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All The Things We Love About Speech Therapy With Adults

This blog is about all the things we at Sanapsis Love about Speech Therapy with Adults. 

As wise as an owl? As dangerous as a plate?

Nana Lehtinen

If you are a speech therapist and work with adults with acquired brain injury you are no stranger to difficulties in interpreting and processing figurative and more abstract language. Chances are you have used a metaphor or two with your patients too! I know I have worked my way trough a lot of worksheets of similes and metaphors with my patients, sometimes truthfully wondering why is this important? What is the gain from this exercise, how will this help my patient to navigate his daily life?

After a lot of time observing and working with patients and comparing notes with colleagues we were able to draw lines from working with similes to actually being more competent in communicating in everyday surroundings. And so much so that we decided to include some exercises with similes in Sanapsis! In our Semantics category you can find two exercises that make use of similes.  Neither of them is the  "Tell me what this simile means"-type of exercise per se, but there is no stopping you from using the material provided for that too. 

Semantics category in Sanapsis

Our Is this simile true -exercise challenges the patient to judge if the simile is true or false. Fairly straightforward, right? However,  under the surface patients are

  1. working on understanding intentions behind the words
  2. doing feature analysis on everyday nouns
  3. working on judging the meaning of what they just heard
  4. communicating their opinion by making choices.

Is this simile true?

In addition to this, I like to take things a step forward and ask the patient to provide a suitable adjective or noun to transform the false similes into something that makes sense (like e.g. as loud as a vacuum cleaner), when applicable. And that, of course takes the exercise to a whole different level.

That new level can be explored further in our Complete the simile -exercise where the patient gets to fill in similes. Sanapsis provides the simile with a blank for the adjective and the patient gets to find a suitable word to match the noun provided. In the small black boxes you can find examples of suitable similes, but only the sky and verbal reasoning skills are the limit on what is accepted here! Yes, you guessed it right — in addition to working on generalizations and figurative language skills I always make my patients tell me exactly why they think their answer is a suitable one. 

Fill in the simile

We chose to use similes for our exercises because they are rather simple and straightforward figures of speech. In addition to these exercises there are many things you can do to expand your repertoire in working with figurative language. With higher level patients one of my favorites is to take a passage from a book or a poem and ask the patient to locate and explain the figures of speech in that piece of text. And if you listen and look closely you will find that similes and metaphors are hiding all around us! Just think of that athlete who "flew like an arrow" in that competition or that sad girl "whose face was like stone" or even the cute little puppy who was "as sweet as a sugar plum". 

In addition to the skills used in these tasks I like working with similes because they provide a good starting point to discussions about the abstract level of language. We often see patients who face the feeling of poor communication skills due to not being able to interpret and use figurative speech in their everyday communication, despite their fluent surface level communication skills. And this is where we can step in and start working on those skills in order to help the patients to understand their difficulties and overcome them in everyday situations. 

As for now, it is your turn. I have hidden four everyday figures of speech in this post (not counting the ones used as examples) and I challenge you to locate them! Happy hunting!

Would you mind repeating that?

Nana Lehtinen

Comprehension tasks in speech therapy with adults not the easiest nut to crack. Patients we work with on comprehension have, well, difficulties in understanding language so it can be a challenge to find common ground as to what we are trying to achieve with a given task. Some patients might not be very aware of their symptoms and think they are doing well in their everyday life, when in reality there are lots of difficulties or just drawing away from social situations where difficulties manifest themselves. There might be denial, frustration and all sorts of things going on around these problems.

Overall, comprehension can be a touchy subject. In therapy, I have found it easier to work on comprehension tasks together with the patient instead of making them work on tasks and me being the one who has the right answer. And of course - we incorporated some of this into Sanapsis!  

Here you can see our Menu for Comprehension tasks in Sanapsis. Lets take a minute to explore a few of our tasks.

 

Follow instructions opens with basic settings: view of two images and a sentence on screen. You are to place the iPad on the table between you and your patient. Now you read the sentence to your patient and they arrange the images following directions you read out loud. 

