We have questions

Questions are a powerhouse for everyday communication and connection. They help us show interest, seek information, clarify meaning, repair misunderstandings, and take a more active role in conversations overall.

Working on questions can be especially important for many people with communication difficulties. As we discussed in the previous post, some challenges can partly stem from difficulty getting started: not only with speech, but with the whole action of initiating communication. And asking questions requires a lot of initiative!

A question begins with curiosity: noticing that there is something we want to know. Then we narrow our interest down to a specific piece of information and make the decision to initiate an action to ask. And this happens in the background before we get to the more visible part: formulating the question itself and taking the conversational turn to ask it.

The Build a Question task provides a tool for familiarizing the client with different types of questions and constructing them in a structured way.

On screen, you see a picture, a sentence frame, and several possible question words. In this first example, the picture shows some cows in a field. Under the picture, the sentence fragment says:

… do cows eat?

The options presented are: What? and Which?

And you guessed it — the task is to select a suitable question word to complete the question. The number of options can be adjusted according to the client's needs, as shown in the next examples.

Task with a wrong answer selected

Task with the correct word selected

In these examples you may also notice that selecting a question word simply changes its color to orange, regardless of whether it is a suitable or unsuitable word for the sentence. So no feedback from the app? How is this helpful? How will they know if their selection is correct?

Glad you asked! No automated feedback means that the task does not end with the selection. After your client makes a selection, you have the freedom and flexibility to evaluate and discuss the task together.

You can start by asking them to read the completed question aloud. For example: What do cows eat? vs. Which do cows eat? This makes the task nicely multimodal: the client looks at the image, reads the sentence and options, makes the selection, and hears the completed question, all of which support the processing of information and meaning as well as self-monitoring and correction. After making their selection, they can verify the answer themselves with your support, or try again if needed to get it right.

Your job as the therapist is to support the process. You can guide the client by asking questions: Does the question sound right? Does it make sense? You can also ask: Is the question easier to understand when you see it on screen with the picture, or when you hear it out loud? How about when the question is written on paper? Is it easier to process when you also see it as a full sentence?

This is where you can make connections to real-world situations. What kind of support does the client benefit from the most? How can they seek that support in their everyday life?

If they are ready for a challenge, you can continue with questions like: What information are we seeking with this question? What kind of answer would it lead to? What is the answer?

So. Many. Questions. All of them provide an angle for supporting the client and help them think about and start formulating questions in various scenarios. This is the versatility of SanapsisPro at its best.

So, although the task format is simple, it can open the door to many useful therapy moments: reading, listening, reasoning, self-monitoring, and conversation. More importantly, it gives the client supported practice in one of the most active parts of communication: noticing that something is missing, becoming curious, and taking the initiative to ask.

That is a powerful skill to build — one question at a time.

I Want To…

Next task in our SanapsisPro Production category is a task called I want to… This task has two to four action pictures on screen and a prompt that says “I want to…”

Hmm. It seems a lot like the Naming - actions exercise we talked about in the previous post. So what is going on? Actually, quite a bit! In this task, you ask the client to:

• Examine the pictures

• Determine the action taking place

• Select the one they prefer

• Start the phrase

• Complete it with their preferred action word or phrase.

In the example shown here, the client may just looove gardening and be very clear on the selection they make. The answer becomes “I want to… work in the garden.”

A different client might not enjoy gardening, but they are not too keen on photography either. They end up selecting the image for taking photos through the process of elimination. “I absolutely do not like working with dirt, but I guess taking photos is not that bad. So, I would prefer the camera.” The answer becomes: “I want to… take photos.” Both are excellent answers!

Completing the task requires a vast array of useful skills: actively working on making a choice, formulating and expressing an opinion, and using verbs in sentence-level expression that is rooted in their preferences. And very importantly, thinking and expressing what they like to do.  A meaningful and communicative way to work on action words; not as isolated vocabulary, but as part of personal expression.

As clinicians know, many people with aphasia experience difficulties with initiation. The difficulty may not be limited to finding the right word or initiating speech. It may also include initiating the whole action arc: thinking about preferences, independently making a selection based on those preferences, shifting from looking to expression, and generating and sharing required information.

