Ongoing Recovery Techniques
My father, John, survived a stroke in August 2000 following a five hour operation to repair injuries from an accident he sustained. It was an intermediate level stroke leaving him with the following deficits:
1. Physical Impact: Right side weakness
2. Visual Neglect: He does not process visual feedback in his lower vision field.
3. Aphasia: Problem retrieving words.
4. Cognitive Damage: Impact in “the executive functioning” area of the brain affecting analyzing information, abstract thinking.
He was an in-patient at Kessler Institute for Rehabilitation for three weeks where he received excellent care. John continued Speech Therapy, Occupational Therapy and Physical Therapy at Kessler on an out-patient basis until he was released from each therapy unit after medical coverage ceased.
Alternative Recovery Activities: My mother and I were left with minimal information upon my dad’s release from Kessler’s Outpatient Program. After politely hounding the talented and slightly overwhelmed therapists, we uncovered some ideas for Alternative Recovery Activities (listed in the same four categories as above):
1. Physical Impact: Luckily, Dad was able to walk out of Kessler’s program without the use of assistive devices. His right leg was a bit weak and his visual neglect made walking safely a bit of a challenge at first. Kessler provided printouts with easy step-by-step instructions for several physical and occupational therapy exercises to strengthen his limbs and improve his fine motor skills. We added ankle and wrist weights when the exercises became too easy for him. We walked in malls in cold or inclement weather and our local parks in pleasant conditions with me spotting him on his right side. As he walked more confidently and improved his visual scanning, he enrolled in a local health club. There, personal trainers set up a program for him on Nautilus weight machines and exercise bikes to strengthen his right side limbs. The big picture goal was to improve his overall body strength, flexibility and coordination. He even takes a senior-oriented yoga class several times a week.
After a year, he has doubled the weight levels from which he started. Also, when he walks he carries a hand held grip strengthener called Grip Master which can be found in most large sport stores. He squeezes down on it every few seconds as he walks to strengthen his right arm. Now, he walks 2.5 miles a day, three to four days a week at about an 18 minute-per-mile pace. It’s not bad for a man who turned 88 in March.
2. Visual Neglect: There is no way, that I have heard, to repair this condition. He just has to be aware of it and remember to turn his head to his lower right side when walking in unfamiliar areas. It is particularly critical when he reads, since he is likely to leave off the last few letters of words. It can alter the meaning and context of what he reads, slowing his comprehension and retention of the material. To compensate, I use a yellow highlighter to mark the right margins of the articles he reads for homework assignments. After much practice, he catches the majority of his reading errors and self-corrects his mistakes.
3. Aphasia: I felt most ill-equipped to cope with his aphasia the first few months following his stroke. My father could only speak a few words and often retrieved the wrong word for an item he wanted (e.g. “radio” instead of “TV”). He couldn’t speak in sentences upon release from Kessler. To complicate matters, it was hard to pin point specific cognitive issues when he communicated so little information to make an assessment. One speech therapist at Kessler gave me copies of pages from a catalog targeted to speech therapists. I read excerpts and noted some helpful workbooks to purchase for my Dad’s home study. The ones I selected are Aphasia Therapy Workbook Volumes 1 & 2 by Julie Guerrero from Imaginart Publishers located in Bisbee Arizona. It has a website of the same name where you can research books and place orders. Another helpful exercise is doing crossword puzzles in easy level paperback magazines. This is good for word retrieval. There are special speech programs available in Montclair State, Kean and William Paterson Universities. Clients enroll in these programs and are taught by graduate students training to be speech therapists. A professor supervises the student clinician and both assess each client’s limitations and customize therapy sessions, both individual and group, to help the client reclaim speech skills. The price range is $400 - $500 per semester. I can only speak for the Montclair State University (MSU) program where my father enrolled. Within the first semester he was speaking in phrases and complete sentences by the second semester.
4. Cognitive Damage: This area is closely aligned to speech recovery. There is an excellent series of workbooks by Susan Howell Brubaker published by Wayne State University Press in Detroit MI. I found their workbooks on websites, particularly on Amazon.com. They are: Workbook For Reasoning Skills, Workbook For Aphasia, Workbook For Language Skills, Workbook For Cognitive Skills. They come in spiral bound workbooks of 250-300 pages which people can do at home at their own pace. The workbooks target skills such as drawing conclusions, problem-solving, following directions, visual/logical sequencing, number/symbols and humor. Some books specialize in vocabulary skills, reading comprehension, word retrieval and spelling skills. My father’s speech has improved in areas of abstract communication and comprehension due to his brain compensating and relearning these various cognitive skills.
In closing, I am aware that every stroke survivor has a unique set of deficits to be identified and overcome. Perhaps some of our findings will apply to you or your loved one’s needs. My father is proof that the brain can compensate regardless of age, if the stroke survivor has determination, stamina and a support system to help reclaim skills.