Our example shows you a task where your patient sees an image of the Colosseum and an image of a stack of hay. The (upside down) sentence reads: Move the hay under the Colosseum.

What I like to do in this task is to have a piece of paper handy and as we work trough the tasks with my patient I complete the task by drawing the images on a piece of paper as the patient is working on the same task on screen. Like you see in the picture here, just a quick drawing will do. After we complete a few tasks, we come back and compare notes. And correct each others work (yes, I make mistakes. Sometimes even intentionally).

I like this way of working because it enables us to work side by side with the patient and give feedback to each other — adding an extra layer to the task.

If you like a challenge, settings in this task allows you to add a third image and longer instructions on screen. You can also choose to use the task as a reading task where your patient sees the text alongside the images.

 

I also want to point out some cool stuff hiding in a task called Questions based on text. 

Questions based on text opens to a screen with a piece of text, as you can see in the examples below. You read the text to your patient, asking them to listen carefully as you will be asking questions. After reading the text, you tap the screen and questions based on that text appear. To mark an answer you tap it and it changes color. Swipe back-forward to find new material and return to completed tasks. Pretty straightforward? Yes, I trust you all know what to do here and when this kind of task is appropriate to use.

If you want variation for the task, go to settings (tap the info-button on the right hand corner) and choose Yes/No instead of Questions. 

When you return to the task you see a piece of text that you read to your patient. Tapping the screen provides material based on that text. But instead of questions, now you get to ask your patient to determinate if you are right or wrong. Again asking him/her to state an opinion and justifying it based on what they just heard. Very much like YES/NO questions but based on the text they just heard. Great stuff, right?

As you already know, Sanapsis does not give feedback. But why? We feel that when assessing and addressing real life skills we need to guide our patients to monitor themselves, recognize when they feel insecure about understanding what their communication partner is saying and help them find strategies in asking for clarification. Because real life situation do not beep when we get it wrong.

(However, sometimes there is a genuine need for feedback from the application, a more mechanical approach. Luckily we are not alone and there are many applications that are very useful for this. Just check out this amazing list by Tactus Therapy!)

Holiday reading with some gems from reading category

Nana Lehtinen

My absolute favorite holiday activity is reading. A nice cup of tea, holiday lights, warm socks knitted by grandma, you know the works. As the holiday season is upon us, I would like to share some gems from our Reading category with you today!

A quick glance of the reading menu will tell you that our tasks range from word level to story level, adding a few very functional tasks in the mix on the way.

Reading-menu

Word and picture - correct

Let's get started with Word and picture. Here you see 2-4 pictures on screen along with one word. Ask your patient to read the word and tap the corresponding picture. Tapping a picture highlights it with an orange rim. But wait, what? No matter which picture you tap, right or wrong, you always get the same rim around it?

Word and picture - incorrect

Yes, that is one of the gems throughout Sanapsis! The app does not give feedback, just like a book does not give you feedback on how well you are doing on your reading. You as the reader are in charge of judging whether you understood what you red. Right?

I like to have my patients working independently on many tasks and Word and picture is no exeption. As Sanapsis does not give feedback, my patients are thinking, making decisions and assessing their work as they go. When they are done, two of us go through the finished work together and my patient tells me how well they think they did. I always urge my patients to point out the tasks they are not quite sure of. If they like, I can then name the pictures on screen for them and they correct themselves as we go. Much more than just word level-reading, right?

The same applies for Sentence and picture.

Sentence and picture, 2 sentences, level 1

Here you get one picture and 2-4 sentences and the patient taps on the one they think matches the picture and it is highlighted. 

Level 1 for this task gives you to simple, straightforward sentences that are easy to tell apart.

 

 

Sentence and picture. 4 sentences, level 2.

For level 2, there is a nice twist. Sentences are more similar to each other, talk about the same items and give subtle differences in meaning. These sentences require deeper reading skills and the number of sentences can always be added in settings. Great for advancing in steps!

