More Coping Strategies

Eventually it became impossible for R to answer the phone and some rather unpleasant cold calls (of which more later) were very distressing. In the end I had to set up a divert service to route calls to my mobile during the day. Solved one problem but created another: R does not happily answer the mobile and now she is effectively unreachable during the day. Still working on that one.

Physical disorientation has got a lot worse. Most of the time she knows that she is at home, although she went through a phase of not recognising the flat and thinking that she was waiting for me to come and take her home. That phase has passed for the moment, but the mental map of the flat is not reliable and frequently she cannot remember where the bathroom is. We discussed putting labels on doors but for reasons discussed elsewhere we decided not to. But leaving the doors open and the lights on has done the trick. She may need to wander round for a while before she sees it but so far it has worked out ok.

Spatial awareness went some time ago. You and I can easily hold a cup level without looking at it while having a conversation, or hold a spoon with food on it level. This is not natural and has to be learned; it can be forgotten. Combined with a weakening of the muscle tone in the wrists this means that we have to be very attentive when she is eating or drinking. She knows about knives and forks but actually applying the knowledge is very problematic. We tend to cut up most of her food or concentrate on dishes where the food can be easily speared with a fork or can be unselfconsciously eaten with the fingers.

Another aspect of spatial awareness is that although she is aware of edges she is not so aware of the spaces between them. This means that, for instance, if there is a place mat or a plate on the table and she is putting down a cup or a glass, she will see the edges and use them as a target point. She will try to put down on the only part she seems to see – the edge of the plate or place mat. Accordingly we have to simplify the tabletop environment considerably.

And a critical point of nonverbal communication – the pointing finger – is also gone. If I point to something she will grab my finger. This changes a whole category of communication. Similarly, turning her to face something does not help her identify it. Her ability to recognise (categorise) items against a background (and there is always a background) is much degraded and we are still working our way through this particular challenge. If I pass her something and want her to take it I usually have to move her hand towards it and encourage her fingers to grip it. Simple things, like passing someone a tissue, suddenly become a major operation. It is tempting to repeat instructions in a staccato fashion and that does not help.

 

Suddenly everything I thought I knew seems to be useless.

 

And the physical coping strategies are the easy part....