9th day

Now Mehmet has a weird schedule: In the morning, at eight he brings me to speech therapy, waits there for me, at nine we drive home, then he drives Kaan to preschool, drives to work, at noon he picks Kaan from school, drives back to work. I'm sure at work his mind is nothing but at his work, instead he researches my condition, why that happened, everything from what my blood counts should be, to how to afford the Michigan treatment.

Sandy greets me with a big smile. We begin with a list of the following words:


Hi (*)
No (**)
Me (*)
You
Bye (**)
Yes
I (**)
See (?)
Day
Go



One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten


Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Out of the list, I've marked what I could say at the beginning of the one hour session with (*), and what I could say at the end of the session with (**).

Sandy says the words and I imitate her. She encourages me to use gestures with each word:

Greeting with "Hi", Waving good bye with "Bye".


After I have mastered "Hi" and "By", Sandy literally takes me by the hand and walks me over the therapy floor and encourages me to say Hi and Bye to everybody I see on the floor. The whole shabang with waving and greeting.

She divides speech therapy into two parts: First half is speech production, second half is word retrieval.

She doesn't spend any time on dysarthria ( right side of my face, and half of my tongue being paralyzed and everything) because she says that when I push to use those muscles on my face hard enough to produce sounds, paralysis will take care of its own. She compares it to two people training for Karate. One of them does a lot of push-ups and a lot of that kind of exercise, the other one just fights, but they spent equal amounts of time doing their own thing. When the one that only fought so far is challenged to do push-ups, she can do as many push ups as the other one, who exercised, plus she is much better at fighting.

So, the second half of speech therapy is spend with me trying to write things on a sheet of paper.

First of all, she wants me to write down my address and memorize it. That way, she says, I can be on my way towards independence. Then she gives me key words and wants me to use them in a sentence.

These are typical of the words she gave towards the end of the first week or second week, and the sentences I wrote with them: But beware! Facing every word my brain drew a blank. Total blank. Then after a lot of thinking I would formulate a concept like "therapy is good" than while writing it with great difficulty I would slowly add on words and concepts to it like "confidence", and of course I would have again great difficulty with prepositions and the word order. In the end after a good hard stare at the paper, I would come up with something like below. But each and every sentence I knew that I needed to push to its very limit, try to cram in as many concept as possible, and not be satisfied with just one concept, however long it may take. For example, I believe writing those 5 sentences below took me a good 30 minutes or more.

Therapy: "Therapy is very good, it gives me confidence."

Coffee: "Mehmet wakes up to the smell of coffee every morning"

Son: "My son is the most polite son in the world."(*)

Friday:"Friday is the 2nd of my son school." (meaning: Friday is the second day of my son's school. - a total nonsense by the way)

Work: "Work is somethink that I don't miss very much."

After that we would do an exercise like listing all the activities I could do to play with my son.

"playdough"

"playing with trucks"

"playing with the alhabet trains"

"playing with the train set"

"making pizza"

"watching tv togeter"

Hey! My essay got published in Newsweek!

Check it out: http://www.newsweek.com/id/38572

8 days after the stroke

That weekends hard work paid off. Now I can pronounce many sounds, and say a few words.
.....
So on Monday morning, the 8th day, we are on our way to speech therapy at Advantist Rehab Hospital in Gaitersburg, MD. Our appointment is at 8am. We are scheduled for 5 day a week, for 1 hour sessions. My speech therapist is Sandy. She extend us such a warm welcome, that immediately feel at home. More over, in her opening speech she says that she will do everything in her power, to help me get my speech back, and by gosh, I will definitely get better! Such and encouraging attitude!

Then she begins her assesment with: (does the picture look familiar???)

Explain!

Of course my vocabulary is so limited I can only bring out:

"mom, son, su (for water)"
I can fully understand what is going on. But of course cannot bring it out. Well almost fully. When I look at the picture, lots of things are happening. First It is hard for me focus on the entire picture, and grasp everything at once (it is still hard by the way) When I found this picture on the internet ( from Boston Diagnostic Aphasia Examination )it was saved with the name "cookie theft". It never occured to me to give it a comprehensive name like this, even today. Please look at the picture carefully, dear reader. Can you grasp it as a whole? I can only focus on the parts, but I'm never able to grasp the whole picture as to give it a name. For example I can focus on kids climbing a stool, boy reaching out for what seems to be cookies, the stool about to fall, the mom, the sink... But I can only concentrate one part at a time. Even today almost 2 years after the stroke. If you do the exercise your self and tell me if you can perceive it as an holistic picture I would be grateful.

