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!