I thought I’d share my experiences on this neuro placement in dealing with patients with dysphasias and language dyspraxias. I hadn’t encountered patients with these impairments before so communicating with them was initially very challenging. I got a glimpse into how difficult it is to perform a neuro assessment when there are language difficulties. I would read the speech therapists’ notes but was a little stumped on some of the terminology, such as “semantic cueing” and “phonetic cueing”. As the prac developed, I found myself with 2 patients for whom the physiotherapy treatment per se was fairly straightforward, but communication was somewhat restricted due to the dysphasias.
One patient had expressive dysphasia. For those of you who haven’t encountered someone with this, they present with a reduced vocabulary, and just really searching for words. “Yes... ah... Monday... er... My kids… and Josh.... er... hospital... and ah... Wednesday... Wednesday, nine o'clock... and oh... Thursday... ten… ten… o'clock, ah doctors... two... an' doctors... and er... teeth... yah”. His PT impairments were a loss of proprioception and light touch sensation to the (R) forearm and hand.
The other presented with speech dyspraxia, and possibly some underlying expressive dysphasia. It’s hard to tell as it is so masked by the dyspraxia. It’s frustrating for her because her mouth just won’t do what she wants it to do. And so most times she attempts to speak, all that comes out is “Ooaaoo”. Her PT impairment was largely a decreased exercise tolerance.
As you can see, both those patients did not really tax the intellect in terms of physio treatment. But communication was restricted, which lead me to wonder if I could pick up a few speech therapy skills to make my treatment sessions a little more multidisciplinary and to improve communication all round. With no idea on how to do that, I decided to seek some extra help. I took the step of requesting to go to a couple of language/speech groups run by the speech therapist. This group was attended by both dysphasia and dyspraxia patients. I did pick up a few communication skills including cueing. In case you’re interested, semantic cueing means cueing with nonverbal signs like moving a steering wheel for car, while phonetic cueing is helping out with the sound of the start of the word, eg. Going c-c-c-ca-ca to try and get car. I’m definitely no expert, but my confidence has increased!
The greatest achievement from this move though, was that I got to know the other allied health staff. They started calling me by name, chatting, informally discussing patients… I learned from this experience that it is definitely worthwhile seeking help from all members of the multidisciplinary team. Not only does it contribute to better treatment, but it can help to strengthen team dynamics and make it easier for members to approach each other in the future.
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