 

 

Organize a story, level 1

Organize a sentence and Organize a story both provide excellent material for working on sequential processing and understanding meaningful entities.

Here you see two examples from Organize a story. The first one shows you a task from level 1 and it has 4 actions that need to be organized to form a meaningful entity. In this case instructions for cleaning the house (for the holidays, of course).

Organize a story, level 3

There are 3 levels to this task. You guessed it right, the higher the level the longer the story. On level to 3 you see a complex story, in this case 7 steps on going to the library.

 

 

 

 

For the last exercise today, I think I will choose Discussion starters. At first, it does not look like a traditional reading task, but let me assure you — it provides functional reading at its best!

Discussion starters, level 1

Here you ask the your patient to read a question and start a discussion with you on that topic. As usual, there is interesting stuff hiding in different levels!

On level 1 this task has questions and topics that can be answered using different AAC-methods like drawing, maps, personal booklets and devices. 

Discussion starters, level 3

 

Level 2 has more abstract and complex topics and is at its best with our higher functioning patients. With this task I often ask my patient to scroll through the questions (reading them all!) and choosing 1-2 topics they would like to discuss with me.  

I also ask my patients why they chose that particular question and with whom they could use this question in their everyday life as these discussions are always fun! It makes the patient explain the process, point out if there was something they did not understand and reason their choices. All good stuff for our patients.

So there you go, some ideas on how to make use of our Reading category. Now I believe it is time for me to put on those comfy socks and grab a book and enjoy some quiet time. 

Nana, happy as a clam

Nana, happy as a clam

Happy holidays everyone, be sure to make the most out of this festive, magical time of the year! Thank you and see you in 2016!

How to make most out of Writing-category in Sanapsis

Nana Lehtinen

If I  would have to name a personal favorite category from Sanapsis, I think it would be Writing (or wait, maybe Comprehension. Hmm. Well for this post, I'm going to go with Writing, so there you go).

I truly get a kick of the way the category seems just a straightforward Copy letter > Copy word > Write a word in context > Write a sentence > Write a synopsis -approach to writing. But when you look closely, you see a world of possibilities.

Our Writing menu

Our Writing menu

Let’s get started with Copy Letters. First of all this is an awesome task to get going on writing with the non-dominant hand (like many of our right-handed patients need to after a stroke).

On screen, you see a letter on the left. On the right you see the same letter faded. Now, ask your patient to and draw the faded letter with their finger. When they get comfortable, add a stylus pen and voilá - sooner than you know you have them rocking the whole paper/pen thing (this on one of my patients rocking the K)!

But why is he writing in blue? Since we are also working on expressing opinions by choosing things, we started by him expressing the color he would like to write with and me adjusting the settings for him. And today, he felt like he wanted to use blue for this writing task.

Settings on Copy a letter by hand

There is a number of things in the settings. The colors are there mostly for patients who have visual constrains and need stronger feedback from their writing. But why not use them for adding to the task, just like us SLP:s know how to!

You can also choose the level of cueing and some other cool stuff, just tap the info-button to find out more!

Copy words using the keyboard

Moving on to working with the keyboard. In Copy words using the keyboard you: a) see a word, b) copy it using a keyboard.

And, as usual, there is more than meets the eye. In settings you can choose a category for the words. The words match exercises Naming nouns in Production and Word and picture in Reading. With these exercises you have the same vocabulary at your fingertips for naming, reading and writing! Awesome, right? And as you can see in this example, the vocabulary has everything we need, as recent research findings suggest.

Then it is time for my all time favorite in this category, Fill in the blank. Againpretty straightforward. You see sentence with a blank space, you ask your patient to fill that in. Now, please, please remember to take full advantage of the levels with this one!

Fill in the blank, level 1

Level 1 gives you a sentence with a noun missing. The sentence provides the context, thus a semantic clue for the word.

In this example the word would be: vacuum cleaner.

