Sunday, December 01, 2002 6:52 PM

Dear Barbara

> My mother had a stroke 1 yr. ago. She has expressive aphasia and apraxia.
> She is in speech therapy at E. Stroudsburg, Univ. of Pa. It is free and for
> as long as we want. My question is, is there any reason to hope that she
> will recover some ability to communicate? I have seen little or no
> progress for many months and she refuses to do any 'homework", but is
> always ready to go. It is a one hour drive from our home twice a week.
> It is very difficult for me with a large family and a job, to keep this
> up, but I don't want to take away the only thing that gets her out, and
> may be the only hope she has. I need some advice and another opinion.
> I would appreciate any feedback you could offer.
> god bless
> robin

Dear Robin,

I think there IS reason to believe she may recover speech. In the Pathway to Recovery guide I explain that speech therapy does not work because of what I believe to be a certain "time frame" that work must be repeated. I believe, from my own observations, that whatever work is done on a given day, must be REPEATED within a 48 hour period of time, or the "doorway" that is being opened in the brain SHUTS. This is one of the Four Keys I talk about in the guide. All four of the requirements must be met before the conditions are met for repatterning the brain--the same conditions that my father had in his recovery.

She must make her alternate hand a "new dominant hand" in order to access language on the other side of the brain or through new pathways that route through the other side of the brain. I recommend getting the guide, because it is far to much to explain here.

I would continue with the therapy or return to it after you have begun working with her at home. She needs someone to work with her almost every day until she starts working on her own. (also explained in the guide)

We've had several people who were not responding to therapy who after they had started the home practice I recommend, suddenly start to gain their speech back. Ben Edwards is one such case. (See Ben's story)

If you haven't ordered the free mini guides, I can send those along too. But get the guide, I think you'll find the answers there. Also Lefty's Tracing Sheets would be excellent for her. She might not even feel too put out by tracing--it's rather pleasant exercise. Since these sheets are seemingly "too easy" to be doing anything, you need to explain how tracing accesses language in the other side of the brain. If that doesn't persuade her, tell her it is for her handwriting--tracing is wonderful for regaining that, at the same time, it is pushing the brain to work in a new way.

I am not a doctor, and I offer this information only for the purpose of education. I can't guarantee she will recovery any speech, but I believe there is still hope, if you are willing to help her. Many people like her have recovered at least some speech this way.

Hope this helps. If you have any other questions, feel free to email me.

Sincerely,

Barbara Dean Schacker

Hi Robin,

I wanted to respond further to your question the other day, but didn't have time. Not wanting to do "homework" is really a common problem. Getting her to use her alternate hand in whatever way you can is a start. If the "homework" does not combine the use of pictures and touching or tracing, it may do little good anyway. If using picture cards, have her touch the card with the index finger of her left hand when she tries to speak. If picture cards are not used, but printed words, try to find pictures to go with them. Printed words without pictures or using the sense of "touch" are routed to the damaged side. It's like trying to drive around with a flat tire. To get to the new tire in the trunk, (the other side of the brain), use pictures and touch, tracing or drawing.

My dad liked old cars, so I got him a book with lots of pictures and tracing paper. Those were some of his first tracings.

I made Lefty's Tracing Sheets so people would have materials to use.

Another note: from my experience it doesn't seem to matter whether or not the words that the therapist is trying to work with and the words you are doing MATCH. (It is helpful and might be more rapid recovery, but not completely necessary.) The brain seems to repattern in an over all way. If you get ONE word out of her, the chances of her being able to say another go up dramatically. Just be sure to repeat the words and tracings within a 48 hour period--if possible. If it doesn't happen, just keep going on the same ones.

Hope this helps.

