Sunday, December 30, 2012

The Benefits of Using an iPad as a Speech Therapy Tool in Nursing Homes and Rehabilitation Centers

For the past two or three years, I've been using an iPad almost exclusively as my go to tool in speech therapy when I moonlight at nursing homes.  Some people might see the iPad as all fun and games (it is fun and there are a lot of games), but there are so many more benefits of including it in your speech bag--or as I call it "My Speech Bag".

Okay, so I'm a male speech pathologist and most therapists are female.  Usually, you can spot a speech therapist either by their stylish promotional tote bag or by their fancy rolling cart.  Yes, I have a couple of each too.  I admit it.  But...then came the 21st century and this little thing called the iPad.  Technology is really cool--if you know how to use it.  The iPad has been great for me as a PRN speech therapist because I travel to and from different facilities. Because of the iPad, I always have my bag of tricks with me.  It saves me in productivity (something they're always trying to increase) and trying to find the right materials efficiently.

Now, some may argue that an iPad shouldn't take the place of traditional speech therapy materials such as workbooks, paper and pencil tasks, and flashcards.  I'm not saying that those all go to the curbside.  I'm saying that an iPad has the capability to have those and then some included.  Using an iPad brings upon other responsibilities such as protecting HIPPA guidelines and making sure you keep it clean and sanitary to void spreading any communicable diseases by using universal precautions.  Being a professional and being trained yearly on these issues certainly keeps these as priorities.  So let me say this--use common sense and don't put personal information of any patients on your iPad.  And, don't use your iPad to block sneezes or to cover open wounds.  If you do, make sure you go to the nurses' station and get some of those kills all living things wipes to disinfect the iPad.  Did I cover all bases?


Okay, now that I've gotten that out of my system.  Here are some things that I've personally used the iPad in therapy at nursing homes:

  • Therapy Books/Workbooks - Have you ever heard of the WALC books, The Source for Dysphagia, or Just for Adults series?  If you work in a nursing home or a rehab facility, then I'm guessing you have.  If you own the books, then you can use the PDF version (included CD in the back of the book) on your iPad.  Remember that tote bag?  It's now in the back of my car filled with crumpled up paper.
  • YouTube Videos - Try explaining a modified barium swallow study to someone.  Then try showing them an actual demonstration video of an MBS.  Which one do you think is more effective and memorable?  YouTube has everything.  Everything.  Need to show a patient how to properly use a Passy-Muir valve?  YouTube.  I've done it.  It's very resourceful.
  • Functional Communication/AAC Boards - If you're like me, you have exactly one half hour to get patients to communicate and participate in therapy.  I've had several instances of working with people with no expressive verbal skills for various reasons.  Having access to a communication board has made it easier for communication (both ways) between the patient and clinician.  A simple board can be created and printed on the fly.  Seriously.
  • ABA Receptive Identification app by kindergarten.com
  • Flashcards - Word finding?  Naming items? Receptive identification? The iPad has a slew of apps that you can use for this task.  Try typing in "Kindergarten.com" in the App Store and you'll find a whole bunch of free ones.  It saves you from carrying around several decks of cards!
  • Swallowing Guidelines - I use The Source for Dysphagia regularly to review proper positioning, modified diets (what's good and what's not), and compensatory strategies.  I use it to show visual models to the patient and to educate nurse's aides who feed patients.  If you were really fancy, you could email/print the reproducible forms to anyone who needs them on the spot.  Do you monitor PO intake?  How about showing them the FDA's MyPlate diagram to show what is suggested for daily food consumption.  
  • Divergent Naming Apps - One of my favorite games on the iPad to use at nursing homes is Family Feud.  It's great for several reasons.  One, it is a great divergent naming task.  Second, it opens up other areas of discussion.  For instance, one question might be, "Name Someone You Would Call if You Were in an Accident."  Questions like that merge into talking about safety issues.  And, to put it simply, it's fun and engaging.
Tap the Frog by Mentals LLC
  • Following Directions, Sequencing,  and Problem Solving Apps - There are a couple that I like for solving problems including Tap the Frog which is a fun way to have patients follow single, multiple, and complex directions involving spatial concepts, sequential order,  and speed and accuracy.  You can have patients read the directions or you can have them follow the directions orally.  Another random app that I really like is called The Moron Test.  I don't necessarily like the name, but I do like the app a lot.  It's good for following directions, short term memory, identifying pictures/objects, sequencing, language processing, and reading comprehension.
I cannot say enough how valuable of a tool the iPad has been while working in nursing home/rehabilitation center settings.  It allows clinicians on-the-spot access to resources limited only by the user's technology abilities.  There have been several times where I've had unengaged patients who have lit up when I played old time music or classic cars from their generation.  I even had one patient who was rather to himself open up when I showed him the Masonic Lodge that he belonged to after I noticed his picture posted on his bulletin board.  The internet alone can give speech therapists the ability to provide immediate information during a therapy session.  If I had my druthers, all therapists and facilities would have access to this incredible device.  Because of its limitless possibilities, the iPad should be an essential tool in all speech therapists' tote bags!
We got grandma an iPad for passover, she immediately goes to her email to pull up Jewish jokes
photo by miserychick on Flickr
(non-commercial Creative Commons license)

