I was also thinking along the lines of considering depression. At the same time anomic aphasia does tend to make individuals shy away from socializing. From your description Ron, what is concerning is that you say her speech is 95% intact. I am not sure but I would explore this 95% aspect further by getting a better idea of her pre-morbid functioning in this respect and then consider whether speech loss to anomia is significant or marginal. Doing so may also mean checking with the neurologist or specialist who was treating her. Going by the depression hypothesis perhaps the answer may possibly lie between your client being seen by a Psychiatrist and exploring if there is any support groups out there for individuals with anomic aphasia. The latter would clarify the picture of speech loss among other individuals with anomic aphasia. And perhaps help her conclude that her speech loss is not as acute as she perceives.
In the absence of a well rounded clinical picture of the client, what about encouraging her niece to take the client to another SLP. Perhaps one who is more conveniently located for her to take. I would also explore alternatives to see if someone else (perhaps a close friend or relative) could accompany the client to the SLP appointment, located conveniently or otherwise. This in itself would foster some social interaction with the close friend or relative, and could be a beginning. Good luck, and do let us know what happens. Best, Biraj ----- Original Message ----- From: Elizabeth Thiers<mailto:[EMAIL PROTECTED]> To: [email protected]<mailto:[email protected]> Sent: March 22, 2005 7:38 AM Subject: RE: [OTlist] OT and Speech Deficits Sounds more like anxiety or depression. Have these been addessed by a doctor/psychologist at all? If she overfocused on one occupation and not the others that are more damaging, maybe there is a way to work her need to communicate with other occupations. What else did she like to do before the stroke? Elizabeth H. Thiers, OTR/L FECTS [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> -----Original Message----- From: [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Tuesday, March 22, 2005 12:47 AM To: Tammy Renaud Subject: Re: [OTlist] OT and Speech Deficits Hello Tammy: >From my limited knowledge, this client has anomic aphasia. When I first screened the client, speech was her major concern. I noticed some balance deficits. I told her that I would recommend speech therapy and that I thought an OT eval was indicated. Her niece has power of attorney, so I contacted her about the SLP and about permission to contact the doctor for an OT eval/treat order. The niece said the client had already received speech and was told that her speech "wouldn't get any better". She denied pursuing the speech order but said it was OK for me to get a script for OT. I evaluated the client on Monday. During the eval, two things became clear. 1. The client is VERY concerned about her speech because it keeps her from using the phone and it severely limits her socialization. (note: her speech is about 95% fluent, however, the client is very embarrassed by the 5% word loss) 2. The only thing that the client is concerned about is her speech The client was a very social person up until her stroke about 5 years ago. Today, word finding difficulty embarrasses her and she spends a good portion of her time lying in bed. She is sort of 'wasting away', both physically and mentally. The niece stopped by at the end of the eval and asked what I thought. I told her that I think speech is the primary concern. She asked if I could do anything about her balance to which I said that I didn't think it would do any good to work on balance because the client was concerned about her speech. And that until her speech improved, the client was not going to get out of her room. I told the niece that seeing OT for three hours a week would not change her balance if she continued to stay in bed. Which, in my opinion, she would. I told both the niece and client that I would 'research' the situation to see if I could ethically and legally work solely on speech. I've thought that I could make socialization the goal, but Medicare won't pay for that! I can make ambulation/balance the goals but that doesn't seem quite right! So, I guess the bottom line is that I can't see this patient. I think the problem with the SLP is that the niece will need to TAKE the client to the appointments. On a side note, this is a great example of 'framing the problem'. This woman: 1. Had a stroke - which changed every facet of her life 2. She is left with residual speech defects 3. Concerns of her speech keep her from socializing 4. She feels isolated and sleeps too much 5. She is losing physical ability because of being sedentary. On several occasions during the eval, I asked the client about what she perceived as the problem. Without hesitation, the client reports that her speech is the problem. No amount of prompting could convince the client that social isolation was the problem. All of this comes back to how OT struggles to fit in medicine. I am going to write another OTnews about this topic but I just wanted to share. Whew! What a post at 12:45 in morning.... Ron -- Unsubscribe? [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> Change options? www.otnow.com/mailman/options/otlist_otnow.com<http://www.otnow.com/mailman/options/otlist_otnow.com> Archive? www.mail-archive.com/[email protected]<http://www.mail-archive.com/[email protected]> Help? [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? [EMAIL PROTECTED]
