Draw and write, it's good for you!

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

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

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?

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.”