that will somehow unlock his brain and things will come back to him? She told me we're searching for that "magic key"....

Where, oh where, is that magic key?


Jenn said...

Interesting. Sometimes I wonder why we have name everything. I know it's the way people identify and control their world. Sometimes I think it's stupid, and we've over defined everything in the world, making it more complicated than it has to be.
Bob has his own language now, foreign to us, but I wonder if it is foreign to other stroke patients? Much like adults not able to understand small children, but clearly the children understand each other.
Truly, where is that key?

oc1dean said...

There is no magic key. What she is trying to help recover is partially damaged brain in the penumbra from a clot or the bleed drainage area from a bleed. If that control area is dead, then your therapist has no clue what to do.