Cognitive Communication Impairments - case2

Brief History

• 88 year old client with a large deep L-MCA with a haemorrhagic transformation.
• Severe cognitive impairments - response initiation, memory, attention, executive functions.

Speech and language

• Very quiet voice - ? self monitoring.
• Language - understanding occasional keywords and understanding parts of conversations in context (attention was a limiting factor). Tangential speech unable to remain on topic, much of the clients speech didn't make sense. Complex sentences/ phrases and words appeared easier for the client to retrieve than simple word/ phrases e.g. man riding bike was - person is accessing the motion cylinders for propulsion. Semantic deficits on the CAT. Severe difficulties following simple instructions in therapy sessions e.g. lift arm.
• Insight - client was aware that they had had a stroke and that they were finding it difficult to participate in therapy.

Therapy session

• Guided conversation on therapy and how therapists could help the client to help themselves.

Guidelines developed with the client (written in their own words and laminated so that they could be referred to in therapy sessions).

1. 'i want you to show me how i can help myself'.
2. 'show me what you need me to do'
3. 'tell me why i need to concentrate on something'
4. 'tell me how long i need to do something for'

Recommendations/ strategies that worked

• Ticking off completed activities.
• Keeping a written list of activities to be done in a session (clients reading was very good).
• Explaining the goals of each activity.
• Writing down key points the client made so that you can refer back to them to keep the client on topic using their own words.
• Reducing distractions.