Finally I get a chance to write a post again. Being a 4th year student isn't easy, and I'm not touching base.
As I have explained in previous posts, Aphasia is a complex disorder, that can present itself in many ways. The two main types you get are expressive Aphasia, where the main problem is word-finding problems, and a receptive Aphasia, where you don't understand what people around you are saying.
You have probably met my patient in my blog "My first experience of a truly helpless feeling". She is an African lady who had a stroke some 10 weeks ago, and was diagnosed with Wernicke's Aphasia, with an Apraxic component. She speaks mostly jargon, and words that don't exist, and doesn't understand when people speak to her.
In my previous blog, approximately 3 weeks ago, this patient didn't understand what is going on around her. She would respond to you with prolonged sounds and utterances that don't make any sense, and wasn't aware that no one understood when she spoke.
In the mean time, this patient has progressed in various aspects. She does still not understand when you speak to her, but she understands when you show her what you want her to do. If you give her mixed pictures of wild animals and pets, or fruit and vegetables, she is fully capable of putting them under their correct headings. She is able to differentiate between two objects when you ask her to give you one, and she can walk on her own.
Now and then, there are some automatic responses that come through with her speech, which lead you to believe that she understands what you are saying. For example, she will greet you appropriately when you walk into her room, she nods her head when you ask her something, and she says "I'm fine" when you ask how she is. I also got a "No don't raise it" from her one day when I wanted to raise the side bar on her bed.
In my previous post I mentioned that this patient has difficulty swallowing, due to her lack of being able to plan the movements for swallowing. At that time, they had just inserted a naso-gastric tube to feed her. About a week later they inserted a PEG tube, which is a more permanent option. A PEG tube is one that is inserted through the abdomen wall, directly into the stomach. Patients with PEG tubes do get hungry, but they eat liquid supplements. I have spoken to patients that say they sometimes get cravings for the taste of various foods (coffee and cheese burgers), but they don't crave it like we do.
At varsity, they never teach you how to feed a patient that aspirates on their food, because it is one of the most dangerous things you can do. So at the hospital, we are expected to be able to do this. As you can imagine my nerves went haywire, because I can kill the patient like that. So I tried, and I got it right, but every time the patient coughs I jump 10 feet high like a scared moegoe, and run for tissues and a bucket.
This week that just passed, the therapists told me I am doing very well, and that I should now see Mrs X on my own (something of which I am very proud). I do therapy with mostly liquids, because this is the safest option. I vary between water, tea and yoghurt. Water is the safest, because your body produces water, and it won't do much harm if it gets into the lungs. Tea I use because it has a taste to it, and it is hot, which will stimulate the nerves and hopefully initiate a swallow. And yoghurt I have just about given up on trying.
I use a teaspoon and put a little bit in the patient's mouth. She Opens and closes her mouth, but then holds the liquid in her mouth. You can see that she knows she is supposed to swallow, but she doesn't know how. And the more she thinks about it, the less she gets it right. She has even gotten to the point where she tilts her head backward to get the liquid into her throat to swallow it.
In the beginning of each session I am usually able to elicit one or two swallows, because her mind is not on what she is doing. I walk in and shove the cup of tea into her hand so that she can take a sip (which she can do - it's an automatic response), and then I usually get a swallow. She then realizes that she is supposed to be swallowing, and forgets completely how. I have tried distracting her by getting her to focus on another activity, like matching objects and pictures, categorization, etc, which works now and then, but sometimes she forgets completely that there is something in her mouth and tries talking. Not good.
This patient has been in hospital now for about 10 weeks, and is about to go home. She has started realizing that no one understands when she speaks, so she speaks a lot less than when I saw her the first time. She knows that she can't get her body to do what her mind is telling it to, and has started becoming depressed. She will be discharged to a Rehab soon, so I'm hoping they will be able to get somewhere with her Apraxia. It's going to be a long journey.
Xxx
Sunday 10 May 2015
Monday 13 April 2015
My first experience of a truely helpless feeling
Today was my first day at a new practical. I am doing the next 6 weeks at a private hospital here in Pretoria. It's probably going to be a challenging few weeks, but hey, that's what learning is about, isn't it? :)
Where I come from, the private hospitals are more or less what you would expect a hospital to be like - big, open, cold spaces where you can almost feel the sickness and disease lingering in the air. I usually feel chilled to the bone when I walk through a hospital, like I should wrap my arms tightly around my body to protect myself from whatever is in the air (and from the people). But Today I was amazed that you actually get hospitals like this. It was clean (no not just clean, spotless!!), it didn't feel infected, it was organized, and the facilities are amazing. There are no more than 3 beds in a ward, the nurses are all friendly, and everyone is clued-up about all the patients. They have a good system going. Oh, and best of all, the patients are put into the wards according to their condition, they aren't just shoved in wherever there is space.
So this practical that I'm doing is a neuro-prac. So I'll be seeing patients with all sorts of neurological problems related to speech. The unit that I'll be working in is one of 5 stroke units in South Africa, so my client basis will mainly be stroke patients. Today was just an orientation to the hospital, and observation of a few therapy sessions with the Speech Therapists running the practice.
