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Friday, June 1, 2012

The Purpose of Speech Therapy

I think the hardest thing for me to deal with post-stroke is aphasia and Bob's inability to speak. That's saying a lot, since most of you know, I have quite a bit to deal with, in fact, you would not have wanted to be at The Pink House yesterday, when there was not one, not two, but three (count them) bowel movements and the last two were complete surprises: one all over the bed and the other landing smack dab into a pair of real underwear. GAA! I tell you, right now, there is a perfectly good pair of real underwear headed to the local landfill because I could just not deal with it. You'd think my gag reflex would be better by now, but alas, it is not. But I have digressed. I was talking about speech therapy.

Since those first post-stroke months, when Bob could not utter a word, only make sounds--sort of garbles and gurgles, I knew he was trying to speak. To get the words out. As a writer, the ability to communicate is far more important to me than, say, the ability to use the bathroom. And so, since those first days, it has been a long and constant struggle to find Bob's speech, to unlock his words.

For a long time, I've been searching for that magic key that would unlock those words. Pretty much I've been trying every type of therapy technique I could get my hands on. Certainly since the "professional" speech therapists have given up on Bob saying that his "prognosis was poor" or he was "functional" enough, I have been trying harder than ever to prove those saps wrong.

This morning, I woke to the sound of rain on the roof. And I thought, well, I won't be taking the dog on a long walk in this weather, so I rolled over figuring I had bought myself a little nap time. When I heard Bob, from the next room, call to me:

"Hey? um, hey?"

That's me he's calling for. I am sometimes known around here as "Hey? um, hey?" But I figured I'd just ignore him, pretend to be sleeping and catch a few more winks. But then he said,

"Hey! The sun is up!"

I nearly bolted upright in bed, not because the sun was up and that meant I should have my butt out of bed by now, but because that was a very good, spontaneous sentence. And Bob's main problem area now is saying anything spontaneous, i.e. those type of sentences which just express what's on his mind.

I recently ordered a copy of the book "The Teaching of Talking" by Mark Ittleman, who is a speech pathologist. Though I haven't even finished reading this book, the one thing I gleaned so far (though the author never really states it) is that the whole purpose of speech therapy is this: keep him talking. However you can, just keep him talking.

I think I've always known that. I know I've always done that. But now, it seems totally clear to me that all along this is the "magic key" I've been searching for and it's been right in front of me, heck I've been doing it all along, and it's really quite simple:

Just keep him talking. 
And make it as easy and fun as possible.

One of the techniques to make it "easy" in Ittleman's book is asking the "embedded question". This is basically a question with the answer already embedded in it. For example, instead of asking, "What flavor pudding would you like tonight?", I instead should ask, "Would you like chocolate or vanilla pudding?" That way the answer is already stated, the words are right there hanging in the air, and Bob doesn't have to search his mind for the word "vanilla" because "vanilla" is floating in the air in front of him--he only has to grab onto it and say it.

Bob is very good at repeating things. He can and will repeat something exactly as I say it. Right down to the tone of my voice. And if I, trying to be funny, say something in a silly Chinese accent, he will repeat it back in the same silly Chinese accent.  So using "embedded questions" has really helped Bob find the right words.

Another of Ittleman's techniques is what the author calls the "Tell me" phrase. This is all about repeating, so Bob is also very good with this technique. The idea here is to get Bob to say more words than he usually does. Here's an example:

Bob: "Up." (which I already know means he wants to be boosted up in bed, but instead of just helping him boost up, I get him to say more words, like this:)

Me: "Do you need a boost?"

Bob: "Yes, boost."

Me: "Tell me, I want a boost, please."

Bob: "I want a boost."

Me: "Please."

Bob: "Please."

I have been working on this technique with Bob daily now for awhile. You can pretty much do this type of thing all day long. I suppose I tend to overdo this, and I'm sure that somedays I am downright irritating to Bob, though I no longer have to give him the "tell me" phrase, I can just ask him for a sentence, as in this example from yesterday while I was giving Bob's morning meds through the feeding tube:

Bob: "Up."

Me: "Do you need a boost?"

Bob: "Yes, boost."

Me: "Give me a sentence."

Bob: "I want a boost, please."

Me: "Good."

Bob: "And, um..." points to his mouth and says "ow."

Me: "You need some pain medication?"

Bob: "Medication."

Me: "Tell me, I want a boost and some medication."

Bob (rolls his eyes), "Oh, puh-leeease."

OK, I tend to push it. But the nice thing about these techniques is I can sort of integrate it all through the day and not feel bad on those days we don't have time to sit down for a proper hour of "speech therapy". As we are now doing neck stretching exercises 3 times daily, and having regular OT visits, time is at a premium.

Recently, both my sister and Bob's mother had an opportunity to speak on the phone with Bob and both said, afterward, that they thought his speech has definitely improved from the last time they spoke to him. Seems he's had a bit of a breakthrough speech-wise.

Even though it's raining here at the Pink House today and things have been mighty hard, as someone said this morning:

Hey! The sun is up!


Elizabeth, John and Jack said...

You are awesome! I love hearing your success stories, and all you are overcoming with Bob. I can only imagine how painful aphasia must be for all of you.

Anonymous said...

My MIL still likes to grunt and point.
ME: water or gatoraid?
HER:Grunt, point.
ME: water or gatorid?
HER: Rolls eyes, sticks out her tongue, smiles "water".
I know that they get tired of us doing this but one word leads to more, I hope.
Good luck to you and Bob

Rebecca Dutton said...

I'm a big fan of embedded exercise(e.g. I stretch my shoulder just before I put on my shirt). If I piled all my exercises into one big boring block of time I would not do them. Using an activity to prompt me when to do an exercise reminds me why I'm doing the exercise.

Anonymous said...

Fantastic news Diane. All that hard work is slowly but surely paying off. I love the fact you never really give up. Just like all caregivers, you get frustrated from time to time, but you never give up trying to improve Bob's condition. Those little gains are always great to read about. Hugs, Dan

Anonymous said...

Dear Diane,
I teared as I read your post about Bob, and using the technique I wrote about in Teaching of Talking. By golly, you are getting it! And you are correct in the assumption that the beauty in the method is that you don't have to sit down to do an hour of speech therapy. (GAA!) You can just use imbedded questions and tell me phrases all day long at the right time and as the communicative situation dictates. That way you don't have to sit down for an hour and do boring exercises that do not pertain to real life speaking needs. You stimulate speech and language when it is necessary and that will have much more meaning. Not only that but I believe that as you stimulate speech responses for important everyday events, the speech required in that event should be easier and spontaneously said in future events!
Just make sure you keep stimulating speech in almost every interaction, and making it easy and fun. If it is fun and easy, I do not think anyone with a communication difficulty, unless they are grouchy heads will mind speaking.
Thank you for sharing this inspiring story.
Mark Ittleman, The speech pathologist who can make a rock talk!

PS: There are some other cool methods in The Teaching of Talking Learn to Do Expert Speech Therapy at Home with Children and Adults. You May Want to Review: Please see the Alternative Choice method and the "I'll tell you about me, if you tell me about you." I think that will also be fun with Bob!

I love your writing, and dedication to Bob and sharing your voice with the world!.........Mark

Anonymous said...

Cool D. What a positive turn of events. Like everyone else I admire your determination and strength. You are one strong lady. Hugs, Patricia

barbpolan said...

Once Bob is up, walking around and speaking, we all know he will be telling everyone about your commitment, patience and how you brilliantly figured out what was right for him. Kudos!

Grace Carpenter said...

Keep on keeping!

I hope the neck exercises are helping, too.