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Aphasia therapy

26 May

APHASIA!

If you’re working with adults you’re PROBABLY working on aphasia. There are maaany types of aphasia. If you use the WAB, which there is a good case you will, then you will give your patients any one of eight aphasia diagnoses (Broca’s, Wernicke’s, Transcortical Motor, Transcortical Sensory, Global, Isolation, Conduction, Anomic). Most aphasias  be classified as fluent (receptive) or non-fluent (expressive). And there are other aphasias out there like primary progressive, alexia, agraphia etc. AND the way you classify aphasia will depend on your “theory” of aphasia.

I say all of this, but really you won’t see “pure” aphasias often – I would say many are mixed. You’ll see patients with a variety of difficulties that manifest themselves in all sorts of exciting ways.

AND QUITE FRANKLY – sometimes the diagnosis is SORTA irrelevant. To me – I’m not treating a diagnosis. I’m treating the issue. Just because someone has Broca’s aphasia doesn’t necessarily mean that the treatments typically used for Broca’s aphasia will work for this patient.

So what do you do with these patients – who may have difficulty speaking, understanding, reading, writing, spelling and a plethora of other troublesome word related tasks?

I’ll try to narrow it down a bit.

The patients I saw MOST OFTEN were having difficulty with word finding. I’ve had one patient with global aphasia and one patient with Wernicke’s. My externship had a very cool “Evidence Based Aphasia Clinic” which analyzed the aphasic characteristics of patients enrolled in the clinic, and then looked at EVIDENCE BASED protocols for treating aphasias. WHICH IS SO SMART. Everyone should do this. Not just with aphasia. With all things. One day I’d like to have at least one legit journal article printed off that explains why I do what I do with each kind of disorder that I focus on.

Back to what I was saying – What do we do with these patients? With a global aphasia you’ll likely be trying to find some kind of multi-modality communication system that will be consistently and appropriately utilized in the patient’s life. These are tough patients but you’ll find a way to communicate. One of my most favorite patients had global aphasia. She was the sassiest.

Wernicke’s? Wernicke’s aphasia is really cool. There is a Treatment for Wernicke’s Aphasia which works, but is extremely tedious and exhausting for EVERYBODY. Be sure to break up your sessions if you attempt it. The idea is you put out six photos (of 12 photos total) of everyday photos and first – hand the patient a card with a word on it. The patient matches the word to the picture. The patient then reads the word or verbally identifies the picture. The patient then repeats the word after you. Then you ask the patient to identify the picture with just a verbal cue. There is no scaffolding or cueing, but obviously for training purposes and for success purposes you’ll want to cue and prompt as necessary at the beginning. When I find the source for this I’ll share it – I’m not sure where I hid it. You can also do Response Elaboration Training, Cloze Procedures, Melodic Intonation Therapy, and I’m sure a number of other procedures.

And the biggie – word finding. This is going to change with each patient. I really enjoy category naming and teaching HOW to do this efficiently. I think often we say to a patient “Name all of the animals you can!” and then they have a hard time and we write down how many they got and then we tell them to name some other things. THIS IS NOT GOOD THERAPY.

Teach, don’t test, people.

So some ways we can deal with naming and word finding is to do semantic mapping tasks and semantic feature analysis. You can TEACH patients how to categorize by really thinking about how our brain works. How is our brain organized? Do we just have a jumble of animals in our brain all willy nilly? If someone asked YOU to name as many animals as you could what would you do? I often tell patients to subcategorize. Tell me animals, but first tell me farm animals, then zoo, pets, woodland, ocean, flying, etc. Tell me vegetables but envision yourself at the grocery store. And also consider – are you asking the patient to name CONCRETE items or ABSTRACT? Example time. Concrete: Animals. Abstract: Red things. Our brain is not organized by color.

Other tasks for word finding: synonym and antonym generation. And not just ONE word. Tell the patient to think of THREE antonyms. This gives you a good idea of where they are as far as what is difficult and what sorts of scaffolding is required. Can you give a patient a FIM score without really pushing them and figuring out what is hard? (No.)

Unscrambling tasks. Idiom defining.  Homonym explanation. Word defining. Seriously – ask a patient with a word finding disorder to define the word “tree”. Try that one. I really recommend the WALC books and Cognitive Reorganization if you work with aphasia often.

Now, I’m going to do the last edit of my thesis because I’ve been…not doing it.

NP: Anna Begins – Counting Crows

PS – if you Google just the word “WALC” you get this website. Lolz.

