Today was a very good cognitive day!
On the ride to Bryn Mawr Corey was repeating her usual questions. The sequence is always the same. The pattern and frequency is a sign of rising anxiety. Our answers are direct and repetitive to help her reorient and prepare for who, where and what we will be working on during our day. For the first time Corey initiated what she was internalizing, “I don’t want to go to Bryn Mawr. I do not want to work with anyone I don’t know”. I was so proud of her and thrilled with her statement…it’s a sign that our conversational behavior plan is beginning to work…she’s vocalizing her fear instead of screaming it!
The behavioral plan we are trialing is not based on any study or statistical information. If it were officially chronicled it should probably be listed under the “wing it” chapter of TBI 201.
Every day we are looking for ways to help Corey cognitively, especially with strategies to bridge her short term memory loss. When a patient suffers a stroke or TBI, typically the therapists will use a calendar, a memory log or a check list approach to help them develop their short term memory. Corey does not consistently recognize letters in the written form so these tools will not work for her. If you spell anything or give her auditory clues, she has no problem bridging the connections.
I’ve mentioned the Drew Barrymore movie, 50 first dates. For those of you not familiar with the movie, I’m about to give away the ending. To cope with Drew’s short term memory loss, Adam Sandler’s character plays a video every morning of their current life together. Drew wakes up, watches the video and she remembers her husband, family etc.
Last week we decided to film Corey’s session with Natalie and play it on the ride up to Bryn Mawr. Even though yesterday was such a volatile response to the initial introduction, after Corey calmed down we showed her the video from last week. It assisted in not only reorienting her but in transitioning her from the hallway to the Lokomat room. She had a very successful session.
Today we filmed Elaine. She spoke directly to Corey. She introduced who she is, the fun they have together during their OT sessions and displayed some familiar games, etc.
We played this for Corey prior to Elaine walking into the room. When Elaine entered, there was an initial push back until we mentioned some of the content from the video and Corey heard Elaine’s voice. She settled down and she was ready to work.
Corey played the Toy Story Memory Game. We chose 3 characters, 6 cards. With verbal queues she matched each character 3 games in a row. We moved onto an old childhood favorite board game…Trouble. Corey placed her left hand on the popper and her right hand over the left to push down and pop the dice. That’s a hard popper to push with healthy arms…she did very well. She moved her colored men, counted the spots and placed them in the little buckets for fine motor control. PS – (for the record) she beat Caitlin!
We used the same approach with Speech. What was very exciting for Kate was our retelling a story from this morning. As we were getting Corey dressed, she asked where we were going. The usual response was Bryn Mawr. Today we work with Elaine and Kate. Elaine is OT and Kate is speech. Corey interrupted, “we play hang carpet with Kate”…Hang Carpet is the same game as Hangman…but we use Caitlin’s cat (named Carpet) as our victim! Kate was thrilled to hear Corey remembered that game from two weeks ago. That’s short term memory folks!!
My favorite part of the day was an observation I was privileged to watch tonight. Corey and I were sitting in the family room. We were watching the Sandlot when I looked over at her and noticed she instinctually lifted her left arm, moved her left hand to her right elbow and was scratching an itch! Sound silly? THIS WAS A MAJOR FIRST! Imagine what it’s like to have an itch you can’t scratch? Now think of the personal pleasure, satisfaction and relief you’d get to scratch it. Corey couldn’t do this for her self a month ago. I know I’m a sap but watching her scratch a simple itch I began to well up…she was independent for that moment. I was so happy for her.
Corey, you know one of my favorite lines; “you’re killin’ me smalls”. Most days we tease each other with this saying. Today you were the Great Bambino hitting it out of the park! I was so proud of you. The games you played (and won), the ability to express yourself, the depth of conversation and level of awareness you are reaching for is more difficult than the physical therapies you have each day.
If you keep working and playing this hard, it’s going to pay off. You are coming back stronger than ever kiddo. Today was a home run! xoxo