Flexibility

The possibilities of a computer in speech therapy have been explored since the very early computers became available. Tablet computers are a new, fascinating platform that has created a great opportunity to explore the possibilities of technology within rehabilitation. We are very lucky to have witnessed a huge outbreak of different kinds of apps for different platforms since Apple launched the iPad in 2010. It is amazing how much creativity, talent and knowledge has been poured into apps that are targeted for speech therapy in a few short years.

 As with everything new, time and experience tend to give a clearer perspective on what the pros and cons actually are. Exploring with different types of apps tends to result in a crystallized view on the benefits you actually get from using new technology in your day to day practice.

 But one thing technology is not good at is flexibility. And boy Oh Boy do we need to bend and twist and turn with our patients. In my experience the most desirable quality of an SLP is the gift of being able to adjust to current circumstances by holding on to your goals, but finding new ways to get there when your first plan fails. As with almost anything, the simple, well designed things tend to pass the test and prevail to help you work better.

We created Sanapsis to be as flexible as you are. Sanapsis is designed to give you an open platform for working with your patient. Yes, Sanapsis has specific tasks to complete, and yes, it will provide you the stimuli. But Sanapsis does not determinate the goal of the task or force you to do one thing with an exercise. It gives you ideas. It allows you to be flexible and work with your patient. With Sanapsis it is always you two working with the provided stimuli, not the patient working with the device while you observe. 

 But what about collecting data? Or documenting progress? We have not found a way that would be simple to use in clinical settings and yet be flexible enough to gather relevant information about the process. We feel that the observations and analysis of the situation need to be completed and documented through professional eyes. A score of correct answers, automatic data collection on how fast a patient performs can turn speech therapy into an arcade game, and we do not want that, do we? 

 We need flexibility to adjust our methods and help the patient understand their symptoms--a way to help our patients cope with their everyday challenges. Sanapsis will be there to help you plan and deliver highly productive therapy sessions, and you need to be there to deliver and document the functional progress.   

Student? New to aphasia?

As you may have noticed, I am quite passionate about speech therapy with adults. To be honest, every now and then people around me actually ask me to stop and talk about something else. Some of them seem to think it would  be a good idea not to look at the world through "How I Can Use This in Therapy?" glasses all the time. Weird, huh?

Anyways, our love for sharing ideas seems to be quite popular with students and SLP:s who are new to aphasia. And we love it! We have students visit our clinic for demos, we supervise students and of course, we love to talk about things they observe in patients. This has led to quite a few people contacting us with questions when they get to the Hands on- phase of therapy with patients of their own.

The hard part comes when colleagues ask "What should I do, can you give me some exercises or examples of what to actually do with him/her next time we meet?". Now this might seem easy enough. But "Sure, here is a list of sentences I like to use when I target various things with my patients" just seems blunt. We like to explain Why, How and When we use certain materials and also encourage our colleagues to think about these things during therapy.  So it's usually a loooong phone call..

A part of why we decided to start developing Sanapsis was that we wanted to reach out to colleagues and colleagues to be. We  wanted to be able to have these discussions all the time! In the Instructions of each exercise in Sanapsis you will find our guidelines on Why, How and When about the exercise and also ideas on how to expand the task outside the iPad. Sometimes we encourage the clinician to use other materials then the iPad all together!

We also also provide ideas in Sanapsis where to go next and what to try when one particular idea does not work well with your patient. We like to think of our instructions as bouncing ideas between colleagues, as many times that is the best way to learn to understand your patient better.

You can have a quick look at the instructions in our video about the Key Features of Sanapsis. Have fun and contact me with any questions. Let's talk! 

No feedback?

We have had a lot of questions about why Sanapsis gives no feedback to patients, such as a reward sound or green color when you get the task right and a horn or red color when you make a mistake. We are so happy when people ask that question because this is actually one of the key features in Sanapsis! 

Sanapsis only records the answers that the patient gives. For example: 

Listen to a story

The therapist reads the story displayed to the patient using a normal speech rate. After listening to the story, the patient is asked to determine what the topic of the text was. Each question has three choices, and the patient taps one of the answers to select it.

 When tapping the text, the answer changes its color to orange. It does not matter if the answer is right or wrong. Why? Because now you, as the skilled professional, can use this task to target many different goals instead of just what the developers had in mind! 