As I have explained in a previous post, Aphasia is generally known as "word finding difficulties". More specifically, it involves damage to one, or all, of the language area's in the brain. What this means is that certain aspects of language are affected in various ways, the planning, processing, or execution of language functions. Two of the main types of Aphasia that we get are Broca's Aphasia, and Wernicke's Aphasia.
In a nutshell, Broca's Aphasia is when a person understands what he/she hears, or better said - the language he/she hears or reads, but they have difficulty expressing themselves through use of language. So for example, if a person were referring to a door, they might not know the word "door", and would use circumlocutions (round-about ways of describing the word). They might say "this thing", and point to the door, or "that thing with a thing that you turn to open it", or even something like "that thing that you use to go into the house".
Wernicke's Aphasia, on the other hand, is when a person doesn't understand what they hear or read. They can't process the language, and thus don't understand when people speak to them. These individuals usually don't make sense when they speak. They either talk rubbish, but with existing words, or they speak using words or phrases that have no meaning whatsoever.
Apraxia is motor planning difficulties - inability to plan, and thus execute, movement.
You seldom get people who have a single diagnosis. They usually co-occur with another diagnosis, for example Wernicke's Aphasia with a component of Apraxia. They seldom occur in isolation.
So today we observed a patient who had a stroke, and was diagnosed with Wernicke's Aphasia and and Apraxic component. I am not familiar with the history of the patient, so I'm not sure how long ago the stroke occurred. The patient was a female, and is currently receiving Physiotherapy, Occupational Therapy and Speech Therapy.
It is evident that there was brain-stem damage from the stroke, as the patient is unable to swallow. In a normal functioning individual, if you get some sort of bolus in your mouth, whether it be a liquid or a solid, no matter how thick, you would either chew and swallow, or just swallow it. What I found really interesting with this patient, is when we put yoghurt or water in her mouth, she could close her lips, and look as if she is going to swallow, and then suddenly she would open her mouth and stick out her tongue. This is where the Apraxia comes in. She can't plan the movements of chewing, or moving her tongue around. Apraxic patients generally stick out their tongue when trying to plan any oral movements. I can't say why though.
This patient can't swallow any food, and she therefore aspirates when the food does enter the throat, so she is fed through a naso-gastric feeding tube.
The Wernicke's Aphasia (WA) in this patient was such a perfect case of WA. It is very rare that patient's have such a prominent case of WA, and the diagnosis is usually very difficult to make, but in this patient it is a perfect Wernicke's Aphasia. She would look at you when you talk to her, and look as though she is listening, and then she would start nattering off in some non-existing language, sometimes in Sotho. She say's whole long utterances, and then looks at you waiting for you to respond. Sometimes it would seem like she understands what you are telling her, because she would give a very long "oooohhhhhhh", and then laugh, but then she would say something unintelligible. You can see that she understands the function of some objects, like a brush, because she showed that it's used for brushing your hair, and a toy banana that she wanted to eat. But she can't tell you what is going on in her head. She reads facial expressions very well. She can see when you don't understand her, and will then repeat herself, and get teary and upset, but she doesn't understand why you don't understand her, because to her it all makes sense.
In therapy, all that you can really do is try and work on memory and vocabulary, and her understanding of words, and hope for some improvement somewhere along the line. Because only when a patient starts realizing that they aren't doing something right, will they show progress. It's such a hopeless feeling sitting in front of a patient, not knowing how much they understand you, and now knowing what they are trying to say. Especially when they get upset, and you can't sooth-talk them, or comfort them in any way. It's a horrible feeling, but all that you can do is hope for the best.
Xxx
Where I come from, the private hospitals are more or less what you would expect a hospital to be like - big, open, cold spaces where you can almost feel the sickness and disease lingering in the air. I usually feel chilled to the bone when I walk through a hospital, like I should wrap my arms tightly around my body to protect myself from whatever is in the air (and from the people). But Today I was amazed that you actually get hospitals like this. It was clean (no not just clean, spotless!!), it didn't feel infected, it was organized, and the facilities are amazing. There are no more than 3 beds in a ward, the nurses are all friendly, and everyone is clued-up about all the patients. They have a good system going. Oh, and best of all, the patients are put into the wards according to their condition, they aren't just shoved in wherever there is space.
So this practical that I'm doing is a neuro-prac. So I'll be seeing patients with all sorts of neurological problems related to speech. The unit that I'll be working in is one of 5 stroke units in South Africa, so my client basis will mainly be stroke patients. Today was just an orientation to the hospital, and observation of a few therapy sessions with the Speech Therapists running the practice.
As I have explained in a previous post, Aphasia is generally known as "word finding difficulties". More specifically, it involves damage to one, or all, of the language area's in the brain. What this means is that certain aspects of language are affected in various ways, the planning, processing, or execution of language functions. Two of the main types of Aphasia that we get are Broca's Aphasia, and Wernicke's Aphasia.