 

Fill in the blank, level 2

Level 2 challenges your patients to describe things, as the missing word is an adjective. Perfect for those patients who need lots of time for processing (they tend not to use too many adjectives in their output), and for patients who are generally were scarce in their output. This can also be very challenging for many higher level TBI patients, be sure to give it a try! 

Fill in the blank, level 3

And finally, level 3. This is where things get interesting with many patients I have worked with. The sentences on this level have vary little information, they function more as constraints than clues for the patient. Here the patient is challenged to create the meaningful context within the frame of the task. And let me tell you - we have had some fun with this one! Also, a great discussion starter on why it can be a difficult task to complete. 

Fill in the blank, level 3

I also encourage you to break away from the iPad with the tasks on Level 3. Give your patient paper and pen and ask them to fill in a couple of sentences on paper, just to write the whole sentence down. Then, have them expand one of the sentences to a little story (they already thought of an idea for the sentence, so why not take it a few steps further).

An example of this could be: Sentence: They did not have the song.  

Story: Alice and his boyfriend loved to sing karaoke. Alice wanted to surprise her boyfriend and had been rehearsing his favorite song, "Yellow submarine", for a week. On Friday night at the karaoke bar Alice got up to perform, but they did not have the song!

Fun? Yes! Even more if you take turns in coming up with the stories, so you get to give examples and ideas within a task!

I still wanted to talk to you about Synopsis and how it has cool levels too and how you can change the background color from black to white to suit your patients needs. But I guess I have to leave something for you to discover on your own too!

So, I will leave you today with a picture of one of my patients rocking the word flowers in Finnish in Copy a word by hand.

Have fun and keep exploring! 

P.S. We are celebrating ASHA15 with a huge discount! You can have these exercises and way more on your iPad for $49,99!

Here we go, gems from Production category in Sanapsis.

Nana Lehtinen

First things first - Naming nouns and Naming actions. 

This is the basic flashcards-type naming task. In settings you choose a category, on screen you see a photo from that category (one of 369 photos in naming nouns or one of 197 photos in naming actions). You swipe to see the next photo.  It is simple, versatile and useful in many ways. 

But as you know, in the settings of this task you can choose how many images are shown on screen (1-4). When you have photo(s) on screen and you tap the one, it disappears. When you tap it again, it comes back. Why? Why does it disappear as the patient accidentally taps the pic? Annoying!! Must be fixed! Or..hmm..maybe surprisingly clever? 

I like to think it is surprisingly clever (as I designed it, hah). You can use this feature for delayed naming/repetition by asking your patient to name or repeat an item, hiding it and asking them to tell you what is hiding in that black screen. Use two or more to add memory challenge to the task. 

I sometimes get my patients to go the extra mile by asking them 1) to memorise the items on screen 2) to close their eyes (as I hide one of four images on screen) and 3) to tell me which one is missing. Instant fun! Using this in group settings or taking turns with your patient works well too. But be aware - if you are not paying attention, it can be more hard than you think to recall the missing item, especially after many repetitions. 

Next up: Create a sentence around words

Hope you remember this task has 2 levels… Level 1 provides two pictures with a connection, e.g yarn and a stuffed animal. This could lead your patient to make a sentence like: “I need yarn to fix my daughters stuffed animal”. Again a versatile task, often something to use after doing the same thing with physical objects from your patients home or your office (I like to warm my milk in the microwave before adding it to my coffee or The secretary needs keys to open the door). 

However, it is level 2 that makes things interesting. This level provides 3 images on screen. The instruction is to create a sentence around these three words. As you swipe through the tasks you learn that this task is quite challenging and needs a lot of deductive brainpower! For some of my patients I like to broaden the instruction and say “Create a little story (2-5 sentences) around these items”. This could result in “I took the bus to visit my sister on her birthday. When I got there I played Happy Birthday on her piano and gave her a CD of me playing the piano as a present.” 