 Usually I like to do 3 or 4 stories and then go back and confirm if the answers were right or wrong. While the app does not tell the patient if the answer they chose the first time was right or wrong, I get to have them evaluate their own performance with me. I often ask the patient to verify the answers while helping them find the keywords on which to base their evaluation. It’s a great way to increase self-awareness and self-assessment in patients! 

 For those patients who need lower level tasks I especially enjoy this “no feedback” feature in: 

Word and picture. 

Sanapsis shows you one word and 2-4 pictures to which you match the word. Tapping a picture frames it with orange. 

 Again, Sanapsis accepts all answers that the patient gives whether correct or not. Now you, as a therapist, get to work with your patient to determine if the answer is correct! You can use this as a word-level reading task and have the patient work by themselves for a while. Then go through the tasks together after completion (yes, you can move back and forward between the completed tasks without losing data). Or, you can use this as a word-level comprehension task, where you read the word to your patient in your own voice and at your own pace, give feedback and learn from them. All without the anxiety of a buzzer going off if you touch the wrong picture and never actually knowing why it went off. 

 With Sanapsis you, as the therapist, determinate the pace and manner in which to work with your patient. As we know, some patients are faster, some need more time and repetition and this is all possible with an app that gives you the power of control.

CSHA2015

So, we were at Long Beach 5-8 March. What an event, guys, what an event. We met many great colleagues (and colleagues to be) and will be busy for weeks going through leaflets and brochures from the expo! What a information and fun filled hall that was. 

In addition to learning about things we were lucky to have swarms of colleagues at our booth to check out Sanapsis. And the feedback had us blushing! Thank you so much for your "Oh, really, that is cool" "OMG, I need this" and "Yes, that is something I really like, I like that" -comments! Also an extra sweet thank you for all of you who came back a couple of times and brought friends! "Here is the cool app I wanted to show you"-moments were the best! 

We were able to attend some of the sessions too. The selection was versatile and the ones we attended were inspirational and packed with information. Luckily we had a lot of pens, pencils and sticky notes from the expo to make notes with!  

And for all of you students out there - As promised at CSHA, I will soon write a post about why Sanapsis is the perfect tool for someone with little experience with adults. 

Everyday noise, noise everywhere.

Are you at home reading this? Stop for a minute and listen. What do you hear? Is it quiet and peaceful? Just the TV from the other room and maybe the dishwasher doing its stuff? Or just the AC blasting? These are background noises that we tend to get accustomed to and hardly notice them after a while. It’s easy to focus on reading a newspaper, or writing down a list for the grocery shop.

 For many of our patients with TBI or stroke, things are not as simple. Background noise, however slight in our ears, may be utterly disturbing or just distracting. For many of our patients, background noise may be distracting enough to restrain them from being able to finish a task, understand long passages of speech or gather their thoughts for a shopping list for the grocery store.  

 I have come across many patients who are able to perform quite well in a quiet therapy room, but performing the same task after I turn on the radio becomes almost impossible. Having done this with a patient, I often get mixed responses, and questions about what just happened and why.

 One of my favorite tricks to demonstrate my point is this. I give the patient two short, simple stories to read in a seemingly quiet room. After reading the first story, I give them noise cancelling headphones (good ones!) and ask them to turn them on and read the next story. Oh the difference! One of my patients described this experience “as a cool drink on a hot afternoon”. One patient could not function during the daytime at her home because the noise from the street - after trying on noise cancelling headphones she has been able to read school books during the day! No more need to stay up until the traffic has slowed down!

Now, background noise is not all bad. Erik X. Raj has written an excellent piece on the good about background noise, and I could not agree more. It is definitely something we should be working on with these patients when they are able to handle it.

To help patients understand the quality of their symptoms and find help my choice of weapon is Bose Quiet Comfort 15 headphones. Yes, they are expensive. But boy, are they good…

I use mine when working on an airplane and in a coffee shop, or just at home with all my appliances blaring. For me, it’s nice. For my patients, it can make a crucial difference in being able to fill in a form on their own and understand what they are reading or not being able to function without help.

Interaction between you and your patient

Interest. Support. Presence. Experience. Reward. Professionalism. Contact. Kindness. All the tools and things and gadgets we have in our therapy room can never override interaction between a patient and a therapist. It might surprise you, but this is exactly why we developed Sanapsis.

Sanapsis is designed especially to promote interaction between you and your patient. The app is filled with ideas about what to do with your patient and the it has means for you to execute them in therapy (picture and text material). The key is that while using Sanapsis it is YOU who is working with your patient - not the app! In other words, the app does not guide your patient, give feedback and move forward in it’s pace. It lets you do the guidance, adjust and use the app for your needs. It even lets your patient make mistakes! 

