Saturday, January 22, 2005

Apraxia

Apraxia: is a motor disorder in which volitional or voluntary movement is impaired without muscle weakness. The ability to select and sequence movements is impaired.
Oral apraxia affects one ability to move the muscles of the mouth for non-speech purposes, for example. Apraxic speakers "grope" for the correct word; they may make several attempts at a word before they get it right. It not only affects language, which is my next story.

Clark is home in this story, and I have to go back to work. I have used up all my short term disability and Clark seems to be capable enough to stay alone. I have asked our friend who lives down the road to check on him when he can.
I had only mentioned to the therapist in passing, that Clark couldn't work the remote to the TV without my help, or go to the bathroom without my help, etc. I thought Clark's memory was impaired and he couldn't remember how to do these things. But, it actually was apraxia, which Dave the therapist discovered when he saw Clark try to fix his own cup of coffee. They were actually excited about working with him on this, because they had only encountered one other person with this problem and they were not as bad as Clark. For example, when he had to go to the bathroom, he sometimes would be fine, but other times he would come to me and gesture at his penis, since he had trouble getting the words out, that he needed me to show him "how" to go. I would take him to the toilet, explain and show him how to accomplish this feat, where as he would nod quickly that he got it. One story that really stands out in my memory is this one: The occupational therapist decided that when Clark had to fix himself a meal, it should always be the same thing, so he could get the sequence down in the brain. Repetition you know? Well, Clark liked raisin bran and that was safe, since he didn't have to use the stove or microwave. I set out the cereal, a bowl and a spoon, side by side. I had Clark come to the kitchen, where I explained and showed him how to prepare his lunch. Pour the cereal in the bowl, open the refrigerator, get the milk out, take the lid off and pour it on the cereal. Put the lid back on the milk and place it back in the refrigerator. He agreed he could do this, so I loaded up and went off to work. Tick, tock, tick tock.....the day is over, and I walk in the door after work. I see the cereal box and the milk sitting out, but no bowl. I open up the refrigerator to put the milk away and my eyes open a little wider, while I try to wrap them around what I am seeing. There is the bowl on the shelf with milk in it. He wasn't able to sequence the correct order to get his cereal ready !! I put the milk away and start to go see Clark, when I see a Cup of Soup (you know the kind you peel the lid away and add water and heat it in the microwave). I walk over to the table and there it is, upside down with little dents in the bottom, next to it is a pair of pliers. OH MY.....poor Clark, he tried to get his cereal and that didn't work, so he decided on trying the cup of soup. He couldn't figure out how to open it, so pliers seemed like the answer. I rushed out to the living room where he is wrapped up to his chin in a blanket, watching TV. I say "Oh Clark you must really be hunger, huh?" He shook his head, yes. I felt so bad. But, I admired his ingenuity and his effort to try. The next day needless to say, I called for help from the County, Meals on Wheels to the rescue. This worked out great, not only did they bring him lunch everyday, but there was someone checking on him around noon everyday. The sequencing is really the strangest condition of Clark's stroke. I can't put it in words really. It amazes me how the brain works, how it can be damaged and yet it can find new paths to accomplish what it needs to. Clark's apraxia was horrible don't get me wrong, but it also made us laugh and brought us very close.
What more could you ask for.....

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