Let's Talk Speech Language Service    By Larisa Berman MS, CCC-SLP Special to ADVANCE Speech-Language Pathologist Strives to Recover Language Amid ‘Mystery of Silence’. "Mom, how come so many nonverbal people come to you?" "Because they want to speak." "Will you help them?" "Of course, I will." "All of them?" "I'll try to help them all." "Mom, why don't they speak?" "For different reasons, son. Some of them never learned to speak, and some have lost their speech." "How can it be lost? It's not money or gloves." My six-year-old son wouldn't give up. And probably this 20-year-old conversation would not have come to mind were it not for hearing the same question over and over again: "Why don't they speak?" A PATIENT SAT in bed tossing old postcards in a box. She seemed to be completely occupied by these mechanical movements, they took away her ability to see, to hear and to react. In her pale face with fine features, one could find traces of faded beauty and colors of a different life. "Good morning! I'll be your new speech therapist," I began cheerfully. There was no reaction. "Is your name Susan?" She gave me a tired and hostile look, continuing her business. I asked questions, showed pictures, photos of her relatives, common objects, but Susan was dejected. Only sometimes did a single sound escape from her never-closed mouth: a-a-a. At times it was a sound such as a signal or reflex; other times, the intonation changed as if bearing some cerebral meaning. Finishing a routine evaluation, I made a note in her chart: "Patient S.N., 60-year old, suffered a severe head injury as a result of a motor vehicle accident, completely nonverbal, receptive abilities extremely poor, unable to follow simple verbal directions. Severe drooling." Two paragraphs were left: "prognosis" and "therapy recommended: yes/no." But something was forbidding me from scribbling the words "no potential for rehabilitation. Treatment is not recommended." What if something can still be done, salvaged from her damaged brain, plugged into life's network? -2- I PORED OVER the file, trying to find at least one hopeful word: "... was airlifted to hospital, underwent brain surgery.. .five weeks in neurosurgical unit... protracted coma, complete lack of motor ability." A profound clinical condition, with practically no chance of rehabilitation. More than two years after the accident-years of total silence and incomprehension of reality, years cut out of her life. We started working. Picture and object training was unsuccessful. She simply didn't see them, didn't differentiate, even while holding the identical ones. Susan refused to work, was irritable and capricious and tried to avoid me at all means. The moment I entered her room in the morning, she slammed the bathroom door. But I came in several times a day, tugged at her, shook her, persuaded massaged her immobile lips, pushed together her unyielding jaws. The moment I took my hands away, her mouth would open again and her tongue would fall out. The first few weeks did not yield any results. Days came and went, but all remained unchanged. We both were exhausted and sometimes-losing hope for success-I grabbed a pen to write, "Discharged from therapy. Trial sessions were unsuccessful." But those were only moments of weakness and despair. Still, Susan had a long way to go before she was ready to begin speaking. At last her reactions began to change and differentiate. She started to understand, to "see" and to become better oriented. Now I only needed to create a situation that would force her to pronounce the first word. For the thousandth time I racked my brain to find a way to do that. ONCE, AS I entered her room, I stopped at .the threshold, amazed. Her bed was covered with boxes and packages. Susan sat in the chair pressing a small color photograph to her lips. I approached and embraced her shoulders. "Who is this, your husband?" I asked. She shook her head. "A brother? A friend?" Susan closed her eyes and wept silently. "Does he visit you?" For the answer, she showed me her hand with an elegant gold bracelet. "Is this from him?" She nodded. "And those are gifts, too?" I asked, glancing at the bed. "So many" Susan perked up, sorting the boxes, untying the packages and trying things on. She looked in the mirror and threw them down. Yet until that very day, all those things had stayed in her closet, completely neglected. We sat side by side sorting bathrobes and nightgowns, sweaters and gloves. -3- Then we took on the photographs. There were many depicting different views, situations and seasons. But all of them showed a tall slender man with gray hair. A desk buried with papers, a beach somewhere in the islands, a picnic in the woods. I peered intently into the faces, trying to understand the nature of their relationship, to feel the mood. I tried to memorize the smallest details so that I could get a feeling for the important moments in her life and somehow recreate those emotional stimuli: BEFORE TAKING Susan on a trip to the park for an off-site session, I had a long conversation