Barbara

Sent: Saturday, December 07, 2002 12:04 PM

Subject: Re: aphasia

> Dear Barbara,
> thank you for your e-mail. they are exactly the kind of help I was
> looking for! Please share whatever you can, even tho' I may not be quick
> to respond. My life is very (and sometimes too) busy and hectic, with
> three kids at home and a job and my mom full time.
> I'm taking your advice to heart and looking for friends to help me with
> her follow-up therapy at home. I know that I cannot make a commitment of
> time and stick by it, but my friends can and will. the first two I called
> have said yes.
> My next step will be to talk to her therapist about my plan. Then I will
> talk to my mom, who may not jump at the chance, but I must start to get
> in the mind set that her good care is now for me to determine, not her,
> even though she is my mom. this is probably the most difficult. I must be in
> line with what God means when He says to "honor your father and mother".
> I believe that that is exactly what I am doing.
> this will be my last ditch effort to help her communicate. i will get the
> tracing book and see if we can get her to work and maybe she will be
> encouraged to try. At least it will get her out from in front of the TV!
> (something she almost never did before the stroke).
> Again, thank you and God bless you!
> You are an answer to prayer!!
> Robin

Robin,

That is great news! I have to say that your "last ditch effort" may have go last for a period of time. I tell people to do the drawing and tracing for up to two years. It took my Dad 1 1/2 years of work to say the first new word. He had learned to keep a notebook or sketchbook way before then and was doing the drawing and tracing mostly on his own. So once you get her started with this, she might be able to do most of this reinforcement work on her own--showing it to you and the therapist and getting your (or their) response to it later. It becomes like "their job". Think of it as about the same amount of time that a child takes to say their first word. (Though, of course, we don't treat them like a child.) It takes the brain that long to repattern and hook up new connections to unused areas of the brain capable of language. When you feel like "throwing in the towel" remember, you might just be a couple days or weeks away from making the breakthrough. On the other hand, you may be hearing new words in as little as two to six weeks. A few people, say their first new word the first or second time they use the "Sensory Trigger" or touch technique I used--touching the picture, clicking on the picture on the computer, tracing or drawing with their alternate hand. You can fit in the touch technique in little ways throughout the day. Hand her an apple and ask her "Say Apple". Get a deck of cards, have her touch the heart and ask her to say "heart", "king", "six", etc.

If you can make it as enjoyable as possible and tie it in with their interests or hobbies--that's a plus.

Best wishes for a successful recovery--we're praying for your efforts to be rewarded!

Sincerely,

Barbara

Sent: Friday, December 13, 2002 9:48 PM

Subject: Re: Lefty's Tracing Sheets

> Dear Barbara,

> I've started tracing with Mom. I started with a,b,c, all 5 senses, 2

> opposites and 3 feelings. we have done them 3 days in a row. Some things

> she can say, but not consistently. Her tracing is quite good. I have

> discovered that she can still draw! I asked her to draw a few simple and

> she could get them from her brain to her hand. Not like talking or

> writing. She can write if she can copy something, but she can't get it

> straight from her head to her hand. So seeing

> her draw was encouraging to me.

> My question is , how long should we stay with the same pages before we go

> on to some more? do I wait until she can do them right every time?

> right after our 'session' I put in one of her Gaither videos ( which she

> hasn't had much interest in since her stroke) and encourage her to sing

> or hum with them. This is her new routine, which gets her away from

> television and gets her mind on something else, hopefully stuff that will

> give her a chance to recover.

> than you for the hope!

> God bless,

> robin

Dear Robin,

It sounds like you are off to fine start! I would say that if you want to go on to another set of things you could. Then since you seem to be working with her every day you could alternate the two sets for awhile. You could then go on to two new sets and alternate them for 3 or 4 days. Then go back and see how she does on the first two sets.

If she can help you pick out things to do then great!

Are the words she saying now with the tracing sheets NEW words for her--was she not able to say them before? If so, THAT IS FANTASTIC news! That means it is working! Just keep going--there will be words that are more difficult for her than others and you just go on. The more words she can "stockpile" the closer she comes to making a real breakthrough.

Getting her away from TV is a very good idea. You are doing the right thing with that. The singing is also excellent! What are these tapes you mentioned?

Keep up the good work!