In a nutshell, Broca's Aphasia is when a person understands what he/she hears, or better said - the language he/she hears or reads, but they have difficulty expressing themselves through use of language. So for example, if a person were referring to a door, they might not know the word "door", and would use circumlocutions (round-about ways of describing the word). They might say "this thing", and point to the door, or "that thing with a thing that you turn to open it", or even something like "that thing that you use to go into the house".
Wernicke's Aphasia, on the other hand, is when a person doesn't understand what they hear or read. They can't process the language, and thus don't understand when people speak to them. These individuals usually don't make sense when they speak. They either talk rubbish, but with existing words, or they speak using words or phrases that have no meaning whatsoever.
Apraxia is motor planning difficulties - inability to plan, and thus execute, movement.
You seldom get people who have a single diagnosis. They usually co-occur with another diagnosis, for example Wernicke's Aphasia with a component of Apraxia. They seldom occur in isolation.
So today we observed a patient who had a stroke, and was diagnosed with Wernicke's Aphasia and and Apraxic component. I am not familiar with the history of the patient, so I'm not sure how long ago the stroke occurred. The patient was a female, and is currently receiving Physiotherapy, Occupational Therapy and Speech Therapy.
It is evident that there was brain-stem damage from the stroke, as the patient is unable to swallow. In a normal functioning individual, if you get some sort of bolus in your mouth, whether it be a liquid or a solid, no matter how thick, you would either chew and swallow, or just swallow it. What I found really interesting with this patient, is when we put yoghurt or water in her mouth, she could close her lips, and look as if she is going to swallow, and then suddenly she would open her mouth and stick out her tongue. This is where the Apraxia comes in. She can't plan the movements of chewing, or moving her tongue around. Apraxic patients generally stick out their tongue when trying to plan any oral movements. I can't say why though.
This patient can't swallow any food, and she therefore aspirates when the food does enter the throat, so she is fed through a naso-gastric feeding tube.
The Wernicke's Aphasia (WA) in this patient was such a perfect case of WA. It is very rare that patient's have such a prominent case of WA, and the diagnosis is usually very difficult to make, but in this patient it is a perfect Wernicke's Aphasia. She would look at you when you talk to her, and look as though she is listening, and then she would start nattering off in some non-existing language, sometimes in Sotho. She say's whole long utterances, and then looks at you waiting for you to respond. Sometimes it would seem like she understands what you are telling her, because she would give a very long "oooohhhhhhh", and then laugh, but then she would say something unintelligible. You can see that she understands the function of some objects, like a brush, because she showed that it's used for brushing your hair, and a toy banana that she wanted to eat. But she can't tell you what is going on in her head. She reads facial expressions very well. She can see when you don't understand her, and will then repeat herself, and get teary and upset, but she doesn't understand why you don't understand her, because to her it all makes sense.
In therapy, all that you can really do is try and work on memory and vocabulary, and her understanding of words, and hope for some improvement somewhere along the line. Because only when a patient starts realizing that they aren't doing something right, will they show progress. It's such a hopeless feeling sitting in front of a patient, not knowing how much they understand you, and now knowing what they are trying to say. Especially when they get upset, and you can't sooth-talk them, or comfort them in any way. It's a horrible feeling, but all that you can do is hope for the best.
Xxx
Monday 30 March 2015
A little boy with Cerebral Palsy
As a 4th year student, we have practical blocks that we're doing this year. My first block in the first term was Neuro, at Special schools. So this is all the little kiddies who have some sort of neurological problem, stuff like Aphasia, Dysarthria (cerebral palsy - CP), Apraxia, various syndromes, etc. And then you get the children with Dyslexia (learning difficulties).
So when we got to the school in February, it was quite a shock to see so many cases in one place. When you go to town, or wherever, and you see one person who has some sort of problem, people tend to gawk at them, stare, and feel sorry for them, or their families. It's sort of traumatizing, seeing people like that in town. So yea, imagine walking into a school where 90% of the children have similar circumstances. I would say about 45% of the children in that school are in wheelchairs, and many of the others have other defects. Most of them don't walk properly, or have spastic limbs, or have some sort of physical difficulty. About 15% of all the children in that school have no obvious, visible defects.
Upon arrival at the school, we received training from the Speech Therapists there regarding therapy for children with Aphasia, Apraxia and Dysarthria. For those of you who don't know, here is what they are - in a nutshell.
Aphasia is word finding difficulties. So a person might know exactly what they want to say, but won't be able to express themselves, because they can't find the words to say it. They also have difficulties with reading out loud and writing. Aphasia is mostly found in older individuals (adults) who have had a stroke, or damage to the brain in the language areas. It does occur in children, for reasons which I am unsure. In children, because they don't already have the language basis that adults would have had, teaching language to these children and providing them with a better means of communication is tricky.