If this is too easy, I ask them to create a DIFFERENT story around the same items. Now that requires flexibility, something most of our patients need a little work on. The next story could be something like: “As a bus driver I was once asked to deliver a present to someone in a small town. I agreed, but regretted after I learned the present was a piano!”

 

Give instructions

 

 

This one I already talked about in my previous post, scroll down to read more about the hidden treasure.

 

 

Ok, that was a brief reminder on what to expect when exploring Production category in Sanapsis. We always love to hear what our users come up with too, so please share your ideas with us! After all, the power of Sanapsis is that as the user you are free to be as creative as you can be, just with a little help from us.

Explore!

Nana Lehtinen

Are you a creature of habit?

I know I am! When I establish a nice routine it tends to stick and I easily forget to look for better or just different solutions, to explore my options. 

At work this often means using the same materials over and over again. And sometimes the new, refreshing idea to so close we forget it is there. If you use Sanapsis you probably have a few favourite things you use it for. For me, the top three look like this: 

 

 

Production - Create a sentence around words

 

 

 

 

Comprehension - Listen to a story

 

 

 

Semantics - Is this simile true

 

 

Favourites are favourites for a reason. For me, I believe the catch is that these exercises are super versatile and I can target loads of things within the task (just take a look at the instructions in each exercise and you find multiple variations for tasks and goals). 

But I should explore the app more often to refresh my ideas! Some of the exercises also have hidden gems when you look closely. A great example is Give instructions is Production category. In this task Level 1 has straightforward tasks for building a sequential, coherent story, like e.g. Explain how to boil potatoes. But level 2 has a fantastic twist - it provides similar tasks, but with problem solving! Here is an example: Paul left his wallet at home and needs to buy lunch at work. Tell him what to do.

And when I am only using my favourite ones, I forget about these gems - and that is just waisting potential. To encourage you to explore Sanapsis more often I am planning on writing a small series of posts on what our categories actually include in the coming posts. So stay tuned and never stop exploring!

Draw and write, it's good for you!

Nana Lehtinen

Browsing one of my favourite places on earth - the bookstore - generates yet another inspiring resource for therapy! 

Some time ago I came across two awesome books, 300 Drawing prompts and 300 Writing prompts. My initial thought was: These will be perfect for me! What an awesome way to be creative while waiting at the tax- or doctors office or listening to those awesome tunes you hear when you would just like to speak to a representative on the phone (we’ve all been there, right?). 

And oh my, it works! The books basically give you a prompt on what to draw or write in the space given. Like e.g. 300 Drawing prompts: Bull’s eye, Bouquet of roses or Something upside down. You would think it is not a big deal, but for a not drawer like me it is! 

We SLPs always encourage our patients to use pen and paper, to draw cues, hints and objects related to the idea when it is hard to find the right words. I often see myself being stuck to a few examples I feel comfortable with. How long has it been since I drew a Bonfire? And how hard was it at first to actually pick up a pencil and try to draw a bonfire? And now, because the book prompted me, I did!  And it made me feel awesome. Not a masterpiece, but a bonfire I was happy with. 

I tried this side by side with a patient and we had so much fun! We chose to show you our masterpieces of a Jackal and Deer antlers. Not bad, eh? 

These prompts are great for getting a patient feel comfortable with drawing and also using their non dominant hand for pencil-skills in general. Drawing together is a great way of being together too, so why not have the patient do this with the spouse or a friend? You draw one, I draw one is an easy way of being outside your comfort zone together - the place where all new adventures begin (like a new, enriched way of communicating with a loved one)!

300 Writing Prompts is another awesome find for our higher functioning adult patients. It is a nice, compact workbook to get your patient going with writing. The book prompts you with ideas and has limited space for writing on that topic (how awesome for working on planning ahead, staying on topic, forming meaningful entities with a beginning and an end). Some of the tasks are more complex e.g. Complete the thought: “I wish I had paid more attention when…”  and some are more straightforward, e.g. “Write about a time you broke something”. Great for homework and also to be used in therapy with a time constraint. I would also not pass the opportunity of using the book yourself, what a feeling when completing a writing task! 

