10 Low-Cost, Low-Tech Tools for SLPs Treating Teens and Adults

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With summer—and client travel—around the corner, I’m sharing ideas for non-electronic treatment activities that are low-cost, portable and ideal for adults with developmental disabilities. Use these activities in the treatment room and for families who want to work on speech, language and communication goals between sessions. Encourage clients to take these materials along during summer travel, on the beach or on a short trip in the community.

Whenever I work with older teenagers and adults with developmental disabilities, I focus on finding age-appropriate activities. An older client might feel disempowered by a childlike activity.

Most people also already own these materials!

  1. Newspapers. A newspaper—which may cost less than $5, depending on the paper—serves as a multipurpose treatment tool. Even better—some papers are free! Target literacy, answering and asking questions about current events, searching for a movie time and location, and social skills or abstract language in the comics section. Check out how to use comics to meet speech and language goals.
  2. Magazines. I love using magazines as a treatment tool with adults. Age-appropriate and interesting, magazines contain a variety of articles, pictures, advertisements and more. Also, the magazines your clients choose may give you insights into their interests and motivations. I recently asked one of my clients to choose a magazine at the local convenience store. I expected him to choose a food or car magazine, but he gleefully went straight for the gossip rag. We had a productive session afterward discussing various sections in the magazine via his communication device.
  3. Grocery circulars. Use free circulars to learn money management, categories (such as food groups) and new food vocabulary. Other goals include facilitating commenting and describing. Circulars also act as conversation starters: “What would you buy at the grocery store?” “I want to make steak and eggs for breakfast. What do I need to buy?”
  4. Brochures/catalogs. Brochures and catalogs—another free option—motivate and engage clients depending on their interests. If your client likes electronics, bring an electronics catalog, for example. Discuss prices, various types of equipment and what they like versus dislike. The same approach works for clothing, gardening or home décor catalogs.
  5. Subway/bus maps. Also free and functional! Work on travel training, literacy and map reading with these resources. Language concepts include problem-solving, sequencing and answering “wh” questions.
  6. Menus. I’m sticking with the free theme, here! And what’s more functional than being able to read a menu and make a choice? Check out my previous article on using menus as a treatment tool.
  7. Employment applications. Stop into any fast-food establishment, restaurant, movie theater or retail store and ask for an application. Filling out an application facilitates improved literacy, answering “wh” questions, recalling information, expanding vocabulary, and sequencing by writing the order of educational or work history.
  8. Dominoes. A set of dominoes offers an inexpensive, portable, age-appropriate and fun developmental activity for adults. Practice matching, taking turns, solving problems and following directions.
  9. Playing cards. Ideas for card games include Uno, Go Fish and War. Again, thiese low-cost games double as age-appropriate, accessible, portable and functional treatments. Examples of targeted goals include matching, solving problems, taking turns and prediction.
  10. Board games/bingo. How about a game of Sorry or Connect Four? These games are less than $10 each and teach taking turns, learning colors, following directions and solving problems. A generic bingo game or a customized bingo set also works well. If you have clients who need work on specific vocabulary related to actions, send them home with an action bingo board. Instruct them to use it with family or friends to build vocabulary, practice taking turns and forming complete sentences.

 

Rebecca Eisenberg, MS, CCC-SLP, is a speech-language pathologist, author, instructor and parent of two young children. She began her website, www.gravitybread.com, to create a resource for parents to help make mealtime an enriched learning experience. She has worked for many years with children and adults with developmental disabilities in a variety of settings, including schools, day habilitation programs, home care and clinics. Contact her at becca@gravitybread.com or follow her on FacebookTwitter or Pinterest.

June is Aphasia Awareness Month—Join the Celebration!

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June is National Aphasia Awareness Month and this year’s host group is the Big Sky Aphasia Program in Missoula, Mont.. This year’s theme is “ It’s Never Too Late To Communicate” and the National Aphasia Association (NAA) is encouraging professionals, consumers, community support groups and aphasia centers nationwide to raise public awareness about aphasia in June and has a poster and resource packet available.

Thanks to Senator Tim Johnson (D-S.D.) and Senator Mark Kirk (R-Ill.) for, once again, co-sponsoring the resolution to proclaim June as National Aphasia Awareness Month! You can find the resolution here.

This year we launched a month-long social media contest to help the public understand aphasia and how to communicate with people who have aphasia. We are proud to introduce our new social media intern, Laura Cobb, whose first assignment is serving as spokesperson for the Aphasia Awareness Month contest. Laura is 27 years old and lives in St, Louis, Mo.. In September 2008 she was a student at Washington University majoring in psychology and hoping to work in the field of autism when her car was struck by a drunk driver as she returned home from studying. Laura suffered a stroke resulting in aphasia along with other injuries including a partial hearing loss for which she wears bilateral hearing aids.With intensive speech services, Laura has been able to regain a good portion of her ability to communicate. She continues to receive speech and language treatment and continues to improve. We first met Laura when she created her own video for You Tube on “How to Talk to Someone with Aphasia.” Her video has received more than 200,000 views to date and she was interviewed for an article in the Huffington Post.