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Memory Therapy

21 May

I don’t know about you guys, but I felt like in many of my SLP classes I learned a lot of “textbook knowledge.” Meaning it’s good info to know and it’ll help me pass the Praxis, but beyond that it’s sort of useless. For example, in aphasia we learned the symptoms of aphasia and the different classifications of aphasia and how to evaluate aphasia. But three months ago if I was presented with a person with aphasia and someone said “TREAT THEM!” I’d be all, “Oh Dear Mother of God.” The knowledge isn’t super practical sometimes.

Which is why externships and clinic are important.

Anyway, I thought I’d take some time to break down some of my favorite areas to work on in the adult realm. Today I thought I’d go over,

MEMORY

As SLPs we address cognition which is an umbrella term for: orientation, memory, attention, problem solving, reasoning, initiation etc. Executive functioning overall. You’ll find often that OTs work on this as well.

Memory is an umbrella as well, since there are so many types of memory. Short term, long term, delayed, procedural, working, autobiographical, muscle, semantic and so forth. And memory has many steps. Your brain has to absorb the info, it has to code it, store it, and make it available for retrieval.

Generally, what I worked on most often was working memory and training patients to compensate for short term memory loss. There are a few agreed upon tricks of the trade and I’ll share them with you now.

1. Teach your patients to associate. This is most often used in the case of remembering new names. I always give my patients the example, “My name is Sam. I am a Speech therapist. And I’m a Student.” Lots of /s/. You could also use physical traits or personality. Like “Democratic Diana” or “Tall Tina.” You can make an association between new information and something you already know like, “My niece’s name is Sam and your name is Sam so I’ll remember you” (I never get how this works but patients always do this as their example.)

2. Repeat repeat repeat. If you want to memorize a list, a phone number, a poem, song lyrics – whatever – what do you do? You say it or do it over and over until you can do it without prompts. If a patient can’t remember what month it is – tell them during your session. A lot. And write it down. Several places. Repetition and rehearsal are great tools for committing something to memory.

3. Visualize it. This is good for prospective memory because you imagine yourself calling the doctor at 3 PM, or you imagine yourself turning on the TV to watch your favorite show. It’s like a little movie in your mind. A way to train visualization is to give a patient a list of words and have them make a story out of the words. Sometimes patients don’t really get it and will just combine a bunch of unrelated sentences. You want to encourage the story to have flow and be related, though it can be really silly. So if the list of words is:

Sock. Keys. Pink. Word. Chair.

They might say something like, “I’m wearing socks. I have keys in my purse. My favorite color is pink. Chair is a word.”

This is beneficial to no one. You want a story like, “I put on my sock but couldn’t find the other. So I got my keys and unlocked my pink car, so I could go buy a new pair. When I got home, I said a curse word because my sock was under the chair.

They’ll say the story to themselves a few times and then you remove the list from their line of vision. Ask them to verbalize or write the list immediately. Then ask again 20 minutes later.

4. Grouping. Which is one we all do a lot anyway – putting like things together. So if you’re making a grocery list, put the meats, dairy, dessert, veggies on the list together so it makes sense. Also then if you forget the list at home you have a better chance of remembering if you had categories.

5. Writing things down. Putting new activities into a planner. Writing notes on your day. Keeping a pad of paper by the phone. Reviewing the day with someone. Writing on a calendar. However you want to do it. But you’re more likely to retain something if you’ve put it on paper. A lot of patients physically can’t do this, so encourage their families or caregivers to help them.

You’ll also want to encourage your patients to make changes in their home environment so it’s more conducive to memory. Like keeping everything in a specific place everyday. Labeling drawers. Using a pill organizer. Using external aids like alarms and calendars. Whatever is going to make their life a little easier.

Working memory is something I really enjoy therapizing and that is just the retention and manipulation of information. So doing things like numbers reversed, or unscrambling letters into words when provided verbally. If you have a patient who has visual impairment these are good tasks to get them settled into therapy and get that brain moving. It’s a challenge for me too!

NP: Memory

Inpatient questions

15 May

 

Q: I read in one of your posts that you didn’t like inpatient at all and that’s all that I’ll be doing. I was hoping you could offer some advice or words of encouragement?!

A: Don’t worry! Not everyone can love or hate everything. I have several friends who adore inpatient, acute therapy. Two of my friends have even taken jobs with acute care.

My beef: I don’t like constantly doing the same thing – which I sometimes feel like in inpatient. You don’t get to follow a patient through their progress – sometimes you may only see them for a very short period of time. On inpatient, I’m hesitant often because I’m uncomfortable – I haven’t spent a lot of time around sick people or hospitals. I don’t want to offend anyone, kill anyone, make anyone mad. And I have a hard time making my voice right – don’t wanna sound like I’m being condescending to grown people when I’m actually trying to sound sweet!

