kathryn kilpatrick, m.a. ccc communication connection · 2019. 8. 22. · elastic shoe laces sock...

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Kathryn Kilpatrick, M.A. CCCCOMMUNICATION CONNECTION

Speech and Language PathologistGeriatric Life Enhancement Consultant

www.connectionsincommunication.com

[email protected]

2019 Communication Connection Kathryn Kilpatrick 1

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mailto:[email protected]

7/26/2019

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➢ Stroke kills about 140,000 Americans each year—that’s 1 out of every 20 deaths.

➢ Someone in the United States has a stroke every 40 seconds. Every 4 minutes, someone dies of stroke.

➢ Every year, more than 795,000 people in the United States have a stroke. About 610,000 of these are first or new strokes.

➢ About 185,00 strokes—nearly 1 of 4—are in people who have had a previous stroke.


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➢ Stroke costs the United States an estimated $34 billion each year.

This total includes the cost of health care services, medicines to treat stroke, and missed days of work.

➢ Stroke is a leading cause of serious long-term disability.

➢ Stroke reduces mobility in more than half of stroke survivors age 65 and over.


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❑ to make choices❑ to have a sense of purpose❑ to reminisce and be listened to❑ to know truth❑ to be comfortable❑ to be touched or be left alone❑ to laugh/ to cry❑ to express anger❑ to have connectedness ❑TO HAVE MEANINGFUL ACTIVITIES


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Just learning to live with

it is not good enough

You must for the sake of all

conquer the situation by working

toward a solution to as full a

healing as possible.

Physically Emotionally Spiritually


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➢ Aphasia is an acquired communication disorder that impairs a person’s ability to process language, but does not affect intelligence.

➢ Aphasia impairs the ability to speak and understand others, and most people with aphasia experience difficulty with reading and writing.

➢ Head injury, tumor, other neurological causes can cause aphasia


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➢ For almost all right-handers and for about 1/2 of left-handers, damage to the left side of the brain causes aphasia.

➢ As a result, individuals who were previously able to communicate through speaking, listening, reading and writing become more limited in their ability to do so.

➢ The most common cause of aphasia is stroke, but gunshot wounds, blows to the head, other traumatic brain injury, brain tumor, and other sources of brain damage can also cause aphasia.


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If symptoms last longer than two or three months, complete recovery is unlikely

◦ People continue to improve over a period of time

◦ Slow process for both patient and FAMILY

◦ Need to learn compensatory strategies for communicating


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More than 1 million have acquired aphasia

More people have acquired aphasia than the number of people that have cerebral palsy, multiple sclerosis, Parkinson’s disease or muscular dystrophy.

Approximately one-third of the severely head injured persons have aphasia

Not about recovery from aphasia – recovery with aphasia


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Global – severe receptive and expressive aphasia

Broca’s Aphasia - Nonfluent◦ Understanding is better◦ Halting and effortful speech◦ Telegraphic

Wernicke’s Aphasia - Fluent◦ Severe auditory comprehension problems◦ Double talk◦ Talk nonstop◦ Jargon or irrelevant words◦ Severe deficits in reading and writing


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Most severe form

◦ Produces few recognizable words

◦ Understands little or no spoken speech

◦ Can neither read or write

Usually seen after patient has suffered a stroke

May rapidly improve if damage not been too extensive

Greater brain damage, more severe and lasting disability


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➢ May be able to carry on normal conversation

➢ May have trouble understanding language only when it is long or complex

➢ May have some trouble finding the words they need to express an idea/explain themselves, orally or in written form

➢ May have word finding difficulties➢ On the tip of the tongue➢ May be able to gesture or point


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Damage to the temporal lobe - also called fluent aphasia

May speak in long sentences that have no meaning, add unnecessary words, even create new "words."

They may say, "You know that smoodle pinkered and that I want to get him round and take care of him like you want before," meaning "The dog needs to go out so I will take him for a walk."

Usually have great difficulty understanding speech

◦ Are often unaware of their mistakes.

◦ Usually have no body weakness since injury not near those areas.


