Aphasia: How a Video IS Worth a Thousand Words

 

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I have been a practicing speech-language pathologist for the past 40 years. My last position prior to my retirement in September of this year was as an out-patient SLP at Virginia Commonwealth University Health System (VCUHS) rehab clinic working primarily with stroke and head injury patients. Ours is a rewarding profession but during the past year and a half my involvement in a community aphasia support group has been one of the most gratifying experiences of my career.

Approximately two years ago, the daughter of a stroke survivor contacted VCUHS Speech/Language Pathology Department asking for volunteers to help her start an aphasia support group in Richmond, Va. She indicated that she wanted to form the support group to provide her mother and others living with aphasia the opportunity to exchange information, opinions, and feelings about this communication disorder.

The first group meeting was held in February 2012. The discussions during the monthly meetings often focused on how little the general public knew about aphasia. Other recurring topics included: loss of insurance coverage for out-patient speech treatment due to “plateau in skills” or insurance caps; false assumption that loss of language means loss of intellect; family members and others lacking appreciation of what it is like to have a head full of thoughts and ideas but not be able to communicate these thoughts to others. One of the group members, a corporate trainer prior to his stroke and subsequent aphasia, had an idea about how to address these problems/misconceptions: He proposed making a video that recorded the personal narratives of group members to educate healthcare professionals as well as their own families and friends on the daily challenges of living with aphasia and strategies for being a good communication partner. He and other group members felt that who best to advocate for aphasia patients than those living with aphasia themselves?

This past year, Marcia Robbins and Kate Schmick (two other SLPs who volunteer with the group), Jan Thomas (support group member who has taken a leadership role in the group), and I applied for and received funding through the VCUHS Speech/Language Pathology Department to produce a documentary style video on living with aphasia. Eric Futterman, a Richmond-based videographer, filmed and narrated scenes of aphasia support group members going through their daily routines and one member interacting with SLP. The 18-minute video highlighted the fact that those living with aphasia were not a homogenous group but rather individuals with unique needs and challenges as they faced the difficult road to recovery from their stroke. The video also showed support group members getting on with living and finding new talents. Our group had a community premier of the video entitled “Patience, Listening and Communicating with Aphasia Patients” during our September, 2013 monthly support group meeting. 90 people from the community attended. Attendees remarked on the powerful and informative message of the film.

In an effort to spread the word about aphasia, we have contacted the National Stroke Association and the National Aphasia Association about posting this video on their websites. NSA already has posted the video on their website.

Susan Hapala, M.Ed.,CCC-SLP, is a retired speech-language pathologist who volunteers with the Richmond, Virginia Aphasia Support Group. She can be reached at rva.aphasia@gmail.com.

Collaboration Corner: “Out of my Mind” Speaks Volumes

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This year, I worked with a fifth grade class who was reading “Out of my Mind” by Sharon Draper. The story is about a nonspeaking 11- year-old girl with cerebral palsy. Her classmates, teachers, and even  her doctors underestimate her abilities. Little do they know she has a photographic memory. One day after months of fighting with insurance, Melody (the protagonist) is given the gift of voice through an AAC device; the drama unfolds from there.

The teachers read a little of this book every day to the class, but wanted the students to get a better understanding of Melody’s struggles. They asked me to come in and show students various kinds of AAC devices.

This was the perfect launching point for a lesson on inclusion and AAC. This was one of the most effective ways I’ve worked with teachers and students regarding the challenges AAC users face everyday.

Here’s all I used:

  • A PECS book;
  • Two iPads with two different communication apps;
  • An alphabet board;
  • Low-tech battery operated voice output device;
  • A sheet with a picture of two “thought bubbles” and two hearts (see below);
  • Index cards with written scenarios; and
  • A sheet of emotion cartoons.

First, the class gathered together, and I gave them an overview of how people might communicate. Most understood body language, words, and some mentioned sign language. Then I brought out the different systems. Their eyes lit up. Then they started to make connections to other children in the building who used these systems. They were hooked.