You will get comfy and that will help considerably. Just listen to your supervisor and copy her therapy moves and it will all work out. And honestly I’m doing better and better with inpatient everyday(but I still don’t want to do it!!)

Dressing like an SLP

6 May

Dressing for clinic. Dressing for interviews. Dressing for work. Dressing for conferences and presentations. Some students, you may notice, have a hard time figuring out the difference between dressing nicely as a professional and dressing nicely as a party girl. We all have different taste and style, but we all need to make good impressions!

These are some examples of what I’ve been wearing to interviews and such! (Usually my clinic wear is khakis and a solid colored shirt and a cardigan…because I’m super creative that way.)

Button downs!

Skirt suit

Professional dress

Graduation dress!

Three piece suit

And after all that, I get to wear this in just two weeks:

Master’s hood and all!

NP: The Cardigans – Lovefool

Sucking at blogging

21 Apr

You guys, it’s been almost a month. I suck. But seriously, a lot has been going on and I’ll tell you all about it!

1) The Job Front – things are looking up! I’ve had a lot of phone interviews and I’m working with the WONDERFUL staff at PediaStaff. They are rocking my world. I totally recommend contacting them if you’re on the job hunt! I would tell you more about which position I’m most excited about but I’m scared to jinx it – feel free to email me if you want to know more about PediaStaff or the positions they’re helping me with 🙂 I want to tell you guys more about phone interviews and I plan to do so in a blog post or so.

2) The Thesis Front – I should totally be doing edits right now but it’s fiiiine. Ha. I defended and got my thesis passed on Monday! Woo-Woo! I have to have the completed draft in to the Graduate College by Monday the 23rd (which is why I should be working on it…) If you’re working on preparing for a Master’s defense I recommend a powerpoint – it’s the easiest and clearest way to review your whole project and you can make sure you’ve got all your bases covered.

What's that? Oh just my signed thesis.

3) The Externship Front – it has been A WEEK at my externship site. I DO NOT LIKE INPATIENT THERAPY. Don’t. Like. It. Don’t make me do it. Please. Outpatient – I wanna do it all day long. LOVES the outpatient. But my supervisor just started floating between inpatient and outpatient and frankly, I am not comfortable in inpatient and I keep messing crap up. I know I’ll get better because I hate being bad at anything speech-related, but I don’t know that I’ll enjoy it more. My supervisor and I went over my midterm yesterday and she started that most of my skills are “emerging” – which makes perfect sense. It’s halfway through my time there, I’ve never worked in a medical, adult setting before – why would I be perfect at it? I wouldn’t. But it’s still hard to hear. As a group SLPs are kind of perfectionists and any kind of criticism tends to make us run and hide. So if you’re in your first medical setting and you’re not so comfortable my advice to you is, “Take a deep breath and remember – you are still a student. You are green. This is NEW. It is OKAY to not be perfect.”

If your supervisor has told you ten times to stop or start doing something differently and you still haven’t figured it out – that’s a problem. But try to keep in mind that you are there to LEARN.

4) The Life Front – got my car back! Boys suck! I really want to adopt this dog from the APA of Missouri. I don’t think I should get a dog because my life is a disaster but like…she’s so precious.  Her name is Peanut. I’ve seen her twice in person and I just want to put her in my pocket. I loves her. If you want to adopt her please do – and then let me come play with her. I contacted the APA about her so we’ll see, maybe I’ll be making an insane decision here in the near future.

Do you love this puppy or what?

My apartment is a friggin’ disaster. Did you see the picture on the Twitter? I’ll put it here. It’s nutso. And my friend Ellie is coming to crash with me today so I hope she doesn’t mind staying in a pig sty.

This is your brain on grad school

5) The Blogging Front – I just sent in my first blog post for the Hearing Journal so look for that soon! Also I’m working on a post for PediaStaff so look for that too :). And I promise to get back in the swing of things here too.

6) The Professional Front – recently attended Missouri’s Speech-Language-Hearing Association annual convention. We won Quest for the Cup! We are here and rocking your world with our brain power.

AWWW YEAH

As always, I have a lot of thoughts after attending a convention and I’ll get into that later. But please please please please JOIN YOUR STATE ASSOCIATION. I cannot say this enough. DO IT. RIGHT NOW.

Alright I’m outta here. I need to brush my teeth and I’m going to see the Lucky One. It’s going to be terrible.

NP: Matchbox 20 – Push

New site!

