Dysphasia treatment

• The Story Intervention and A Stroke Patient by Robert J. Smith, LCSW, NBCCH, 3/21/98
  
  

Dear Robert

I had a patient a few years ago who consulted me as he had read somewhere that hypnosis could help speech recovery after a stroke. I was somewhat taken aback as at Med School I had been taught that some speech recovery could occur over the next three months due to dissipation of the surrounding oedema. He was now 14 months post CVA and my teaching said that what he was asking for was neurologically impossible given that he had had nor made any progress in the preceeding 6 months. He estimated that his speech was about 70% recovered and still very frustrating. He had expressive dysphasia and no obvious articulation problems. It took quite a while to take a history given his speech difficulty but his story was that he was a very succesful business man who had a stroke out of the blue that caused a paralysis and initially an almost complete aphasia. After a few hours he could articulate only two words , both swearwords, but no others. Gradually over time he regained a limited vocabulary and was now at his current level of 70 % at 14 months post CVA. He told me that the words took ages to come and that he had lost the ability to use many "big words".I knew very little about speech therapy as a family doctor but he had great faith that I could help and he had travelled many hours over a great distance. I asked him to give me some time to think about how to best help him. I was however completely lost for ideas but did not convey this to him. One week later he arrived at my rooms keen to start therapy. I still had no ideas! I therefore induced a very permissive low key trance and reached into my innate story telling ability and started to tell him a story about the gorge that he had travelled through to reach me. It is a well known steep gorge with a precarious road that clings tenaciously to the hillside. It is the main highway from West to East. The road is renowned in winter for occasional slips and loose rocks that sometime tumble. I asked him to imagine a huge landslide that had completely blocked the road. He was then asked to imagine driving up to the landslide as the first car to reach the slip. He had to stop. There was no way through. The road was narrow and he could not turn around. He had to wait, and wait and wait. Eventually a couple of local hooligans arrived coming towards him on trailbikes over the slip. They were cursing and swearing and most unpleasant. Eventually some repair crews arrived and they managed to make a path through the rubble such that a person on foot could pass through. Eventually people on motor bikes could also pass through. But still no cars and no trucks. I then talked about how when there is a road repair that closes the road that at times the person with the STOP/GO sign seems to sense that you are coming and turns the sign to STOP just as you arrive. He grunted agreement and I wove the story further about how it always seemed to take forever for the line of traffic to get past the obstruction - then seemed to take an eternity for the oncoming traffic to end. I pointed out that he could choose to fume, or to listen to the radio perhaps. He chose the radio and said there was a song on . I sugested that he could sing along if he wanted to and to my surprise he sang smoothly and easily. He himself was surprised by this. I then pointed out that although he was being delayed for a while that the repair crew were working in the winter rain whilst he was warm in the car. I pointed out how boring it must be to be the operater of the STOP/GO sign. He agreed. I then explained that there were lots of times when the traffic could only go one way at a time when the highway was obstructed. I pointed out that the road was always being cleared eventually and pointed out that there were lots of interesting goat track detours that could be accessed by foot. I spent some time discussing the futility of raging at the apparent malevolence of the landslide and the unpredictable vagaries of the STOP/GO sign operator. I pointed out that he was warm and dry and able to stop concentrating on the road ahead and take some time to sing a song. I then told him that he would find many meanings in the story and that more imprtantly his subconscious would do its best to show him other ways around the landslide. I also suggested that he could remember how to put himself into trance and could repeat all his early speech therapy exercises in self hypnosis. This was a single session lasting about one hour. Obviously I have truncated the story was that was the essence.I did not expect much if any response I confess. I never met him again but his family doctor phoned me up a month later to ask what I had said to him as he was now accessing about 95% of his pre-CVA speech. His doctor was quite incredulous. So was I. It's a single case anecdote but perhaps instructive. Best of luck with your patient.

• What a wonderful intervention! by Diane Kistner, 5/25/98