I learned that stroke
survivors are challenged on so many levels. The condition called Aphasia[1],
the term for the results of brain damage, is an incredibly cruel master of the
body and psyche of its victims. Because of the brain damage, their challenge is
monumental. For example, in cases like John’s where the stroke is massive, it
is extremely difficult for them to motivate themselves to do therapy of any
kind.
The loss of language from aphasia causes the patient to be unable
to put together concepts, make decisions, or anything related to internal or
external communication. Internal communication refers to the brain’s inability
to communicate within itself in addition to an inability to think clearly.
External communication refers to the inability to communicate what thoughts exist
to anyone else.
John lost his ability to rationally look at issues and make
decisions. He was merely an observer in the process of life. Initially, he was
not able to understand the concept of therapy relative to its potential for
him.
In our case, for the first
three weeks after the stroke, John was malleable and just did what his speech, occupational
and physical therapists told him to do. He didn’t have much choice. He was a
captive in a rehab unit. His time was managed by the system. His daily schedule
was mapped out for him. His choices came later, when his brain began healing.
After about a month, there was
enough healing in his brain to start to clear away some of the aphasia shroud.
Here’s where I as Caregiver
essentially held that life line out to John. I got to encourage him to pick up
that life line. Since I knew the value, I insisted that John and I continue as a team,
as we had for so many years in the music business. This time we were a Therapy
Team instead of a musical team, with the new goal of bringing John back to his
former life-skills. Over a longer time he was able to conceptualize that there
was some success from the therapy and he began to participate in earnest.
Individual education, personalities,
determination, and previous skills become a part of the tool set therapists use
to evoke healing, too. The variables for potential outcomes are endless.
I’m extremely grateful we
had both been teachers for many years. We knew the value of building skills
using a variety of tools. As musicians, we both subscribed to a method of
“practice, practice, practice”. These were and are the methods we used then and
the methods we still use: tools and practice.
One note of caution here
regarding definitions of aphasia and stroke victims: all strokes are different.
Damage can occur in one area, or it can be spread around like small meatballs on a plate of spaghetti. It just
depends upon the injury itself, and the type of injury. A lot of the initial
aphasia is due to the brain swelling immediately after the injury. The brain
swells, like any other part of the body when there is injury. Thus the healing
of the brain occurs over time as the swelling goes down. As this swelling
gradually disappears, many electrical pathways are reconnected.
I was told that most of
the brain swelling would be gone at the one month period. The next benchmark is
at three months, then six, and then nine months. After approximately two years
after the CVA, the swelling is considered gone. Because of this healing
process, these same benchmarks exist for the benefits from therapy. This is an
incredibly complex process. I am not a neurologist[2]
and I ask that you educate yourself on this field of medicine if you desire
more information.
Because I knew of the
swelling/healing benchmarks, I understood that the greatest benefits from
therapy occurred within the benchmark windows. The clock ticks.
[1]
Aphasia definition: https://www.aphasia.org/content/aphasia-definitions
[2] Neurology definition: http://en.wikipedia.org/wiki/Neurologist
Great images accompanying these last two entries.
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