Apraxia is referred to as motor planning difficulties. Also found in people who have had strokes or brain damage to the Broca's area of the brain (speech planning area). These people know what they want to say, and they know how they want to say it, but they have difficulty planning the movements of the oral structures to get the sounds out. These people very often have start-restart behaviors while speaking, because they know what they should say, and what it should sound like, but what is coming out isn't what they expect to hear. Children with Apraxia generally also don't have any language basis, and therefore speak with very short words or sentences, and often don't say the words or sentences right either.
Dysarthria - the more widely used term is Cerebral Palsy (CP). These are mainly congenital disorders, and affect the whole, or parts of, the body. You get different types of CP: quadriplegic, where all 4 limbs are affected. Hemiplegic, where only one side of the body is affected (for example, the left arm and leg), and Diplegic, where only the bottom half, or the upper half of the body is affected (either both legs or both arms). Then you get either Spastic CP, where the muscles are in constant contraction, and the person is spastic, or you get flaccid CP, where there is very low muscle tone in the affected limbs, and they are almost "floppy". These are mainly the children who are in the chairs, and who need facilitators to assist with their everyday needs and activities. Their neurological functioning, however, is many a time not affected. So they have these wonderful brains, but are trapped in a body that can't do what they want it to.
So when we received our training, and started with therapy, we were given a 6 year old boy who has CP. He is a spastic quadriplegic. So most children with CP have sensitivity problems. They are either hyper-sensitive (over sensitive to any sort of stimulation), or hypo-sensitive (they don't really notice stimulation, and you have to really do deep-touch for them to feel anything). This boy has hyper-sensitivity, so he is overly sensitive to anything that touches him.
By the time he was 18 months old, he had seen 12 different Speech Therapists, non of who could help him. The head Speech Therapist (ST) at his school saw him at 18 months, and has been his ST ever since. She told us that he was so sensitive, that if you came closer than half a meter to him, he would anticipate the stimulus to a point where he would start gagging, stop breathing, and eventually turn blue. As you can imagine, he was fed through a PEG-tube (feeding tube directly through his abdomen into his stomach). The ST started desensitizing him from his distal limbs (feet and legs), to a point where we are now able to work inside his mouth. Needless to say, it took her about 2-3 years to get anywhere near his face.
During our time at the school, we had the privilege of working with this little boy, and learning how to handle children in situations like this. Initially we were afraid of taking him out of his wheelchair, and working with him, because we were scared of hurting him. He is pretty much like we are, so he isn't breakable. He is such a clever little boy, and has the cutest personality. Being able to work in his mouth and see the responses that we got from the techniques used to target muscle tone and feeding was absolutely amazing!! Knowing that no one could even get near his mouth as a baby, and actually being able to feed him, and see responses while working in his mouth, is a feeling that no one can describe.
My co-therapist and I took turns in doing the oral activities, so that we could get enough practice and experience. You get a technique called sensitivity training, where you rub your finger along various parts in the mouth, one of them, being from right behind your teeth, backwards across your palate, but not too far back. This puts a sensation on the palate that makes the tongue follow your finger, eliciting good retraction of the tongue (something CP children don't have). So the first time I did it myself, I was wearing a special medical glove with no chemicals and smells. So I gently put my finger in his mouth, and completely forgot that his mouth is so much smaller than mine, and stuck my finger in a little too far. You can imagine my horror when he started gagging, and I had to bend him forward in case he vomited. He laughed at me for doing that, but was afraid to let me stick my finger in his mouth again, something which I was petrified of doing again. Nevertheless, that's how you learn, and now I know to be careful and not overly-optimistic.
The experiences I got from working with this little boy is something that will help me throughout my career. At varsity, they don't prepare you for the things you are going to encounter out there, and they definitely don't teach you the stuff that I learnt at this school. I don't know what I would have done if I didn't get this wonderful opportunity and have the knowledge and experience I got there. All that I can say is WOW! :)
Xxx
So when we got to the school in February, it was quite a shock to see so many cases in one place. When you go to town, or wherever, and you see one person who has some sort of problem, people tend to gawk at them, stare, and feel sorry for them, or their families. It's sort of traumatizing, seeing people like that in town. So yea, imagine walking into a school where 90% of the children have similar circumstances. I would say about 45% of the children in that school are in wheelchairs, and many of the others have other defects. Most of them don't walk properly, or have spastic limbs, or have some sort of physical difficulty. About 15% of all the children in that school have no obvious, visible defects.
Upon arrival at the school, we received training from the Speech Therapists there regarding therapy for children with Aphasia, Apraxia and Dysarthria. For those of you who don't know, here is what they are - in a nutshell.
Aphasia is word finding difficulties. So a person might know exactly what they want to say, but won't be able to express themselves, because they can't find the words to say it. They also have difficulties with reading out loud and writing. Aphasia is mostly found in older individuals (adults) who have had a stroke, or damage to the brain in the language areas. It does occur in children, for reasons which I am unsure. In children, because they don't already have the language basis that adults would have had, teaching language to these children and providing them with a better means of communication is tricky.
