Hi all,
I begun a neuro outpatient clinic this week and just wanted to share some experiences to date with aphasic patients and maybe seek some solutions to communication difficulties.
A couple of my patients have suffered (L) TACIs with one of the impairments being aphasia (both receptive and expressive). Being the first session with the patients I have found it very difficult to communicate and establish that rapport that you need in the beginning. One 44 year old gentleman in particular was very frustrating. He had been coming to the clinic for 6 months and had established a long file of notes. In the file it mentioned his aphasia (mainly expressive) but did not mention his communication book that helps him to communicate. In the first session whilst he was on the tilt table, I attempted to start up some conversation and I could see that he was keen to communicate. I could understand much of what he was saying but I could also tell that there was much more that he wanted to say but just couldn't. I could see he was getting frustrated and often resorted to the loud expletive 'f#*k' every 10 sec or so. He kept on pointing to another room where he had left his bag, but I didn't think anything of this. Eventually I went and got his bag and he pulled out a communication book with pictures of varous aspects of his life. This immediately broke down much of the communciation barrier, and I started posing many questions related to his favourite football teams, family, former occupation etc. He became less frustrated and we had a great session with plenty of laughing.
On detailed examination of the notes it did mention the book earlier on but this was not really highlighted. So, what I learnt from this was experience was how important it is to thoroughly read the notes and put this information regarding the book in future transfer summaries. Also from my experience to date with these patients, I have often found that if you give them time to respond they can usually communicate what they want to say. I know one of the solutions to effectively communicating with these patients is to pose only closed questions to them, but are we as Physios denying them a chance of developing their communication skills?. If you have the time (such as when the pt is on a tilt table) then just be patient. It would be interesting to get some more ideas from a 'speechie' on this, so if anyone has sat in on a session with a 'speechie' and an aphasic patient please let us know.
Cheers
Nico
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1 comment:
Hey Nico, it’s my first week on my neuro placement and I’m also working with a patient with aphasia. The notes from the medical staff indicate that the patient is both expressive and receptive aphasic. I don’t have a lot of experience with patients with perceptual disorders, so similar to your situation, I too am finding some difficulties conversing with my patient. The difference between our two patients would be that my patient is acute and thus does not have any strategies in place as of yet. What I’m finding is that if I stay away from abstract verbal communication and stay focused on more concrete ideas, the patient is able to answer questions correctly and thus seems more comfortable and relaxed. Also the use of demonstration and guidance has been useful. I didn’t even notice that I was using non-verbal strategies until having a discussion with my peers. I guess your blog asks a hard question as I think that even though patients have similar diagnoses, they will present with different deficits in understanding or expression. So even though there are suggested communication strategies for patients in this category (i.e. demonstration, short concise instructions), as it seems with every placement, I think with more experience we will be able to recognise which strategies are most effective for our patients. Enjoy your 2nd week.
Gareth
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