Broca’s aphasia with apraxia-3

 58 years old; 18 months post onset, Broca’s aphasia, severe apraxia, 6 week program

Client8’s depression interfered with his motivation and willingness to cooperate fully with therapy. After approximately 4 weeks of extensive counseling with his speech therapy treatment, he agreed to participate fully in the program. Daily goals were set with this client so that he could see his progress more frequently and easily.

Client8 may not have seemed as though he would be a good candidate for treatment. His depression had not been disclosed prior to his acceptance, but typically depression lessens while at the program. Once a client begins to see that he can make progress in his speech, he tends to have more hope about the future. This particular client stopped taking his medication for his mood during the program, but began taking it again by the 4th week. Despite his depression, Client8 was a highly educated professional, researcher, and entrepreneur who wanted to get back to his daily life routines. He had been sitting around just watching TV for months. He maintained strong support from family, colleagues, and friends, and he displayed relatively good cognitive skills. What he needed more than anything was encouragement, tough love, support, and hope.

Goal: To use verbal expression independently 50% of the time.

When Client8 started treatment, he could say “no” independently. His only speech was when he could repeat short words and phrases produced by the clinician. Independent speech was approximately 5% successful. Client8 was very reluctant to try speech without assistance as he felt that if it wasn’t going to be perfect, he wasn’t going to try it. We used a functional word list (family names, greetings, beverages, etc) and within the first week, he was producing practiced words independently 50% of attempts, meeting his goal. He also read short sentence aloud with 60% accuracy.

By the middle of the program, Client8 was saying 2-3 word phrases 75% accurately and communicated verbally 50% of the day instead of using gestures. He began to order his own lunch verbally with some help. This continued until the end of the program.

Standardized testing showed that he his overall aphasia rating (fluent speech, repetition, following commands) went up 47% at the end of the program. Reading scores increased by 15.5% without being directly treated. Writing scores increased by 30% without being directly targeted. His caregiver rated changes of 20-27% in areas such as recalling someone’s name, indicating understanding of what’s being said, having a spontaneous conversation, and talking to strangers.

 Summary of Treatment

While Client8 remained frustrated about his speech, he did begin to see that he was improving and became more willing to complete homework. He developed a renewed outlook on his aphasia and vowed to return home and continue to work instead of just sitting and watching tv all day. We made a detailed plan for him, so that on certain days he spent a few hours in his office at work, on other days he was responsible for going about his grounds and inspecting the crops. Other times were to be spent doing homework and practicing speaking. This was the most challenging client we had ever seen, and through a combination of taking his prescribed medication as directed and intensive counseling about aphasia and expectations, he made incredible leaps in speaking, reading, understanding, and writing.