We are headed home

It is November 2nd. We are going back. The beautiful colors of the fall have turned into wind gusts and chill. For a few days now, snow has been falling steadily. Smoke from wood burning fire places is pleasing to senses. For the last week things have been pretty lax at Umap, it is almost like the last days in school, nobody pays much attention to therapy sessions anymore. People are anxious to go home.
Ruth is flying with her third and final son to Florida to her boyfriend, Mike has his challenge cut out for him: they are moving to Tennessee to retire, they are building a house there and he is going to oversee the process, plenty of opportunity to talk! Mac is going to stay three more weeks because he made so much improvement at the last minute.
As for us we are going home, having a stop over in Pittsburg, our previous home town. We leave Ann Arbor on a clouded morning. On our way we stop at every science museum possible. In Toledo, in Pittsburg, in Delaware… All of them are geared towards children. Kaan is really having the time of his life!
Before I depart I receive a second evaluation. Here is the report. (the official was written later in November)

A few more tips

Every speech therapist I see, recommends me talking in rhythm by patting a table or my own leg. Like this: re-com-mend: tap-tap-tap. You tap with each syllable.
When I pay much attention, it seems to work, but it is against my nature. I always confuse whether to tap my hand or focus on my mouth or what. I don’t feel comfortable with this method.
Instead I have another method: With multisyllable words I start by saying the last syllable and then the last two syllables, and the last three etc…
Congratulations: (kon-gra-chu-lei-shens)
shens
ei-shens
lei-shens
chu-lei-shens
ra-chu-lei-shens
gra-chu-lei-shens
kon-gra-chu-lei-shens
I find this method to be especially useful in Turkish, my mother tongue, because unlike English it is based on one word plus many suffixes.

A few tips

While reading a word, I ask my therapist to write down, how it is actually pronounced, how it is sounded out. For example:
Alfa: al-fah
Familiar: fah-mil-yer
Lullaby: lahl – ah –bai
Egyptian: ɛ-gip-shɛn
Especially: ɛs-pɛh-shl-lee

Then I would cross out the original word, so that only the phonetic transcription would remain. If you think the phonetic letters further confuse you, then you must find out which letters make the most sense to you to replace sounds.
To me it felt like, while trying to read a text, I was fighting on two fronts:
1) translate the symbols on the page to sounds,
2) deal with the intricacies of English language, which are constantly changing from word to word.
So I would read a sentence or a small paragraph out loud. And if any words prove themselves problematic, then I would my therapist or my caregiver to sound it out for me. Then cross that word out and replace with the new version.
Of course after the session I would collect all these words, write them down on one side of the page, the transcriptions on the other side, like I have done above. Then I would repeat them until they became second nature.
You may find with the sight-words this may not be necessary, but especially with three or more syllabic words, I found it quite useful.
The second thing I found useful is working on prosody. In Wikipedia prosody is defined as: “the rhythm, stress, and intonation of connected speech (as opposed to smaller elements like syllables or words). Prosody may reflect various features of the speaker or the utterance: the emotional state of a speaker; whether an utterance is a statement, a question, or a command; whether the speaker is being ironic or sarcastic; emphasis, contrast, and focus; or other elements of language that may not be encoded by grammar or choice of vocabulary.”
Being unable to produce the rhythm, stress and intonation of connected speech is called (surprise, surprise…) aprosodia. Producing these nonverbal elements requires intact motor areas of the face, mouth, tongue, and throat. This area is associated with Brodmann areas 44 and 45 (Broca's area) of the left frontal lobe. Damage to areas 44/45 produces motor aprosodia, with the nonverbal elements of speech being disturbed (facial expression, tone, rhythm of voice).
So what do I do? There are exercises your therapist or your caregiver can work on with you. For example take a sentence: “it is a nice day.” You can say it in many different ways. First let the other person say it, and repeat after her with the same prosody. Sentence after sentence…
Question:
“Is it a nice day outside??”
“It is a wonderful day!”
“It is a nice day.”
The third thing I found useful:
While repeating after the person (therapist or caregiver) definitely, absolutely, positively look at her face. Let her say it a couple of times, observe the mouth very carefully, repeat after her, then say it together in tandem. When you are convinced you mastered the pronunciation, then say it twice, wait for 10 seconds, say it, wait for 30 seconds then say it again. Repeat this exercise until you have a complete mastery of the word so that it rolls of your tongue with ease.
The brain science behind this is as follows: Mirror neurons! (According to Wikipedia)
“A mirror neuron is a neuron that fires both when an animal acts and when the animal observes the same action performed by another animal (especially by another animal of the same species).[1] Thus, the neuron "mirrors" the behavior of another animal, as though the observer were itself acting. These neurons have been directly observed in primates, and are believed to exist in humans and other species including birds. In humans, brain activity consistent with mirror neurons has been found in the premotor cortex and the inferior parietal cortex.
Some scientists consider mirror neurons one of the most important findings of neuroscience in the last decade. Among them is V.S. Ramachandran, who believes they might be very important in imitation and language acquisition.[2] However, despite the popularity of this field, to date no plausible neural or computational models have been put forward to describe how mirror neuron activity supports cognitive functions such as imitation.[3]”
“In humans, functional MRI studies reported that areas homologous to the monkey mirror neuron system have been found in the inferior frontal cortex, close to Broca's area, one of the hypothesized language regions of the brain. This has led to suggestions that human language evolved from a gesture performance/understanding system implemented in mirror neurons. Mirror neurons have been said to have the potential to provide a mechanism for action understanding, imitation learning, and the simulation of other people's behaviour.”[
Well, the existence of mirror neurons in the brain still open for debate, but proven or not, I have seen it in action.

