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
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