Stories of Speech Pathology and Rehab
The following are stories of real life survivors of brain injury. Clicking on the titles will take you to their actual story.
Her therapy was in four basic areas, physical, occupational, speech pathology and psychology. Quite intense some of the work that I had to do there especially in speech. The speech pathologist would say cut a newspaper from cut out an article from the newspaper and then write a summary and one of the problems I have is I am, I am known to confabulate and add on a lot and I would try to write a synopsis of a story and it would be a whole page long and that’s not exactly what she wanted so I had a problem following directions and speech pathology was one of the difficult sessions that I was in when I was at Curative.
Perhaps because historically the speech issues after brain damage were among the most obvious, much of the hardcore cognitive rehabilitation after severe brain injury falls into the gamut of speech pathologists. Betty describes a love hate relationship with speech pathology, hating it because it reflected the image of her deficits so clearly to her, but now so thankful for the level of care she got. I hated it but I love â€“ I hated it but it helped me. I felt that I was being treated as an 8 year old and I didn’t, I, and I didn’t feel that I needed it. I â€“ well, to this point I still don’t see fully my deficits but it’s something I have to live with. Speech pathology and other disability assistance helped her complete her last semester of college. With professional assistance, she persevered and obtained her diploma. Such was not an easy process, including being asked to leave one program. She asked the professor so many questions it became clear she wasn’t understanding the curriculum.
Chris states that she was in the hospital 3 days short of a year. She was in 3 different hospitals and had physical, occupational for her hand and speech therapy during her stays.
“At Sacred Heart she was at the combative stage. She was aware of what was going on, she just couldn’t speak. Couldn’t take care of herself, she was very combative. But they weren’t, she was not progressing fast enough for them, her speech, her occupational, her physical therapy. It, she was just not progressing fast enough for them to keep her there. At Clearview, she worked with a neuropsychologist, a speech pathologist, physical therapist, occupational therapist and a vocational therapist. “Every weekend when we went there. It was like she worked hard with them all week and we drilled her on the weekend.”
Chris was at Clearview for seven to eight months. That she wasn’t just dumped into a nursing home made the difference in: Her walking, talking, understanding, her reasoning, her physical appearance everything.
Nothing really changed as far as her coming home and her routine. She got up at 6:30 in the morning and went to her physical therapies, speech therapies before she went to school.
So tell me about your therapy.: “I have some severe spasticity problems in my shoulders and my elbows and so, probably about, 100 days of that, every other day. Speech language, therapy which of course you know runs out pretty quick. So I got involved in a system called interactive metronome, which I’m actually one of the clinicians for now.”
After the neuropsychologist, you started to get some cognitive therapy. Did that also include speech pathology or not?: “Yep. I went to a speech language pathologist.” Is that who was doing the cognitive therapy or was it separate?: “I had two. I had Sara, who did the speech language and memory. Then I had Brian, who did the cognitive, more of the long-term memory, the behavioral-type things and some biofeedback and a couple of other things.” So tell me about the speech language pathology.: “Now Sara, she got it. She knew what was going on with me. She was the first person that actually explained to it (besides my attorney who I got later) explained to me what was going on – this is what’s happening, and made it so that it made sense. (That was the) first time that they didn’t make me feel guilty, the first person that I didn’t have the guilt that this is happening.” So what were you doing in speech pathology?: “A lot of phrases, words, memory things. I remember the memory blocks, pictures and she’s also the one that introduced me to the interactive metronome. Like I said, once I could time my brain again, control it, that’s when the rest of the impulsivity started getting better.”
Doug does have a good memory of the speech and occupational therapy he received. Doug states;”It’s just like repetition, I’m going over different puzzles, different word games, different, different – I’m trying to think whatever else was – word games, mind games, yeah, word searches. Just trying to work the brain into learning how to do things, on your own. Repetitions. Just – I guess just trying to – like the word searches, trying to find the words, just trying to put everything together. Put all the right – to find the words in the sentences, to put the sentences together, to put everything back, put things together, to find the stuff in the right sentences.” Speech Pathology was frustrating at times:”Because some of the puzzles were harder and harder and it’d be frustrating because you couldn’t find some of the puzzles or the words. And they’d make it harder and harder for you because some would be easier and then it would get harder and harder and they would just like – you couldn’t figure them out. I would just, you know, be frustrating.”
Do you have any problems with speech? Doug states;”Not really”. (The only thing we noticed in terms of speech was that he would often pause mid-sentence, to gather a little momentum, then finish a thought.)
