Apraxia is a careful diagnosis.&nbsp; I am certain that they were diagnosed correctly.&nbsp; As a speech-language pathologist, I would want to know what kind of damage was sustained, I would need to know if it was a hemorrhagic event or anoxic event.&nbsp; What kind of damage was there? What hemisphere?&nbsp; Was it diffused or is it focal? For example, if the imaging shows you that it's a left frontal lobe damage, that would go hand in hand with the diagnosis of apraxia.&nbsp; If they exhibit behaviors like groping or inconsistent errors or importantly, if they’re able to imitate.&nbsp; The number one most important thing is if your child is able to imitate the sound that family members are giving them. If they can repeat, that's a really good positive prognosis.&nbsp; That's something that I would say might not be of an apraxia type of origin.&nbsp; So number one is to get the right diagnosis. Let's say we know it is apraxia. We’d start with visual sounds - they're called bilabial - so that would be sounds like “ba”, “pa”, “ma” - something that you're producing with the front of your mouth. After the individual masters the bilabial sounds, we go into the alveolar sounds.&nbsp; That means t's and d's and s's and z’s - so we're going back in the mouth where it's less visual.&nbsp; So you could say “tie”, “tee”, “top”, “door”, things like that. After the individual masters alveolar sounds, you go further back in your mouth and start with the velars. which is “kuh”, “the”, etc. Everything that speech language pathologists do to treat apraxia is really structured, and consistency is key.&nbsp; It can feel very robotic in nature, but it’s effective because you're retraining by taking the sound classes and building and applying to the other words.

Great to hear he is making steady gains! Try to start with bilabials, then move the sounds to alveolArs, then velars. Singing helps:) I'm sure you already know that. Best of luck, and it was a pleasure.

speech language pathologist

Thank you so much for answering. My son was kicked by a horse on the left side of his  cheek right where you feel the cheek bone, across to his ear. It was a diffused injury. He was left handed before the accident and they said that might be beneficial but that his speech woul most likely be the last thing to return. He has made a remarkable recovery per his neurosurgeon but he still has a long way to go. We know for sure that his speech problems are motor related but everything points to apraxia from what I've researched as well. His cognitive skills are great, right side hemiplegia/weakness. He is only making vowel sounds and N,M and G sounds usually but cannot imitate the same sounds that we say. He tries so hard but you can see that the conn is lost. Thank you agai!

Answer transcribed from the <a style="background-color: rgb(255, 255, 255);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: This is really difficult, especially with a seven-year-old because he probably wants to communicate and talk and say all the things that are going on in his world. Very frustrating for you as a parent because you might not always know what your child is trying to communicate. I would definitely consult his speech-language pathologist first. I don't know the background of your son’s case - apraxia has different levels of severities and treatment.&nbsp;But as a speech-language pathologist, my goal for treatment typically is to help someone achieve their highest level of independent functioning, whether it's communication or language or swallowing. We want to make someone as independent as possible to participate in conversation and communication with others. My thought, without the background information, would be has your child trialed any AAC devices (augmentative and alternative communication)?&nbsp;Is he able to gesture or sign?&nbsp;You can train using a communication board or a low-tech or high-tech communication device - those are all options that don't necessarily replace verbal communication, but can help to support communication. You may also find that he can verbalize more when he hears that model first from a high-tech communication device - to be able to repeat it. Low-tech can be pretty much anything.&nbsp;It might be a piece of paper with a yes and a no on it - so being able to point to yes or no to answer a question. For high-tech, there are a variety of companies that produce communication devices. Usually an iPad or a tablet that has built-in software for communication.

Speech-Language Pathologist

He is seven and almost a year out from his severe TBI.&nbsp; He can say mom, dad, and hi.&nbsp; He tries so hard but it's not coming easily for him.

What can I do to help my son with apraxia?

Thank you for the question. May I ask what type of injury? That would lead me in the right direction to answe. is there voicing? How is his comprehensio? respiratory status? Looking forward to your response.

