Tuesday, September 29, 2009

We start everything from scratch!

After my first session Jan thinks about me long and hard, then she decides that we need to go back to the drawing board and start everything from scratch!
What? How is that even possible? Do I need to forget everything I have learned so far?
She concludes that right after the stroke I had paralysis of the left side of my speech apparatus. Therefore I needed to exaggerate my movements, the tongue, the cheeks, the jaw, in order to produce the correct sounds. She believes that as I have been working on my muscles for almost six months now, they are ready to produce the correct sounds without having to overextend, like normal people do. Because she says, as of now, my main problem is not my muscles anymore, my main problem is apraxia of speech.
According to the American Speech-Language-Hearing Association (ASHA)
Apraxia of speech is: “a motor speech disorder. It is caused by damage to the parts of the brain related to speaking.
People with apraxia of speech have trouble sequencing the sounds in syllables and words. The severity depends on the nature of the brain damage.
People with apraxia of speech know what words they want to say, but their brains have difficulty coordinating the muscle movements necessary to say those words. They may say something completely different, even made up words. For example, a person may try to say ‘kitchen,’ but it may come out ‘bipem’ or even ‘chicken.’ “ They may have “
· difficulty imitating speech sounds
· groping when trying to produce sounds
inconsistent errors
slow rate of speech
Apraxia can occur in conjunction with dysarthria (muscle weakness affecting speech production) or aphasia (language difficulties related to neurological damage)”
Jan believes that because I exaggerate my movements my muscles get stuck at a sound and I cannot move fluently from sound to sound.
If I can re-learn to produce sound with minimal muscle movement, she believes that everything else will fall into place, my speed, rhythm, and fluency.
Wow! It is a tall order! Besides, should I believe that?
On a certain level it makes sense, if you think about it. For example: the way I produce the “L” sound. I curve my tongue upwards inside my mouth, touch my two front incisors at the back, right at the gum line. That way I can pronounce “LLLLLLLLLLLLLLL” as long as I want. My tongue is stretched, almost cramped in this position, and it hurts after a while. But when I want to say Elisabeth, I have great difficulty, because after producing “L” in such a cramped position, I cannot move to the next sound, which involves planning the lip movement of “iiiiiiiiiiiiiiiiiii” It is difficult to plan the muscle movement of different muscles in the brain and then execute it by telling the muscles “Now do it!”
On the other hand, if I don’t move my weak muscles as much as I used to, won’t I be losing the strength in them? I mean, if you are weak, in order to get stronger muscles you have to lift weight, right? The more weight you lift, the stronger the muscles become, and it is easier for you to move them, right? Well, yes and no. In medicine, as my husband always tells me, you cannot always make deductions from one field to another field, empirical evidence rules. He believes medicine is more art than science, especially the therapy part. The above principle may be true as far as the muscles go, as for the brain, it must be a different story. My problem lies in the brain. There is nothing wrong with the muscles, if the brain could give the right commend. Even when they tell you have muscle weakness, is a manner of speaking only.
So, what do I have to lose? It makes partially sense, although in my hearth of hearths it is hard to believe.
We start.

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