Barbara

Sent: Saturday, December 14, 2002 5:46 PM

Subject: Re: Work with Lefty's tracing sheets

> Dear Barbara, My mom likes to listen to the Gaithers, they are a down
> home gospel family. She has lots of their videos from before her stroke,
> so /she is watching them again and listening and trying to sing. today
> is Saturday and the first day I will not be able to do her tracing with
> her. Will that be harmful to the continuity? I know there will be times
> when I just can't do it every day, especially weekends. What do you
> think?
> robin

Dear Robin,

Don't worry about missing a day. The 48 hour repetition is a guideline. You could easily miss a day without doing any loss of progress at all. What happens is that after 48 hours, each day the memory patterning degrades or gets a little weaker. So on the third day it is weaker, but not completely gone. After that, you start to go back to where you were before. So you are kind of starting from that previous point. Further on down the road, I believe the patterning builds a stronger network, so losing days here and there have less of an effect than in the beginning. I know that my father had several times when he was sick with the flu or with drug toxicity and couldn't do anything for a week or two, but each time he would go back and start again with tracing and drawing and it would come back to him.

Toward the end of his life, all he had to do was to continue to do art in order to maintain the words he had--his 700 word vocabulary. Sometimes I wish I had urged him to keep trying to learn new words. With what I know now, I could have had him talking much more than he did, but my mother was not well and she would have had to do this with him. (I lived in California, then.) It just wasn't possible. Anyway, he was very satisfied with his recovery. So I just accepted it and let it be.

So don't worry about losing a day! It will be all right. Just go back to what you were working on the last day you worked with the tracing sheets. It will be just fine.

Sincerely,

Barbara

Sent: Sunday, December 15, 2002 5:17 PM

Subject: Re: Another thought

> Dear Barbara,
> Thanks for your advice.
> I wish I had a scanner, because yesterday, although I couldn't do the
> whole routine with Mom, I did write out about 20 different words on a
> large sheet of paper and asked her to draw what I wrote.( she can read
> just fine). When I came back she had drawn every word very clearly. My
> son was watching her and saying "Wow, Granny, you draw better than I
> can!" I would love to send you this page!
> I am curious to know if she could draw to communicate or would she only
> be able to draw something on command, like she did yesterday. She can
> write well, but only if she can see it, not straight from her brain. I
> wonder if it will be the same with the drawing.
> Anyway, I am still encouraged, and she has been very willing to work so
> far. Let's see in a few weeks or so if her attitude changes. right now I
> am just grateful that she will do something.
> robin

Dear Robin,

I just realized something else, I should have mentioned before.

At some point your mother my be able to do drawing or tracing on her own. My father drew pictures and wrote in his notebooks when I was not there and Mom was too exhausted or depressed to do anything with him. He did this all on his own, with his own determination. I think your mom might get to that point too, especially because her tracing quality is so good. Does she seem to enjoy tracing and drawing? I have a feeling she likes this and is going to be able to do it on her own at some point.

This will give you some break time. It is important for you to have "time off" and "time away" so you can rejuvenate yourself. Please don't feel guilty about taking care of yourself. That's just as important as taking care of her!

I can tell you are doing a great job with this!

Sincerely,

Barbara

Sent: Sunday, January 26, 2003 4:52 PM
Subject: a new breakthrough


> Dear Barbara,
> I do believe that we have witnessed a breakthrough for my Mom this week.
> We were working on tracing and I asked her (just for the heck of it) if
> she could write her name. She picked up her pencil and wrote her first
> and maiden name without hesitation. Then I said how about your married
> name? She couldn't remember at first, but when I told her what it was,
> she wrote it down perfectly! the wonderful thing about this is that since
> her stroke on Dec 2 2001, she could not write anything without first
> seeing it and copying it, including her name. She couldn't get anything
> straight from her brain to the paper. Now she can write her name without
> a second thought. Of course, she can't write mine or anyone else's, but I
> still feel that this is a big thing and I told her so. the next day
> something just as fantastic happened. She was trying to tell me something
> , but could only get out jargon. I finally told her to pick up a pencil
> and paper and draw what she wanted to say.(She can draw quite well, even
> with her left hand). Well, I went to do something else and came back to
> have her hand me a paper. On it was drawn four round objects and next to
> them was the word "haven't" written perfectly, apostrophe and all! The
> message was clear she hadn't had her pills! I was almost in tears with
> her looking at me like I was nuts. I tried to explain to her that this
> was something she was not able to do in over a year and that it was a
> wonderful thing.
> We start back at the college for speech on Tues. I have already talked to
> her clinician and she wants to see what we have been doing and will
> welcome our working together. This thrills me!
> I hope you see it as a breakthrough, too. and Thank you again and
> again! God Bless!
> Robin

Dear Robin,

This is indeed a breakthrough! You have reached a new "threshold", a new
level! The fact that this is spontaneous is especially significant. It
means that now she can initiate communication through drawing and writing and
that her language-motor system is starting to function. You are following
the very same pattern that lead to my father talking again. It may be a few
months away before she says her first clear spontaneous word. She may stay
at this level of drawing and writing spontaneously for awhile before the
speech develops. Her mind is now working in a different way. The
"patterning" from the tracing is building up and is working!

