Case Study #1 -- M.S.
(Therapeutic period: November 2013-January 2014).
M.S. is a 92 year old woman who has lived in a senior residence for 2 years. She came to therapy out of frustration with fatigue and memory loss.
On intake, MS was alert, aware, responsive. She described a constant “hissing” in ears and has no vision in her right eye. Having struggled with academics since her youth, she dropped out of high school one month before graduation to work as a seamstress.
She demonstrated good physical dexterity, strong mental imaging skills, and strong sensory-motor skills.
Her goals: improved memory and attention
Problems assessed (lower processing deficits):
• Short-term memory problems (unable to remember 3 item sequence)
• Signs of “Neglect” (sensory deprivation in left brain) in visual-spatial tasks (clock and house drawings askew) (see Intake/Assessment photos at right)
• Slow speed of mental processing (only able to recall 2 recent
US Presidents after close of session)
• Shown to have strong emotions about current life experience
issues / Neuro Distress (expressed in endless looping and
By end of session, M.S. seemed more calm and relaxed.
▪ Stabilize Neuro Distress
▪ Increase speed of mental processing
▪ Increase accuracy of long- and short term memory
▪ Increase visual-spatial strength
Stabilize Neuro Distress before proceeding to visual-spatial tasks and encoding/decoding exercises to strengthen processing ability, attention and memory.
Progression of Therapy
M.S. was visibly tired, showing signs of physical and emotional stress (about current life issues). She seemed uncommunicative, staring blankly ahead, without affectation. Though “not doing well,” she consented to therapy.
During the 90 minute session, she moved from emotional incapacitation (depression, sadness, constant repetition of life issues) to cognition (thoughtful discussion). A multi-layered exercise combining reading (of the storybook/fable Seven Blind Mice with large colorful illustrations) and thoughtful discussion of a poster (that drew upon M.S.’s strong mental imaging abilities to visualize a river with a small stream branching from it, with the words: “What appears to be the end may really be a new beginning,”) served to strengthen memory as well as to initiate talk of change and new beginnings. It also brought about a noticeable change in M.S. in the form of a quieting in mind and body. By end of session, she was physically and emotionally more relaxed.
M.S. appeared more relaxed and composed. She rationally spoke about life issues and her evolving response to them. Visual spatial tasks and encoding and decoding exercises were used to strengthen memory, attention and processing ability. Design 4 from the Therapeutic Drawing Series (TDS) was introduced along with guided imagery exercises to jump-start memory. In reviewing our storybook reading, however, mention of the word “reading” triggered tension and fear (of her inability to recall details) in her. In lighthearted approach, she was able to recall a few of the associations before turning the page to reveal the color-illustrated answers. A glimmer of joy flashed across her face in “remembering.”
Session note: Since our first meeting, M.S. has shown noticeable improvement in the form of heightened awareness and a growing interest in working toward her own ‘recovery’ (i.e., improvement of attention and memory). She is beginning to “talk out” her issues and gain personal insight. She is also beginning to recognize her own anxiety and the physical manifestations of stress on her.
M.S. seemed more carefree, untroubled by her life experiences. In the spatial-motor exercise, she showed greater manual dexterity. Memory recall exercises, building upon the TDS design from our previous session, showed in her a strengthening in memory retention, and M.S. was able to correctly identify shape placement. The clock drawing proceeded at a slower, more deliberate pace as we talked through each step in placing numbers and detail. Spacing was a bit uneven and the 9 and 3 did not evenly align. M.S. needed assistance with positioning of clock hands (see Week 3 clock photo).
On my arrival, M.S. was seated alone on the couch, quietly reading a newspaper. Relocating to the activity room for our session, she mentioned feeling “bored” as there was “nothing (at the residence) to challenge her brain.” She was excited to begin the session.
As a warm-up exercise, M.S. used various crayons to make colorful circles and squiggly lines on paper.
Six "figure" drawings were attempted, alternating hands and with eyes alternately open and closed. With her right hand, she made smooth, bold strokes and was able to complete the right-to-left transition without hesitation, commenting that she was “getting better” at it; but when switching to the left hand, she struggled with two false starts which were not completed. Interestingly, with eyes closed, she remarked that the task was easier, especially with the left hand, because she was visualizing it in her mind.
Exercise 9 of the Therapeutic Drawing Series was presented at three progressive levels of design, though at a more relaxed regimen in keeping with M.S.'s abilities and needs. First, we identified geometric shapes in the design, then M.S. loosely drew the design on an 18” x 24” pad using crayons to match color and shape (see Week 4 -- photo 9-1). In comparing this first draft to the original, M.S. noticed that the right-angled triangle she drew differed from the original. Wondering aloud about her misperception, she attempted to make a correction using a red crayon, although she drew the same triangle at a slightly different bent. She commented that it was “not quite right.”
At the second level, we took a closer look at placement. In semi-active mode, M.S. drew in each figure, more aware of spatial relationships, with her triangle drawn a bit closer to original (see photo 9-2). In review, she addressed errors and we compared positions in correlating lines and angles.
At the third level, M.S. was more aware of design, although she could not recall correlations. Before she drew in the shapes, we discussed correlations so that her placement was more on task (see photo 9-3). Once again, however, she drew the triangle at a right angle. I asked her to demonstrate the correction by first tracing it with her forefinger onto the paper, for which she required help to complete. Upon further discussion, she corrected the triangle using green. When comparing this drawing to the original, she was able, with some assistance, to voice line-angle correlations. She commented that her brain "had waken up.”
The session concluded with free-style painting of the ocean (see "ocean" photo). M.S. thoroughly enjoyed the freedom of large-brush painting and the stimulation of mixing colors in a harmonious palette.
When asked her whether she thought her brain had been challenged, she emphatically replied, "yes!"
Two months following therapy:
Commenting on the therapeutic benefits of NAT in her everyday life, M.S. says, “It keeps my mind open.” She now actively engages in mind- stimulating activities like reading, puzzle making and art classes. Her most recent library selection: a book of poetry.