Our philosophy is to ensure the best outcome after a TBI, the post morbid plan has to simulate the growth in behavior and maturity that we experience as children and young adults. The concept is easy to grasp in the context of speech pathology and physical therapy in the inpatient setting. Many severe TBI survivors have to relearn to both walk and talk, as if they were children again. When you apply that principle to long term improvement in the community, one must start from the realization that the frontal lobes are the slowest part of our brains to develop. Much of the neural networks that govern mood, executive functioning and maturity continue to develop well into our 20’s. If one is doubtful of that statement, think how you or your children behaved differently at 25 than at 18.
Doug also talks about receiving speech therapy to help exercise his brain with a variety of word and mind games.
Elizabeth says that she had speech therapy to help her talk correctly so that she would get things right. She didn’t always get things right even though she knew what something was she might call it something else.
After I left the hospital I could not stay alone, and my husband worked different shifts and somebody had to be with me 24 hours a day. So they took me to my mom and dad’s house in Wisconsin Rapids and I saw the speech therapist down there, and he was good for putting up with me. He was working really hard with me to try to help me understand, and because of my short- term memory, not being able to remember things, he’d have me write things down, you know, and try to figure out what he said and tried to repeat him, and so that took about two months it took to do that. And I was doing the best that I could, and when he said pretty much this is the best you’re going to get, then it was time to move, time to move back home.
He isn’t quite back yet, but he is getting close. While at Norwood Rehabilitation, he got physical therapy, occupational therapy, speech therapy. He explains: “They have everybody on physical therapy that’s at the Norwood, and I think it has something to do with, because we’re all, everyone that has a brain injury I believe is hospitalized for a period of time to where they’re not mobile, so the physical therapy is to get you back into shape. He remembers most of that physical therapy. In addition to his leg, he has some problems with the right side of his body.There’s a, the right side of my body has, is, it’s not nerve dead or anything, or completely numb, but the nerves don’t, aren’t the same. They, it’s like one side it feels the same and the other side doesn’t feel as the same. I actually haven’t told anybody really about it and I just do my normal exercises and just do things and it’s been coming back as much as it will.
When asked what kind of therapies he was receiving he states; “I’m going and seeing a speech therapist weekly as well as I’m seeing a vision therapist weekly. The speech therapy is not, not for my speaking ability. It’s for my, my brain to, to help me think quicker and they just give me more tests every time I go in and they’ve helped me out really well.They have me, it’s a web site called lumosity.com and that’s a, actually a, a brain game thing, web site, where actually it deals with brain injury and whatnot. I think it’s targeting minor, minor brain injuries in comparison to mine was a traumatic brain injury, to where like if you had a bad concussion to where you aren’t as quick as you used to be, to start with and then you just do the lumosity and you can go back to normal.”
She got speech, physical and occupational therapy while she was there. She explains: “Mainly I know addition, subtraction, just a lot of flash cards, a lot of reading and comprehending and going back, a lot of writing. They wanted me to write with, I’m right-handed and they wanted me to right with both hands. I didn’t understand why they were forcing me to write a lot of stuff with my left hand because I, I guess I was coming in and out of it. I, I was fighting a lot of it, just making them, why do you have to do this? They did some physical therapy.”
He received speech, occupational and physical therapy as part of his rehab. I asked him to tell about the earliest things he remembered in speech therapy.: “Well like what I can remember probably is, are things like I was taught to watch programs about â€“ that word programs, like Jeopardy. So I got to see Jeopardy when that guy won the most in a row ever and so that exercised your brain. And, Wheel of Fortune too exercised your brain. She would give some word lists and I don’t remember if I had to try to remember those and then she would quiz me on, on them or how that worked, but I had some type of word lists and while learning to speak again, of course, just sentences and such.” When you say learning to speak again, could you speak at all?: “I could talk somewhat to people, but I would, what would I, what I’d be thinking would not come out of my mouth. Other words would come out of my mouth. I don’t really know how to explain. Just that you would see a banana and you’d think it’s a orange or not you wouldn’t you’d know it’s a banana but you would call it an orange. Or you might call it a person. Or you might call it a table.”