I absolutely love these books for therapy and for myself. When I have some time to burn I find myself occasionally reaching for one of them instead of my phone and end up doing something creative and soothing instead of just spending 20 minutes lost on my phone.  And, maybe not so surprisingly, completing something creative makes you feel great. Who knew?

These books were Published by Piccadilly (USA) Inc. in 2015 and I found them at  Barnes & Noble

This one is for the caregivers

Nana Lehtinen

Today was day 1 of a great conference, the 15th annual PSA Regional Stroke Conference. First of all, the conference took place at The Magnolia of Millbrae which I thought was an awesome venue for this crowd. A stroke conference in a retirement home, very cool! (I feel bad I did not have time to get a better look at the premises - I might have to go back soon to check the place out in detail.. I just loved their attitude!) 

Secondly and more importantly, I was lucky to hear three great speakers, Dr. Jeremy Bornstein, Dr. Sheila Chan and Dr. Stephanie Linn. Amazing presentations, all of them! The one that stuck to me most today was “Patterns of Psychological Adjustment of Stroke Patients and Families” by Dr. Jeremy Bornstein. He did a great job reminding us all of the huge and overwhelming impact stroke has not only on the patient, but also to those around him or her.  

When working in outpatient rehab, we get to see our patients after they return home from the hospital. This time is usually filled with hope and high expectations, but the new days, weeks and months in familiar surroundings can also be full of new and surprising obstacles. Figuring out how to overcome these obstacles and rebuilding ways of doing things (like communicating needs, wants and feelings or socializing) can be scary and hard.

Also, rebuilding a way of functioning as a spouse, daughter, son or parent is a complicated process. Dr. Bornstein reminded us today that there are many, many paths people take to rebuild their relationships after a stroke and sometimes that path can be a winding one.

I have been lucky to meet many amazing people who work tirelessly to provide the best possible care for their loved ones - sometimes at the cost of their own well being. We all know that recovering from a stroke involves the risk of depression. The one thing I was reminded today was that in regard to this it is not only the patient we need to be looking at - we need to turn our attention to the caregivers too. Also they have had dramatic changes in their lives and have great demands in their new role.

As professionals working with stroke patients our holistic view of the recovery process needs to include the people close to the patient. One thing we should include in our routine when working with caregivers is encouraging them to take care of themselves as well as their loved ones. In speech therapy this can be done by simply acknowledging the great job the caregivers are doing. Positive reinforcement works! I also like to talk about what the caregiver has done that they themselves enjoy. Sometimes a gentle reminder that it is ok to take care of yourself too works amazingly well.

When the caregiver is well rested, happy and balanced, they are able to maintain better care for the patient too. Also, caregivers need time and space to adjust to the new circumstances to be able to rebuild a balanced relationship with their loved ones. Kind of simple, right? 

So everybody, lets give it up for all the caregivers out there doing a great job! You guys are true heroes of our time. 

P.S. Today was day 1 of the 15th annual Stroke Conference. Day 2 is coming up on May 15 and to my understanding you can still register for that one. Hope to see you there!

Homework

Nana Lehtinen

So, you work with adult patients who have aphasia. Do you ever give your patients homework? You know, those sheets of paper full of writing, matching or naming exercises? You ask them to bring it back completed for the next session, and then together you go through the tasks and give praise on how well they did. I used to do that, too! 

Having done that for a number of years (!) I started to get tired of it. Why? Not because of me, but because I felt it was not getting us anywhere. Sure, the patients felt the joy of achievement while completing the tasks at home. Sure, I got some info on what they were doing at home or whether were they doing anything at all. Sure, it gave us continuity between sessions. 

