Here we go, gems from Production category in Sanapsis.

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!

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!

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.” 

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.