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.