First, like Mrs. Mayya, it would be helpful to know what type of injury he suffers from. Secondly, assuming his vocal chords are fully healthy, the only other possible physical disablement that may be causing him to not speak would be his breathing and lung capacity. However, if that's alsi fully functional and his lack of speech is purely voluntary, an unwillingness, then there's only two things I could suggest. (1) The first, less aggressive, approach would be to simply play some music he likes and sit in the room with him and start singing along. This would encourage him to start singing as well, and that would work as a way to get him to restart using his vocal chords, but without any obligation. That is,  just by singing along, his words don't have any "consequences", so he shouldn't be afraid to say them. (2) The alternative, less pleasant and more aggressive approach would be to give him two options, but he needs to speak to tell you which he chooses. Along the same lines as the music choice, that could be as simple as telling you which band/CD he would like for you to put on. And don't hold up the CDs, but just lost the options and ask him which he'd like best. Then, instead of just pointing at his choice, he would actually need to speak and tell you his choice! Worst case scenario he still refuses to talk, you might need to use some more aggressive mean. For example, the two music choices are one band he really likes, and one he really hates. If he refuses to talk, then put in the one he dislikes, and let him kno that he can simply tell you to switch, but only by using his voice. Of course, you should only use this option after trying the other ones, and even then, only once all physical inability reasons have been definitively ruled out.  Hope this helps, and best of luck Moniquebtown!

My 20y/o son is 22 months out from date of injury and is still nonverbal. His vocal cords have been scoped and show no sign of injury. He can communicate with his hands. How can I help him to regain speech???

How to help with return of speech

I would most likely want to educate my partner or whoever it is on causes and effects of traumatic brain injury.&nbsp;I have a few groups that I wrote down that would be really good to join - these are on Instagram but I'm sure they're also on Facebook:<ul><li>@lifebeyondbraininjury</li><li>@brainhealthsummit</li><li>@thestrokestoryteller</li><li>@thebrainpossible</li></ul> They share a lot of TED talks and experiences of surviving brain injury, compensation, making gains, and growing relationships.&nbsp;I would really recommend using something like that. It’s very difficult to understand an individual's struggles if you're not in their place.&nbsp;It's very difficult to understand - “what does that mean you don't remember?”,&nbsp;“what does that mean you're getting tired and anxious and agitated?”.&nbsp;But I think education is key - reading about it and joining groups and hearing other individuals is a big plus.

Any strategies to cope with someone not believing you can't remember something?

It's a good question, but I would ask many questions, as prognostically guessing is not fair.&nbsp; Some things that factor in: How long ago was the stroke? What kind of stroke was it?&nbsp; This is really important because hemorrhagic strokes and focal strokes have very different types of treatment.&nbsp; Why was the shunt placed?&nbsp; Was there hydrocephalus?&nbsp; Was there swelling on the brain?&nbsp; What physically and how physically independent are they?&nbsp; Can your husband walk or&nbsp; feed themselves? What kind of confusion are we dealing with?&nbsp; Is it pleasantly confused?&nbsp; What stage of confusion?&nbsp; I recommend a scale called Rancho Los Amigos - it's a 1 through 10 scale and is a reference tool we use to understand the step-like recovery in brain recovery.&nbsp; This can help to determine what type of confusion your husband may present with. That said, I'm a big believer in neuroplasticity.&nbsp; I have witnessed the principles of neuroplasticity over the years.&nbsp; No one should be ever told that you have one year and there's no more recovery after that.&nbsp; Throw that out the window.&nbsp; I work with individuals who are 17 years post-injury that are still making gains, rewiring, and relearning - they're making steady progress.&nbsp; I have many questions but yes I would say prognosis would be deemed positive.

The confusion was very bad in the beginning. There's always a little bit here or there and I forget a lot but overall two other people they don't notice. Just to my immediate family. It does get better with time. It just takes a while and it won't ever be perfect but it will get better and be easier with time.

The important things are regular rests, regular schedule, get him to read to the children to improve his skills and sing songs... have someone who specializes in family adaptation (from the rehab centre) to work with your husband and you and your children As he eases into home life.

Hi! My husband, 42, had a hemorrhagic stroke. He was on a ventilator, feeding tube, etc. He had a permanent shunt inserted into his brain which I guess would stay in there forever??He is doing well now; still in a care facility. It seems as if he can do everything on his own physically. Cognitively we will probably only be able to determine later on?I am anxious about when he comes home; I have a daughter of 9 and a baby of 17 months... I am worried that it might traumatize them even further.

