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
