Aphasia

I had the opportunity to run a course for those with impaired language capabilities and I want to tell you about one of my patients who has somewhat helped me decide that I want to pursue a career in neurological physiotherapy. I cannot name him due to patient-therapist confidentiality, therefore we will call him ‘Karl’.

Karl has aphasia and for those of you who do not known what aphasia is, simply put it affects the patient’s ability to comprehend or produce language. See the diagram below for the different subtypes and symptoms of various types of aphasia.

Karl has Broca’s aphasia, whereby he can understand language, but is unable to produce language himself. As you can imagine this would be an annoyance to anyone, since it limits the ability to communicate substantially. Luckily Karl can type and write, as well as use photos and pictures to express himself. Strokes inevitably cause drastic changes to persons life, but they never cease to fascinate me, symptoms presented by patients after stroke are never the same and these symptoms tell us that the neuron (brain cell) die-off is in a particular area. Solely from analysing the patients presenting symptoms allows assumption as to which part of the brain is affected and which artery was blocked, if the stroke is ischaemic (aka a blood clot in the brain). A cerebral infarction (stroke) involves blood loss to the brain, which leads to anoxia (lack of oxygen supply) and lack of nutrients. This consequently causes cell death and inevitably loss of function relating to a specific portion of the brain. In Karls case aphasia is associated with a middle cerebral artery blockage affecting the dominant frontal lobe. Karls other presenting symptom was weakness of one side which affects the motor cortex also located in the frontal lobe, which consequently left him wheelchair bound.

But that’s enough of the technical explanation for now. On the penultimate day of the current course the other instructors, patient and I took a trip to a café in the town centre, to get out of the clinical setting. While returning to the clinic one of my colleagues began to tell me that Karl was a basketball player in the past for a high division in Finland. I asked Karl if he has ever seen wheelchair basketball and he replied with a shake of his head, so we watched some videos on youtube and he was fascinated. I asked Karl if he wanted to try, and at first Karl was reluctant to even consider trying. He contemplated for about ten minutes and then decided he wanted to give it a try.

Karl was enthusiastic about playing ball again, we went into the hall and gave it a try. Since Karl can only use one arm, the basketball was too heavy for him so we switched it for some lighter balls and he was shooting and getting more accurate every time. You could see both enjoyment and frustration, I told him “Rome wasn’t built in a day” and although he only made one basket during our half an hour session, he demonstrated to himself that it’s not impossible and he is not as limited as he believes. This gives Karl the opportunity to work and improve upon something, set himself goals and most importantly to have fun again doing something he loves to do. The body has an amazing ability to adapt and neuroplastic possibilities (restructuring of the brain), if Karl continued practicing then he would eventually become more receptive and stronger. Unfortunately Karl will not be a permanent patient of mine. If he had I would have structured his rehabilitation around functional development, while incorporating his love for basketball. 

He also has a passion for photography but is unable to hold the camera and use the button to take a photo, since it’s on his weak side. I did some research online and managed to find two products that will allow Karl to take photos once again (see below).

A remote shutter release - used in Karls left hand

Having the power to have such a positive impact and reawaken Karl's passion for basketball and photography, was a priceless experience for me. I’m a strong believer that in life our paths bring us to where we are supposed to be and I hope that in the future I will be able to help more people.

Physiotherapy is not always about giving exercises to a patient, they have an ability to make a profound impact on someones life. So to all the physiotherapists out there, remember that and give hope to those who need it.

This has probably been my favourite post to write so far! Please give me some feedback in the comment section, I really want to know what you like and what I can improve.

Thank you for reading!

Aivoliitto

In one of my previous posts I briefly mentioned one of the activities in a rehabilitation course, but I realised I haven’t introduced you to my clinic so I’ll do that now. As well as participating in an Erasmus, I’m actually doing an internship at the same time. My internship is at a neurological care centre called “Aivoliitto” on the island of Hirvensalo and the blue dot represents Aivoliitto. 

This particular practice works with neurological patients including those who have had cerebral infarctions or haemorrhages (strokes), those with multiple sclerosis (MS), Parkinson’s disease (PD) and children with neurological conditions. My position within the practice is in the stroke and MS. We do individual physiotherapy consultations, group sessions and also run week long courses that involve movement improvement, speech improvement and even relationship improvement between couples.

At the moment, my main roles include general physiotherapeutic sessions assisting the weekly courses and teaching hydrotherapy classes. Hydrotherapy classes involve various movements and activities in the pool to facilitate movement as well remove gravity, which can be a limiting factor for patients with hemiplegia (weakness on one side of their body). By changing the environment in such a way is able to eliminate/ reduce fear in the patient, which can be a massive limiting factor for the patient. Here’s a link with an example: https://www.youtube.com/watch?v=fEG5_3VWFOU&t=218s

I will go into more detail about my experiences at the clinic in future posts, so subscribe and keep reading!

Blueberry Pie

So I chose a course called ‘get finternational’ as part of my Erasmus, whereby we (the students) have to participate in certain lectures and activities to get stamps and therefore earn our credits for the course. These courses are associated with Finnish culture, so we get to take a look at what Finland is about. Well apparently Finnish people are into baking pies, and get this…eating it afterwards! Not just any pie, but a blueberry pie! Needless to say, I'm beginning to really enjoy Finnish culture after eating pulla and now blueberry pie! The recipe was both simple and quick.

Below is a blueberry pie recipe so you can try yourself!

Ingredients

                        85g softened butter

                        175g caster sugar

                        175g ground almonds

                        2 Eggs - beaten

                        A few drops of almond extract

                        2 x 125g punnets Blueberries

                        23-24cm cooked shortcrust pastry tart case 

                        icing sugar, for dusting

Method

                        Heat oven to 190C/170C fan/gas 5. Beat together the butter and sugar until it is light and fluffy, about 1 min. Stir in the almonds, egg and almond extract.

                        Stir in half the blueberries and spoon into the pastry case. Smooth the top using the back of a metal spoon, then scatter over the remaining blueberries, pressing them in lightly. Bake for 45-50 mins until the pastry is crisp and golden, and the filling is golden and feels firm to the touch.

            Cool the tart for 10 mins in the tin, then lift onto a serving plate. Dust with a little bit of icing sugar and serve warm or at room temperature.