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Thank goodness for speech therapy...

January 5, 2017

 

I had major brain injuries because lots of different parts of the brain were affected with my stroke, hence I have Aphasia. It is a problem with using and understanding language. 


One big goal is improving my communication - particularly speaking, writing, reading and understanding. In fact, every post has been authored by me. Definitely my words and thoughts, but little help with my wife and my speech therapists. They are helping me with my grammar; consequently my speech is 'work in progress' still.

 

In the early days at the hospital, I was confused about lots of things and I was struggling to find the words and sentences and my communication was very poor. In computing (Yes... I am a IT nerd), the brain is a computer and I lost (or damaged) lots of brain cells in my stroke - including file system and structure - and my brain was fragmented and some parts of my brain was destroyed. For example, I remember I had to write my signature for the health care form and but physically can't do it - my problem is not left-hand writing but my brain not functioning well, hence my signature was gibberish.

 

 

Three years ago I never heard of Neuroplasticity. It basically refers to the ability of the brain to rewire or reorganise itself after injury - and including speech, hand-motions, physio exercises etc. But luckily for me, more new research is available for better treatments (and stroke survivors) and my brain is changing for the better... but 'Neuroplasticity is nothing without good reinforcement and diligence' and 'the more you practice and repeat an exercise over and over, the stronger those new pathways in your brain become'.


Loz said I awoke from my coma and had no words, no sounds and no ability to even make signs to communicate. We tried communication with gestures, body language or expressions and also picture boards but at first that too was inconsistent and unreliable. Also, Loz tells me that my mouth and jaw muscles were affected by the stroke and initially I was put on a mushy baby food diet to make sure I wouldn't choke. Only when my muscles were working better and were strong enough could I start eating normally.

 


Rehab hospital (Caulfield Hospital)

 

In the Rehab hospital, I had two speech therapists (same thing as speech pathologists) - Cath and Kelly - they were discussing my problems and the direction for therapy (with Loz) and Cath said [paraphrasing] 'Where do I start??'. They were decided to focus on articulation (saying speech sounds) and comprehension first, and after they concentrating on different topics like sentence structure as I could say some words separately, but not join them into a sentence.


My articulation was woeful at the early stages of my speech. In my first session, they would sit me in front of a mirror and I had to practice trying to sound out the letters of the alphabet. I used the mirror to practice making the write shapes of my mouth and positioning my tongue to get the correct sounds. My speech therapists always commented on the English language is terrible to learn as there are always exceptions to every rule.
 

I tried to use technology whenever I could to help me communicate. Initially I relied on emojis to respond to messages (eg. thumbs up 👍 and thumbs down 👎). This meant any messages had to include one question only so I could properly respond to each question otherwise it got too confusing and I sometimes would cut-and-paste (eg. Twitter or Facebook posts) to make it easier to express myself with words (and after tried videos, movie lines etc) convey my message because 'a picture is worth a thousand words (...and videos)'....

 

 

My retention (of information) or 'working memory' is improving, but I am still plagued this problem still now. For example, new faces, my therapists, friends new babies names, my phone number, PIN numbers, passwords, etc. Listening to people's stories (face-to-face) also is very confusing and hard to follow. I prefer to have instructions given in writing  (or demonstrate or videos) and this is the best way for me to understand and remember detailed information because I have difficulty in learning new information and problems in conceptualising and generalising (especially abstract words or phrases). 


I always liked reading and I recalled that when I received a present (at the hospital) - a book. The book is ~350 pages and I remember thinking 'fat chance' of reading this book because I was struggling reading one paragraph! I can read silently (eg short newspaper articles) but my comprehension was lacking in the early stages and sometimes my brain was overloaded with the information.

 

 
Eventually, when my speech improved I started to use the microphone on the phone. I use voice to text as it's easier for me then typing out words because I found out writing and speaking is very different skills. I am fortunate to be tech-savvy and I can write because my speech technology available now - particularly my microphone and predicted text.

 

Eventually, I moved on to learning and recognising single words or very short sentences. I would see an object eg a fork and I would know it was a utensil but couldn't get my brain to tell my mouth to say the right word, so often I would say spoon or knife. Same for similar grouped words like mum and dad, brother and sister, auntie and uncle, items of clothing, furniture, left and right etc Through lots of repetition, games and homework activities, more words crept into my brain.
 

I spent five months working with Cath and Kelly and from that they both got to know my interests and kept my sessions interesting by tailoring my therapy sessions around what I like you talk about most. A lot of conversation discussing with my family, friends, sports entwined with 'normal' speech therapy also. For example, Cath is barrack for Melbourne (AFL team) and I also barrack for Melbourne and we talked about Melbourne footy club (and seven of years misery), Paul Roos, Jack Watts, AFL umpiring, tribunal decisions, tanking, Essendon saga, and lots more. 

 

My sessions, included practiced phonetic sounds, face-to-face conversations, phone conversation, and common phrases, comprehension, expression, reading, writing, similar words, vowel and consonants, verbs and numbers etc. For someone who knew minimal about speech therapy or about how the brain works, I was astounded by how much I needed to relearn, and still am!

 

Alfred Health Community Rehabilitation

 

After that I was discharged at hospital and I was still continued community speech pathology sessions with Claire and Tracey.