24 Mar

I started my medical setting on Monday and it’s been pretty good! I’m doing only outpatient right now, which is good but I spend a lot of the day sitting (something I kind of abhor). Next week my supervisor starts floating so we’ll be running around between inpatient and outpatient which will keep me awake I’m thinking. I bought some ugly, but super comfy shoes from DSW – and if you’re going to be running around a hospital you may want something similar.

My clients are a mix of stroke and TBI, and we do a lot of memory, word finding/semantic activation, and executive functioning tasks. We currently have one dysphagia patient but we’ve got a few evals too. My site has access to FEES equipment which is cool, but I’m a little disappointed that I won’t get hands on MBS experience.

I think overall its going to be a great learning experience, my supervisor is incredibly intelligent and competent – she’s someone that I hope to be like when I’m a grown up. 🙂

NP: Drake – Headlines

some reflection

18 Mar

I finished my school externship on Thursday and I begin my medical site tomorrow. I’m really excited to get started with some adult patients. My supervisor is the float SLP for the time being, so we’ll be doing a little outpatient, and a little inpatient. Most of my patients will be stroke, TBI – dysphagia, aphasia, executive functioning. I CAN’T WAIT FOR A CHANGE IN PACE.

So now that I’m finished with 12 weeks of the schools, I want to talk about my experiences as a whole. I saw 3-5 year olds, and third to eighth graders. My two sites couldn’t have been more different and my two sites were quite different from those of my graduate school peers. I had one classmate in an early childhood setting, but everyone else was in a regular LEA, phase 1 or 2 setting.

What I liked: I liked working with the kids. I had so much fun interacting with students. Students, are fun! They want to play and laugh and doing therapy is a game. And I enjoyed learning how to be an important part of meetings, how to interact with teachers, and how important interacting with related staff is. The best part was getting ideas – seeing how real therapists do things, what real therapists make a priority, what materials real therapists think are vital. When you’re in a clinic setting you have one million materials at the tip of your fingers but out in the world – you have personal purchases, what other clinicians have left behind, and you use a lot of creativity. I have a therapy materials box that I’ve been gathering over the years, so that if I end up in a school setting or a home health setting that require my own materials I don’t have to start from scratch (maybe sometime I will share what I’ve got in there).

What I disliked: Paperwork. Boring meetings. Bureaucracies that have demands on your time and teacher energy and student capabilities for state assessments, national assessments, school achievement standards. I didn’t enjoy the amount of downtime at one of the settings – but I think that just depends on the way someone makes their own schedule. I think my least favorite part was the non-verbal part of things. I think AAC is cool. I like it. I have compassion for the students that need it and I want students to have it and benefit. But, I ENJOY the speech part and the language part. The verbal side of things is definitely what I like to do. I could deal with a part of my caseload being non-verbal, but I need some verbal component of my caseload. I loved my kiddos, but it was hard at times, I won’t lie to you.

NP: Kanye West – All of the Lights

I promised

12 Feb

Okay so I said earlier that I would give readers my typical day schedule. So that’s what I’m doing.

IF it was a normal semester, my schedule would likely look a bit like this:

8:00 – Work

11:00 – Therapy

12:00 – Class

2:00 – Work

5:00 – Therapy

6:00 – Class

9:00 – Home

Obviously that is a simplified look, but you get the idea. Usually toss in a few meetings, and some late night clinic work. Also on days when I had free time I would be driving about 40 minutes to collect thesis data, or doing paperwork, or napping.

When I was at Early Childhood, my schedule looked like this:

8:00 – Arrive

8:30 – Bus Duty

9:00 – First Session

9:30 – Second Session

10:00 – Third Session

10:30 – Fourth Session

11:00 – Fifth Session

11:30 – Bus Duty

12:00 – Lunch

1:00- First Session

1:30 – Second Session

2:00 – Third Session

2:30 – Fourth Session

3:00 – Paperwork

3:30 – Bus duty

4:00 – Home

NOW, my schedule looks like zeees:

8:00 – Arrive

8:15 – Consult (which means creating PCS symbols for classrooms, talking to teachers, working on devices, planning, meetings etc)

10:00 – First session which works namely on picture exchange

10:30 – Consult

11:30 – Second session which is currently working on using a visual schedule

12:00 – Lunch

12:30 – Consult

1:30 – Third session which is currently working on following functional one step directions

2:00 – Consult

2:30 – Fourth session which is currently working on discriminating and following one step directions, some picture exchange

3:00 – Bus duty

3:45 – Home

In this schedule we do mostly group, push-in therapy, but we do pull-out twice a week. I’ve also attended a few IEP meetings, a SETT meeting, and Data Team meetings.

