The Aphasic patient

I'm on my neuro placement and dealing frequently with acute stroke patients. I have one patient who has had a (L) MCA and as a result has global aphasia. I didn't anticipate the extent to which it affects communication. I knew that it would be more challenging but there's just no point explaining much at all. I've found that the whole approach to Rx changes because of the patient's response. The scans have also showed some frontal lobe involvement so in addition to the communication difficulties we also have to combat the behavioural changes.

I'm amazed at how much he has improved over the last week in terms of communication. Whe we first saw him all he could say was 'yes' and 'no'. Now he is beginning to form proper sentences and is able to comprehend 2 stage commands. I struggled for the first few Rx sessions to communicate and thus treat this patient because I found we were so used to explaining everything before we did it we ended up confusing the patient. We would go throught he entire plan of what we wanted him to do and he wasn't able to communicate to us that he didn't understand. He would begin doing the right movement but soon got lost and ended up doing something completely different.

It was a challenge to change the approach to Rx but after a few days we worked it out. Now we only give one command at a time and luckily he has adequate motor control and strength to do most tasks. For example, he is able to 'stand up' on command and all the support he needs is minimal assistance to control his weaker knee. We've learnt not to talk so much and let our hands guide his movements. Demonstration of the task is useful and the use of mirrors works quite well. I never realised how challenging it would be to treat someone with global aphasia and the amount you have to adapt the approach to Rx. Through this experience i have become alot better with the use of manual contacts to guide the movement and the ability to communicate with only keywords of the task.