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https://m.youtube.com/watch?v=3oef68YabD0

https://m.youtube.com/watch?v=3oef68YabD0

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Speech output severely reduced

◦ Limited mainly to short utterances of less than four words

◦ Vocabulary access limited

◦ Formation of sounds often laborious/clumsy

◦ May understand speech and be able to read but limited in writing

◦ Halting and effortful quality of speech


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https://m.youtube.com/watch?v=JWC-cVQmEmY

https://m.youtube.com/watch?v=JWC-cVQmEmY

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Impairment carrying out purposeful movement

◦ Cannot perform expressive gestures on request (limb apraxia)

◦ Affect oral, non-speech movements (facial apraxia)

◦ Impaired in the voluntary production of articulation and the rhythm and timing of speech – highly inconsistent errors (apraxia of speech)

◦ Often have automatic speech


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https://www.youtube.com/watch?v=bZ7pnmd9UHI

https://www.youtube.com/watch?v=bZ7pnmd9UHI

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Disorder of speech production resulting from weakness, slowness or incoordination of the speech mechanism due to damage to a variety of points of the nervous system.

Errors often highly consistent

Difficulty being understood but language can be intact

More problems when tired.


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https://www.youtube.com/watch?v=SriryvkbU9c

https://www.youtube.com/watch?v=SriryvkbU9c

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◦ Problem with speech and language

◦ Problems in comprehension

Do not overestimate understandingof speech

◦ Explore non-verbal communication

◦ Behavioral style

Slow and cautious

Disorganized when attempt new task


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Unaware of deficits Often more difficult to care for self◦ Often problems are more consistent and severe◦ Often appears uncooperative, unmotivated, overly

dependent or confused, emotional Difficulty with spatial/perceptual tasks◦ Trouble judge distance, size, position◦ Often overlooked especially if communication

is good


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Lose place – reading and math issues

Impulsive behavioral style

Poor judgment – try to do things not within their abilities

Rapid movements, noise and gestures can complicate comprehension

Needs frequent verbal cues/ tasks broken down


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Right Neglect Left Neglect Things to consider◦ Where put items◦ Confused return same corridor◦ Problem see all of message ◦ Reading and writing


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Injury to brain not eyes

Not fixed by glasses

Skip lines

Spatial disturbances

Visual background issues


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Swallowing issues◦ What are the symptoms?◦ Oral pharyngeal exercises◦ Swallowing guidelines◦ Safety techniques◦ Meal preparation◦ Fear factor◦ Adequate nutrition◦ Changes in status◦ Quality of life


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Red flags◦ Aspiration pneumonia

◦ Clearing throat

◦ Cough on certain foods/liquids

Diet modifications◦ Liquids – nectar, honey, pureed

◦ Solids – regular, mechanical soft ( and modified meats etc.), pureed

Swallowing guidelines

Other recommendations/concerns


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Communication

Physical limitations

Activities of daily living

Hobbies

Environment

Support system

Finances

Other diagnoses


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Hearing Vision Educational Background Occupational History Leisure Activities Medical History Motivation Support System


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Prior level of functioning

◦ Normal aging changes

◦ More severe

Issues with hearing

Caregiver limitations

Prior diagnosis

Daily concerns and reminder support

Adjustment and needs not recognized initially


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RECEPTIVE SKILLS - LISTENING

objects

sentences

commands

longer information


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RECEPTIVE SKILLS – READING

matching

words

sentences

longer information

complex information


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EXPRESSIVE SKILLS - VERBAL automatics repetition naming function answer simple question longer sentences complex and abstract information


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EXPRESSIVE SKILLS - WRITTEN

automatics

copy

words – phrases - sentences

longer sentences

complex and abstract information


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Math skills

◦ Handling money

◦ Time concepts

◦ Checkbook

◦ Bill paying

◦ Exploitation risks


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MORE THAN HOME SAFETY CHECK - QUALITY OF LIFE

EATING/KITCHEN◦ Utensils◦ Meal preparation

Toaster/microwave/mini chopper◦ Special tools

Jar opener Bowl holder 1 handed can opener Paring boards ALIMED.COM


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HOUSEHOLD

◦ Doorknob extension and grips

◦ Touch lamps – converter

◦ Build up scissors

◦ Build up key holders

◦ Long handle sweepers - dusters - mops


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DRESSING

◦ Buttons aids

◦ Zipper pull

◦ Elastic shoe laces

◦ Sock aids

◦ Long handle dress stick

◦ Shoe horns


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PERSONAL CARE

◦ Build up toothbrush

◦ Denture brush

◦ Nail clipper

◦ Multiple use lotion and medicine applicators

◦ Reachers


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BATHROOM◦ Most accidents◦ Bath seats – transfer benches◦ Raised toilet seats – safety frames◦ Tub and wall grab bars◦ Long handle bath sponge◦ Handheld showers◦ Water temperature settings


