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!