Monday, December 1, 2008

It's All in Your Head

Several weeks ago, I met a woman who was by far the most frustrated client I'd ever seen. She'd had a stroke several months earlier but hadn't been getting speech therapy since she'd left the hospital, and not only couldn't talk, she could make any sound other than sort of a growl. She didn't have any physical limitations so she could get her basic needs met, but she clearly had a lot to say that wasn't being communicated in any modality.

There was a lot to her picture, but I thought it was somewhat evident that she had severe apraxia, meaning she couldn't get her mouth to do what the brain was directing it to do. And she'd been like this for months.

I didn't see her again for almost a month, and then she came back in on a day I was working last week. She able to repeat anything I said. If I asked her to do something with her mouth, she did it without difficulty. She was popping out single words left and right to kind of string together a message (e.g. "sister" "book" "tomorrow" to indicate that she would pick up a communication book we'd asked her sister to order the next day). She'd only had 2 other therapy sessions. She simply didn't fit the rules.

Usually if you tell someone with apraxia to stop doing something, they do it even more -- not because they don't want to do what you're telling them to do, it's just the way their body responds to a volitional movement. If I told her stop doing something, she stopped. If I prompted her to add a word or two on to her single word response she could do it, and then do it again. It was too easy. Things just didn't add up.

She is not faking. She's not. What I think happened was that she had a change in her brain, she initially had incredible trouble talking, and she got knocked off track. And all of the stress and strain in her very difficult life settled into her talking, and she couldn't let go of it.

Some people have low back pain when they are stressed, even if they don't realize it. Some people have shoulder tension. Some people develop/maintain communication problems. The brain is something, isn't it?

I do this, but usually under physical strain. I have developed hives when crazy sick from a sinus infection that I thought would never end, and came very close to throwing up when I twisted my ankle on the tennis court. Apparently, that's not all.

I knew I've been stressed lately in a way I've never been before, though it's been staying at bay, more or less. This past weekend my nose blew up -- I mean blisters all over the place. Swollen, itchy, painful and weird. Now I'm a scabby mess but things are on the mend. I suppose it could have been the Chicago wind and dry airplane air, but I think I hit a point where there was nothing left and the junk around my heart boiled over. Yuck.

The treatment for psychogenic communication disorders is convincing the client that they have control over the problem. I'll work on that -- it might be true for noses too.
The image shows the relationship between stress and strain. I wonder at which point the nose blows up...

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