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Secure floor coverings Cover holes Throw rugs Avoid wax Free pathways Loose steps Secure stair pads Check handrails Widen door Couch on blocks

4 inch foam – raise mattress Plastic tablecloth over

mattress Programmable phone Cell phone as go around the

house Life line Hospital bed Incline wedge Bed board – sagging


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Smoke detector Read surface incline Anti slip fabric – plates Fat pan Read glass Commode Armchair – pillow back Firm cushion elevate Support affected arm

Handicapped sticker Bell – baby monitor Easy light on by bed Set up the environment Insulated mug Bath tub seat Calendar Log book Raised toilet seat- safe

bars


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Emergency situations

Kitchen

Bathroom

Driving

Finances

Walking

Yard work

Hobbies


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Building on their strengths

Regular practice

Development of compensatory strategies

Training caregivers

Reassessment as needed

Use of augmentative communication devices


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Hearing aid evaluation/instruction Amplification devices Develop compensatory strategies Family education and written instructions Safety devices – phone, doorbell, alarms, etc. Local organizations and catalogs Answering machine Amplified phone Fax machine - texting


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Safety Checklist

Family education

Written instructions

Large print materials

Sight center referral

Catalogs

Safety devices

Talking book program

Reading glasses

Layout of home with visual neglect

Lighting issues

Remote control adaptation

Equipment


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Introduce topic with a single word or short phrase - then provide more details

Speak slowly and loudly

Pause frequently

Check with the listeners to make sure that they understand you

Limit conversations when feel tired

Use other options

◦ Point or gesture - Try again later - Use A to Z chart


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Talk to the person as adult NOT child Give them time to talk and permit a reasonable amount of

time to respond Accept all communication attempts Keep your own communication simple but adult Simplify sentence structure/reduce your rate of speech Encourage◦ Speech/writing/drawing/yes-no responses


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Keep your voice at a normal level and emphasize key words Augment speech with gesture and visual aids when possible Repeat statements when necessary Do not attempt to finish the person’s statement

for them Minimize or eliminate background noise Have the person’s attention first Encourage and use all modes of communication Create a communication list


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Medical information sheet Contact information Baseline information for MD or EMS Lifeline GPS tracking Phone

◦ 911 (also alert EMS)◦ Large buttons – speed dial – pictures – cell phone◦ Answer machine

Buzzer - apartment


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◦ Guideline list of strategies

◦ Overview of medical information

◦ Memory notebook

◦ Communication Chart

◦ A to Z chart

◦ Oral spelling

◦ Finger spelling

◦ Communication device

◦ Main idea

◦ Strategy checklist

◦ Communication devices assessment


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Simplification of reading material

Areas of interest - suggestions

Catalogs – picture books - magazines

Strategies and written suggestions

Guide cards

Books on tape - Talking book program - Bible on tape

News programs – sight center

Family recording stories


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Large pen - assess which easier

Print non - dominant hand

Signature template

Simple puzzles

Grocery list

Messages

Cards and notes


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❑ Family conference - responsibility❑ Practice materials - assess interest❑ Assist at needed level❑Caregiver notification

❑ Bill payment – with assistance❑Prior patterns

❑ Template for spelling for checks❑ Use of calculator❑ Financial power of attorney


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Simplify presentation Do not jump from item to item Reduce distractions in environment Verify information Write out details Repeat – Repeat – Repeat Demonstrate Reassure and educate caregiver 2 word choices and yes/no options Look for red flags – referral


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Provide educational materials

Emotional lability

Depression – what to look for

Medication – keep records

Ways to structure environment

Modification of presentation of information

Observation of triggers

Plan for prevention of future episodes

Sharing information

Setting boundaries


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Wait and allow them time to speak. Resist the urge to answer for them. Learn what they find to be most helpful.