Next, the children broke up into groups of four or five. Each table had two AAC systems. Within each group, students paired off. One student had a “speaker” card, and the other a “listener” card. Speaker cards had clues like, “you can’t speak, but you can point and read. You really want to tell your friend about the movie you saw last night.” The partner’s card (“listener”) read, “Your friend can’t speak, but she can point and read. She really wants to tell you something, find out what it is.”

I wish I had taken a video. The interactions were amazing, and the students really dove into the activity. Each group got a turn with a different kind of system. A nice, unexpected experience: Teachers went by and facilitated interactions with tips like being closer to the speaker, or waiting and not interrupting.

Finally, I collected the devices. Each group received a copy of a words related to emotions and a worksheet, which they worked on individually. This gave them a chance to reflect.

On the worksheet were only two fill-in the blanks on top:

When-I-was-the-speaker

On the bottom were two more:

When-I-was-the-listener

And then the teaching part happened! Here were some of the responses:

  • I was thinking, why can’t he understand me!!! I was outraged!
  • This is so hard! I felt like giving up.
  • I don’t have enough words. I felt like oh, well, never mind.
  • I wanted to help you, I’m sad and frustrated for you
  • I can’t understand you, I felt impatient.
  • Keep trying! I felt helpless.
  • I can’t spell, this takes too long! I felt annoyed.

I kept copies of every single sheet, I’m not exactly sure what I’m going to do with them, though I’m fighting the urge to wallpaper my office with them.

Kerry Davis, EdD, CCC-SLP, is a city-wide speech-language pathologist in the Boston area. Her areas of interest include working with children with multiple disabilities, inclusion in education and professional development. The views on this blog are her own and do not represent those of her employer. Dr. Davis can be followed on Twitter at @DrKDavisslp.

 

 

 

 

How to Provide Bilingual Services (Even When You’re Monolingual)

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Evaluation is one huge hurdle to working with English Language Learners (ELL). The second is providing therapy. Once you’ve determined there is a disorder, what do you do? Do you provide treatment in English? What goals do you target? Can you provide competent treatment in English only?
It may be easier to address some of these ideas for specific age ranges. For the children under 3 years of age, working with an interpreter in the primary language with the family on how to talk with toddlers and babies is your best friend. It is important to be mindful of possible cultural differences in how adults and children relate to each other. Not every culture values parent-child verbal interactions as the stereotypical white middle class family might. How to address these differences is like a dance. If one person is too powerful of a leader the other cannot follow, might stumble, and ultimately will quit dancing. A parent/caretaker who does not share the value we place on parent-child interactions will most likely not follow through on our recommendations. In which case it may be better to train a sibling how to model language for a younger sibling. Make sure you understand the family and/or cultural relationships as much as possible first.
For preschool age children (depending on family views of preschool) your efforts should go toward encouraging the family to enroll the child in Head Start, preschool, daycare, or even scheduling consistent “play dates” to expose the child to typical language development. If possible, encourage both languages (primary language and English). What about therapy? Targeting social language, the Basic Interpersonal Communication Skills, in English is essential. Children will need these skills to be successful in the academic world.
For school age children, research suggest that there is a strong correlation between ELL students with a language learning disorder and poor and/or inappropriate social skills and therefore, have fewer friends when compared to other students who are ELL. Social skills groups are very important for these students. Simultaneously, targeting Basic Interpersonal Communication Skills and Cognitive Academic Language Proficiency will help close the language gap these students have. One approach to do that is by teaching root words, suffixes, and prefixes (morphology). As we learn in linguistics, they are like puzzle pieces. For example, you can take the root word “view” and the prefix “re-“ and teach students that the view means “to look” and re- means “again.” When added together form “review” or “to look at again.” Then applying context, “The teacher tells you to review your work,” what does she want you to do? Helping students understand contexts for which they might hear the word and then additional contexts for when they might use the word is important. How does your work in English translate over to the primary language? Here is where parents come into play. Most parents I’ve worked with prefer you send the list of “academic” words (from curriculum and/or state standards) home in English. They can then use their personal dictionary to look up the correct correlating word in their home language, versus us guessing on a translation website. Have the parents talk with the child about these words in their home language. This builds the foundation for carryover from primary language to English. When using root words you can also can help students make educated guessed on definitions for words. Once students have a decent grasp on root words, some great games to play are Scrabble, Boggle, or Balderdash. An added benefit for teaching root words, is it’s included in the Common Core State Standards.
Here is some personal evidence. Last school year I had a 5th grade student who scored Level 1 (Beginning) on an English Language Proficiency Assessment for all of his academic years, Kindergarten through 4th grade. His 5th grade year we implemented a social skills group and taught root words from the curriculum. With the entire team’s support (student, parents, teacher, SLP) this student scored a Level 3 (Intermediate) on the same assessment. Some beliefs for such success was that our intervention targets were meaningful to him. Social skills helped his friendships and the root words helped him understand and communicate in the academic setting, which is the majority of his day Monday through Friday.
I am sure that there are other evidence-based therapy approaches to working with this population and they should all be founded on the same principals. 1) It is better to target both BICS and CALPs together that waiting for BICS to be mastered well enough to move to CALPs. Reason being, the language gap will only increase exponentially. 2) It is also better to work with the family.
I’d love to hear about other approaches. How do you address therapy for children and families who are not fluent in English?

