Speech Therapy

As some of you may know, Will's formal therapies were discontinued some time ago because they were either deemed unnecessary or non-productive. After a while, it became clear to me that they were still necessary and needed to be re-instated. I decided to try speech therapy. The exercises included breathing exercises for projection, lip rounders for precise articulation, jaw droppers for strengthening the soft pallet and opening up the throat, tongue twisters for clarity of vowels and consonants, and humming for head resonance and volume.

As we began these exercises, I pretended I was a therapist to one of Hollywood's brightest and most shining stars, having Will say such things as , "How now brown cow!" and "a big black bug bit a big black bear." It was fun and I was pleased to see that Will was entering into the spirit of the therapies. He did them for sustained periods of time and with some effort and it wasn't long before I was noticing that it was making a difference, not only with his voice, but also with mine. These were therapies that worked!!!

A statement of a friend whose brother had suffered a stroke prompted the reinstatement of these therapies. She said. "My brother recovered all but his left arm and that was because he refused to do the therapies that were given him for that." It was a haunting statement because I thought, "if Will always speaks with a slur because he never got the speech therapy he needed, I will feel personally responsible. I teach Elocution. I should have the resources at my fingertips. I should be his therapist." As soon as I took ownership of this phase of his recovery, I remembered where the resources were and went to work.

In one of the notes by one of the exercises it said, "the voice muscles need to be exercised just like the leg muscles if they are to become strong and perform their proper function." Will's stroke knocked out his ability to swallow. His tongue, throat, and lips were frozen in a type of paralysis similar to my friend's brother's arm. It made perfect sense that Will's speaking muscles would need to be worked on, exercised and strengthened if they were to regain full function. Teddy Bruschi had physical therapists to help him reclaim his acumen as a foot-ball star, Will had his mom. Neither man had been left without resources for recovery.

Currently I am looking for some exercises that might help with the return of Executive Function. This is the part of the brain that causes a person to initiate behaviors. It is located in the frontal lobes and is one of the highest forms of reasoning; a demonstration of a person's will. Leaders of men have lots of Executive Function. Will acquired a great deal of it while he was a missionary in Argentina. I know he can gain it back with some help and effort.

In as much as many of you are people of faith, I want you to know that your fasting and prayers have enabled him to perform at an amazing level of 83% over all in his first neuro-psyche exam, a fete which is nothing short of miraculous. Humbly and with a sense of great indebtedness, I am asking you to please pray specifically for Will's ability to reclaim his Executive Function. It is such a critical part of the recovery.

June through August Summary

From my observation, Will made huge progress in interpersonal interactions during the summer. It began as he got very involved with his nephew Simon and with Summer's nieces and nephews. He entered into more conversations with his siblings about the time Chris returned from Brazil and Lizzie visited from New York City (last half of July). He now initiates conversations, ask questions, comments on the responses, and keeps the conversation alive.

I discussed this with Dr. Mayer on July 29th. At that time, Will had met with Dr. Mayer 8 times but had never opened up to him. The usual patient would have become a non-stop talker by that point in therapy. Dr. Mayer offered some possible explanations: (1) An interaction with a child may be less demanding than one with an adult, so Will more readily enters into it. (2) Will may have neurological (brain circuits don't work right) difficulty in forming sentences to make a conversation. (3) Will may have psychological reasons (a motive) not to talk with people, so they wouldn't find out how broken he thought he was. At the end of July, Dr. Mayer was leaning toward the neurological explanation, but wasn't sure.

Yesterday Dr. Mayer said he thought that Will's deficit in brain executive function was definitely neurological, and that the tests showed that the whole brain was affected; there was no localization to one side or the other. He also mentioned that Will had begun to open up to him in their most recent sessions.

Neuropsychological Evaluation

On August 25th and 26th Dr. Mayer administered the Wechsler Adult Intelligence Scale III IQ test to Will. He adminstered all the subtests, including the optional ones. The final report isn't yet done, but Dr. Mayer shared his preliminary findings with us yesterday.

Here they are at a high level:

1. Will's basic intelligence is intact.
2. On timed tests, Will's accuracy was 100% or nearly so, but his speed was very slow.
3. Will currently has deficits in most types of memory, but not all.
4. Will is currently weak in the executive function of the brain.

Some additional observations:

1. Will scored in the percentile range of 80 to 91 on many conceptual and analytical subtests. This is compared to the total population his age. If the test were normed to all people who had completed medical school, his percentile scores would have been lower.
2. In tests where speed was a factor, Will scored below the 10th percentile. Removing the adjustment for speed would have put those scores in the percentile range of 30 to 50. My own speculation is that Will thought this evaluation was important and cared about the results, so he chose to optimize on accuracy and to let timings be what they may. He may never have thought of balancing speed and accuracy.

• The Stroop test is an example. There is a long list of words that are the names of colors (the names of only 4 colors are used). Each name of a color is printed in a colored font. The color of the font is always different from the color described by the word. I.e., the word 'Blue' is always printed in red, or green, or tan type. The first time through you say the words. (If the word is 'Blue' you say 'blue.') The second time through you say the color of the font. (If the word 'Blue' is printed in red, you say 'red.') The first time through Will did well. The second time he only got halfway through the list in the alloted time. But in that time he only made one mistake.

1. Dr. Mayer talked about 7 or 8 types of memory:

• Long-term: The adage for this one is "First learned, most rehearsed, last lost." Long-term memory is usually not affected by a stroke, and this is true for Will.
• Short-term: This is working memory and is important to attention and concentration. Will scored quite high in this area and got corresponding high marks in attention and concentraton.
• Aural/Verbal and Visual: Not so high. Will has a learning curve, which means he improves with repetition, but his learning curve is not as steep as for most people, i.e., his rate of improvement with repetition is lower.
• Immediate and Delayed: Not so high. Immediate is being able to tell a story back right after he's heard it. Delayed is being able to tell it back after 30 minutes filled with other activities. When telling a story back, Will does well in relating appropriate story themes, but not so well in including the details.
• Episodic: This is being able to relate your experiences. [I don't remember the evaluation of this one. This might be part of long-term memory.]
• Prospective: Not so high. This is remembering what you plan to do.

1. Prospective memory is related to the brain's executive function, but is not the same thing. Prospective memory is keeping a task or goal in mind. Executive function is figuring out how to do it and then making yourself do it. Will currently has deficits in both.