Aphasia 107Your memories of life experiences are largely intact, and your kind, caring personality still
exists. Although the stroke and aphasia have destroyed your ability to abstract verbally, verbal
abstraction is not necessary to appreciate a cold woman’s desperate need, maneuver the wheelchair
to the door, firmly press down on the bar with your left hand, weather a blast of cold air, and accept
a chilly hug from a grateful smoker.
Case Study 5-7: A 55- Year- Old Woman With Aphasia and
Severe Depression
The rehabilitation team meetings are held in the third- f loor conference room. The meeting is
held every Tuesday, starting promptly at 7:30 a.m. Agendas have been provided, and the physiatrist
sits at the head of the conference table. Soon professionals from many disciplines take their usual
places at the table, and the meeting begins. Ruth is the first patient on the agenda.
The physiatrist summarizes Ruth’s current medical status. She is a 55- year- old clinical psy-
chologist with a history of diabetes. Several members of the team saw her while she was in the
acute care wing of the hospital, and she has been in the rehabilitation unit for 14 days. The patient
suffered a dense thrombotic cerebrovascular accident as a result of occlusion to the left middle
ce re bral artery. The radiology report shows brain damage to Broca’s area in the posterior inferior
left frontal lobe and surrounding areas, including the insula. Ruth has right hemiparalysis and
aphasia and was incontinent for a while.
The physical therapist reviews Ruth’s pro gress in learning to transfer from wheelchair to bed
and to use a walker. The patient is having little success. Two days ago, she fell in the physical ther-
apy gym but was not seriously hurt, and an incident report was filed. The therapist notes that the
range of motion of Ruth’s arm is severely reduced, and its occasional spastic contractions are pain-
ful. He also says that Ruth is lethargic and often is only partially motivated. Using the hospital’s
rehabilitation rating system, he says that Ruth continues to function at a 2.5 level. Unfortunately,
he believes that the goal of 4.0, semi- independent movement and transfers, will not be met.
The occupational therapist also suggests that Ruth is less than enthusiastic about relearning the
activities of daily living. This therapist has substituted Velcro for zippers and shoelaces, but Ruth
continues to have difficulty dressing herself. In de pen dent eating is also problematic. Although
some movement is returning to Ruth’s right hand, she is very clumsy in using it. She prefers to use
her left hand during meals but is quite awkward. The therapist gives Ruth a 2.0 and also questions
whether she will meet the initial occupational therapy rehabilitation goals.
The social worker reports that Ruth’s financial situation is adequate. She has good insurance
coverage, but the out- of- pocket expenses will be considerable. Apparently she will be able to pay
them. Ruth has one daughter living in a distant state. Initially, a few friends visited occasionally,
but the patient has little consistent social and emotional support. The social worker says that Ruth
is lethargic and aloof.
The speech- language pathologist notes that Ruth’s receptive abilities have improved consider-
ably since her first visit in the intensive care unit. The clinician reviews the results of the recently
administered token test, in which the patient followed commands by pointing to or rearranging
differently colored and shaped objects. The results show that Ruth can understand the speech of
others. “Expressively, Ruth has some prob lems sequencing and planning muscle movement to
produce speech, but retrieving the words from memory is the main aspect of the dis order,” the
therapist reports. Both finding the correct word and then planning and programming it are prob-
lematic. Using professional jargon, she says, “The patient has Broca’s aphasia with a preponderance
of anomia.” Ruth is given the same numerical rating she received last week, showing little, if any,
improvement. However, the clinician notes Ruth’s improved right- hand motor functioning and
reports that this is accompanied by increased expressive communication in many patients.