 

Leisha Vogl, MS, CCC-SLP, is a speech-language pathologist with Sensible Speech-Language Pathology, LLC, in Salem, Oregon. She can be reached at leisha@sensiblespeech.com.

 

How to Navigate the Profession One Binder at a Time

Binders

 

My entire professional career can be summarized by what binder I was holding, and where I was while holding it. I waltzed into my interview for graduate school with a small binder, and a ton of nerves; I entered the current school I’m working in (my first job, ever!) holding my giant binder containing my portfolio. However, the most important binder in my very “speechy” timeline is the one I took to my school practicum.

Many departments offer different variations of clinical experience, whether they’re in a clinic, school, or hospital setting. Everyone gets their hours, but sadly to say, some either have poor experiences or don’t make the best use of their time. When I entered into the first day of my school practicum, I was chock-full of bulletin board ideas, and holiday-themed crafts. I almost exploded with Velcro and stickers! Then it hit me–I was going to have five faces staring at me every day as I navigated teaching them everything they needed to know. All while attempting to be as entertaining as their Xbox or iPhones. I began to panic.

That’s when I recalled the power of supervision. I had almost forgotten the wonderful woman who showed me around the building on my first day. Oh yeah–that nice lady is going to hold my hand through the first few weeks of this! Thank the Speechy Powers That Be!

Not only did my supervisor support me through my practicum, but she let me fly. Our first sessions with the students from the self-contained classroom left my head spinning. Were we shaking maracas and throwing scarves? Did I need to invest in Velcro’s stock? How many times can we sing that song? Oh, and when will this song leave my brain!? By the third week, I was singing, shaking, and velcroing with the best of them. We had an intense caseload with fantastic kids. Everything my supervisor uttered, handed me, sent me, all went in my binder. I knew I only had this window of opportunity for so long and I had to keep it all. binder1 I left my cozy clinical experience and now have embarked upon my Clinical Fellowship Year. I went to pick up one of my first students, and was met with a non-verbal child with autism spectrum disorder. He, of course, did not have his AAC device. I grabbed his hand, said a small prayer to the Speech Gods, and we went to the classroom. It was scary, sure, but I had this; I knew what to do. Not only did I have the materials from my binder, but I had the training to go with them. Skills I learned in a classroom are necessary and invaluable (especially when I pull out those technical words in a meeting to prove a very Speechy point!). However, the knowledge I gained from my supervisor, and my school practicum, is what makes me a good speech-language pathologist.

So my advice is this: Take the time to cherish, learn from, and stumble during your school practicum. Rewrite things, ask questions, and most importantly, make sure you’re in the placement where you will learn best. I’m now navigating my CF in a new building, with new students, new faculty, and a new non-graduate student version of myself. I’m surviving and, even better, also learning something every second (or so it seems). However, I always say that if I had not had the practicum experience that I did, or my handy binder that absorbed it all, I most likely would be crying in a corner hugging my Praxis book!  