This task format provides scaffolding for the whole process of generating informative expression. The beginning of the sentence is already there to prompt you. What do I like to do? Visual options provide ideas and a limited number of choices, reducing the pressure and overwhelm of initiating an idea from scratch. The task creates a small, supported bridge that links personal experience and intent to sentence formulation. Nothing more powerful than that!

When the task goes smoothly, it naturally grows into a conversation exercise. When they select, for example: “I want to work on my car,” ask them to tell you more. Beyond the rather abstract question “Why?” or “Tell me more”, you can continue by asking: Have you always enjoyed working on cars? Where did you learn? Do you have a specific memory or a story related to fixing a car?

Now, we are not just drilling vocabulary verbs. We are working on personal, meaningful information, preferences, opinions, memory, narrative language, and supported conversation. Sometimes communication starts with a small nudge of finding a way to express: I want to…. And sometimes that is all you need.

Need variation? You can adjust the number of images on screen in task settings. Two is a good starting point. As your client becomes more familiar with the concept, you can introduce more images for added complexity.

Naming Nouns and Actions

To kick things off for the Speech Production category, I will cover not just one, but two tasks in this first post! These tasks are Naming, Nouns and Naming, Actions.

As you can guess from the names, one of the tasks contains images for eliciting noun responses and the other ups the stakes by introducing images that show an action. I will save the story behind the images themselves for a separate post — and that one will be fun. Plenty of stories behind the real-life images in SanapsisPro!

Technically these two Naming tasks are very similar, and both are familiar speech therapy flashcard-type tasks. This is the task format people envision when they think about speech therapy. You have a picture, you show it to your client and they say the name of the item or action in the picture.

When you launch the exercise in SanapsisPro you see an image or multiple images, and swipe forward or back to alternate between them. You can adjust the number of images shown on screen and filter them by category. So simple, so useful and so versatile.

But hey, wait a minute! When you tap an image, it disappears. When you tap the screen again, the image comes back. This seems a bit odd. Why does the image disappear? Seems like something that should be fixed! Or… hmm… is it maybe surprisingly clever? A feature, not a bug? Well, I like to think it is surprisingly clever (as I designed it, hah).

This feature allows you to work on delayed naming or repetition. Ask your client to name or repeat the object in the image. Then tap the image and ask them to tell you what is hiding behind that black screen.

When I have multiple images on screen I can get my clients to go the extra mile by asking them to:

1. Memorize the items on screen

2. Close their eyes (as I hide one of more of images on screen) and

3. Tell me which one is missing.
   =>  Instant, playful fun featuring memory and naming challenges!

This can work well in group settings too. Have clients team up for the memory challenge!

You can change up the task and add an element of reciprocal communication by taking turns. Images are easy to hide and reveal for the client, and having them quiz you can be a fun challenge. This can target many goals, such as taking a leading role in the exchange, practicing memory and attention, and listening closely to verify answers.

With over 500 images in Naming, Nouns and more than 300 real-life action images in Naming, Actions, there is plenty of material to keep your sessions fresh and engaging for a long time. Hope you have fun mixing up the familiar Naming task!

New update - Speech Production category

Happy to announce that the Speech Production category update is live!

Head over to the App Store to download the latest version of SanapsisPro and access the new content. As always, all materials are included for all users at no extra cost.

Moving on to our next category - Speech Production

Speech Production category tasks are designed to support and activate speech production during speech and language therapy. Exercises range from simple naming tasks to more complex tasks that require higher-level cognitive and linguistic processing. In this update, we have expanded the content in some of the old favorites and trimmed down others for clarity. All exercises include improved task instructions and tips on how to simplify or increase the difficulty level, or where to go next. All aimed at providing a well-curated and streamlined user experience.

The Speech Production category includes exercises:

• Naming (noun)

• Naming (action)

• I Want to…

• Build a Question

• Precise Sentence

• Descriptive Sentence

• Give Instructions

• Retell a Story

If you miss the old favorite, Organize a Sentence, you can find it in the Reading section. The task Create a Sentence Around Words has, however, retired. If you would like it to return in the next update, drop me a line!

In the coming weeks, I will share a closer look at each of these exercises. I hope these tasks, materials, and instructions offer an inspiring starting point for you and your clients.

On that note, I would love to hear how you use SanapsisPro in your clinical work! Please drop me a line anytime via email via the link on the upper right hand corner. After all, the strength of Sanapsis is that you and your clients can be as creative as you like, with just a little structure and support help from us.