For example I can understand what is going on in this picture. It is simple, well defined. As opposed to the above picture.

I guess people with aphasia need simple, well defined images. Photographs as opposed to hand drown pictures. This is especially true for aphasia aids. You know, the binders or sheets with pictures on them in order to help point out what a person wants to communicate. If possible I would all throw them into a garbage bin. When a person newly acquires aphasia after a stroke or brain injury, I woul take clear simple pictures of their home environment and glue them on a sheet of paper.

What was wrong with the speech therapy at the hospital?

Now that I have 20/20 hindsight, I can clearly see what was wrong with the 5 days of speech therapy at the hospital: The sounds! For 5 days I tried the sounds: A, E, I,O, U. In other words the vowels. But given that half of my face and tongue was paralyzed, I couldn’t pucker my lips to produce the sounds O and U, I couldn’t use chin and cheek muscles to produce the E sound, and I couldn’t use my tongue inside to produce the A sound. So all I was left with was an unrecognizable “I” sound like “It”. Whatever the therapist would point at I would always say “I”. But when I left the hospital, I was given the homework of working on: P,B,F,V, none of which required any vowels. I could bring my lips together to be able to eat, so I could at least utter P and F.
So we began with those sounds. “Bring your lips together. Now blow hard!” That was the “P” sound. “Feel how my vocal chords are vibrating. Feel it? OK, now you should do the same. OK now it gets complicated a bit. When at the same time you utter the “P” sound, if you make your vocal chords vibrate or hum you will have “B”.Wonderful!” Now “F”. Place your lower lips so that it touches your upper teeth. Now blow air out. If you can vibrate your vocal chords again while saying “F” then you will produce the sound “V”.
Mehmet and I would sit opposite to each other and say “pen” over and over again. Then mom would take over and put her index finger slightly into her mouth close her lips around her finger, urging me to do the same. “Now hold it, hold it. After I close my lips around it I will take my finger out. It will leave your lips in an O shape. You should do the same but not let you lips slacken, and then hum.” When I hummed, out came the sound “O”, because my lips were still forming an O. I was so delighted. From now on when I couldn’t think of how to form an “O” I could always put a finger into my mouth, take it out, and then say “O”.
We worked that weekend very hard. Whenever I wasn’t eating or sleeping, we worked.
On the aphasia front (putting concepts into words) there was also homework to be done. My caregivers (mom and Mehmet) were to draw some pictures with simple sound, then point them to me and ask me to say it, when that failed they would say it and then ask me to say it. Then they would ask me to write it, when that failed they would write it themselves and ask me to copy it down. So they drew “water” (in Turkish “su”), medication (meds), fork, sun, pen, paper, bed, table, up, down, left, right, book, ball, hand, moon, moon, bell, boot, head, lamp, home, salt, milk, food… I could understand all their drawings that was an achievement by itself. But I couldn’t come up with words. After several times they said it I could say something similar – maybe. They would say “fork” after some time I could say “fo” etc.

your mission- should you accept it - is to produce the sounds:

Your mission - should you accept it - is to produce the sounds: P,B, F ,V .

This is the homework the last speech therapist left us with. Mehmet and I are sitting face to face. He takes the lead. As I've described in my previous blog we relentlessly work on production of these sounds. Slowly I can also say ba ba da da...

By now I'm also much better with gestures. I guess I can do the full range of facial expressions now. Happy, sad, angry, puzzled, jump with joy... Also, I'm able to write more and more things, if I can remember the words.





I have borrowed my 3 year old son's Magnadoodle. It is a magnetic drawing surface, with the attached pen you can draw pictures and write messages. Easy-slide eraser on the bottom clears the screen. I can write on it with the attached pen, then I can erase very easely. I can draw basic pictures. It is available at every toy store, costs only a little. The first few weeks my son protests, then he gets used to mommy using his toys. This becomes my main communication device for the next month. Isn't this cool? It is a perfect tool, as I'm starting my communication life from the beginning, and going through the same stages as my son went 3 years ago: Ba ba ba da da da.