Taylor’s therapies are going REALLY well, and he is about to transition from “home health care” to true “outpatient therapy”.
The Mayo Clinic here in Scottsdale has a great facility, as does Barrow Neuroscience Institute, so shopping for this phase of therapy is really just sorting through the best of the best. We are in a good spot for this, for sure.
Still house-hunting for a place to rent over the next year, and it is either North Scottsdale, or Carefree/Cave Creek areas, which is really as good as it gets for living in the Phoenix Metro area. Please remember T’s casa es su casa; there will ALWAYS be room for visitors to stay!
Taylor’s speech pathologist has concluded that he is neither apraxic nor aphasic, so his issues with speech/swallow are more likely attributed to mouth/jaw architecture rather than affects of brain damage. Cognitively, he is functioning at a very high level. His mouth shapes words perfectly, so if he is having a tough time with the toggle from nasal airflow and mouth airflow, you can easily read his lips. When the soft palate at the back of the mouth hangs low and is weak muscularly, air will not exit through the mouth for voice, so words are being shaped, but with little or no output volume.
Taylor met with one of his plastic surgeons this morning, for a preliminary consult on the jaw, palate and dental work on the horizon.
Taylor’s jaw has an extremely limited range of motion aside from a simple open/close. Lateral motion is also necessary, and it is tough to know at this point if his limits are muscle weakness/tightness or something at the hinge itself.
Also, when he broke his jaw, it broke his palate, so there was concern over the shape of the palate as it healed.
According to Dr. Joganic, Taylor’s palate has healed perfectly – with symmetry – and visible movement in the soft palate (in the far-back roof of the mouth). The movement is quite weak, so a nasoendoscopic procedure will tell if this is a structural issue which can be surgically corrected, or something else that can be addressed through specific speech therapy approaches. The nasoendoscopy is being scheduled for next week.
Dr. Joganic also performed a few quick tests to assess cranial nerve function. By having Taylor lift his gaze, pucker his lips, squeeze his eyes tightly, and several others, Dr. Joganic was very pleased to see Taylor’s cranial nerves 3, 5, 7, etc., were all responding. This was not the case upon his last examination of this sort a few months back!
**I should mention Dr. Joganic’s obvious delight as he saw Taylor walk through the door into his office today. Taylor was standing, talking with me in the exam room, when Dr. Joganic entered, still smiling and shaking his head in disbelief.
“Therapies are going very well, I see!” he said. “You really look great!”
Taylor smiled and nodded. “Hi Dr. Joganic.”
So the doctor conducted the entire exam as Taylor stood, feet wide, hands-in-pockets.
The last time Dr. Joganic saw Taylor was the day he checked into ER/ICU a few weeks back: Taylor was in his wheelchair; not responsive; not swallowing or speaking at all. BIG difference!
I have missed conversation with Taylor, and in the past few weeks, he has been able to lift that palate and speak clearly through his mouth. When he fatigues, the back of the mouth stays pretty closed, and he can get pretty quiet. It’s just such great news that this is not evidence of brain damage, but instead a weak set of muscles in the back of his mouth. When he does speak, it’s all Taylorisms. The rest of the time he is typing for communication, or writing things out on a dry-erase board.
He is looking forward to getting his laptop up and running. He wants to start writing his book.