However, what I did not feel good about was feeling like a teacher. When the patients lost interest in homework, forgot about homework or I could not convince the caretaker to get involved or in general the circumstances were just against us, I hated it when I saw how my patients felt. Some felt like they had to make excuses on why their work was not completed or they felt embarrassed because they had forgotten. And even when they did complete their homework on time and perfectly, I did not like the student/teacher relationship this got us in (I’m not even going to mention the number of times the homework was completed by the spouse. Aargh!) Again, I wanted more. 

So, I took a different approach. Typically, I never give anyone anything to take home. Instead I ask them to bring stuff from home to me. 

 I ask my patients to do things like: 

·       When reading the newspaper on the morning of speech, circle an article/headline/picture you find interesting and bring that newspaper with you! 

·       Mark the shows you watched on TV during the week on your TV guide and bring that! 

·       Take pictures of your garden and write down the names of the plants! 

And then we actually USE that material in therapy. I always alter the tasks to be relevant to the patients’ everyday life. When suitable, I include loved-ones in these tasks, and give specific instructions on what the patient is supposed to do and how the loved-one is supposed to work with him/her.  

With this change I really feel like we are getting somewhere! Patients and caregivers are more alert on how to use their environment for speech-related tasks (and communication, bonus!), they have a say in what topics we cover in speech therapy and in general I feel that our sessions are actually based on the everyday life of my patients. Instead of going to school and completing tasks, patients come to speech therapy to tell me about their everyday lives and the obstacles they face - often resulting in good conversations on how to make that environment more supportive and accessible! 

 This approach has proven to be more fruitful in the long run, too. The reality of Speech Therapy services is that they are not endless. Embedding the homework in real life tends to stick more than completing sheets of paper or using random tasks as homework. Quite often patients and loved-ones find new ways of doing or talking about things together and that is what we all like to see. 

What have you been up to?

Nana Lehtinen

Many discussions start with the question "What have you been up to?" Quite often we get the "Nothing much" or "You know, the usual" as the first reply. But then, the magic happens. The question triggers stories about meeting old friends at the grocery store, finally fixing the broken lawnmower, relatives who visited on Sunday or a good movie on TV the other night.

However, in speech therapy, even with our high functioning, fluent patients the “nothing much” is often the end of the story. The question does not trigger the spontaneous ideas behind the stories that could be. The overlearned phrases are enough to get us through the exchange and that is where the exchange ends. 

However, sometimes this can be a great achievement for a person who has difficulties with speech! Being able to react, respond and engage. The overlearned, automatic responses are there to establish a connection between individuals, and as such, they are great. I encourage my patients to use these automatic phrases as much as the next guy! 

But being an SLP, I want more. I want these phrases to be a starting point, not the whole deal. I want the phrases to buy time for making that connection between the time since I last saw the person I’m talking to and what I could tell them. This is why I generally begin our session like this: 

 Me:      Hi, how are you? (Pause)

P:         Good. 

Me:      Good to hear. What have you been up to? (Pause) 

P:         Nothing much.

Me:      Really? Now, I don’t believe you. It’s been a week since I last saw you. What have you been doing? (Pause) 

P:         The same.

Me:      Ok, tell me about your “the same.” What does that include? (Pause) 

If you want, I can help you think about things you might have done during the week. Would that be good?

I offer ideas that might relate to that person (for example, have you talked to your neighbor?). Write down different options—everyday things and unusual activities (remember to include crazy ones like “went bungee-jumping” to prompt reactions) and so forth. 

I tell my patients that we will be doing this every time we meet, so “come prepared”. And usually about the third time I meet with them, they get the idea and the discussions go something like this: 

T:         Hi, how are you? (Pause)

P:         Good. 

T:         Good to hear. What have you been up to? (Pause) 

P:         Nothing much. (Long pause) But in physio, it was not the same girl.

T:         Really? You have a new physiotherapist?  

P:         Yes.

T:         Tell me about her. (Pause) 

 And Voilà - we have a story. Something the patient came up with by themselves, something important to them. And they know I’m there to hear that story, I have time to wait for it to unfold. A step closer to a real conversation which I always see as “The Ultimate Goal in Speech Therapy.”