I am so excited about this. You are doing a fantastic job, Robin. You are
intuitively knowing what you can do with this process--and try new things
"just for the heck of it". Another big step. She is also emotionally healed
enough to handle the little challenge of this. Keep giving her little
things to draw out. Memories or ideas that come to you, whatever is in the
moment. Maybe old photographs would stimulate her to draw out some idea.
Every time you do something new and she writes down a word, she is building
up the patterning for speech to attach to.

This is such good news. I would like to share it with others on the web
site. It is this step by step progress that is the "pathway to recovery".

I'll be happy to work with her therapist when she goes back to therapy. You
may find ( and we will hope and pray) that therapy works better now. Keep
going! You're both doing great!

Sincerely,

Barbara Dean Schacker

Sent: Monday, March 24, 2003 1:55 PM

> Dear Barbara,
> Thank you for the drawings. I printed a lot out and my mom is
> tracing them. She is beginning to work independently sometimes. I can't
> seem to get it through to her, though that we are working to get her left
> hand working like her right hand once did. She will give up if she can't
> say the right word. This is a problem when she has to work on her own,
> because I can't be here to cue her. My question is: If she can do the
> tracing independently, should we not worry about whether she can say the
> word at this time or not? She can sometimes say words with me cueing her,
> but I want her to be able to do this stuff on her own so that when things
> get busy for me , I know she is not just going to give up on herself. We
> are not seeing any great or fast progress right now, but that does not
> worry me. I know that it may take a long time and it has only been since
> Dec that we started.
> Thank you for your continued support and encouragement!
> God Bless you,
> Robin

03/24/03

Dear Robin,

It's great to hear from you! I'm happy you like the drawings. I don't
think that it is a problem if she can not say the word or the right word
with the picture. My father spent hours drawing and tracing on his own and
I don't think that it hurt his progress. Mother and I could not always be
there to say the word. He actually developed a liking for this time drawing
and tracing by himself. Trusting him to be alone and not hovering over him
all the time (as we were tempted to do) helped him become independent. The
important thing is being motivated to work on her own, learning the patience
and not giving up.

This brings up something that I never really realized before. I believe
that the brain is still imprinting the word and repatterning even if she is
not speaking. In fact, I think that it is good to have some portion of time
doing this silently and not trying to talk. I think that making the effort
to talk brings in a whole other brain patterning. It is almost like this
silent work needs to happen before the effort to talk takes place. Doing
just the tracing or drawing is like developing the pattern underneath it
all--laying the foundation that builds up and is waiting there to be tapped,
so that when you then add the effort to speak, it just comes out
automatically.

Also, writing and drawing is valid in itself as a form of communication.
There are many paths to recovery. One person might readily talk more as
soon as they start tracing. Another person will get the hand fully
functioning and only after it is fully functioning, they will pop out their
first new words. It strikes me that your mother is following the pattern my
father took almost exactly. Remember, his hand writing became very neat and
more fluid first and he wrote words to communicate first. His reading came
back and he started to read more and more on his own and understand more and
more from this. Then finally, after a year and a half, his first
spontaneous words and writing came. Your mom is actually doing better than
he did! She has already written a spontaneous word!

Don't be surprised if there is a long pause between this first spontaneous
written word and the next one. (I can tell from what you said that you are
not worried--This is good.) Also, is she saying some words but they aren't
exactly what she wants to say? I would say that if she is saying anything,
she is doing phenomenally well! As she gets more and more control of her
hand, she will be also get closer and closer to saying what she wants to
say. The two go together.

You are doing great, as usual. Just keep going.

Best regards,
Barbara

P. S. Tell her it is OK to just trace without trying to talk. Read my letter to her.

Tell her I said she is doing REALLY WELL!

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