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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

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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! ­čÖé

NP: Gym Class Heroes – Ass Back Home

 

I just don’t know

4 Jan

I don’t have a right or wrong answer here – just some thoughts. I’ve noticed that when doing therapy with students in a group there are two options. You can (a) match the students based on need, or (b) do the complete opposite and pair up students who are advanced in therapy (a “role model” if you will) with students who are still beginning.

Now, there is a side and benefit to each. There are also draw backs. If you choose to match students based on similar supports needed you can get a lot of work done. You can tackle the same skills and still reap the benefits of peer interaction. Both students win. But there is no peer leader, there isn’t anyone saying “Look at me do it – now it’s your turn” and a lot of kids need that. Kind of the “cool kid” effect.

If you match up an advanced student with a student who needs more support you get to work with that cool kid effect. However, do you feel like you’re jipping the advanced student? Perhaps that student, with a little extra time and focus on their exact deficits could be dismissed from therapy. By pairing them with a student who has quite different skilled services, are you retracting from their time?

I’ve seen both of these options used in my externship setting, and I think it is also something we need to consider for push in therapy. Any ideas or opinions?

Winter clothing core curriculum vocab

27 Dec

At my externship site we use the district’s recommended core vocabulary and follow the curriculum. As such we spend a lot of time doing activities that last a week or two that teach the same words over and over and over. Last week I made this snowman to work on Winter Clothing Vocab. The snowman is laminated and the clothing velcros on to facilitate turn taking and active learning.

In the mind of preschoolers, every snowman is named Frosty

question

15 Dec

Does anyone diligently use push-in therapy? And if so, why? Is your district mandating it? Is the state? Some other force to be reckoned with? Is push-in EBP? What resources do you have regarding push-in efficacy?

okay okay, I’m back at it

15 Dec

After quitting my job and starting externships I’ve found I don’t have a lot of blog-access. But here I am! I’m back and I’m ready to tell you all about my life.

AHEM.

Ok last week was my last week of university clinic! Aack! We took lots of pictures which I want to share at some point. I’m so glad to be done with the over-protective, hand-holding environment of the clinic. I GOT THIS, YO.

I had a dysphagia final (100% woop woop), a dysphagia take home final, and a special pops final (surprisingly not too hard).

And here we are, almost a week has gone by. And what a week it has been!

As I’ve said before, I’m at the Early Childhood Special Education center for 4 weeks. We’ve got three to five year olds, mostly boys, with a pretty wide range of functioning, behaviors, disorders, and skills. Oh my Lord are they just the cutest? THEY ARE. Ugh.

I’m learning an incredible amount. Even just in terms of how to function in the workplace, cotreating and coteaching, working with others, scheduling conflicts, paperwork, meetings, referring – it is crazy! Not only that but the structure is so incredibly different than a clinic setting – it is great. We see the kids in groups (2-4, usually), for 30 minute sessions, and the time FLIES. I don’t know if most universities do 50 minute, individual sessions but I swear that is a NIGHTMARE in comparison to this. You’d be amazed how much you can get done in half an hour with a roomfull of goofy, four year old boys.

I’m also really enjoying just seeing kids interact. In the university clinic you don’t see much interaction so it has been really interesting seeing the best and worst pairings of kids and disorders. Today we had an individual session because this child was just on sensory overload and bouncing off the walls – he got to bounce on the trampoline twice during our time with him. But a lot of my time is spent learning how to be flexible and go with the flow. Coo coo kachoo.

Other random tidbits I’ve learned: 1) don’t pick up the children, 2) we don’t help parents with car seats, 3) play doh is a germ factory (and the mixing. Oh God. So much mixing. My OCD side HATES IT), 4) whatever you had planned won’t go that way, 5) there’s drama and gossip no matter where you go!

In related news: I have a blood blister on my thumb from a rowdy kid, I have a sore throat, my nose won’t stop running, and I’m POOPED! But learning a lot and having a wonderful time. Totally worth it.

Tomorrow I need to track down a storage unit because I’m moving out NEXT WEEK. Saturday is cookie day with my dear friend KG and her mom and nephew. And I’m friggin’ obsessed with this song, it makes me want to cry and I don’t know why:

NP: Maroon 5 – Runaway

 

This is Halloween, this is Halloween! Halloween! Halloween! Halloween! Halloween!

26 Oct

Ten points if you get the reference.

The other day @ASHAWeb prompted (haha, I would use the word ‘prompted’) SLPs to share their Halloween therapy ideas. I wasn’t really ready to think that far ahead. But now it is WEDNESDAY which means I have therapy with my little one tomorrow and we will do Halloweenie type things.

First on the agenda:

Paint Pumpkins. On Thursday we generally address /p/ so I thought this would be good.

Next up:

Do something to teach Halloween vocabulary, like a memory game. My client is SUPER into finding matches, so I’ll make some flashcards that say things like Trick or Treat, Please/Thank you, Boo, candy, Pumpkin – you know the drill.

