If you visit Cleveland Hearing & Speech Center on almost any Monday afternoon, you'll see a group of very active adults in the Center's large community room playing poker, trying out video games and just talking about the events of the day. But this isn't just any social club. These men and women are members of the Speak Easy group, which provides unique and innovative programming for post-therapy stroke patients and others with acquired neurogenic communication disorders.
Speak Easy was established nearly 25 years ago to help stroke patients who, after completing traditional individual or group therapy, found themselves simply going home and having minimal communication contact with others. The group, which is coordinated and facilitated by speech-language pathologist and Case Western Reserve University (CWRU) adjunct instructor Jean Nisenboum, provides a support system that is geared toward communication.
"It's a difficult thing to have a loved one who one day is functioning as you've known them, whether it's your mother, your father or your spouse, and the next second you are worried about them living as they have this stroke," says Nisenboum. "And once you get past that fear, you worry about how you are going to get them back home. And then reality sets in when the individual cannot communicate the way that he or she did before."
The Speak Easy group is composed of individuals from a variety of different economic and living environments who have communication disorders resulting from stroke, head injury or diseases such as Alzheimer's or Parkinson's.
The group size can range from 18 to 30 people, with approximately one-third of the attendees accompanied by caregivers. The youngest current member is 32 years old, and the oldest was 90. The typical member is in his/her mid-60s.
One of the current group members is a woman, 50 years old, who held a very important position at a bank before suffering a significant stroke several years ago. For the first two years she barely left her room at the nursing home where she now lives.
"She has been coming to Speak Easy for three years, and everybody at that facility cannot believe the change in her," says Nisenboum. "She goes all over, she talks to people, and she will tell you this is her group. She just looks forward to every single Monday. If you talk to her, she is very verbal, but she still has a lot of problems that aren't so obvious that come along with the stroke, in terms of decision-making and remembering things."
"There are a lot of stroke patients who can't go back home and end up at long-term-care nursing facilities. But if you are a younger person with a stroke, your peers are not the persons in the nursing home. Most of those people are 70 or 80 years old, so the group provides a nice opportunity for those younger individuals to socialize with people closer to their age."
Under Nisenboum's supervision, graduate students in CWRU's Department of Psychological Sciences
program volunteer their time to develop activities and work with the group members. They create lesson plans in coordination with activities that the group members enjoy and establish target outcomes for each individual in the group.
MEET SOME OF THE SPEAK EASY CLIENTS
12+ Year Stroke Survivor
Mr. D. has attended the Speak Easy Program weekly for over eight years. Prior to his stroke, he was a employed as a mailman. Communication is very important to Mr. D. After his stroke, Mr. D. found himself unable to talk. He says it took him years and the Speak Easy group to get him where he is today. When asked where that is, he quips, "Unable to shut up". Mr. D. is a tireless advocate for stroke survivors. Besides being an active member of Speak Easy, he is past president and current member of the Cleveland Stroke Club. Mr. D. is credited for coming up with the Speak Easy motto, which is "Different Strokes for Different Folks."
8+ Year Stroke Survivor
Ms. Schivitz was independent and living alone prior to her stroke. She loved animals and raised horses. Ms. Schivitz participated in 18 months of therapy at local hospitals and was discharged from therapy due to lack of progress prior to joining the Speak Easy group. Ms. Schivitz credits the Speak Easy group with providing her with the support and opportunities to improve her communication skills and continue living independently in her home.
12+ Year Stroke Survivor
Mr. S. is considered the "grandfather" of the Speak Easy group, not because he is the oldest member of the group, but because he has been coming to the group weekly for more than 10 years! Mr. S. is a husband, father and proud grandfather. Mr. S. was employed as a successful salesman prior to his stroke. The type of stroke Mr. S. suffered resulted in the inability to talk, ending his career as a salesman. Currently, Mr. S. is able to understand speech and written language, but he is only able to talk in one- to three-word sentences, with great difficulty. Still Mr. S. is able to communicate successfully by using speech, gestures and some limited writing. Mr. S. is a valued support to all new group members. Mr. S. credits the Speak Easy program with allowing him to continue to use and refine his communication skills. Mr. S. is accompanied to the group meetings by his recently retired wife, Vivian.
During the first 40 minutes of the group, members sit together and converse, just like sitting around the family table. Because their speech is either quiet or slow to initiate, it is difficult for Speak Easy members to keep up in family conversations at home. The Speak Easy group is structured to be an environment where members can participate in conversation and have opportunities to choose the topics.
"We cover everything in the group, from daily news topics, what you did on the weekend, who saw what movie, politics, even beer, because we have a beer-maker who is a stroke survivor in the group. It's just conversation. And that sounds easy, but for our group members it's the only time they have a chance to just converse," says Nisenboum.
After a brief break time and snack, the group divides into smaller groups, which give more emphasis to each person's individual communication goals and activities of interest.
"So on any given day we always have a group that plays poker," Nisenboum explains. "Poker itself provides a lot of cognitive opportunities for people and a lot of communication opportunities. Many of the people who go to that group want to be able to participate in those kinds of games at home. So within that group, besides working on those general things, they might be working on their counting skills or getting their speech loud enough for the person across from them to hear."
"Right now we have a group that is doing Wii bowling, which is a great motor activity, but we're also gearing it around speech and language goals. So if they are playing bowling, they have to focus on counting how many pins they got down, if it was a strike or a spare and if their speech was loud enough for the person they're competing against to hear them. So they are motivated, and they are talking in environments where it matters to the other person to be able to hear them."
Recovery from a stroke is a lifelong process. Survivors can continue to improve their cognitive and communication skills for many years after the stroke if they continue to be involved in activities. However, this type of long-term rehabilitation is not covered by health insurance.
To Nisenboum, the main evidence of Speak Easy's importance is the fact that so many members keep coming back. "The students are always amazed when they come in and ask, 'How long have you been coming to the group?' We have a couple of people who have been here between 15 and 18 years; this tells you the need that is out there in the community. One of these men is very verbal; if you met him on the street, I would guarantee you wouldn't know he had a stroke. Yet he is still coming to this group, and he'll tell you that this is his peer group, where he gets the opportunity to converse in the way he wants to without people making judgments about him. There are other people who use the group as a stepping-stone and then move on. But a lot of our members are "lifers" until something prohibits them from coming back."
The Speak Easy group meets every Monday, except holidays, from 1 pm to 3 pm at Cleveland Hearing & Speech Center (University Circle) in room 140. For more information, call (216) 231-8787 or email firstname.lastname@example.org. There is no charge to attend.
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