with Michael, the man in the pictures. In the park with Susan, everything was exactly as it was in the photographs: fall, a bushy red maple tree, a small table with food beneath the branches. Everything was like it was then, only I added a few photographs on the table. Susan stared at them for a long time. It was obvious that the autumnal colors and fragrances stirred some long forgotten memories within her. She fell into a kind of indescribable excitement: walking around the table, changing her seat, frowning, trying to remember, smiling at something. Susan was peering into the photographs, and I saw how her memory was coming alive, as if she was floating upon some magic current and repeating the actions of that day. There she is hiding behind a tree, throwing back her head, just .like in the photograph. Then she's running down to a pond. Abruptly she stops, turns around, as if trying to call for him. I gave her a tip: "Michael, Michael!" Suddenly, she repeats after me, "Michael, Michael Wilson." So Susan uttered her first words. Tears welled in her eyes and slowly rolled down her cheeks. Perhaps she remembered it all: the hot sun of the Bahamas, the red lawn covered with maple leaves and the stillness of the pond. Perhaps now at this very moment, she understood for the first time what had happened to her. Today, being 60 years old, she began learning to talk again and started the second circle of her life. BEFORE ENTERING the next room, I glanced again at the chart, although I felt that I already knew it thoroughly. "Patient B.D. 47 years old, found on the floor of a bathroom, right side paralyzed, completely nonverbal." "Wensy, wensy," Bill greeted me, smartly maneuvering his wheelchair around the room. It was all that was left of his speech after the stroke. I have never found out what that word meant: a day of the week, a woman's name, a place. "Wensy, wensy," repeated Bill, hurriedly opening drawers and giving me some rumpled yellowed papers. Sign language -- the language of gestures, pictures, symbols-a way of nonverbal people's communication. In America there is a whole arsenal of gadgets. If you don't speak, no problem. You are offered an alternate system of communication: symbols. gestures, electronic speaking devices. Bill used those to express his needs and wishes. -4- Rapport with Bill was established quickly. He was willing to work from dawn to dusk, until complete exhaustion, just to start speaking. At the beginning of every session, he pedantically placed his papers on the bed, rewriting the same words over and over and showing the same symbols. Bill could not comprehend why I refused to work with them and completely ignored them. THE SECOND WEEK of therapy was ending, yet we still could not escape from his papers. Once, at the end of the day, I invited Bill for a cup of coffee. "Bill, do you want to speak as you did then, two years ago, before the stroke?" I asked. "Wensy, wensy," he nodded. "Bill, you can speak," 1 said. "I will help you. 1 will teach you as a child letter by letter, syllable by syllable, word by word. Trust me. Forget gestures and symbols. You are not deaf. You hear and understand me. You had an accident and lost your speech, but it can be restored and returned to you. You must work a lot, and you know how to work. But the most important thing is that you have to forget about these papers. They only bother you. Throw them away, and we will start anew." Bill became angry, grabbed his papers, hid them in his chest. Red spots flashed in his face, veins on his head swelled. He left me without finishing his coffee. Bill met me at the entrance every morning, impatiently waiting for the therapy. But if 1 uttered a word about the pictures, he would immediately lose his cool and demand that 1 leave his room. Now, for purposes of security, he covered his papers with a bedpan and barricaded his bed with chairs. "Bill, relax, trust me," 1 told him. "I will not touch any of your papers. You wiI1 make your own choice when you want to speak." I CLEARLY understood that by encouraging him to make the sacrifice, I was taking away his only chance to communicate. But we had no alternative. Development of speech could only happen under conditions of the acute, critical necessity of self-expression. One morning upon entering the building, I saw Bill waiting for me at the elevator. He snatched my briefcase from my hands, put it on his knees and, propelling his wheelchair with a metal stick, rolled to his room, motioning me to follow. The neatly stacked papers somberly awaited their fate. Bill was nervous and fussy and breathed heavily. I saw at what cost he had made his decision, with what selfless look he relaxed the fingers of his only good hand and threw his priceless pictures in the garbage can. Terrified, he suddenly exclaimed, oh, boy!" "Bill, you are starting to talk!" I said. "Repeat, repeat again, quickly!" “Oh, boy!" he said with tears in his eyes. Joy and fear -- all got mixed in that first long-awaited word of his: It seemed that he could not believe his ears.