Here is a key to phonetic transcriptions:



A
A
ae /eɪ/[3]

B
Bee
/biː/

C
Cee
/siː/

D
Dee
/diː/

E
E
/iː/

F
ef (eff as a verb)
/ɛf/

G
gee
/dʒiː/

H
aitch
/eɪtʃ/

haitch
/heɪtʃ/

I
i
/aɪ/

J
jay
/dʒeɪ/


K
kay
/keɪ/

L
el
/ɛl/

M
em
/ɛm/

N
en
/ɛn/

O
o
/oʊ/

P
pee
/piː/

Q
kue
/kjuː/

R
ar
/ɑr/[4]

S
ess (spelled es- in compounds such es-hook)
/ɛs/

T
tee
/tiː/

U
u
/juː/

V
vee
/viː/

W
double-u
/ˈdʌbəljuː/ in careful speech[5]

X
ex
/ɛks/

Y
wy or wye
/waɪ/

Z
zed
/zɛd/

zee in American English
/ziː/

Further in Michigan

Ruth has a boyfriend. Did I mention that Ruth was 84? She says her boyfriend calls her every night. Well, at first I thought that the boyfriend was like “Harvey” the imaginary rabbit in the James Stewart movie. It is very hard to picture Ruth talking on the phone each night and actually making sense, because she has trouble understanding the spoken word. But Ruth says she is very good on the phone.
Later on I confirmed this with one of her sons. At least we know that his name is not Harvey. She says he is 90 years old, a very good dancer with the right moves. Three years ago Ruth lost her husband of 50 odd years. Then she moved to a retirement community in Florida, where she made new friends, among which also a Boyfriend! She is clearly taken by him.
We (My family and I) also made friends with Max and George and their wives Joy and Joanne. George, who is by far the more handicapped person, seems the happier one among the two of them. Max, for some reason, has no patience it seems. Every time I try to communicate with him, he loses his temper. Today at lunch time I was trying to find out everybody’s favorite color. When I came to talk with Max I the conversation went as follows:
“Max, what is your favorite color?” – I write down the words, blue, green, red, yellow, purple, orange… He looks at me as if he doesn’t understand. I repeat “what is Your favorite color?” This time I point out to the different colors I see around. “Is it blue like my shirt? Red like Ruth’s sweater?” This time he is clearly confused. He shakes his head repeatedly. I don’t give up for I want to reach him, to communicate with him. So I run out to the art room and grab different colors of pencils. I think, if I stick to one type of material and the only difference is the color, I may be able to communicate the concept of ‘color’ to him. I run back, clearly proud of my thinking. When I approach Max again, he literally runs away from me, well because he is wheelchair bound, he wheels away. I approach him again, he wheels away again. O.K. I get it! He is frustrated and he doesn’t want to deal with me any more – I laugh and turn this into a game of “Tag”.
Later, I ask my counselor Marie, what was the problem with Max, what blocked him from understanding the concept of color. Marie said Max isn’t ready to understand higher order concepts yet, especially a concept like “favorite”, he may understand “color” but he may not understand “favorite” especially in relation with color. Although of course he knows what his favorite color is, it is blue, I have asked his wife Joy. His eyes are blue, he picks up blue shirts among many others… But he cannot decipher the words “what is your favorite color?”