 

We continued to use lots of technology and  we  made a video that was presented to all of the staff at Caulfield hospital about how to use technology to help communication. This included using Therapy Apps such as Tactis, using speech to text for Google searches, and lots of other Apps to help me to do fun things with Oscar, such as sing along to nursery rhymes.

 

She introduced to learning new grammatical structures to assist me to use and understand "Proper English". Eg. regular and irregular verbs and auxillary verbs, pronouns, comparatives (eg. Melbourne beat Essendon = Essendon was beaten by Melbourne), determiners, conjunctions, prepositions, tenses, memory and lots of more. We continued to work on pronunciation, word meanings and learning to spell as it was still hard for me to write even the names of my family. I had to relearn which sounds went with which letters.

 

A big focus in my therapy was making practice something I could do across the whole day in all sorts of activities, not just whilst in “sessions” eg I still now empty the utensils from the dishwasher, and as I place them in the drawer, I say out loud what each item is that I'm placing in the drawer..., "spoon" "fork", "knife" or when I am helping Oscar get dressed using short sentences that talk about what we are  going to put on next. 

 

An important part of therapy is not only learning new skills but then actually using them in real life situations, such as giving a Thank You speech to my cricket club. Claire and I started sending each other emails to confirm appointments but also to give me practice writing. We started a Card playing group in the cafe with other IT people who had a stroke, it was hard for me to order a coffee at that time. I also participated in a Presentation skills group where I had to stand up and give Powerpoint presentations to the group and we worked on making Blog sites as well. To help with my talking, reading and writing I also started a project about  talking with my local community and  writing letters to petition my council to put in a pedestrian crossing, pleased to say we were successful and it will be built soon across Grange Road. 

 

 

We talked about joining various groups for support such as Blokes with Strokes in Elwood  or the Music Sessions group in Elsternwick and the Australian Aphasia Association and arranged for my Aunty Judy to come along to sessions to learn how to help me do my therapy tasks at home.

 

Claire is not really interested in sports (I don't get it haha) but she loves music and suggested that singing is enjoyable and achievable because different of the brain. Claire and I sometimes my session including singing and after practice myself around the house... eg. 'It's a Grand old flag', 'Throw Your Arms Around Me lyrics', 'Better Be Home Soon', 'Advance Australia Fair' and of course 'Piano Man' for my mate Josh. We also did lots of nursery rhymes to make my sessions more interesting for Oscar.

 

Last year (~ November 2015), Claire also introduced verb tenses to my speech therapy (past tense, present tense and future tense). Prior to that I was very confused with tenses and time, and I reckon huge step forward with my speech because more context my sentences and more understanding after that. However, I still struggling to find 'little words' eg A, the, and, in, on, or, but, into, he, she, us. And If I'm tired, I will often see my speech deteriorate.

 

- Excerpt 'Spaceballs' movie discussing 'time'.... I showed this clip with Claire ... safe to say she loved it :)


Throughout my rehab journey I had heard numerous times people talking vaguely about progress plateauing eventually. One session with Claire, discussing my progress and she said (paraphrasing) spontaneous brain recovery from stroke after one year or so slows down and maybe eventually plateaued, however with ongoing meaningful, specific and regular practice guided by therapy, neuroplasticity enables ongoing long term improvements to occur. I trust Claire, I always appreciated her direct approach and openness about any topics, and her comments so much motivation for me and my aim is 'buck the trend' of my recovery time and always improving. So thank you Claire for being honest and thank you for more motivation. I am still hunting for more Speech therapy now, because I am scared of stopping my momentum.


Hunting for more speech therapy 


Thus, three months ago I started new chapter of speech therapy at Australia Catholic University (ACU). It is relative new course. One-on-one session, tailored my deficiencies and great to work with new faces with fresh approaches. Last-year uni students running it (and one qualified speech therapist overlooking the course) and I recommend anyone with speech problems - especially when finished at the hospital or outpatient therapy. Contact Julia Kawanishi at ACU (Admin.HealthMelb@acu.edu.au).


My speech therapy sessions (in general) always very tough (relative to physio and OT) because non-stop thinking. I averaged about five yawns each session... I was not bored, and I was not tired ... but because my brain is working. 


I think I am improving still, but not sure if it natural progression, or my work sessions with speech therapists, or brain-training, or my homework etc (I reckon it is combination). Also I am trying to get more social (coffee anyone??) because more talking means > helping my speech. Other people can noticed [my improvements] but not me hence I sought feedback often. I know that my speech not perfect. My son is three years old, and he notices everything, and my aim is (Oscar after growing up) and I want proud with me - not embarrassed. 


Thank goodness for speech therapy 


In closing, speech therapists is so underrated profession because no speech therapy, I reckon 'up the creek'... and now I have a better life now because I am communicating with people who can understanding my speech. So, thanks to my speech therapists - especially Cath, Kelly, Tracey and Claire - also Anne, Claire, Anna, Fiona, Celeste, Hayley and 'Aunty' Judy - I have a voice now - literally and figuratively. I am still indebted to them for helping me and I am blessed with so much support.

 

Paul

 

- (Excerpt 'The Kings Speech' movie)...

 

 

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