Alexis Gaines, MA, CF, is a speech-language pathologist for the New York City Department of Education. She is using Instagram to document her clinical fellowship and you can follow her @practicallyspeeching and #instacfy! You also can follow her blog “Practically Speeching.” She can be reached at practicallyspeeching@gmail.com.

Kid Confidential: Using Thematic Instruction in Speech Therapy

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I have seen many speech and language activities labeled as “themed” therapy activities just by the mere coincidence that they may sport graphics or clip art associated with a particular theme or holiday.  However, simply pasting an associated picture on a stimulus card while asking a student to perform a generic speech or language task is the not the same thing as participating in a themed activity.  Until I learned from my educator colleagues what it truly meant to teach via themes, I made this same mistake, too.  Regular and special educators are taught to understand the importance of themes and how they relate to child development and learning.  However, at least based on my own personal experience, newly graduated speech-language pathologists lack the instruction needed to fully understand what thematic teaching is really all about.

I see myself as an educator first and foremost.  Therefore, I learned many valuable things about education through colleagues and by reading educational research and textbooks.  This particular topic has been no exception.  Marjorie Kostelnik, Anne Soderman and Alice Phipps Whiren, spend an entire chapter explaining what thematic units really are and how they can effectively be used within the academic environment in their book titled, Best Practices in Early Childhood Education.  The following information is adapted from this source.

What is a theme and why would we use them in speech interventions?  A theme can be defined as the creation of various meaningful activities planned around a central topic or idea. The activities are then integrated into all aspects of the curriculum (i.e. language arts, reading, math, science, social studies, etc.).  Thematic instruction has been researched and observed to help children learn about concepts (i.e. ideas about objects and events in a child’s world) and facilitates in connecting various concepts together cognitively. In SLP lingo, this means thematic instruction helps to teach our children about categories. Through first-hand experience and additional learning activities, our students are improving their semantic mapping/networking skills thus improving receptive and expressive vocabulary, understanding and using synonyms and antonyms, word retrieval skills, story comprehension and story retelling skills, answering “WH” questions, as well as improving their ability to make inferences and predictions, thus resulting in improvements in overall language skills.

How do we create effective thematic lessons for our speech sessions?  According to Kostelnik, et al., there are five necessary components to creating an effective theme:

  1. Relevance: The theme must be relevant to your student’s real-life experiences and timely in that themes should be targeted based on your students’ current interests.  For example, a field trip to the pumpkin patch may be planned in the fall. Creating a theme-centered around fall harvest/fruits and vegetables, around this time would be an appropriate time to maximize your students’ interest in learning about this topic.
  2. Hands on activities: Concepts whose informational content can be accessed through hands on activities are appropriate for students 3-8 years of age.  These activities can be offered via exploratory activities, guided discovery, problem-solving activities, group discussions, cooperative learning, demonstrations or direct instruction.  I think as SLPs we tend to be very good with demonstrations and direct instruction (i.e. speech/language activities, what I like to call “drill and kill” activities) as well as guided discovery (particularly in book reading when asking student’s to infer or make predictions), however we miss opportunities for students to use self-talk to problem solve or use cooperative learning to have a discussion with peers.  These are important executive function and social skills that should be trained at an early age so as to generalize to other environments as our students mature.  If, during our group therapy sessions, we step out of the equation as facilitators, will our students educate each other on the necessary skills for continued development (e.g. teaching each other to self-monitor speech production or how to use appropriate social skills in real-time, or even help each other use correct grammar in sentence formulation)?  We must create opportunities for our students to use what they learn independently to help themselves and their peers.
  3. Diversity and balance across the curriculum:  Many of you might be reading this and think, well this doesn’t apply to me because I teach speech and language skills.  However, the truth is, you are already doing this!  Through your planning of speech therapy activities you are incorporating science (e.g. matching pictures of clothing to correct seasons, mixing red and blue paint to make purple, etc.), social studies (e.g. discussing community helpers and matching up the helpers to the objects/tools they use), math (e.g. counting and sorting animals into correct categories), and language arts (e.g. recalling details of a story or retelling a story in correct sequence).  Therefore, the use of “academic” or “curriculum-based” materials in the upper elementary grades, middle school and high school is, more than likely, what most of you have been doing for years!
  4. Primary and secondary sources of information must be available:  When planning a theme, thought must be given to the primary and secondary sources of information.  Primary sources of information are seen as what the child already knows (background knowledge) or can determine via concrete information present.  Secondary sources of information are sources that provide students with additional information they had not known nor can determine via concrete information present.  For example, when focusing on “farm animals” as a theme, a child may already know that a pig says “oink” and can see from a picture that it has four legs.  This is known as primary information.  An example of secondary information would be using books, pictures or other additional resources or materials to explain the role of pigs on a farm or the types of pigs and where they live.  So in a nutshell, a good theme uses the background knowledge your students already have and builds on that by providing additional new information.  Doesn’t this sound a lot like reading comprehension strategies (background knowledge, pre-teaching vocabulary, introducing new information, recalling information, etc.)?
  5. Potential for projects/“discovery learning”:  A good theme must lend itself to discovery learning. Discovery learning simply means you present your students with opportunities to problem solve and/or reason information not factually presented to them.  These projects are child-centered and/or child directed.  This piece is very important in planning themes because as you introduce information to your students you want to follow their lead and listen to the questions they have about the information presented.  Then you want to create a “project” that addresses the student’s questions or concerns.  For example, if when discussing farm animals a child asks have you (as the SLP) ever been to a farm? Your student is expressing the interest to learn more about others personal experiences about farms.  So you guide a “project” where your student asks the other students in your therapy group (language practice in formulating appropriate questions) or classroom if providing in class therapy, and you graph their responses.  Now you’ve just incorporated math (graphing, counting, adding, concepts of more/less) into a “project” your student directed and by the end your student has problem solved a way to survey his/her peers to find out more information about themselves.

I can hear the collective frustrated sigh from many of you out there reading this. “I have my students for 30 minutes, two days a week.  How am I supposed to use thematic units to teach them what they need to learn in that time?”  The first thing I would suggest to do is to start small.  Focus on the use of thematic teaching for a small portion of your language delayed students. Listen to what they are interested about learning and begin to create activities based around those topics. Remember you need to know what your students already know (primary source) so you can provide appropriate expansion materials/activities (secondary source).  Then compare your results.  See how the use of themes aid in learning and language development for this group as compared to the therapy groups for which you do not provide thematic lessons.

Another important key to successful themes is the stay flexible.  Follow your students’ lead.  Remain on one theme only as long as your students’ interest in the topic lasts.  This means, you don’t have to perform five or six thematic activities within your two therapy sessions a week. You can take as long or short a time as needed.  You might even take two sessions to participate in one activity.  I used to work with a colleague who used two or three sessions of repeated book reading as part of thematic teaching and it was amazing to see the improvements in numerous linguistic skills of her students after these sessions.  It just depends on your students’ current level of skills and interest.

So the next time International Pirate Day rolls around on the calendar throw out those multi-step direction cards that have nothing remotely related to learning about pirates. Rather, spend a week or two reading pirate stories while increasing the use and understanding of pirate-associated vocabulary (e.g. treasure, map, spyglass/telescope, etc.), and pirate lingo (e.g. “Shiver me timbers!” “Matey” and “Land ho!”), recalling details and or retelling the stories read (language arts), discussing famous historical pirates and from where they originated (history, geography), creating a “treasure hunt” for your students to cooperatively complete (following directions with pirate lingo, problem solving and reasoning, use of appropriate social skills), and spend time creating a pretend play scenario about pirates (hands-on, expansion activity) using all the information your students’ learned throughout your therapy sessions.  I promise you that your students will have just as much fun learning from you as you will have teaching them.

 

Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona.  She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name.  Maria received her master’s degree from Bloomsburg University of Pennsylvania.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ.  Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech.  For more information, visit her blog or find her on Facebook.