Apraxia is referred to as motor planning difficulties. Also found in people who have had strokes or brain damage to the Broca's area of the brain (speech planning area). These people know what they want to say, and they know how they want to say it, but they have difficulty planning the movements of the oral structures to get the sounds out. These people very often have start-restart behaviors while speaking, because they know what they should say, and what it should sound like, but what is coming out isn't what they expect to hear. Children with Apraxia generally also don't have any language basis, and therefore speak with very short words or sentences, and often don't say the words or sentences right either.
Dysarthria - the more widely used term is Cerebral Palsy (CP). These are mainly congenital disorders, and affect the whole, or parts of, the body. You get different types of CP: quadriplegic, where all 4 limbs are affected. Hemiplegic, where only one side of the body is affected (for example, the left arm and leg), and Diplegic, where only the bottom half, or the upper half of the body is affected (either both legs or both arms). Then you get either Spastic CP, where the muscles are in constant contraction, and the person is spastic, or you get flaccid CP, where there is very low muscle tone in the affected limbs, and they are almost "floppy". These are mainly the children who are in the chairs, and who need facilitators to assist with their everyday needs and activities. Their neurological functioning, however, is many a time not affected. So they have these wonderful brains, but are trapped in a body that can't do what they want it to.
So when we received our training, and started with therapy, we were given a 6 year old boy who has CP. He is a spastic quadriplegic. So most children with CP have sensitivity problems. They are either hyper-sensitive (over sensitive to any sort of stimulation), or hypo-sensitive (they don't really notice stimulation, and you have to really do deep-touch for them to feel anything). This boy has hyper-sensitivity, so he is overly sensitive to anything that touches him.
By the time he was 18 months old, he had seen 12 different Speech Therapists, non of who could help him. The head Speech Therapist (ST) at his school saw him at 18 months, and has been his ST ever since. She told us that he was so sensitive, that if you came closer than half a meter to him, he would anticipate the stimulus to a point where he would start gagging, stop breathing, and eventually turn blue. As you can imagine, he was fed through a PEG-tube (feeding tube directly through his abdomen into his stomach). The ST started desensitizing him from his distal limbs (feet and legs), to a point where we are now able to work inside his mouth. Needless to say, it took her about 2-3 years to get anywhere near his face.
During our time at the school, we had the privilege of working with this little boy, and learning how to handle children in situations like this. Initially we were afraid of taking him out of his wheelchair, and working with him, because we were scared of hurting him. He is pretty much like we are, so he isn't breakable. He is such a clever little boy, and has the cutest personality. Being able to work in his mouth and see the responses that we got from the techniques used to target muscle tone and feeding was absolutely amazing!! Knowing that no one could even get near his mouth as a baby, and actually being able to feed him, and see responses while working in his mouth, is a feeling that no one can describe.
My co-therapist and I took turns in doing the oral activities, so that we could get enough practice and experience. You get a technique called sensitivity training, where you rub your finger along various parts in the mouth, one of them, being from right behind your teeth, backwards across your palate, but not too far back. This puts a sensation on the palate that makes the tongue follow your finger, eliciting good retraction of the tongue (something CP children don't have). So the first time I did it myself, I was wearing a special medical glove with no chemicals and smells. So I gently put my finger in his mouth, and completely forgot that his mouth is so much smaller than mine, and stuck my finger in a little too far. You can imagine my horror when he started gagging, and I had to bend him forward in case he vomited. He laughed at me for doing that, but was afraid to let me stick my finger in his mouth again, something which I was petrified of doing again. Nevertheless, that's how you learn, and now I know to be careful and not overly-optimistic.
The experiences I got from working with this little boy is something that will help me throughout my career. At varsity, they don't prepare you for the things you are going to encounter out there, and they definitely don't teach you the stuff that I learnt at this school. I don't know what I would have done if I didn't get this wonderful opportunity and have the knowledge and experience I got there. All that I can say is WOW! :)
Xxx
Saturday 21 March 2015
An interesting case
So at the university, we have a clinic called CHRIB - Clinic for High Risk Babies. It's an Early Intervention clinic, where parents bring their children to be assessed in various aspects. They are assessed by an Occupational Therapist, Psychologist, Speech Therpist, and an Audiologist. Many a time these patients are referred to us by a pediatric Neurologist, or another doctor.
So yesterday (Friday), I had a re-assessment on a little boy that was assessed at CHRIB last year, so this would be his second year by us. This little boy has "Sotos Syndrome". I'm not 100% sure exactly what all the implications of the syndrome are, but I do know that he is 1 of 5 people in the whole of South Africa who have been diagnosed with Sotos Syndrome, so yea, it's very rare.
For confidentiality reasons, I am not going to give my clients any names. This little boy will therefore be "client B".
This little boy (client B) is 5 years old now (65 months), and has no form of functional communication. We aren't even sure whether we will be able to get him to use any form of communication, but we are definitely going to try.
When he wants something, he goes to his parents, and takes them by the hand, leading them to where he wants them to be, to show them what he wants. A lot of the time, his parents already know what he wants, so he just has to lead them to the fridge, or the swimming pool, or whatever.
