All The Things We Love About Speech Therapy With Adults

This blog is about all the things we at Sanapsis Love about Speech Therapy with Adults.

Would you mind repeating that?

February 10, 2016Nana Lehtinen

Comprehension tasks in speech therapy with adults — not the easiest nut to crack. Patients we work with on comprehension have, well, difficulties in understanding language so it can be a challenge to find common ground as to what we are trying to achieve with a given task. Some patients might not be very aware of their symptoms and think they are doing well in their everyday life, when in reality there are lots of difficulties or just drawing away from social situations where difficulties manifest themselves. There might be denial, frustration and all sorts of things going on around these problems.

Overall, comprehension can be a touchy subject. In therapy, I have found it easier to work on comprehension tasks together with the patient instead of making them work on tasks and me being the one who has the right answer. And of course - we incorporated some of this into Sanapsis!

Here you can see our Menu for Comprehension tasks in Sanapsis. Lets take a minute to explore a few of our tasks.

Follow instructions opens with basic settings: view of two images and a sentence on screen. You are to place the iPad on the table between you and your patient. Now you read the sentence to your patient and they arrange the images following directions you read out loud.

Our example shows you a task where your patient sees an image of the Colosseum and an image of a stack of hay. The (upside down) sentence reads: Move the hay under the Colosseum.

What I like to do in this task is to have a piece of paper handy and as we work trough the tasks with my patient I complete the task by drawing the images on a piece of paper as the patient is working on the same task on screen. Like you see in the picture here, just a quick drawing will do. After we complete a few tasks, we come back and compare notes. And correct each others work (yes, I make mistakes. Sometimes even intentionally).

I like this way of working because it enables us to work side by side with the patient and give feedback to each other — adding an extra layer to the task.

If you like a challenge, settings in this task allows you to add a third image and longer instructions on screen. You can also choose to use the task as a reading task where your patient sees the text alongside the images.

I also want to point out some cool stuff hiding in a task called Questions based on text.

Questions based on text opens to a screen with a piece of text, as you can see in the examples below. You read the text to your patient, asking them to listen carefully as you will be asking questions. After reading the text, you tap the screen and questions based on that text appear. To mark an answer you tap it and it changes color. Swipe back-forward to find new material and return to completed tasks. Pretty straightforward? Yes, I trust you all know what to do here and when this kind of task is appropriate to use.

If you want variation for the task, go to settings (tap the info-button on the right hand corner) and choose Yes/No instead of Questions.

When you return to the task you see a piece of text that you read to your patient. Tapping the screen provides material based on that text. But instead of questions, now you get to ask your patient to determinate if you are right or wrong. Again asking him/her to state an opinion and justifying it based on what they just heard. Very much like YES/NO questions but based on the text they just heard. Great stuff, right?

Basic settings, text

Questions

Settings-menu

Yes/no, text

Yes/no options

As you already know, Sanapsis does not give feedback. But why? We feel that when assessing and addressing real life skills we need to guide our patients to monitor themselves, recognize when they feel insecure about understanding what their communication partner is saying and help them find strategies in asking for clarification. Because real life situation do not beep when we get it wrong.

(However, sometimes there is a genuine need for feedback from the application, a more mechanical approach. Luckily we are not alone and there are many applications that are very useful for this. Just check out this amazing list by Tactus Therapy!)

Holiday reading with some gems from reading category

December 08, 2015Nana Lehtinen

My absolute favorite holiday activity is reading. A nice cup of tea, holiday lights, warm socks knitted by grandma, you know the works. As the holiday season is upon us, I would like to share some gems from our Reading category with you today!

A quick glance of the reading menu will tell you that our tasks range from word level to story level, adding a few very functional tasks in the mix on the way.

Let's get started with Word and picture. Here you see 2-4 pictures on screen along with one word. Ask your patient to read the word and tap the corresponding picture. Tapping a picture highlights it with an orange rim. But wait, what? No matter which picture you tap, right or wrong, you always get the same rim around it?

Yes, that is one of the gems throughout Sanapsis! The app does not give feedback, just like a book does not give you feedback on how well you are doing on your reading. You as the reader are in charge of judging whether you understood what you red. Right?

I like to have my patients working independently on many tasks and Word and picture is no exeption. As Sanapsis does not give feedback, my patients are thinking, making decisions and assessing their work as they go. When they are done, two of us go through the finished work together and my patient tells me how well they think they did. I always urge my patients to point out the tasks they are not quite sure of. If they like, I can then name the pictures on screen for them and they correct themselves as we go. Much more than just word level-reading, right?

The same applies for Sentence and picture.

Sentence and picture, 2 sentences, level 1 — Sentence and picture, 2 sentences, level 1

Here you get one picture and 2-4 sentences and the patient taps on the one they think matches the picture and it is highlighted.

Level 1 for this task gives you to simple, straightforward sentences that are easy to tell apart.

Sentence and picture. 4 sentences, level 2. — Sentence and picture. 4 sentences, level 2.

For level 2, there is a nice twist. Sentences are more similar to each other, talk about the same items and give subtle differences in meaning. These sentences require deeper reading skills and the number of sentences can always be added in settings. Great for advancing in steps!

Organize a sentence and Organize a story both provide excellent material for working on sequential processing and understanding meaningful entities.