When asked about his accent Jeremiah resonds; “Yes. I can’t explain why except for I can probably explain obviously that I had to relearn to talk all over again, and perhaps, you know, there were, there were probably people with accents who taught but, I would imagine you piece together what you can of what you have in â€“ left in your brain and as it’s pieced together you work on what you have which maybe accents and what you hear which are possibly accents and then also you piece on what you can use in your vocal cords and lips and such too. But, like for instance, I guess, I was speaking French, which I hadn’t had since ” I had one semester in college, one summer semester. And, I was talking to my wife’s friend who speaks fluent French in Canada and, I guess, I don’t remember doing that but, I guess, I was speaking French pretty well. And I’ve had many people say that I sound like I’m foreign accent as well.” After discussing this issue with a neuropsychologist friend, I learned that Jeremiah likely suffered from a rare but well known condition called Dysprosody, or “foreign accent syndrome.” While the relation to his head trauma is nearly undeniable, the pathological explanation for why this happens is a bit of a mystery, although in Jeremiah’s case perhaps not an unsolvable one.
Jeremiah had to relearn to walk, relearn to play the guitar, he also had to relearn language after his severe brain injury. Writing lyrics to songs was as integral to that process as the guitar was to reusing his right arm.
Tell me about your speech therapy.: “Well let me qualify this by saying that I have a degree, I had at the time of my injury, a bachelor’s degree in communications. I read a lot of books. I read a lot. So I would say that I’m a voracious reader, and my speech therapist, well of course ever since the injury somebody prejudges you, you and your abilities. So this speech therapist judged my abilities as being non-communicative. I’m very communicative.” What did she mean by non-communicative?: “That I didn’t speak properly or I didn’t anoun, I didn’t, I didn’t pronounce my words appropriately. And so she was forever trying to get me to say a word and I would usually jump ahead of her. It’s like I could bump, read her mind where she was going with it.” But what did she mean to say that you were non-communicative?: “That I was be, lower than her level of teaching abilities.” You could think ahead with her but you couldn’t speak at the same speed that you were thinking?: “Exactly. That’s, that’s a good way of putting that. Well my mind tends to run pretty quickly and if you can’t catch up you’re left behind. If you can’t stay with me, you’re behind. But she was trying to be ahead of me and she couldn’t stay ahead of me”
Tell me about going from the flatter personality back to where you are today. : “Well some of that was introduced to me in the speech therapy portion of the therapy. She would give me words and to inflect and different situations where I would role model or we would role play. And I would have to be either the good guy, the bad guy, the good cop, bad cop, something like that, whatever role we were playing. But it was usually in the field that I had experience in sales. I was a salesperson. She was a buyer. And I of course I would try to close the deal.”
What do you remember about the speech pathology?: “The speech therapist gave me a card or she showed me a card and with a picture on it and it had the letter A on it, then I had to pronounce A and then a picture of an apple and B as in barn and all that and then, then I’ll talk better and had to sound out each letter during speech therapy and all that and ” Did you have trouble with that in the beginning of your therapy?: “Yeah. I couldn’t, like, like see I went to another speech therapy, okay after Mercy I went to a place in Waterford for, brain rehab place, rehabilitation, and they were more, more thorough about speech.”Did they do things in speech pathology or other therapies that made you at least, accept for that moment that you had disability?: “Yeah. Like, like write a check out and then well balance book, whatever they gave you, do story problems like some add and subtraction problems, the basic stuff in math. “
Tell me about the speech pathology you got while you were an inpatient.: “I remember when I began with speech, well, when my memory began with speech pathology – I was, we were playing games. I’ve always loved to play games, and we were playing adult kind of games.” With an adult kind of theme?: “I guess we were playing, maybe child kind of games with adult words, maybe, okay? Words with more than four letters, I guess I could say. And it seemed like it developed pretty quickly into that I was able to work on a computer in therapy. Not that I was able to do it properly, but in speech pathology I could start using a computer. I learned in speech pathology, I’m sure that I learned in speech pathology, the English language better than I did when I went to school the first time. So I learned, um, I learned, I learned how to learn, I guess. I learned, I was learning things that I didn’t know. If that’s clear, I was learning how to find out what I didn’t know.” So I started, watching game shows on TV which helped me learn. I was learning that I didn’t, that I had lost a lot of words and that I didn’t understand how to describe things, or that I didn’t understand colors. “
The speech pathology you were getting during that period what was that like? : “You know, it’s been so long ago. Speech pathology. nd, and so in the question that you asked me about speech pathology and what was it like, at the time when I started walking more freely and things were going proper, it just seems when I think about the timeline and where things were, that that’s where my desire to go back to the Board of Realtors was, and speech pathology, that’s probably about the time that they had me more working with the computer. Where when I was in the hospital, or early on in outpatient therapy, it was being able to turn the computer on and to touch the keys. But I’m sure that speech, speech pathology at that time was more being able to function with computer programs.” How would you distinguish between the work you were getting from the speech pathologist and what the neuropsychologist was doing for you? : “Those seemed really close. The speech pathologist worked with me more directly on like the English language and the use of English language and the use of talking; conversation, understanding people. “
“My speaking at first, there were problems with it, but I recovered that actually rather quite rather quick and so I didn’t have occupational therapy or speech therapy for too long.”
