What does . . . → Read More: What is Apraxia?]]> This post is a reprint of a recent article I wrote for our newsletter. If you weren’t aware that we had a newsletter, you should definitely join us and get this information in a more timely manner! Go to http://stepstherapy.net/news-and-resources/publications/ to see more articles, or go to http://stepstherapy.net/intensive-therapies/welcome-to-the-aphasia-center/ to join the newsletter. Enjoy!

What does it mean to have apraxia?

There are different types of apraxia, but all forms have to do with movement. In general, there are problems with voluntary, but not automatic movements. So in the case of oral-verbal apraxia, automatic speech comes out much easier than purposeful speech. For example, when you are driving, the person with aphasia may say “look out!” very clearly and easily, but strains when they need to say something during conversation.

When you have damaged a certain part of your brain, you may get apraxia. There is a part of your brain that helps you plan to do something, a part that holds the motor sequencing to do it (pre-motor cortex), and a part that then tells your muscles to carry out that command (motor cortex). Damage to the pre-motor cortex results in problems “remembering” how to make your muscles do what you want them to do, such as say a word.

Oral apraxia—in oral apraxia, your mouth will not move the way your brain is telling it to move. If I tell you to blow me a kiss, your brain may be trying to make you blow a kiss by puckering your lips. However, your lips may be doing something else, such as pulling back to smile. You may or may not be able to feel that you are making the incorrect movement. If I give you a mirror to see what you are actually doing, you may be surprised to see that your mouth is “groping”. This means that it is making different movements, trying to do what your brain is telling it to do. The connections from your brain to your mouth have been changed. You may start with a smile, then open your jaw, then finally get your lips to pucker. Now, if I didn’t tell you to do it, but your spouse makes a kiss-face to you, you may make one in return and be able to do it correctly. This is because your brain is doing it automatically; it doesn’t have to try to remember how to do it.

Verbal apraxia—same problems as in oral apraxia, but it affects your speech. I may ask you to say “we”, and you say “way” or “zoo”, or “ah”. Your brain is telling you say something, but the connections to make you speak it are changed. There are several factors that go in to speaking a word–you need to use your lips, tongue, jaw, teeth, and vocal cords. These must all be coordinated together to produce a sound. For example, to say “ahh”, you must take a breath, turn your voice on, drop your jaw open, and lay your tongue flat or pull it back in your mouth. You may have more than one type of apraxia at a time, depending on how large an area of your brain was affected by the stroke.

We will continue with part 2 of this discussion in the  next post! Stay tuned…

Today I’d like to talk about isolation and aphasia. This is a relevant topic for discussion because there are relatively few aphasia support groups and limited information readily available for caregivers and persons with aphasia. . . . → Read More: Aphasia support]]> Hello everyone and welcome to #2 in the Aphasia Myths blog. This post was previously published on our www.aphasiainfo.blogspot.com site.

Today I’d like to talk about isolation and aphasia. This is a relevant topic for discussion because there are relatively few aphasia support groups and limited information readily available for caregivers and persons with aphasia. Many people with aphasia are not aware that there are aphasia support groups, or that there is an organization called the National Aphasia Association (NAA)(www.aphasia.org). According to the NAA, approximately 40% of persons with aphasia have no contact with other persons with aphasia. Considering the frequent social and other losses that come when someone gets aphasia, this number is staggering! Imagine having a disorder that robs you of your ability to communicate, that you receive little information about this disorder and your prognosis, and that you can no longer work and relate effectively to others. Then imagine that you don’t know that there are others out there like you–that there are others who can provide hope, give advice, provide cameraderie, and have “been there”. We, as clinicians and physicians, need to make a greater effort to reach out to those with aphasia.

If you have aphasia, you are one of over one million folks in the U.S.! There are people all over the world with aphasia! Some of them have better communication than you do, some of them do not. Some of them are in wheelchairs, some walk with canes, some walk without any assistance. Some persons with aphasia have severe difficulties with their arms and legs, some do not. Persons with aphasia are young and old, all nationalities, all education levels, all careers, and may have different causes. I encourage you to make the effort to find others with aphasia–you’ll be glad that you did. If you join a group and you don’t like that group–make your own or find another group. You can find organizations online at the NAA website, or do a search for “aphasia support groups” and your location. Whatever your choice, get involved in your life!