If you want to be an SLP, prepare to stay busy! 🙂

NP: Gym Class Heroes – Ass Back Home

 

first week of new site

3 Feb

I’m all moved into my new apt in St. Louis and it was my first week at my new externship site. I don’t have internet and I don’t have computer access at school, so expect to hear from me on weekends!

I’ve been deliberating on what to say in this post. I had a really great week at Special School District, it is an interesting facility and a very different experience than what I imagine many of my classmates are doing. Some background:

Special School District STL is rather unique. There are five schools that are solely dedicated to the education of students with special needs. They aren’t state schools, they are a part of St. Louis County Public Schools. SSD-STL also serves 22 other “partner” school districts (265 schools total). They do everything from EC to tech schools.

I say it is unique because I think it is unusual to find exclusive schools, where there are zero regular education classrooms. Every student in the five special education schools has an IEP. Most of my classmates are in a regular education school and are providing services to students with IEPs, RTIs, 504s – what have you. But those students are involved in the reg ed process.

I’d have to say that because of this, I would strongly recommend all SLP students to take advantage of every experience they can get. My experience now is SO COMPLETELY different than my Early Childhood setting. And those two settings are going to be COMPLETELY different than the experiences of my classmates. Here are some ways JUST my two sites have been different:

  ECSE SSD-STL
Service Delivery Pull Out except for once a week lang group Almost solely push in, with some pull out
Supervisor Female Male
Case Load Verbal, core vocab, literacy, increasing MLU, intelligibility Non-verbal, picture exchange, AAC
Resources Supervisor had personal supply of materials All SLPs have a community materials closet
Experiences w paraprofessionals Mostly positive Mixed interactions
Collaboration Strong collab w teachers, paras, behavior tech, OT Strong collab with teachers, paras, OT, ABA
Hours of TX a day Saw approx 4-6 hours 2 hours/day
Interaction Lunch everyday with teachers, paras Lunch in office
Set Up Supervisor had her own room w table and materials Supervisor shares large office space w other SLPs, OTs, PTs, ABA, guidance
Outside duties Bus duty on Weds, collaboration, some IEP write ups, meetings Assist w buses, collab, IEP write ups, data team, meetings, AAC consult/planning

Right now, I don’t have a strong opinion of one being better than the other. Each has pros and cons and I’ve learned a TON at both sites. WHICH IS WHHHHHY it is SO important that you get as much hands on experience as possible. I’ll keep you updated on my SSD adventures and insights!

 

getting things wrapped up

25 Jan

Right now, as we speak, I should be studying for my Professional Issues midterm. But you know, it FEELS like common sense so I’m having a hard time “studying” for stuff I feel I should already know.

What is a Professional Issues course you ask? Well let me tell you. It is a two week crash course in….issues that affect the professions. I feel as though the last two years has been a crash course on this topic but nobody asked me! I’m pretty sure one way or another every CSD program has this course.

So what am I doing instead of studying? Listening to music, drinking tea, blogging, sending resumes, Facebook creeping, WordPress creeping. The usual.

I’m going to finish up my thesis data tomorrow and let’s just talk about that for a second.

I wanted at least eight participants with dementia, and I only got four. We added a component where we used “healthy aging” participants for comparison (and to increase my sample size). I got four of those. Then two backed out. Luckily I’ve made a new SLP BFF who works in a nursing home and she’s getting me the hookup with two more participants. THANK GOD.

Overall it has been a hassle but once I can finish with the data collection it should be good.

My thesis advisor keeps asking me if I could go back would I opt for the thesis option? And my answer is always yes. It has been a pain in the behind but, for ME, it is worth it. I want to do a Ph.D. in a few years. I love doing research. I want the real life experience of doing research. So yes, I would always opt to do the thesis. I’ve got everything set up and ready to go, I just need to analyze my data and format it. Then it is all editing from here on out.

I’m unsure as to WHY the thesis is so dreaded for advisors, especially considering the lack of clinicians interested in legitimate research. I DO think if you opt to do a thesis you need to be dedicated and motivated, it is a COMMITMENT. But stop telling people that by doing a thesis they likely won’t graduate on time! That’s an exception, not the rule! I think it is irresponsible for faculty to encourage people to not pursue more advanced research if they have a real interest.

On Monday I start at SSD-STL and I’m pretty darn excited. I talked to EBS today and I’m hoping to get in contact with Genesis Rehab about interviewing and such for my CF. My first interview is coming up in about two weeks, I really can’t believe I’m getting to the point where I can start interviewing! It is all coming together and I can’t wait to get the next chapter of my life started.  It’s about time!

NP: Vonda Shepard – Baby, Don’t you break my heart slow