Client B has a huge delay in all aspects of his development, Speech and Language being the most severe. While my co-therapist student was doing a play assessment on him, I was doing an interview with his dad. I asked general questions, and also did the Developmental Assessment Scale (DAS) ( Northcott, W. H. (Ed.) Curriculum Guide: Hearing Impaired Children 0-3 years and their parents. DC: The Alexander Bell Association for the Deaf). According to the DAS, his general development is severely delayed. His parents refuse to leave him alone at any given moment, for safety reasons.
Last year they tried getting him to use the PECS system (A picture communication system), to teach him how to communicate his basic needs. This did not work, he ignored the picture cards completely. So now this year we will try and focus on imitation, and trying to devise a communication mode that he can use. We will consult with professionals in the Alternative and Augmentative Communication (AAC) department, and see if they don't maybe have a device that could be beneficial for him.
In the mean time, we will see what we can do in terms of communication and development. I will keep writing about our progress with him, or even what we don't achieve. If anyone else can learn from our experiences with him, or even have any suggestions, that would be great. That is the whole point of a blog, isn't is?
Xxx
Thursday 19 March 2015
From solely children, to adults and geriatrics.
I've always thought I would have worked solely with children - babies. My passion is, and always has been, children. When I was a toddler, no older than maybe 2 or 3, I would go to the shops with my mom, and disappear, wandering the isles of the shops alone. Then suddenly I would reappear by my mom's side, holding a stray baby, a baby not much smaller than I was, so I could hardly hold them. So yea, I've always been a child person.
When I decided I was going to become a Speech Therapist, my perception of speech therapy was teaching children to articulate sounds correctly. I went to observe a Speech Therapist in my home town when I was in standard 9 (Grade 11), and didn't see much more than articulation and language therapy (which at the time, I thought was just working on memory). I got all excited about it, but did no further research. My main motto was "children", I would be helping children who struggle with speech. Which, to a certain extent is true. Never did I imagine the broad spectrum that Speech Therapists really work with. So in my first year, I got quite a shock, learning that I will be working with adults and geriatrics too. I insisted that I will go through the motions of studying the work for geriatrics and adults, but I would still focus on children.
I persisted with my fixation on children until last year (2014), when we started coming into contact with the adult population. We are doing our thesis this year, and our topic is "Caregiver-child interaction before and after intervention using the Neonatal Communication Intervention Programme for parents (NCIP)". In a nutshell, we will select caregivers of premature babies who are currently in the Neonatal Intensive Care Unit (NICU), assess their interaction with their babies, give them information and training on how to interact with their babies, and what will have the most benefit, and then re-assess after intervention has been provided. So yes, my passion still lies in children... In this case, the tiny babies. Early Intervention. But recently I have had a surprizing interest in the adult population too.
In 2013, my granny was diagnosed with Major Depressive Disorder and Anxiety. It was a huge story, because she couldn't be left alone, or else she would go into a tizz about what she should make for lunch, or what she will wear the next day, etc. And my granddad couldn't look after her, because he had Alzheimer's, and couldn't remember from one moment to the next. So way before we could get a helper for her, my parents had an overseas trip planned, so I spent my 2 week holiday babysitting my grandparents. I hated every second, but got so many comments on how well I work with the elderly. I suppose this had quite an impact on my interest in adult disorders, and how I work with them.
I had a therapy session with a 61 year old man, who was diagnosed with Broca's Aphasia in 2006 after a left-hemisphere stroke. He has been getting therapy now for 9 years this year, and still has some word-finding difficulties, and is still unable to write. The adult sessions are so quiet, and most of the time I feel like I am supposed to be doing more, making a noise, talking, teaching, stimulating, but actually, silence is a key to adult therapy. By keeping quiet, you give them a chance to think, process and make decisions. Take your time, be polite, and give them a chance. I walked out of the session feeling like we made some progress. Even if it wasn't a huge leap, baby steps are better than none at all.
So yes, I still love children and babies, but I would like to include adults into my field of expertise. I don't want to limit myself. I will help whoever I can, and wherever I can. Adults take a lot of time, and more precise planning for each session, but in the end it's really worth it. :)
My day was good, my session was a success. I feel content, and like I am learning more and more each day. I hope this experience and learning through everyday activities persists. :)
Xxx
When I decided I was going to become a Speech Therapist, my perception of speech therapy was teaching children to articulate sounds correctly. I went to observe a Speech Therapist in my home town when I was in standard 9 (Grade 11), and didn't see much more than articulation and language therapy (which at the time, I thought was just working on memory). I got all excited about it, but did no further research. My main motto was "children", I would be helping children who struggle with speech. Which, to a certain extent is true. Never did I imagine the broad spectrum that Speech Therapists really work with. So in my first year, I got quite a shock, learning that I will be working with adults and geriatrics too. I insisted that I will go through the motions of studying the work for geriatrics and adults, but I would still focus on children.