“I’m excited to work with the NAA now,” says Laura in the first of her weekly video clips discussing the NAA’s contest, which encourages people to post about aphasia on Facebook, Twitter, Instagram and YouTube using the hashtag #AphasiaAwarenessMonth.  Each week, participants are tasked with a different challenge. For example, in week one, people were asked to answer the question “What is aphasia?” In week two, participants shared their tips for communicating with people with aphasia and in week three they posted pictures of themselves with the June poster. Click here to learn about this week’s challenge.

“It’s never too late to communicate. So, we want your tips. My favorite tip: speak s-l-o-w-l-y,” says Laura. At the end of each week, a winner will be selected randomly and awarded a series of aphasia-related prizes; then a new weekly challenge will be announced. At the end of the five-week contest, the top prize, an iPad Mini, will be awarded on June 27. There is no cost to participate. The more people post using #AphasiaAwarenessMonth, the more chances they have to win and the more we can raise awareness of aphasia!

But that’s not all you can do. Here are some other suggestions as to how you can celebrate National Aphasia Awareness Month in June:

  • Provide training at local hospitals, clinics, senior citizens centers, nursing homes, etc.
  • Send packets of information to doctors and other professionals and staff who work with aphasia (e.g. physical therapists, occupational therapists, social workers, nurses). Training for these groups would be very helpful in dealing with the communication difficulties.
  • Provide training workshops and support groups for family and caregivers.
  • Provide workshops for local religious groups – many of these have existing programs for helping people in the community.
  • Display posters and disseminate materials in local shopping centers, libraries and supermarkets about aphasia.
  • Set up an information table to educate employees, patients and families about aphasia.
  • Get your city/town to pass a resolution proclaiming June as National Aphasia Awareness Month- we can provide you with the template.

Remember, aphasia advocacy and increasing awareness is a year round activity so join the effort! For more information or to receive your Aphasia Awareness Month packet, contact the NAA’s Response Center at 800-922-4622 or visit the NAA website.

 

Ellayne S. Ganzfried, M.S., CCC-SLP, is a speech-language pathologist and the Executive Director of the National Aphasia Association. She is Past President of the NYS Speech Language Hearing Association (NYSSLHA), Long Island Speech Language Hearing Association (LISHA) and the Council of State Association Presidents for Speech Language Pathology and Audiology (CSAP) and remains active in these associations. Ellayne is a Fellow of the American Speech Language Hearing Association (ASHA). She was a site visitor for ASHA’s Council on Academic Accreditation (CAA) and a practitioner member of the CAA for four years. She is currently on ASHA’s Committee on Honors. Ellayne has created and managed several speech, hearing and rehabilitation programs in New York and Massachusetts. She is an adjunct instructor at Adelphi University-Garden City –NY. Ellayne has written articles and presented regionally and nationally on a variety of topics including aphasia, rehabilitation and leadership skills.

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.

Giving Aphasia a Voice in Baltimore

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Nationally, more than one million Americans are living with aphasia. Aphasia is more prevalent than Parkinson’s disease, cerebral palsy, or muscular dystrophy, yet public surveys show that only one in 100 people know about aphasia.  If aphasia is so prevalent, why are so few people aware of this condition?  The answer is simple. How can people with aphasia advocate for themselves and increase awareness when their central problem is communication?

 

Fortunately advances in technology are providing new opportunities for people with aphasia to speak up.  Individuals with aphasia who attend the Snyder Center for Aphasia Life Enhancement, a community treatment center in Baltimore, are dispelling the notion that they are unable to advocate for themselves. Members who attend the center use an array of technologies to enable their ability to express their thoughts and reveal their competencies and during Stroke Awareness Month they were, indeed, heard.

 

Forty members with aphasia who attend SCALE decided to increase awareness about aphasia in Baltimore through the arts. On May 4, SCALE hosted a play about aphasia entitled “Nightsky.” The SCALE community partnered with the Hugh Gregory Gallagher Motivational Theatre, a non-profit organization that raises public awareness of disability issues and discrimination in our society through dramatizations of real-life and fictionalized experiences. SCALE members invited the group to perform “Nightsky” to their friends, neighbors and folks from the larger community. Despite severe communication impairments they sold tickets, wrote presentations and presented to more than 135 guests.

 

Some members read their written messages orally. Those who have limited spoken output used programs such as WordQ, and Lingraphica to formulate their messages. Several SCALE members used the Vast Program to enable them to fluently produce the materials that they had written. The Vast Program is an innovative research-based application of video technology designed to facilitate and improve communication abilities for speech-impaired individuals. Following close-up video of mouth movements combined with visual and auditory cues allows individuals to readily produce speech. SpeakinMotion LLC has made this approach available to individuals with motor speech disorders such as aphasia and apraxia through its speech therapy apps and custom recording service.

Howard at NightSky

SCALE participant, Howard Snyder, presents information about “Nightsky” to an audience.

Learning to use these programs, creating their messages and practicing what they intend to say required weeks of preparation and hard work by stroke survivors with aphasia. But, the hard work paid off when they were able to deliver their unique messages themselves to advocate for themselves and to educate the public about the effects of stroke on communication and quality of life.