Thirdly:

Read something like The Little Old Lady Who Wasn’t Afraid of Anything┬á , Spooky I Spy, or Go AWAY Big, Green Monster.

Last:

Putting that vocab to work. We have an EDHH preschool at my University and they are trick or treating around the building. This will give me a chance to assess my client’s spontaneous speech and the kiddos can have some fun.

I plan on wearing my Halloween socks which I bought from the $1 area at Target. THAT IS THE BEST PLACE ON EARTH. Seriously – go there. You will find so many great therapy materials. And…socks. Usually they have a bunch of holiday stuff so if you want Halloween prizes or treats I recommend looking there.

NP: One Eyed – One Horned – Flying – Purple – People -Eater

 

PS – this website has a ton of activities for a number of holidays: Speaking of Speech

I adore fluency therapy

26 Sep

This semester I have a fluency client. I am LOVING it and I thought I’d share some of what is working and what isn’t with you.

Let me preface this by saying my client is a teenager and getting them to do ANYTHING is a chore but I love being able to say “Nanny nanny naaaanny” when something works that they didn’t want to do because it was “stupid” or embarrassing.

Okay so we start our sessions with some facilitating techniques – systemic relaxation, rote speech (ABCs, 123s), and discussing techniques we’re going to use. This kind of gets the ball rolling on the “feeling” of fluency. If your client can do something fluently, start the session with it. That way you’re getting a kind of errorless learning – the client can be successful right away and if they can’t do something you can always take a few steps backwards.

My goals for the semester are to establish fluency in structured speech tasks but my client has already surpassed that so I’m going to have to start working on fluency in connected speech/conversation.

Anyway, so I use word lists for one word, two word, three word, four word phrases and then sentences. Usually I use those right after we do rote speech tasks to keep up the fluent speech. We quickly practice the techniques we’ve seen success with on these word lists (thoracic breathing, reduced rate, low pitch, easy onset). Then we read an article from Missouri Conservationist for Kids, and I parse the article before the session so I know how many syllables my client will be reading (makes for easier tracking later). Each paragraph we read we use a different technique and record it so that my client can listen to them and count the stuttering moments for themself (not a word but I don’t want to say he or she).

The techniques we use: first we use DAF – not because it is a technique but because my client thinks it is cool and I use it as a reward. Also, my client does BETTER with fluency when using targeted techniques so I can say “Hey you know what – DAF is cool but you got this on your own, you can physically be fluent without any technology.” I think with teenagers who stutter this is a big deal – it’d be soooo nice to just have some earbuds in that look like an iPod that would make them fluent, but it doesn’t work that way, and even if it did – they can do better without them.

Then we read with thoracic breathing and practice inspiratory checking and conversational breathing. This is a hard one to monitor but I’ve seen a lot of progress with some coaching prior to speech acts.

Usually then we work on reducing rate. To reduce rate I taped a tongue depressor to the table and the client is prompted to read each word but not finish the word before finishing running his hand over the length of the depressor. Now we’re working on staying slow without the tactile cue (usually there’s a lot of me making┬á crazy “slow down” hand motions). Reducing rate has a HUGE effect on my client’s fluency – which is likely why the DAF works.

To target disfluent moments, we do easy onset and cancellation. My client really seems to hate easy onset, but it works. If you’re working with a teenager, expect a lot of ‘splainin – they want to know what they’re doing, why they’re doing it, and when they can leave. At least once a session I have to say “This isn’t something you would do in real life, I just want you to feel control over your speech.” Sometimes we’ll do things like negative practice or speaking at a ridiculously low pitch and my client HATES it but, it works (that’s when the “nanny nannying” comes in).

If you’re working with a teen, be relaxed and really make them feel like this is a team effort. Being different is not cool, so make sure they know they aren’t alone. Before you make them do something, do it yourself! At least then if they think what they’re doing is stupid they’ll feel like you both look stupid rather than them looking stupid alone.

If anyone has any tips for working on stuttering at the connected speech level please let me know! I’ve noticed with my client that when reading or speaking at a reduced rate, the naturalness of speech goes out the window. It becomes very robotic, but when prompted to add intonation to a reduced rate the dysfluency comes right back. We do a lot of modeling right now, any input is appreciated.

NP: The Rascals – Good Lovin

quick and dirty

23 Sep

If I’ve said it once, I’ve said it a million times. A really easy, convenient way to learn about CSD masters and doctoral programs is through EdFind.

Go there. Use it.

I have to go remember how to use the Visi Pitch because I have a diagnostic at 4 PM. I have the worst hangover.

NP: Spice Girls – Two Become One

PROMPT

21 Sep

Hey guys,

I’m watching this video to prepare for a presentation and I think it is really interesting so I thought I’d share:

PROMPT can be used for phono, artic, CAS, AOS, fluency, ASD, dysarthria, HI, DD, aphasia, foreign language – so it is definitely worth taking a look-see!

I hope everyone has noted and appreciated my new skill: embedding video directly into my post. Why did this take me so long to figure out? I have no clue.