Grit plus wit equals success for stroke victim

Warren Palmer uses an E-tran frame (eye-transfer frame) to communicate.
Warren Palmer uses an E-tran frame (eye-transfer frame) to communicate.
A crippling brainstem stroke left Dunedin man Warren Palmer locked in a cruel world - paralysed, speechless and able to communicate only by blinking. But he has amazed those closest to him with his determination. Elspeth McLean meets a man who is fighting back.

Senior mathematics and statistics teaching fellow Warren Palmer might laugh his ready throaty laugh if he knew of my struggle to start this story about the beginning of his recovery from a massive brainstem stroke.

Should it say he replaced algebraic determinants with determination, or that he is defying the odds rather than defining them . . .

"Struggling to communicate? You don't know the half of it," he might say (in his mathematical way).

He does know.

On January 26, when the then 55-year-old Mr Palmer was halfway through teaching a course at the University of Otago's Summer School, he had a stroke in his bathroom at his Dunedin home.

His wife, Loas, remembers him telling her he was having a stroke.

He also managed to convey his determination to fight it and live.

He was rushed to Dunedin Hospital and, while he had a voice of sorts initially, his condition deteriorated and he had to have a tracheostomy tube inserted so he could breathe.

Paralysed, but with his hearing intact, Mr Palmer had what is known as "locked-in syndrome" - able to communicate only with his eyes.

He could only blink replies to yes or no questions.

When decisions were being made about the level of medical intervention to be used in his care, doctors used this limited communication to ensure the treatment was what he wanted.

The next step in his communication came with the use of a talking board suggested by his daughter, Rebecca, which divided the alphabet into six by colour.

Letters were selected by blinking.

A more sophisticated version of the talking board, known as an E-tran frame (eye-transfer frame) was introduced by speech language therapist Alison Zani.

Mrs Palmer said her husband always had a big store of words and plenty to say through the E-tran frame.

It was a painstaking business and Mrs Palmer, who was spending many hours with her husband, admits her concentration wavered sometimes and the sense could be lost.

She remembers wanting to escape at times when she could anticipate he was about to communicate something rude.

Being able to laugh has been vital in the often traumatic recovery process, she said.

Laughter therapy has also been a physical help, helping to build up his muscles and cough reflex.

Mrs Zani came to expect the unexpected in her conversations with Mr Palmer, including an early question asking what the population of Venezuela was.

Mr Palmer found the slowness of the letter-by-letter process of communication frustrating.

Gradually, he was able to move his head sideways and, towards the end of February, also gained some movement in his left hand (he is right-handed).

His friend, Peter Buckingham, then set him up with a computer with a special wrist support so he could tap out words with that hand.

Visitors could see on a monitor what he was writing and could also type messages to him.

He began writing poetry, has completed an article reflecting on being locked-in and has already written 30,000 words of a book about his experience.

"It's going to make us millions," he said, joking.

There was cheering from those present when his tracheostomy tube was removed on March 20 and it was discovered that his vocal cords were still moving.

He would have a voice.

His first word was "hello", followed by "cynosure", a word not widely used, but known to his family (one of its meanings is anything that strongly attracts admiration or attention).

In typical style, he has not been content to stick to simple language, delighting in such expressions as: "The peculiar purple pie man of Porcupine Peak," or from My Fair Lady, "In Hartford, Hereford, and Hampshire, hurricanes hardly happen."

As his voice improved, he still used the E-tran frame much of the time, using his left index finger to point to letters, but does not use it now.

Once the tracheostomy tube came out, much of Mrs Zani's work was spent on improving his ability to swallow, something which requires the use of 33 pairs of muscles.

His speech is also improving, although it sounds slurred (dysarthric) and its intelligibility depends on how tired he is and the complexity of the communication being attempted.

Mr Palmer has been home since mid-July.

He is now able to brush his teeth and wash his hair.

He has considerable right-sided weakness throughout his body, but hopes to walk again.

He would also like to get back to his partially completed PhD in mathematics education.

He says the stroke has made him concentrate more on goal-setting; previously, he "meandered along".

Mrs Zani finds that hard to believe.

All of those who had worked with Mr Palmer have been amazed at his progress, she said.

The support of his family, including his three adult children Chris, Rebecca and Nick, his determination and sense of humour had all contributed greatly.

"It's been great to work with Loas and Warren."

They had done what therapists always hoped people would do - focused on the little things getting better, rather than being overwhelmed by the big things.

Or, as Mrs Palmer puts it: "We don't think of the journey we have yet to make, but how far we've come."

 

 

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