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.