While using Sanapsis in therapy you get to have all the time and space you need for talking with your patient about the task at hand, making observations, going through the completed tasks, correcting and learning about mistakes.  All the good stuff we get when using more traditional tools like picture cards or paper and pen. And yes, it’s an app. It’s all there, at your fingertips when you launch the app.

Photos in Therapy

So, I’m sitting in a cafe, having a latte and leafing through an issue of Wired. Getting to page 036 made the people around me give me funny looks. Thats how hard I was nodding and making little noises of agreement. Clive Thompson just nailed the thing about stock photos that has irritated me all these years using picture cards in therapy!

According to Clive, most of the stock photos represent a cliche, the imaginary is hackneyed and in fact these photos do not represent the real life as we (and our patients) know and experience it. This is one of the reasons we do not use any stock photos in Sanapsis and always encourage our patients to take pictures from their everyday environment and use those pictures in therapy.  Please read what Clive had to say in a broader context and let us know what you think. Have a great day!

Robotics in PT

At the SCVTBIC2015 I was lucky to attend a workshop presented by Darrell, Melissa and Jill from Ekso Bionics. Initially I wanted to attend to learn about how robotics are used in PT since, well, robots are cool (check out NAO!).

 But what I learned during that workshop totally exceeded my expectations. Not only do these things called “Ekso” look cool but they are much more manageable than I anticipated. In addition, there were so many good things going on between the therapist and patient during sessions when Ekso was used.

 We saw a couple of videos of single patients during traditional PT sessions with one to three therapists compared to PT sessions with a patient with an Ekso and a therapist. Of course there was a lot of good things happening PT-wise. But the first thing that popped out from the screen to an SLP’s eye was this:  

 During a session with Ekso the therapist spent much more time interacting with the patient. They maintained eye contact, told the patient what to expect from the Ekso, asked for feedback and in general worked with the patient in using the Ekso. Often the therapist was in front of the patient or side by side talking with the patient at a comfortable, conversational distance, not touching the patient and not in their personal space.  Just look at photo above. He himself is doing this with the help from Ekso!

During the traditional therapy sessions therapists were facilitating movement from the patient, holding, supporting more or less doing things for the patient. They also tended to spend time with the patients leg more than the patient (Sorry if that sounds harsh, but you guys know what I mean. You do need to keep your eyes where the action is in traditional PT, right?).  

From the beginning, Darrell and Melissa told us that patients whose therapists used Ekso with them reported improvements not only in their measurable, targeted PT goals. They also noted more holistic changes in their patients. They mentioned improvements in cognition, memory, self-awareness and even communication. I was kind of skeptical at first; but after listening to Darrell and Melissa explain how they train their therapists to use the Ekso together with the patients and seeing the videos, I think there might be more than meets the eye in this thing called Robotics in Rehab.

SCVBIC2015

SCVBIC2015

What a fabulous couple of days I had at the Santa Clara Valley Health Center Traumatic Brain Injury Conference (SCVTBIC) in San Jose, CA! It’s amazing how many great people can fit into one conference. I attended so many wonderful talks, spoke to so many nice, smart, people and once again realized how lucky I am to be involved in such a cool field.

I stumbled on some very interesting things during the conference, and to do them justice, they will be standalone posts. In the meantime, here are some highlights from my perspective.

 Robotics!

CTE!

Managing Fatigue!

Structured additions to environmental distractions!

SPECT!

Mapping the human brain!

Losing identity/partial death!

Will Smith!  

TSM!

Community support!

And, oh, all those nice, cool, interesting people I got to talk to. There are not enough exclamation marks in the world for them!

Please have a closer look at the agenda here SCVTBI2015, and do not miss this event the next time it’s in town.

New site is in

Here we go! I am so excited to share my thoughts with the world! As developers of the iPad app Sanapsis, we love to share and discuss the ideas and things about Sanapsis with our users. As it is impossible to have separate ongoing conversations with all of you individually, we decided to start a blog!

In addition to Sanapsis we will talk about all kinds of things related to speech therapy with adult neurological patients (mainly aphasia and cognitive deficits) in this blog. A strong point of view will be the use of technology in therapy, and how the widespread use of technology is influencing our work with patients. Being situated in Silicon Valley does not hurt, right?

I am so much looking forward to this journey of blogging.  Hope to hear from you along the way!