Frau Witt-Weller

Berlin, 18.5.2008

Anamnesis and diagnostics

Mr. Distler came to me at the 31.3.2006 to get logopaedia therapy. My name is Doris Witt Weller and I works in the logopaedia practice Sandhöfner and Krause in the Turmstrasse in Berlin, Moabit. 

In his first meeting Mr. Distler with accompanied with his wife and his small daughter, who at this time was still sitting in the buggy. 

The first meeting was aimed to get to know each other. He told me that due to an aneurysma which happened to him on the 11.8.05 he had suffered from a stroke. The stroke was also accompanied with a heavy bicycle accident with a lower leg fracture. Since then the right visual field is reduced and he has problems with distinguishing left and right and also the language is substantially affected. 

To the first 5 weeks of his half-a-year stay in the hospital he hardly doesn’t have any remembrance. There he received logopaedia therapy and afterwards in the ambulatory rehabilitation afterwards about 4 to 5 times per week for 30 minutes language therapy.

Since then he was continuously fighting to learn to speak again. He was able to provide me all the information with liquid language. Sometimes, if a word did not occur to him, he used suitable rewritings, so that the listener who didn’t know Mr. Distler before his disease couldn’t notice a difference to a normal speaker. 

After his own experience he could not speak at all at the beginning. But now things are improving everyday. At the beginning reading didn’t work, then after some time, small, short, sentences. In general he has problems with the “ABC”, some sentences he can read, but with some he has serious problems. As soon as he is reading articles he has problems to read.

From his private life I got to know what he had been a computer scientist working in the field of perception and research. He did work in his own company. He did call himself a workaholic. He said that he only needs 4 hours of sleep and the rest of the time he was working a lot, but it was mainly fun for him. 

After this we met two times a week for 45 minutes each week for Logopaedia. In the first couple of hours I performed the aphasia test from Aachen with Mr. Distler. I did this in order to get a picture of the existing deficits on the different linguistic levels. The AAT is a standardized test. In the case of Mr. Distler the investigations of his language resulted in a anamnestic aphasia, this is the weakest form of a language disturbance. It means that he can speak everyday life colloquial language but with a few small disturbances. With the repetition of sounds, words and sentences, as well as with the designation of individual articles up to situation pictures Mr. Distler did not show/minimum disturbances.

With the language understanding easy disturbances arose, i.e., with more complex connections he could assign the word of the sentence meanings not always clearly.

Mostly effected was the language writing. There Mr. Distler’s abilities were at the border between middle serious up to a small disturbance.

That expressed itself e.g. that he could express given things as a word characterized, but he wasn’t able to find the appropriate characters or couldn’t add it in the right sequence.

After I had evaluated the test, we got together and were discussing which goals we wanted to obtain in the near future. Mr. Distlers largest desire was it to learn reading and writing again, particularly in the view to be able to read out to his daughter later. 

This goal he had in front of his eyes and was firmly decided to work hard to reach this. And the work began… 

Been suitable to the renewed acquisition of the writing language appeared to me „Anagramm”, a fastidious program, in which with increasing degree of difficulty all letters and combinations of letters of the “ABC” are learned anew again.

At the 26. 4. 2006 we began with the first chapter, in which the Grapheme T, H, A, U were introduced. Mr. Distler task was to put characters in the correct sequence and to create small sentences such as „the woman has a colored hat“, or gap sets with a given words should be filled or small cross word mysteries should be solved. Read exercises and writing after a dictation of sounds and words. 

In order to embody the characters better in memory, we put together so called “Anlaut-Tabellen” (initial sound tables). Mr. Distler should connect individual characters with certain articles like A for apple or H for head. For that purpose we took school like initial sound tables and partially private words such as Distler for “D”. In the therapy I used magnet characters which Mr. Distler should pick out and assign. At home he did use large wooden characters. 

In order to get an idea of the time which he required to learn four or five new characters, it took about three weeks to obtain this. The characters compiled in the therapy should be strengthened at home in small exercises. I could give to Mr. Distler never enough „homework“, always everything was thoroughly and fast settled and beyond that tasks of diligence made.

Gladly Mr. Distler used even the smallest places, in order for example to fill hole DIN A 4 pages with A’s or H’s.

The 45 minutes of therapy were loosened up by interesting discussions. Mr. Distler always let me be part of his new experiences and realizations over his experiencing language, the characters, the numbers, the memory… and I was fascinated from the almost childlike joy, with which Mr. Distler did relearn the writing again, without ever complaining about his fate or express displeasure or express thoughts about giving up.

That happens with my work as Logopaedia person more frequently that patients give themselves up and become depressive over their suffered loss of the full language functions and give up themselves at some point. My task is then to give the patient again courage, to regain her or his remaining abilities. That I did not need at Mr. Distler. He was always motivated.  

Probably he had these phases as well, but he never let these phases win and so it always was a joy to accompany Mr. Distler’s linguistic development. I admired and admire the power and his will to achieve and set these goals. The amount of work was enormous! 

To sit daily hours for hours untiringly for the acquisition of new characters, that presupposes a very strong will and it is hard to believe for someone who does not have this experience. 

In the course of the coming months were added more characters until the whole alphabet was compiled. 

The degree of difficulty of the tasks became higher and more fastidious thereby. With the learned characters he had to solve syllable mysteries or the task was to complete text with gaps.

Secret code had to be recognized in the text like e.g. “L” and “J” had to be replaced with “J” and “Q”. Another task was to decipher text from a long sentence, which did not have any gaps (e.g. iamhartwigdistlerandiamhappytolearnreadingagain (I am Hartwig Distler and I am happy to learn reading again)). Another task was to find hidden words in a word.

Parallel to the exercise program memory exercises were done (not completely as much as was needed, but since he received “Ergotherapie” and also did use a computer program (Cogpack). To break up a bit we were playing memory or made tasks of word identification like finding topics or finding subtopics. Mr. Distler e.g. should find all possible animal terms. Thereby I learned then that Mr. Distler had studied biology.

In the course of time abilities to write and read increased very much. At the beginning it was still very difficult for him to read individual words, after some month he improved very much and also in writing he had good success. But especially when writing words it was obvious that it took him some time to get words correct. 

At the end of the year Mr. Distler announced that he wanted to terminate the therapy. In order to have an objective proof of the progress in black and white, I performed the aphasia test from Aachen with him again. 

The results were impressing: Within all linguistic ranges he had improved and particularly with the writing language and with the language understanding he had ascended from the middle disturbance to the minimum or no disturbance level. Of course he did not yet completely recover to the state he had before, but he was able to express himself and that is a very good result! 

With a small regret I terminated with the meeting at 17.1.2007 the therapy. With a small regret, because I enjoyed the co-operation with him as well as I got new thoughts and new ideas. Above all I will not forget the positive view of life and this will always accompany me, when ever I don’t feel so well …