Treatment Idea of the Month

Because I would rather spend more time with people with aphasia and less time updating this website, I will add speech therapy ideas on a monthly basis.

FORCED CHOICE WITH HAND CUES

People with aphasia of the non-fluent kind often indicate yes when they mean no, and vice versa.  When asked a choice question (“do you want regular tea or herbal tea?”) they look “stuck.”  People without aphasia, if unable to speak (say, the thermometer is in my mouth!) might hold up one finger for regular tea and two fingers for herbal.  The Person with this kind of aphasia often has “apraxia” of the left arm and hand.  Nevertheless, with training, he or she can use the left limb to reach out and make a choice — provided auditory comprehension is relatively intact.

Here’s how it works:  the Helper holds out his two hands, palm up side by side, or with one hand slightly above the other.  The Helper says “Regular?” and wiggles his right-hand fingers.  And then says “Herbal?” and wiggles his left-hand fingers.  Repetitions and going slowly help.  The person with aphasia then reaches out and grabs the Helper’s hand representing her choice.  The Person with severe limb apraxia might need someone to lift her left elbow up slightly, getting her ready to reach out and make her choice.

Often training the Helper and Person takes less than one session, and conveying choices is easier for everybody from now on.

I once asked an aphasic man his political party.  (Because of his right-sided “neglect” I positioned my two hands one above the other.)  “Democrat?” I asked, wiggling the top-hand fingers.  “Or Republican?” I asked, wiggling the bottom-hand fingers.  He grabbed neither, but instead waved his own left hand enthusiastically way above my two hands.  A lightbulb went on in my head:  “Independent?” I asked.  He rewarded me with emphatic nods and a big smile.