 

Thanks to the National Aphasia Association for uniting scale and the Hugh Gregory Gallagher Motivational Theatre for this collaborative opportunity to promote aphasia awareness.

 

Denise McCall, MA, CCC-SLP,  is the director for SCALE in Baltimore. She can be reached at dmccall@scalebaltimore.org.

Helping Clients With Aphasia Retrieve Words—On Their Own

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Eric Broder Van Dyke / Shutterstock.com

“I can’t hear it!” This was said by Mrs. A, a 67-year-old woman with aphasia, who actually hears fine. What she meant to say is that she can’t recall the sequence of sounds to express a particular word or idea. When we have that tip-of-the-tongue loss of a name, how do we try to remember it? What strategies are we using to get to that word that we can’t remember?

Our success depends on our ability to hunt and gather—and on the number of neural connections we can tap into to access the information. These skills are cognitive, not simply learned operantly.

In my last blog post, I talked about establishing cueing hierarchies and functional activities for our adult clients. This post looks at using the cueing hierarchy to stimulate the rewiring process. Sometimes I think that I am a sort of electrician rather than an SLP. I work on finding the connections based on observed behavior from evaluations or activities (like writing, gesturing or drawing) that require least intervention.

How do we develop these skills? How can we teach strategies for short and long-term functional success?

Sometimes, we spend the therapy session working on the most disabled aspects of the communication disorder: comprehension, word retrieval, writing and reading. But if we don’t tap clients’ best abilities to foster some success, and if we don’t address whether they are continuing to practice these skills outside the therapy room, how will compensatory skills, adaptive skills and new connections work for them?

Let’s look at Mrs. A, who said, “I can’t hear it.” She was telling me about the very connection that she lacks due to her aphasia: re-auditorization. She can’t hear the words or the phonemes that make up the words in what I call “her mind’s ear.” If given the first phoneme, or a carrier phrase, she almost always names the word. She is able to write the word about 75 percent of the time but can only read it aloud about 30 percent of the time. She will often be able to speak complex multisyllabic words or a short phrase when discussing a topic. Auditory and reading comprehension is 75 percent for paragraphs. She is very intact cognitively, but her affect varies emotionally from congenially engaged to depressed and angry.

She is about two years post-stroke and has an all-in-one AAC that she doesn’t use. Our goals must address her frustration by establishing immediate successful compensatory strategies for communication. Then we need to build skills that will help in the rewiring, so that she begins to cue herself. The rewiring will be difficult here because she doesn’t link the phoneme to the letters she is able to write. But if she can write the word and then read it aloud more often, she can develop a clear strategy for verbalization that will reduce her frustration.

We will begin by simply reviewing phonetic placement in monosyllabic words. I like to use real words—which have semantic value—rather than nonsense syllables. Consonant-vowels alone don’t work as well as consonant-vowel-consonants that mean something. Mrs. A started relearning that a /b/ means that the lips come together when starting a whole word like “beer.” We chose beer for the visceral, emotional connection it has for many people. We talked about when she might drink beer, such as at a baseball game, which lends itself to picture assistance to boost cognitive links. We initially used a mirror to model the placement while sitting next to her. We highlighted the first letter and said it with her. She saw the picture, then wrote the word.

Mrs. A can now produce the whole word “beer” after seeing a picture of it. Looking at the Cueing Hierarchy, we have moved from most clinician involvement to independent self-cueing for this phoneme. She is moving on to more phonemes rapidly so that we may not need to review every letter after a period of time. Mrs. A. is beginning to generalize the link to other sounds. New neuro-behavioral links and relinks are helping her associate the orthographic letter with a physical movement and the sound that is produced. New cognitive links and self-cueing has begun!

Next, she will need to use the strategy in controlled conversation and small groups to increase her comfort level and functional use outside of treatment. This is a big hurdle. Families and caregivers are crucial players and need to be instructed how to encourage communication without frustration. When possible, teach the caregivers and families how the strategy works. They will use it more readily at home and will see how it can work in a variety of situations, such as in restaurants.

Another client, Mrs. C, had a similar functional ability to write but not verbalize. With time, she was able to trace the first letter in the air to cue herself to say a word.

In both cases, skills that had been present were improved, then used to create a compensatory strategy for functional communication. We must teach our clients strategies for improving the scope of their communication without our cues, using their own strategies, thereby making them more independently functional. While available strategies are unique to each client, they usually take the form of low tech gesturing, drawing, writing, even circumlocution.

We want our clients to be learning and improving communication dynamically. If we always fill in all of the sentences or speak for them, they cannot make their own connections. When allowed to use strategies independently, they then blossom, not only communicatively but socially.

Betsy C. Schreiber, MMS, CCC-SLP, is a clinical supervisor at Ladge Speech and Hearing Clinic at LIU/Post on Long Island, and a partner at Hope 4 Speech Associates, P.C. She is an affiliate of ASHA Special Interest Groups 2, Neurophysiology and Neurogenic Speech and Language Disorders, and 18, Telepractice.