Mirror Therapy

Bob & Mirror Therapy

Bob's Occupational Therapist made him this "mirror box" although it isn't a box, it's a spiral notebook with a mirror pasted on it.

The idea here is to create an illusion that his right hand is moving and this will trick his brain into thinking the hand/arm is moving, and (hopefully) the hand/arm will begin to move.

He's supposed to do this ten minutes a day.

Friday the 13th Woes

Blogger (the host site for my blog) had some major problems today. All blogs were down this the morning and some posts disappeared (including my last one! aargh). They are up and running now, but my lost post hasn't reappeared even though they promised to "restore" any lost posts.  Other than that, it's been a crappy day. Chris, my neighbor, was going to sit with Bob so I could run some errands this morning, but she overslept, and after I finally woke her up, after two promises to be right over, she got sick. A whole morning's plan wasted. So, everything got behind schedule and when I finally got Bob up, bathed and in the wheelchair it was already 1:30.  I was behind on tube feedings, meds, everything. Then, he wanted to go immediately back to bed (had to pee) (yes, we are still dealing with this), so back in bed he went, then he spent the entire afternoon trying to urinate. The urologist gave him a new medication, but the stuff takes two weeks or more to "kick in", and he's only been on it a week now. At 2:00, I attempted to do another tube feeding but when I was checking for residuals (you have to put the syringe in the tube and pull back to see if the last feeding has been digested) the syringe popped out and sprayed Bob and the bed and me with half-digested Jevity and stomach acid. This just after I had bathed him, changed the sheets, etc. aaaargh.  Finally, he peed at 4:00, but then he was cranky and not wanting to do any therapy.

So, all in all, not a good day. I am typing this fast, just wanting to put a post up to see if it's working!! Also, to let you know there were problems on this site today. Hopefully, my last post will reappear. It was about perseverance, apraxia and aphasia....... If it does, it should be below this one.

Tomorrow's another day.....

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?

Clip Art Notebook: Need Some Advice

Here's my quandary: The Speech Therapist wants us to put together a notebook for Bob. This notebook would contain pictures (mostly clip art) of everyday objects or people and also words like "yes" and "no". The idea here is that Bob could point to a picture of what he wanted, for example, if he wanted a tissue, he could point to a picture of a box of tissues. Or if you asked him a question, instead of saying "yes" or "no," he could point to the word. This is supposed to make life easier for him and she has made these personalized notebooks for a number of her patients and thinks it's a great idea and it will help him communicate better.

All right.

I am not so sure about this. My concern is that if he has such a notebook, he may not try to speak the words because it's easier to point at a picture. I am worried this would be more of a hindrance to his recovery than a help. Am I wrong? Am I just being stubborn? Am I in denial?

I know there are a lot of wise women (and men) out there reading this blog and I would like some advice on this dilemma. I need to hear some other opinions. What do you think?? Would this be a help or a hinderance? What would you do? Let me know by leaving a comment. Thanks.

Rehab Approved For Another Month

Yes! We got the good news yesterday and a new schedule for rehab going through June 3rd (another eval. due then). All three therapists were on-board and all three said they were seeing progress. phew! I was worried, especially about OT.

The Physical Therapists actually think they can get Bob out of the parallel bars and walking around the room in a couple of weeks! Wow. Although, I was warned "it won't be a pretty sight." Believe me, it will be a pretty sight, for me, at least. (I'll have to get my camera ready!) They are going to try either a specialized walker or a shopping cart. Yes, you read that right. A shopping cart. And when I first heard this, I thought it was a joke, but evidently they do have a shopping cart at Rehab and the idea here is that if the patient has balance problems like Bob does and the patient leans too far forward with a walker, the walker can run away from them, so they use a shopping cart loaded down with weights to keep it steady. And he may have to wear a leg brace--still having problems with that right knee buckling, and I know Bob doesn't like that idea.... One of the Physical Therapists told me that "quite frankly" they were ready to give up on Bob and discharge him a few weeks back (after that wilted flower imitation at the standing machine), that they thought he'd never come around and then he asked me what happened? What did I say to Bob to get him motivated? Ha ha! (See earlier posts, "Rehab Says Shape Up or Ship Out" and "Up & Down, Up & Down again")

Unfortunately, the Occupational Therapist is giving up on the E-stim for his right arm. Not seeing any improvement there, and she's going to concentrate now on "life skills" meaning, learning to live one-armed. yikes. Seems a bit of a cop out, but I asked her to work on his reading/writing skills, because he really needs help in that area and she said she would. Also, I think she'll continue the mirror therapy. And I'll just have to do more right arm therapy here at home with him.

Speech/Swallow Therapy told me to start giving Bob "treats" to eat at home for swallow practice. So, I guess I'll be the one pushing a shopping cart--looking for something he likes, but mushy enough for him to get down. She wants to hold off on another Swallow Video for a few weeks. She does think he might be ready for one, but wants to play it safe and is waiting to see more improvement. Right now, he certainly isn't ready to "eat a meal".

So! Good news pretty much on all fronts. We are off to see the urologist today and hopefully he'll have some good news too.

Urodynamic Test Explains A Lot

Yesterday, I took Bob back to the Urologist for a "urodynamic" test. This was not a pleasant ordeal. The examination table for this test looks like a cross between a dental chair and a toilet, on a hydraulic lift. They had to lift Bob onto this contraption because there was no way to slide him onto it with a slide board. Then, they ran a catheter into his bladder and a second one into his rectum and attached several electrodes and everything was hooked to a strange machine which made a terrible squeaking noise. After he was hooked up, they poured water into his bladder and the computer monitored his bladder function. Poor Bob. The test was done by a technician, not the doctor, but she did share some of the results. Seems that he cannot completely empty his bladder, that he is always retaining about 100 cc of fluid (this is about 4 oz) and that is what is causing his constant "urge" to go. Also, his pelvic floor is contracting instead of relaxing as it should. She also found pus, meaning he still has an infection. She was unsure whether these problems were caused from the stroke or the infection. We see the doctor on Thursday. Hopefully, there is something he can do to give Bob some relief (and me, too.)

After that, we hustled home so that I could give Bob a tube feeding and some medicines, then went to Rehab where Bob took some big steps on the bars and even asked to go on "the bicycle"--meaning the Nu Step machine. The phrase "the bicycle" is a big improvement from what he used to call the Nu Step which was "carrots".... I was pleased that Bob did so well at Rehab especially after the ordeal at the Urologist. I had tried to reschedule the rehab appointment because I thought it would be too much for him in one day, but they had no other openings. I tell you, my guy is a trooper.