Does the confusion get better with time or might this be the permanent damage?

Apps like Tactus Therapy, Lumosity, Brain HQ and Constant Therapy are definitely something to try. We also have something called the WALC series - this is a series of cognitive rehabilitation books - there's WALC 1 through 10.&nbsp; They specialize in different speech and language areas and different cognitive areas.&nbsp; I would recommend WALC 2, 3, 9, and 7.&nbsp; The PDFs are free to download - you can just google “WALC books”.

Answer transcribed from <a style="background-color: rgb(255, 255, 255);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/2%3A-dr.-thomas-franz-pt-2" target="_blank">Brightway's interview with Dr. Thomas Franz</a>: I don't have a particular online therapy that I endorse or that I have worked with extensively enough to say that oh you ought to go to this website or use this app. Although I'm working with some people to develop some that may be useful in the future, I don't have a particular site that I endorse right now.&nbsp;There have been a lot of these that have been developed over the years and what I would say is look at the ones that are out there. If they have you practicing real-world tasks like recalling a grocery list or taking you through some sort of simulation of a shopping trip, things you might do in your actual life, those are going to be more useful than just memorizing lists of words or playing video games. This is because what we do know is that you get better at what you practice, so if you practice memorizing and reciting lists of words that's the skill you develop. If you practice playing a video game, and unless that video game has some grounding in a real-world task, you're just getting better at playing the video game. You want something that has a connection to what you want to do in your day-to-day activities to make it translate to what we call generalized. You want to pick a task that will help you with the cognitive things you want to do in your day. Similarly, you wouldn't try to strengthen a weakened leg by working your thumb because that would be very little benefit. It might strengthen your thumb but it's not going to help you with the task at hand.

Division Director PM&R

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: I'm going to focus on the speech and language side of this question, but check out my answer about cognitive symptoms to learn more about how to improve memory. I’ll start with the language side first.&nbsp; To work on receptive language (that's the understanding of language), speech-language pathologists can target simple directions all the way to multi-step, complex directions depending on the level of where you are at the time. For expressive language, we use lots of visual supports and supported conversation when strategies can then be established.&nbsp; I’ll also pick apart things that are motivating and functional in your environment - we're not going to be working on basketball terms when you might have no knowledge of basketball. Some of the more descriptive areas - for word finding in particular - is through semantic feature analysis.&nbsp; This is the ability to use semantic features or meanings of words to assist in accessing the actual word.&nbsp; For instance, if you're having difficulty finding the word “dog”, you may able to get to it by saying “it has four legs, it barks, it's a man's best friend” - “oh, that's a dog”.&nbsp; Another area in word finding is VNST, which is verb network strengthening treatment.&nbsp; This focuses on verbs or action words to help formulate full sentences, and there's a wide protocol to help train individuals and their caregivers in in these areas. Speech pathology has a role in training caregivers to be supportive communication partners and I feel this is really important, especially in those early stages of recovery.&nbsp; A speech-language pathologist will strategize and come up with a lot of things to implement in any setting.&nbsp; And all of these skills can be carried over into the home environment.&nbsp; A tip that I usually tell families of those I work with is to keep conversation going.&nbsp; It can be socially isolating following a brain injury, so being able to practice speech language or cognitive skills in a functional setting - whether it's at home, at a doctor's office, at a restaurant - can be so helpful and meaningful.

What online or other type of therapy that can be done at home do you recommend to stimulate memory and speech?

Our brain is compensating after a brain injury, so when we have damage, unfortunately we do not regenerate cells once there's damage.&nbsp; If there is a bleed in a certain area of the brain, that area does not regenerate like everything else in our body.&nbsp; So what we need to do is establish neural pathways and rewire and compensate for what's not there anymore.&nbsp; That's why we train a different hemisphere that can potentially take over what the damaged area did before, but that requires a lot more effort.

