Monday, April 11, 2016

What don't you understand?

Just as we use our words to communicate and express ourselves it is even more important that we understand what is being said.  Obvious right?

We take this for granted.  Sounds and words enter our auditory periphery, we hear them, and now its up to our brains to make sense of it all within milliseconds.

Individuals with aphasia can have difficulty with the 'processing' piece of communication (it obviously varies in each person).  There are many factors that can contribute to this difficulty of processing language:

#1 extraneous noises -  babies crying, kids fighting, walking down a busy street, crowded restaurants.
#2 complicated sentence structures and figurative language
#3 phone conversations

Ayal initially had a very difficult time trying to focus on any particular sentence the first couple of years. That complicated a lot of things.  Not only could he not express himself but now I had to change the way I spoke to him! I had to shorten my sentences and frequently 'check-in' to make sure he understood basic concepts of time, space, numbers, days of the week.  Phone conversations were almost impossible as it was imperative for him to look at my face to understand what I was trying to communicate.  We joke about husbands and wives not communicating well with each other, but if there was a prize for "the worst communicative couple", we would have received that award.

Explaining pick up times and places always got misconstrued.  "I will pick you up in front of this bank at 2pm."  Did he comprehend in front of this bank?  This could easily have been inferred as in front of the bank on this side of the street or on the opposite side of the street.  But it was still in front of the bank, no? Did he really understand 2pm?  Not always.  I learned this mistake pretty quickly as well.  It was important that I did all of the following for time related concepts:  Speak it, hold up two fingers, show him on his watch and mine and have him repeat all of these acts by himself so that I knew he understood.

This is the part where I exude my somewhat pessimistic side.

Conversing with each other became this dreaded back and forth game of ping pong, which required constant checking in, became routine but very exhausting, especially when you don't have ALL the time in the world to be supportive and calm. When our kids used to fight (of course they are all angels now), this added to our highly coveted 'calm factor', which we lacked.  How does an individual try to process language when they are distracted by their children's angelic screaming voices?

I couldn't accept the fact that it was hard for him to comprehend my words, and he was frustrated that I didn't understand him.  It almost becomes this existential crisis of feeling trapped in a crowded shopping mall desperately trying to find the nearest exit.

At the time, this was all very disheartening because  I knew he wasn't mentally challenged nor psychologically unstable.  He had and still has aphasia - that was the cold, hard truth.

The challenging part for someone whose loved one has aphasia is that WE don't always understand. We don't understand that processing language is a very labor intensive physiological process, and we take this for granted.  We don't always learn from our mistakes for the first, second, or even third time, when we experience 'miscommunications' with our loved ones, but we are aware that we need to try harder next time.  

[I highly recommend the 5 message steps of "The New Conversations Initiative" for effective communication to prompt us in filling in the blanks in our conversations with our loved ones:
          1. "When I saw/heard...."
          2. "I felt....."
          3. "because I need/want...."
          4. "and now I want (then I wanted)..."
          5. "so that..."
Sample:  When I saw the dirty dishes in the sink, I felt annoyed, because I wanted a clean kitchen, so                 that our guests wouldn't think we're slobs". ]

When we express ourselves, our brains are working faster than we can formulate the words we want to say.  We occasionally lose track of what we did or didn't share with our listener, especially when we are trying to multi-task.  We all need to check in with our spouses, children, and parents, etc. from time to time to make sure we are on the 'same page'.  This does take an extra step, an extra few breaths, one extra minute, but if we lose sight of this the consequences will cause more frustration and heartache.

Sunday, April 3, 2016

The Magic of Communication

When we think about the basis for communication the concept of 'speech' stands at the pinnacle of this hierarchy of communication.  The ability to speak elevates us above the animal kingdom making us the supreme creature to walk this Earth.

When two people converse the interaction is speech-based, whether its face-to-face, on the telephone, or on a bad skype or face time connection.  We are sharing and expressing our message through the words and sounds that flow from our mouths.  Speech between two people is a masterpiece of music and a magical dance of words which play off of each other to create a symphony of communication.

However, ''Communication'' and the act of communicating is more than just talking.  We communicate with gestures, with our facial expressions, our vocalizations, and our overall body language.  It is possible and sometimes even more powerful when we utilize these aspects of communication to truly express ourselves.  Without these elements we don't connect to the person standing in front of us.

Overtime, Ayal was slowly starting to make progress in producing more words.  We started measuring progress from a monthly basis, to every 6 months, and currently, to a yearly basis.  Family and friends often commented on how impressed they were that Ayal was continuously making progress and noted how he had many more words than the last time they saw him.  Yes, it was true, he was acquiring more words, but his ability to consistently produce these words, even on a daily basis, is not 100% accurate.  In fact, speech production is often inconsistent as it is with most people who have aphasia.  One cannot compare speech acquisition of an individual with aphasia to a baby acquiring his first words.

Expressing his wants, needs, and his desire to join in conversations was comprised of a communication rainbow consisting of a medley of words, gestures, vocalizations, and facial expressions.

I'll be honest, our conversations weren't so magical and they definitely were NOT a harmonious dance of words. In fact, there were so many miscommunications it was amazing we were able to accomplish anything and maintain our sanity at the end of the day.

Ayal's ability to consistently produce all our names was like trying to find all matching socks after they've completed the drying cycle.  When he called out our oldest daughter's name he used our middle child's name, our middle child became our oldest, our son generally stayed the same, and my name took on a variety of possibilities: mommy, Ima, Julie, yeah, and a mix of our two daughter's names.  It wasn't that he was in the least bit confused or had forgotten the names.  They were cradled in his brain in some hidden hemisphere waiting to be accessed.  However, the signal from his brain to his mouth was severed so his original intent was altered and 'out of his control'.

These speech breakdowns were frustrating, NOT magical.

However, even though his output wasn't accurate, we all ended up learning and adapting to these inconsistencies.  We began to understand over time.  If humans just had 'speech' we might as well be robots.  We understood these speech inaccuracies and his intent because this is what makes us human. Isn't that magical?

I offer the following saying Í was sent recently :

We have 3 choice in life:
Give Up
Give In
Give it your all

I believe each day is a new beginning, a new opportunity.  Which one will you choose today?