I persisted with my fixation on children until last year (2014), when we started coming into contact with the adult population. We are doing our thesis this year, and our topic is "Caregiver-child interaction before and after intervention using the Neonatal Communication Intervention Programme for parents (NCIP)". In a nutshell, we will select caregivers of premature babies who are currently in the Neonatal Intensive Care Unit (NICU), assess their interaction with their babies, give them information and training on how to interact with their babies, and what will have the most benefit, and then re-assess after intervention has been provided. So yes, my passion still lies in children... In this case, the tiny babies. Early Intervention. But recently I have had a surprizing interest in the adult population too.
In 2013, my granny was diagnosed with Major Depressive Disorder and Anxiety. It was a huge story, because she couldn't be left alone, or else she would go into a tizz about what she should make for lunch, or what she will wear the next day, etc. And my granddad couldn't look after her, because he had Alzheimer's, and couldn't remember from one moment to the next. So way before we could get a helper for her, my parents had an overseas trip planned, so I spent my 2 week holiday babysitting my grandparents. I hated every second, but got so many comments on how well I work with the elderly. I suppose this had quite an impact on my interest in adult disorders, and how I work with them.
I had a therapy session with a 61 year old man, who was diagnosed with Broca's Aphasia in 2006 after a left-hemisphere stroke. He has been getting therapy now for 9 years this year, and still has some word-finding difficulties, and is still unable to write. The adult sessions are so quiet, and most of the time I feel like I am supposed to be doing more, making a noise, talking, teaching, stimulating, but actually, silence is a key to adult therapy. By keeping quiet, you give them a chance to think, process and make decisions. Take your time, be polite, and give them a chance. I walked out of the session feeling like we made some progress. Even if it wasn't a huge leap, baby steps are better than none at all.
So yes, I still love children and babies, but I would like to include adults into my field of expertise. I don't want to limit myself. I will help whoever I can, and wherever I can. Adults take a lot of time, and more precise planning for each session, but in the end it's really worth it. :)
My day was good, my session was a success. I feel content, and like I am learning more and more each day. I hope this experience and learning through everyday activities persists. :)
Xxx
Wednesday 18 March 2015
Sudden inspiration to blog about my experiences.
After my therapy session today, I was suddenly inspired to start a blog about my journey as a Speech Therapist. Well, this far as a speech therapy student. (this first post is going to be a long one....... :) )
I'm new to the whole blogging thing, so this is going to be a new experience for me.
I am currently a final year student in Speech-Language Therapy, at the University of Pretoria. I had a Therapy session this afternoon with a little boy who was diagnosed with higher functioning Autism at the age of 4 (last year). He was unable to speak even 30 words when he was diagnosed, and since he started speech therapy to present, his vocabulary has increased to more than 300 words.
As you can expect from a higher functioning Autistic child, his mind is constantly racing, and he is very busy. He has difficulty concentrating, and refuses to listen to you if he is not interested. So my first therapy session with him three weeks ago, I learned this very big lesson. I had planned to do specific activities with him, which turned out to be catastrophic. I couldn't get anything into, or out of him. So I went home and did some very deep thinking. I now have a theme for each week, based on an Activity I can use as an educational experience. Today we made a butterfly by painting our hands, and using the hand prints on paper to create the butterfly. My session was a success, and I got this sudden inspiration to write about how I have grown as a speech therapist.
During my first year at varsity, I was a mess, and my studies were a mess. I had 23 modules for the year, all of them theoretical modules. Coming into this from having only practical subjects at school was a major change for me. I walked around on campus scared to look anyone in the eye, because they would know I was a first year student (I wanted to look big). I would sit in class, and try my best not to look stressed about work, and studies, etc. My lecturers would reference books and authors left, right and center throughout each lesson, which would astonish me profusely. How is it even possible to remember each author of every book you used??? Needless to say, I didn't think I was going to make it through my first year. I had moved away from home, so I had no support system here with me, and I was in tears every day. But, I made it through the year, with not even a supplementary exam.
Second year came, and I was excited not to be a newling anymore. I had some background, and could start calling myself a therapist, or "teacher", as the children called us. This year was my year of Articulation and Developmental Phonological Processes (DPD) therapy. I was excited at first, because I am actually applying what I have studied, even though I can still not name any books or authors off the top of my head. Things were still new, and I knew hardly anything. My very first client was a 6 year old girl, with DPD and Articulation errors. We managed to help her within 8 months of therapy, and she was our first success. (When I talk about "us", I'm referring to my co-therapist student friend, Nicole.) So second year went by, and still I felt overwhelmed and scared. I wasn't even sure I was studying the right thing.
Once third year came, I started gaining more confidence in myself, and my therapeutic abilities. Third year was language and language learning Therapy. No, not the best type of therapy that you can give, but a very important type of therapy to be able to administer. 90% of CHILDREN that you will see for therapy have some sort of language component, hence you will have to incorporate it into your sessions. I must say though, I'm quite disgusted with how we were supervisod during this year. Language therapy includes in-depth language training, such as use of all parts of speech, sentence construction, vocabulary expansion, explanation and understanding of concepts, etc. Where we were only taught that we had to do receptive and expressive vocabulary expansion and understanding. Not once were we told that we had to incorporate things like prepositions, pronouns, participles, sentence structure, deminutives, etc. Nothing!! So I spent a year teaching children new words. BORING!!!