I’ve been doing some research on this. So there's just a lot we don't know about neuroplasticity, but there's a lot of things that we do know. So the brain is really fascinating where it can regenerate and reorganize itself to make new connections in order to compensate for the injury and kind of adapt. It can make new nerves and can change structure and reorganize what we call cortical maps. That's been really studied with stroke patients, but not so much with tbi patients. I think it really depends, plasticity can really vary depending on where the traumatic brain injury happened and the severity of it. I think with that being said it's just so important for people to participate in rehab and do your therapy, especially in the first three to six months. So really focusing on therapy, and then also because even if you're in therapy that's only three hours a day for the most part, so making sure that you're following up and doing therapy outside of the sessions. I think that patients that do that are you know the most successful in recovery.

Occupational Therapist

Are there parts of the brain where neuroplasticity does not work well?

That's a hard question.&nbsp; Diet modification is something to look into.&nbsp; There's a lot of research suggesting your gut and your brain are in a direct relationship.&nbsp; So I would recommend tapping into diet modification - what kinds of food you eat.&nbsp; The diet has a big impact on energy, so perhaps some elimination of certain foods i would talk to a dietitian a nutritionist and get an opinion. Naps are very common especially after trauma.&nbsp; It's also important to see how many hours you sleep during the night.&nbsp; Do you sleep too many or too few hours?&nbsp; Exercise and meditation are also worth looking into.

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/12%3A-recreational-therapy-for-physical-symptoms-with-recreation-specialist-holly-auth" target="_blank">Brightway Answers interview with recreation therapist Holly Auth</a>: I love to take naps. Current research says if you are going to nap you shouldn't nap longer than 30 minutes (no snoozing!)&nbsp; I know it's hard to do, but that's what the research says.&nbsp; I’m not a sleep expert, but I believe it starts to mess with your sleep cycle (falling asleep, staying asleep) if you sleep longer than 30 minutes during the day. If you're totally against napping, there are other ways that you can help with energy conservation. One thing that is very important is pacing yourself throughout the day. Find out the length of time you can complete a task before you start to feel fatigued, and take a break before the fatigue starts.&nbsp; Then you can resume your task after a break.&nbsp; This practice avoids front loading your day with all your tasks and avoids a major crash at the end of your day. So take a break, do something, take a break, do something. You'll find that at first you might only be able to do a task for 10 minutes and then you have to take a 10-minute break. But you're working on your cognitive endurance, so down the road you might be able to do 40 minutes of a task then take a 5-minute break. Building up your cognitive endurance is easy to do when you pace yourself. Some people find it very helpful to set alarms and reminders on their phones to assist them in remembering to take these breaks throughout the day.&nbsp; This will help you to avoid feeling totally drained by the end of the day.

CTRS

How can i get past my energy crisis so i can function through a whole day without a nap?

As a speech-language pathologist, we have both formal and informal assessments. Given the nature of teletherapy for the last year I've been using a lot of informal assessments.&nbsp; Sometimes the internet connection might not be great and my sound may be a little funny, so it doesn’t have the context of a formal proper assessment.&nbsp; We have many sources of informal assessments where we can understand areas of cognition or speech and language. There are also a lot of formal assessments that we use.&nbsp; There's RBANS, SCATBI, SLUMS, MAST, CLQT, BDAE.&nbsp; These require a proper setting, proper minutes, proper administration.&nbsp; Many of these are very similar in what they're looking at. They're assessing short-term memory, temporal orientation, visual spatial, problem solving, cause effects, abstract reasoning, generative naming, attention.&nbsp; Pragmatics, or social skills, are difficult to assess - that is a subjective section based on what the clinician observes. I like to use both, and can get a comprehensive assessment from both.