This will be a 5-part series about misconceptions or poor information that some folks have received or have given to others. I hope with these postings to help both caregivers and persons living with aphasia to get a better understanding about . . . → Read More: The aphasia therapy “plateau”]]> (These are reposts from my other site that I am moving to this site)

This will be a 5-part series about misconceptions or poor information that some folks have received or have given to others. I hope with these postings to help both caregivers and persons living with aphasia to get a better understanding about aphasia–knowledge is power.
For this first piece, I’d like to address the concept of the every-dreaded “plateau”.
I’m betting that almost each and every one of you were told at some point that you were no longer going to receive treatment because you had reached a “plateau” (don’t take that bet, I know I’m right!). There are a few elements that contribute to this phenomenon. The primary force is the insurance company, because the facility needs to get paid to see you. The insurance company will authorize so many visits for therapy, and then that’s it. You can fight for more visits, but your therapist must be on board with this by showing your progress in therapy. The insurance wants to make sure that your visits are 1) medically necessary and 2) that you have been showing progress and that 3) there is a reasonable belief that more therapy would show more progress. This is where it is very important for your speech therapist to present the data.
The speech therapist is the second force for therapy discharge. Your therapist may have more or less run out of ideas or ways to help you. They are bound by hospital rules, insurance rules, and ethics rules. An easy way to change the “plateau effect” is to change the goals or that way those treatments are administered, but this doesn’t often happen in these settings for a multitude of reasons.
I say that this plateau is a myth in aphasia because I have always believed and practiced therapy that is designed specifically for each individual. If I am working with you and the evidence is that we aren’t “making progress”, then I need to change my approach, because what I’m doing isn’t working. Saying that you “can’t go any further” puts the responsbility on you. Maybe I need to do more in-depth testing for a particular function (e.g., reading) that is complex, or perhaps what I thought would work doesn’t work. If I continued to try to teach you something that wasn’t working, then yes, you would “plateau”. BUT, if I change the way I do the treatment, then perhaps we can find the key to unlocking your individual processing. You may never have been a person who used his hands or face for gesturing and facial expressions before your stroke, so could we get much progress if we try to teach you to do this after your stroke? If we try it a few times and it isn’t working out so well, then we need to go to Plan B. Then Plan C. Then… you get my point. My bag of tricks expands on a daily basis.
So, the point of today’s blog is to tell you–don’t accept that you have reached a “plateau”. If you are told upon discharge “Maybe we can re-assess you in a month or so if you’ve made progress”, then ask that professional what their reasoning is for this comment. Do they really believe that if you don’t have therapy for a month that you will get better during this time so that you can come back and “make progress”? That doesn’t make any sense. If you can get better all by yourself, then why are you coming to therapy? You can continue to make progress and continue learning even years after your stroke. Don’t stop trying and get advice from as many professionals and support groups as you can.

 I was explaining our philosophy and our program to a prospective client the other day, and I heard these familar words. Of course, it seems everyone’s goal is to speak better–that’s the hallmark problem of aphasia! However, we want to explain why using gesture and other  multimodal forms of . . . → Read More: Improving Communication]]>   “I want him/her to talk!”

 I was explaining our philosophy and our program to a prospective client the other day, and I heard these familar words. Of course, it seems everyone’s goal is to speak better–that’s the hallmark problem of aphasia! However, we want to explain why using gesture and other  multimodal forms of communication are so important. Speaking better and being able to use gesture, written words, or writing are all part of the same goal!

Communication is important, we all know that. But communication doesn’t consist entirely of speech. If you’ve been having issues or frustrations because your loved one plays “20 questions” with you, then wouldn’t it be nice for both of you to have alternative and augmentative systems of communication. Our goal is to reduce the amount of frustration for all parties involved, as well as to improve the communication pathways. If your loved one cannot say at that time “I want to get the boat cleaned” but can point to the boat or give you the number for the boat-cleaner, isn’t this a good place to start?

 What most people don’t know is that by using these alternative, or multimodal, forms of communication, comprehension and expression of language are improved for both the listener and the speaker. The person with aphasia may produce speech more quickly and easily when the gesture and verbal attempts are paired. For example, unable to say “toothbrush”, the person with aphasia may make the gesture, then spontaneous produce the word while gesturing. Additionally, seeing the word “toothbrush” may cue the verbal production. This happens ALL THE TIME!

 So please remember, your goals are our goals, we may just go about them differently. The end result, however, should be improved overall communication. This is what we’re striving for!