Sunday, August 30, 2009

5 myths about aphasia

This will be a 5-part series about misconceptions or poor information that some folks have received or have given to others. I hope with these postings to help both caregivers and persons living with aphasia to get a better understanding about aphasia--knowledge is power.
For this first piece, I'd like to address the concept of the every-dreaded "plateau".
I'm betting that almost each and every one of you were told at some point that you were no longer going to receive treatment because you had reached a "plateau" (don't take that bet, I know I'm right!). There are a few elements that contribute to this phenomenon. The primary force is the insurance company, because the facility needs to get paid to see you. The insurance company will authorize so many visits for therapy, and then that's it. You can fight for more visits, but your therapist must be on board with this by showing your progress in therapy. The insurance wants to make sure that your visits are 1) medically necessary and 2) that you have been showing progress and that 3) there is a reasonable belief that more therapy would show more progress. This is where it is very important for your speech therapist to present the data.
The speech therapist is the second force for therapy discharge. Your therapist may have more or less run out of ideas or ways to help you. They are bound by hospital rules, insurance rules, and ethics rules. An easy way to change the "plateau effect" is to change the goals or that way those treatments are administered, but this doesn't often happen in these settings for a multitude of reasons.
I say that this plateau is a myth in aphasia because I have always believed and practiced therapy that is designed specifically for each individual. If I am working with you and the evidence is that we aren't "making progress", then I need to change my approach, because what I'm doing isn't working. Saying that you "can't go any further" puts the responsbility on you. Maybe I need to do more in-depth testing for a particular function (e.g., reading) that is complex, or perhaps what I thought would work doesn't work. If I continued to try to teach you something that wasn't working, then yes, you would "plateau". BUT, if I change the way I do the treatment, then perhaps we can find the key to unlocking your individual processing. You may never have been a person who used his hands or face for gesturing and facial expressions before your stroke, so could we get much progress if we try to teach you to do this after your stroke? If we try it a few times and it isn't working out so well, then we need to go to Plan B. Then Plan C. Then... you get my point. My bag of tricks expands on a daily basis.
So, the point of today's blog is to tell you--don't accept that you have reached a "plateau". If you are told upon discharge "Maybe we can re-assess you in a month or so if you've made progress", then ask that professional what their reasoning is for this comment. Do they really believe that if you don't have therapy for a month that you will get better during this time so that you can come back and "make progress"? That doesn't make any sense. If you can get better all by yourself, then why are you coming to therapy? You can continue to make progress and continue learning even years after your stroke. Don't stop trying and get advice from as many professionals and support groups as you can.