Tell me about the last 40 days at Saint Vincent’s.: “They had him in the rehab. He got moved to the rehab floor where he had occupational therapy, physical therapy, speech therapy and he started to talk, maybe a month after he woke up. He had left neglect really bad where he didn’t focus on the left side of his body at all, you know? He would try to wash himself up and it would just be the right side. He would never go to the left side.” Let’s talk about him learning to talk again.: “He had a trach and he would try to talk but nothing would come out so because he just couldn’t talk. He tried to. So then they decided they were going to put a cap on it so they would like put their thumbs over it so you could kind of hear what he was trying to say. The day they put the cap on there, probably for the week before he left he was starting to talk some and that was by when you would hold your finger over the, the trach, so you could kind of hear what he was trying to say and it was normal talk but it was at a very slow pace.”
So tell me about speech therapy.: “They make you write on sentences in there.” How are you doing with that?: “A lot better than I was. They can read me a story, like today, and while I’m going on, he can ask me about the story he read me and I can tell him what the story was about.”
So you were working with the speech therapist as far as relearning to use your brain?: “Yeah.” Talk to me about that.: “She would give me like three words; bird, cloud, car, and then ask me to repeat those three words back to her, and then work on something else and then come back and ask me to repeat them, and then at the end of the hour or something ask me to repeat them again. What used to be simple tasks was unbelievably hard, because I couldn’t remember. In the beginning I couldn’t remember two out of three words, yeah. And learning how to associate words with something in my head, that I could remember them, and, you know. She had me write a story; pick a subject and write a story. The subject was a car, and I could only get out, you know, two or three sentences.”
“She goes to physical therapy three times a week, she went to speech therapy for a while. You know, I, there’s a bunch of help out there. I mean, I, especially Bayfront speech and occupational people sent us home with a bunch of stuff. So we just kind of stayed home and, you know, worked on all that ourselves.”
Is she getting any speech therapy?: “No.” Can she communicate at all?: “Oh yeah, oh yeah, she communicates fine.” She talks?: “Oh yeah. Yeah.” Does she talk normally?: “No. No.” Why isn’t she receiving speech therapy?: “You know, I don’t know. I know Medicaid doesn’t cover that. I have been doing it myself. We’ve been doing it ourselves. So that’s what we’ve been doing.” What resources are available for you to self-administer this type of therapy?: “I have no idea.” Have you used the Internet?: “Sandra Honeycutt: Oh the Internet, yes. I was thinking of community things. Yeah, oh yes definitely the Internet, oh yeah, yeah.” What are finding on the Internet now?: “There’s some, just different ideas of different games to play, that kind of thing. There’s also this thing you can get. Everything I do is for free too, I’m not going to pay for anything but they have different, programs where you can just tap things that you want. But really my daughter, you know, we got that but she can’t tell what she wants.”
“I got a little bit of that. They seemed more focused on me being able to somewhat take care of myself when I was released, which is understandable. And they were kind of more directing their efforts towards, I guess, the alleviating my stroke and like getting me to where I could use both sides a little better equally – getting me to walking in and tying shoes and things like that.”
Now, you went through speech pathology?: “I’m going through it again.” How many times have you been to speech pathology?: One time and now I’m doing it again.When I first went, I couldn’t really talk.” TJ explains what he does at speech therapy: “Then we go over our exercises that she gave me for homework.” So what was your homework?” To say certain syllables and stuff out loud into the mirror, so it comes out clearer.” So you’re talking into a mirror?: “At home by myself.” Do you have certain words you’re supposed to say?: “She made a list so I can go through all my words and just say “em.”
He said he had two rounds of speech therapy. Has he had more than that?: “Well, no, he had speech therapy in Spaulding and then we had speech, we went every day to outpatient therapy from July until November in Connecticut (in the year of his injury.)” Did he have any speech therapy after that?: “Once we came down here he had, yes, he had therapy down here. We’ve done a lot of different kinds, they have a little bit different systems down here. They have what’s called interactive metronome down here, so he went through that therapy.” What is that?: “It’s where they hear different sounds in their ears and they have to clap or tap their foot in different (sequences).”
What has been the most work for you?: “The balance issue, the speech issue. That’s basically it.”