Answer transcribed from <a style="color: rgb(17, 85, 204); background-color: rgb(255, 255, 255);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank">Brightway's interview with physical therapist Susan Little</a>: From a PT point of view, all assessments are really our standard. You probably have heard therapists talk. We're very goal-driven, where we'll talk with you about what your goals are and we will establish goals. All of that starts with assessment tools, where we will evaluate impairments and strength in endurance, balance, and coordination to find a baseline of what problems need to be addressed and to also provide a starting line. Those evaluation tools will then be repeated at intervals to see if we're making progress and if what we're doing is the right thing or if we need to change up what we're doing. I could go on and on about the names and I'm not sure you want to be burdened with all of the names of those assessment tools, but do know that therapists have a tremendous toolbox of assessment tools that can be utilized.&nbsp;I would certainly encourage that if you know your family member is having difficulty with balance and that is their chief difficulty, ask the therapist what assessment tool they plan on using, at what intervals they will repeat that tool, and what that tool tells you for balance. Most of our assessment tools will predict a probability of having a fall and that's something you might want to know. If grandma is 90-likely to have a fall, you know that you're not going to want to get much further than an arm's length away from grandma because you don't want that to happen. With therapy, perhaps grandma gets up to the point where she's only at a 25 risk of having a fall. Providing her with that freedom and that quality of life might be worth the chance of that lower probability of having a fall. So we have many tools that are very useful. Certainly, discuss those with your therapist to see what tools are being utilized and how what they're doing is improving the scores. Everybody likes to hear a score right, so I tell my patients those scores and I cheer for them every time I repeat that they're going to do better on those.&nbsp;&nbsp;As for which ones are used more than others, that's kind of an individual thing to a therapist. My favorites for balance are one known as the bird balance assessment. It was developed many years ago to predict falls among the elderly but has been shown to be highly effective in predicting whether somebody will have a fall after a brain injury as well. Another one of my favorite higher-level balance tests is the community balance and mobility scale, which was designed in Canada. It’s tough, I did a study at a university with young healthy college students and they could not get a hundred percent on this balancing test. I'm betting Simone Biles would have no trouble with it but students and individuals, even without challenges to their balance and their brain, struggle with it. As a therapist, I like that because I don't want a test that's too easy. Remember, I always want to challenge people and make sure that I'm giving them difficult but doable challenges. So certainly, I need that in the test as well.&nbsp;In regard to strength, the gold standard for therapists is what we refer to as manual muscle testing. You've most likely all been through it, where we ask you to hold and we push against your joint for different motions and we grade your strength on a scale from zero to five. As for flexibility, the basic one is goniometry, which is that funny little tool that we use to measure your joint angles to see if you have flexibility problems that may be impacting your ability to move. Everybody loves the coordination tests, which are all of those tests where we ask you to touch your nose and touch a finger or do crazy things like that. These are basic movements to evaluate how coordinated you are. Lastly, from a muscle tone point of view, or what many people might refer to as spasticity, my favorite assessment is the modified Ashworth.

Physical Therapist

What assessment tools are useful for determining prognosis and progress in brain injury?

We need to view the brain as a muscle, and unfortunately short-term memory is often the thing that goes first.&nbsp; With brain trauma, long-term memory is usually preserved and short-term memory is the one that's affected most. I recommend external aids like calendars and writing things down.&nbsp; I would use color associations - let's say writing something in one color and another task in a different color.&nbsp; This allows you to use the artsy ability of the right visual hemisphere and we're applying it to memory.&nbsp;&nbsp; I would also use verbal reminders.&nbsp; For example, you could tell Alexa to remind you about a certain thing. And I know it seems vague and open, but try to be aware and take down notes to help yourself memorize a little bit better. There are a lot of apps that you can try.&nbsp; There's something called Tactus Therapy, which is a wonderful app that lets you work on a number of different disorders.&nbsp; You could try Lumosity, which is a cognitive type app.&nbsp; You can also check out Brain HQ and Constant Therapy.

One of the only known ways to improve memory capacity in the large picture is by doing daily meditation. It's been scientifically proven that meditation increases brain health, both for memory capacity and for problem solving. For more immediate memory results, simply repeat to yourself in your head (or by saying it out loud if there's no one around) the thing you want to remember. And for somewhat intermediate-term memory, simply write down all your thoughts on other, unrelated topics so you can clear your mind and focus only on remembering the things that are most immediately needed.

I read a lot. It uses my memory muscles and helps improvement.

It seems like I can't remember or retain information, especially when trying to remember, problem solve, train people, run a business, etc.

How do I improve my memory, problem-solving, etc.?

Let's take apraxia for example, as this is a deficit where the connection between the brain and your verbal output is disturbed.&nbsp; There's an execution issue, not a muscle weakness - it's just there's no connectivity between what the brain tells you to do and your verbal response. We would train the right hemisphere using something called melodic intonation therapy, which applies the musicality of the right hemisphere to take over the language in the left hemisphere. This means we use singing to facilitate verbal responses and to alleviate the struggle to produce language.

mtspeech's Answers