This year, my fourth year, has brought a new light and perspective to my way of thinking. I have learnt more during these first 3 months of the year, than in the last 3 years of my studying career. We are now supposed to give 6 different types of therapy, most of which I have heard, or written about in my first and second years. We are now giving Early Communication Intervention (ECI), Aural Rehab, Voice, Complex Language, Neuro and Dysfluency therapy. I am able to reference authors and books off the top of my head, and I actually speak in the Speech-Therapy lingo (which I never thought I would be able to do). Things come naturally to me now, ideas come naturally, therapy techniques come without much thought. I will walk into a session, and have it go completely opposite to what I planned for, and still have success, because I am able to improvise.
So this first post doesn't really have any stories, or experiences in, but from now on I will blog about my experiences, ideas and my journey as a speech therapist. Make it my own little hobby and reflection about how I am experiencing my career and journey as an up and coming speech therapist. :)
Xxx
I'm new to the whole blogging thing, so this is going to be a new experience for me.
I am currently a final year student in Speech-Language Therapy, at the University of Pretoria. I had a Therapy session this afternoon with a little boy who was diagnosed with higher functioning Autism at the age of 4 (last year). He was unable to speak even 30 words when he was diagnosed, and since he started speech therapy to present, his vocabulary has increased to more than 300 words.
As you can expect from a higher functioning Autistic child, his mind is constantly racing, and he is very busy. He has difficulty concentrating, and refuses to listen to you if he is not interested. So my first therapy session with him three weeks ago, I learned this very big lesson. I had planned to do specific activities with him, which turned out to be catastrophic. I couldn't get anything into, or out of him. So I went home and did some very deep thinking. I now have a theme for each week, based on an Activity I can use as an educational experience. Today we made a butterfly by painting our hands, and using the hand prints on paper to create the butterfly. My session was a success, and I got this sudden inspiration to write about how I have grown as a speech therapist.
During my first year at varsity, I was a mess, and my studies were a mess. I had 23 modules for the year, all of them theoretical modules. Coming into this from having only practical subjects at school was a major change for me. I walked around on campus scared to look anyone in the eye, because they would know I was a first year student (I wanted to look big). I would sit in class, and try my best not to look stressed about work, and studies, etc. My lecturers would reference books and authors left, right and center throughout each lesson, which would astonish me profusely. How is it even possible to remember each author of every book you used??? Needless to say, I didn't think I was going to make it through my first year. I had moved away from home, so I had no support system here with me, and I was in tears every day. But, I made it through the year, with not even a supplementary exam.
Second year came, and I was excited not to be a newling anymore. I had some background, and could start calling myself a therapist, or "teacher", as the children called us. This year was my year of Articulation and Developmental Phonological Processes (DPD) therapy. I was excited at first, because I am actually applying what I have studied, even though I can still not name any books or authors off the top of my head. Things were still new, and I knew hardly anything. My very first client was a 6 year old girl, with DPD and Articulation errors. We managed to help her within 8 months of therapy, and she was our first success. (When I talk about "us", I'm referring to my co-therapist student friend, Nicole.) So second year went by, and still I felt overwhelmed and scared. I wasn't even sure I was studying the right thing.
Once third year came, I started gaining more confidence in myself, and my therapeutic abilities. Third year was language and language learning Therapy. No, not the best type of therapy that you can give, but a very important type of therapy to be able to administer. 90% of CHILDREN that you will see for therapy have some sort of language component, hence you will have to incorporate it into your sessions. I must say though, I'm quite disgusted with how we were supervisod during this year. Language therapy includes in-depth language training, such as use of all parts of speech, sentence construction, vocabulary expansion, explanation and understanding of concepts, etc. Where we were only taught that we had to do receptive and expressive vocabulary expansion and understanding. Not once were we told that we had to incorporate things like prepositions, pronouns, participles, sentence structure, deminutives, etc. Nothing!! So I spent a year teaching children new words. BORING!!!
This year, my fourth year, has brought a new light and perspective to my way of thinking. I have learnt more during these first 3 months of the year, than in the last 3 years of my studying career. We are now supposed to give 6 different types of therapy, most of which I have heard, or written about in my first and second years. We are now giving Early Communication Intervention (ECI), Aural Rehab, Voice, Complex Language, Neuro and Dysfluency therapy. I am able to reference authors and books off the top of my head, and I actually speak in the Speech-Therapy lingo (which I never thought I would be able to do). Things come naturally to me now, ideas come naturally, therapy techniques come without much thought. I will walk into a session, and have it go completely opposite to what I planned for, and still have success, because I am able to improvise.
So this first post doesn't really have any stories, or experiences in, but from now on I will blog about my experiences, ideas and my journey as a speech therapist. Make it my own little hobby and reflection about how I am experiencing my career and journey as an up and coming speech therapist. :)
Xxx
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