120 Chapter 6
the first throw- down, Freddy was placed in a hold resembling the old half- Nelson, where his head
was forcibly turned to the right and the full weight of his body was placed on it. Ninety seconds
into the first round, Freddy lost consciousness, and the paramedics rushed to his aid. When his
limp body was placed on a stretcher, loaded into an ambulance, and rushed to the hospital, every-
one knew his injury was serious.
On the way to the hospital, Freddy suffered a seizure. Two doctors and several nurses met the
ambulance when it arrived, and Freddy was rushed to the emergency room. A tracheotomy was
performed to help his breathing, and the doctors and nurses worked for hours to save his life.
Early the next morning Freddy was sent to the radiology department, and the neurologist’s and
emergency room physicians’ suspicions were confirmed: Freddy had suffered a severe brain injury.
One or more of the arteries supplying blood to Freddy’s brain had been pinched during the
match. As a result, the blood supply to his brain was interrupted long enough to cause irreversible
damage. The primary part of the brain damaged was the cerebellum, resulting in ataxia so severe
as to render him unable to walk. Freddy’s family’s health insurance would not pay for the motor-
ized wheelchair he wanted, but fortunately, the community and his friends stood by him. One
eve ning a benefit was held for Freddy, and hundreds of persons from the community came to the
high school to watch amateur comedy skits, juggling acts, musical renditions, and magic shows.
Enough money was donated to purchase the expensive wheelchair Freddy wanted. At the conclu-
sion of the program, Freddy thanked the audience in a speech that he and his speech- language
pathologist had worked on for weeks.
When Freddy first heard that the benefit was being planned, he asked the clinician if they
could prepare a speech to thank people for their kindness and support. The clinician agreed but
was uncertain whether Freddy would be able to speak intelligibly. His severe ataxic dysarthria had
resulted in distorted speech, and his intelligibility was less than 30%. However, Freddy insisted,
and the goal was set. They had 3 weeks.
Freddy took the lead in writing the speech, dictated to the clinician, assuring the audience that
he would approach the challenges of his injury with the same resolve that had marked his wrestling
career. Once the speech was written, Freddy had to learn to speak it clearly and articulately.
Freddy’s speech coordination was impaired. The damage to his cerebellum had disrupted the
rate, rhythm, speed, and force of speech articulation. Freddy’s respiration and voicing coordina-
tion were also impaired, causing poorly articulated speech sounds produced with irregular pitch
and loudness f luctuations. Because of these motor speech deficits, most persons could not under-
stand what he was saying.
The first goal of therapy was to reduce his rate of speech. Red lines were drawn on the writ-
ten script to show him where to pause to create bound aries between words. The length of the
pauses was indicated by the corresponding length of the pause lines. This helped Freddy to slow
his rate of speech by increasing the number and duration of the pauses, immediately improving
his intelligibility.
The second goal of therapy was to increase the precision of each phoneme. Freddy was taught
to exaggerate each sound. He was shown the proper positioning for the speech sounds and how
to make them. The clinician and Freddy also created a feedback system and a method of commu-
nicating goals. Speech precision was placed on a scale of 1 to 10, where 1 represented extremely