Expressive dysphasia

Hello everyone,
Week three nearly done. So this week at my neuro outpatient's clinic I had a pt. who has pronounced expressive dysphasia. His vocabulary is around six words. Unfortunately he hasn't warmed to the idea of using a communication book and his writing hand is the affected side from a MCA stroke...so he doesn't like to write. Anyway, I have been liaising with orthotics to try and fit him with a new AFO. The orthotist wishes him to buy a new pair of more supportive shoes. He has become very aggravated by this demand and I have tried to determine where, precisely, his concerns lay. I have had limited success except to determine that the whole process is becoming very frustrating for him. His difficulty in expressing his concerns is understandable.

Unfortunately one impact of this frustration is to increase his tone. Thus my higher level Rx must now take a back seat to the freeing up of his rock solid UL. Today's session I SIMMed his lats and pecs for ages and there was only moderate response.

The lesson for me in this case is slightly complicated because firstly: it has become evident from both speaking with the orthotist as well as my PT supervisor that the communication lines between these two departments are a little bit disconnected ATM - and so I feel it important to step in and help all parties communicate their concerns. Secondly: as a direct result, the pt. views me as being more responsible for any outcome that may occur. The result is a blurred line of responsibility on one hand and being part of a functional MDT on the other. I can see now why such boundaries are so important to understand and respect...it affects the pt!!!

So anyway the goal now is to maintain the communication between departments but also to bring the pt back to the stage where his precious little outpatient PT time is focused on matters that I can directly have an affect on as a therapist and to hopefully provide him the comfort and focus to let his other concerns pass for the moment.

Have a GREAT Australia Day to all you good folks, MJFJ