Do not shout and restrict the distracting background noises.

Encourage different ways for getting the message across –gesture, draw, write and spelling may be options.

Check in - is message is being understood?


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Do not jump around/topics

Simplify

Assess situation and triggers

◦ UTI

◦ Dehydration

Adapt communication

Calendar/Memory Board

For appointments

One calendar

Large print

One day at a time


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Give permission to ask/cue them to speak up or repeat

Reduce distractions

◦ Pay attention to the speaker

Let them know when you have difficulty understanding them

Repeat the part of the message that you understood so that the speaker can verify or repeat. May do yes/no questions.

After unsuccessful repeated attempts, have the speaker write their message to you if able – key word or draw or gesture


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What was the relationship prior to stroke? What is their support system able to do? How can they best make the home safe and functional? What resources can they utilize? What do they qualify for?

What about an emergency plan? Caregiver respite part of the discharge planning It becomes an issue of choices based on the reality of the

situation


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Friends know each other’s personality Friends do things together Friends communicate Friends build self esteem Friends laugh often together Friends are equals – learning is a two way street Friends work at the relationship


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Ways to improve socialization opportunities

Suggestions that are practical

To be able to think over the choices

To be asked how they are doing

Sensitivity to their schedules and routine

Less complex systems

Accessibility to the MD and health care professionals

Helpful resources

Alternative health care information


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Caregiver burnout diminishes quality of life Burnout decreases compassion and patience Stress increases with isolation and inability to ask for help Permission to simplify Create a list of ways others can help

◦ Little Things◦ Personal Assistant◦ Groups◦ Financial◦ Practical gifts


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Normal aging◦ Word finding

difficulties◦ Slower to process new

information◦ New learning takes

longer◦ Do not like to multitask

Stress related◦ Depression ◦ Worry◦ Pain◦ Chronic Illness◦ Poor nutrition◦ Lack of sleep◦ Lack of exercise


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Saying yes to support/help Support groups ( include Stroke Clubs)◦ online options

Respite options◦ adult day

Companion Services◦ Churches◦ Faith in Action◦ Fee for service


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More than the services provided

Organ of vision is the heart

Helping them process the next part oftheir life◦ Do not take away their hope

Cannot let our goals and agenda restrict how we show up

Meet them where they are ◦ Learn their story


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Older adults are less tolerant of meaningless activities - Increases with aging

Stories are a confirmation of the person’s life experience

Finding the thread that connects◦ Strengthens social relationships

Simple events of past give continuity and context to life

Strategy for memory enhancement

Elicits more verbalization

Increases opportunities for family involvement


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What could they do?

What do they want to do?

What is safe for them to do?

What needs assistance?

What needs supervision?

What works the best?

What gives them enjoyment?


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Boredom is a an issue

◦ Trouble initiating activity

◦ Cannot do without assistance

◦ Had no previous hobbies

Caregiver overload is a factor

Provide resources

◦ Home companion services

◦ Volunteers

◦ Community programs2019 Communication Connection

Kathryn Kilpatrick 65

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FOCUS – what pleases them and your connection with them?

Maximize preserved abilities

◦ How can the activities be modified?

What can be done if set up for them?

What can they do together?

Share what works

Explore new interests

Your ATTITUDE is key!!!!!

CREATE THE OPPORTUNITY BUILD ON WHAT WORKS


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Too often we underestimatethe power of a touch,

a smile,a listening ear,

an honest complimentor the smallest act of caring…all of which have the potential

to turn a life around.


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Jill Bolte - Taylor Stroke of Insight

Communication Connection◦ www.connectionsincommunication.com

Sample worksheets, blogs Privation Geriatric Life Enhancement Consultations

National Aphasia Association www.aphasia.orgSTATE AFFILIATES - CONTACT FOR LOCAL RESOURCES

Brain Injury Association of America www.biausa.org American Speech Hearing and Language Association www.asha.org


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http://www.aphasia.org/

https://www.npr.org/2015/02/20/384949665/how-can-a-stroke-change-your-brain

https://www.npr.org/2015/02/20/384949665/how-can-a-stroke-change-your-brain

kathryn kilpatrick, m.a. ccc communication connection · 2019. 8. 22. · elastic shoe laces sock...

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