Here you see two examples from Organize a story. The first one shows you a task from level 1 and it has 4 actions that need to be organized to form a meaningful entity. In this case instructions for cleaning the house (for the holidays, of course).

There are 3 levels to this task. You guessed it right, the higher the level the longer the story. On level to 3 you see a complex story, in this case 7 steps on going to the library.

For the last exercise today, I think I will choose Discussion starters. At first, it does not look like a traditional reading task, but let me assure you — it provides functional reading at its best!

Here you ask the your patient to read a question and start a discussion with you on that topic. As usual, there is interesting stuff hiding in different levels!

On level 1 this task has questions and topics that can be answered using different AAC-methods like drawing, maps, personal booklets and devices.

Level 2 has more abstract and complex topics and is at its best with our higher functioning patients. With this task I often ask my patient to scroll through the questions (reading them all!) and choosing 1-2 topics they would like to discuss with me.

I also ask my patients why they chose that particular question and with whom they could use this question in their everyday life as these discussions are always fun! It makes the patient explain the process, point out if there was something they did not understand and reason their choices. All good stuff for our patients.

So there you go, some ideas on how to make use of our Reading category. Now I believe it is time for me to put on those comfy socks and grab a book and enjoy some quiet time.

Happy holidays everyone, be sure to make the most out of this festive, magical time of the year! Thank you and see you in 2016!

How to make most out of Writing-category in Sanapsis

November 13, 2015Nana Lehtinen

If I would have to name a personal favorite category from Sanapsis, I think it would be Writing (or wait, maybe Comprehension. Hmm. Well for this post, I'm going to go with Writing, so there you go).

I truly get a kick of the way the category seems just a straightforward Copy letter > Copy word > Write a word in context > Write a sentence > Write a synopsis -approach to writing. But when you look closely, you see a world of possibilities.

Let’s get started with Copy Letters. First of all this is an awesome task to get going on writing with the non-dominant hand (like many of our right-handed patients need to after a stroke).

On screen, you see a letter on the left. On the right you see the same letter faded. Now, ask your patient to and draw the faded letter with their finger. When they get comfortable, add a stylus pen and voilá - sooner than you know you have them rocking the whole paper/pen thing (this on one of my patients rocking the K)!

But why is he writing in blue? Since we are also working on expressing opinions by choosing things, we started by him expressing the color he would like to write with and me adjusting the settings for him. And today, he felt like he wanted to use blue for this writing task.

There is a number of things in the settings. The colors are there mostly for patients who have visual constrains and need stronger feedback from their writing. But why not use them for adding to the task, just like us SLP:s know how to!

You can also choose the level of cueing and some other cool stuff, just tap the info-button to find out more!

Moving on to working with the keyboard. In Copy words using the keyboard you: a) see a word, b) copy it using a keyboard.

And, as usual, there is more than meets the eye. In settings you can choose a category for the words. The words match exercises Naming nouns in Production and Word and picture in Reading. With these exercises you have the same vocabulary at your fingertips for naming, reading and writing! Awesome, right? And as you can see in this example, the vocabulary has everything we need, as recent research findings suggest.

Then it is time for my all time favorite in this category, Fill in the blank. Again, pretty straightforward. You see sentence with a blank space, you ask your patient to fill that in. Now, please, please remember to take full advantage of the levels with this one!

Level 1 gives you a sentence with a noun missing. The sentence provides the context, thus a semantic clue for the word.

In this example the word would be: vacuum cleaner.

Level 2 challenges your patients to describe things, as the missing word is an adjective. Perfect for those patients who need lots of time for processing (they tend not to use too many adjectives in their output), and for patients who are generally were scarce in their output. This can also be very challenging for many higher level TBI patients, be sure to give it a try!

And finally, level 3. This is where things get interesting with many patients I have worked with. The sentences on this level have vary little information, they function more as constraints than clues for the patient. Here the patient is challenged to create the meaningful context within the frame of the task. And let me tell you - we have had some fun with this one! Also, a great discussion starter on why it can be a difficult task to complete.

I also encourage you to break away from the iPad with the tasks on Level 3. Give your patient paper and pen and ask them to fill in a couple of sentences on paper, just to write the whole sentence down. Then, have them expand one of the sentences to a little story (they already thought of an idea for the sentence, so why not take it a few steps further).

An example of this could be: Sentence: They did not have the song.

Story: Alice and his boyfriend loved to sing karaoke. Alice wanted to surprise her boyfriend and had been rehearsing his favorite song, "Yellow submarine", for a week. On Friday night at the karaoke bar Alice got up to perform, but they did not have the song!

Fun? Yes! Even more if you take turns in coming up with the stories, so you get to give examples and ideas within a task!

I still wanted to talk to you about Synopsis and how it has cool levels too and how you can change the background color from black to white to suit your patients needs. But I guess I have to leave something for you to discover on your own too!

So, I will leave you today with a picture of one of my patients rocking the word flowers in Finnish in Copy a word by hand.

Have fun and keep exploring!

P.S. We are celebrating ASHA15 with a huge discount! You can have these exercises and way more on your iPad for $49,99!

Here we go, gems from Production category in Sanapsis.

October 27, 2015Nana Lehtinen

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.

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