Making progress

Susan says I am making progress: My smile on the paralyzed side is widening. I like her. Because I like her, I am more comfortable with her and thus I can speak better. Isn’t that funny? I have also noticed this with Linda, the fellow patient: her speech, when she speaks to us or to a therapist is very incoherent, irrelevant. But a few times I saw her speak with her husband and she is much much much better. She can bring up more relevant words, more stringing them together…
I have noticed that, like stuttering, the more people here feel under stress, the worst their speech. The more they feel at ease, comfortable with the person they chat with the more fluent their speech. Also, the noisier the environment, the more people you add to the conversation, the worst it gets. Everything is better one a one to one conversation, in a quiet room with a trusted person.
I believe that before everything else, a therapists, or anybody for that reason, must earn the trust of the person she is helping. When people don’t feel the that constant anxiety with you, then you can let the best come out.
Susan lets me speak and speak, on subjects that matter to me. We have a real chat most of the time. She congratulates me when I say three syllable words like “information”. She also takes Ruth and me to field trips to nearby coffee shops and restaurants. We have to order by ourselves. As we are in Michigan, people are not so much accustomed to foreign accents, so our field trips start with some embarrassment: When I give my order from the menu, waiters have to ask again and again. When Ruth gives her order and the waiter repeats it, she doesn’t understand, but says yes to whatever he says; the Marx brothers duo in action.
On the vowel front there is no improvement, especially with long vowels like “I”, or “a” “oi”, which involves pronouncing “y”, but I am much better with the sounds: “sh”, “ch” now. From 8:30 until bedtime I have to speak. I become so tired, my jaw muscles ache, my tongue muscles ache, but most of all I’m drained at the end of the day because my brain works overtime, forming new synapses.

Kaan is having the time of his life:

Kaan is having such a good time here. He likes going places. He likes being in that different environment of the hotel room. He likes going to the hotel lobby for breakfast, and for dinner. Most of all he likes the exercise room on top of the lobby. I don’t understand his fascination with big machines, but I reckon this is a male thing.
He sometimes comes to the UMAP building, of course everybody is in love with him. He is a cute boy, still a baby with big, beautiful brown eyes, they talk to him and indulge him in many ways. Also we discovered something new: a room full of toys! I didn’t know that, but UMAP has also a speech therapy program just for kids, for that reason, they keep a room full of toys. We go there quietly, and ask whether we can borrow some toys. That makes his day. The music teacher, Lynn, brought mom an article about what to do in Ann Arbor with small kids. Of special interest to us was: Fantasy Forest. It is an indoor play ground. On a rainy day Mehmet brought Kaan and mom to the Fantasy Forest they must have spent there six hours. He also enjoys going to restaurants very much. He sits on his high chair and orders from the menu, o.k. sometimes the menu is upside down, but still…
I guess just being all together with his dad and mom and grannie “on vacation” does it for him.
It was my job to read to him to sleep before all this happened. When I came back from the hospital, Mehmet took this over of course. We all lay in the same bed together, Mehmet would read and we would all listen. After two or three nights like this, my son didn’t want me in bed with him anymore, pushing me away with his little feet. But Mehmet told him with a certainty, that I am grateful even to this day, that this wasn’t acceptable. We either read all three of us together or not read at all.
Now that I can talk somewhat Mehmet encourages me to take that role again. So I accept the challenge. We borrow books from the UMAP therapists, and go at it. My favorite is Dr Seuss. Of course my speech sounds awful to the normal ear. But Kaan’s little ears it is sweet music, he doesn’t care. And I enjoy the process so much, it is a real blessing to be able to read to my little man again, that I read to him for half an hour every night since then.