Friday, December 21, 2012

The Electric "Speech" Company



My memory of The Electric Company as a kid is solely the fact that they had Spiderman on the show.  I thought it was the coolest ever.  Well, let's say after twenty some odd years later, after seeing it again, it was really cheesy.  After little research (looking at a picture), I noticed that Bill Cosby and Morgan Freeman were on there too.  I actually stumbled upon some of The Electric Company activities when writing my previous blog about age appropriate activities.  I started messing around and found a slew of articulation and phonemic awareness interactive games, activities, and videos from the Electric Company.

Since I'm a speech language pathologist and technology enthusiast, I found it very interesting that PBS Learning Media had so many resources for phonology and articulation.  Their activities are built around these areas:  decoding, phonemic blending, vocabulary, connected text, and motivation.  The website integrates these areas using interactive games and videos for practice and fun.  Here are some of the example activities:

Say What?
Say What? is a game that focuses on recognizing different sounds in different positions of words.  Players must listen and find the correct sounds to complete the words.  This game focuses on consonant blends, word families, consonant digraphs, and short vowel sounds.  This game could most definitely be done either in an individual setting or in a classroom setting.  Try it on your SMART Board!

The Chain Game
In this activity, users must listen to directions and create new words using different sounds and sound blends.  The game teaches players how to replace a sound in one word to make another word while exploring phonics and word-building skills.  The games include levels for consonant blends, digraphs, vowel combinations, and short vowel sounds.  This could be a great SMART Board activity to try with an entire class.  Search "Electric Company" or "Chain Game" on PBS Learning Media's website to find the entire list.

The Electric Company Videos
As a fun way to supplement these interactive activities, The Electric Company has many videos that practice using these skills through songs, story telling, and poetry.  You can "Bop along with the Music Man" or listen to beat boxing with "Shock & Friend".  It's really fun stuff.  Again, these would be great if you were doing "push in" therapy with an entire class.  If you search "Electric Company" and narrow the search to "videos", they have over 150 videos available.

Wow!  Who would've guessed that there was so much that the Electric Company had in terms of teaching phonemic awareness?  I actually did a search on PBS Learning Media's website to see what all they had to offer from The Electric Company.  It opened the door to a ton of sound segmentation and combination activities.  This website has so many more activities that I haven't even played around with yet.  Check out their website and follow them on Facebook and Twitter for up to date information.

Saturday, December 8, 2012

PECS Gifts in a Jar

It took me awhile to fully understand the Picture Exchange Communication System (PECS) and how I could implement it into different activities in the classroom.  Before I took the training, I thought PECS was just using picture cards to make choices.  In special education, it's pretty normal to see pictures being used in the classroom to make choices, for visual schedules, or to indicate a want or need.  After being formally trained by Pyramid, however, I now understand the purpose of PECS better--to initiate communicative acts.  Really, we want our students to make requests and to comment while gradually increasing the complexity of the message.  Obviously, I won't be able to train you in using PECS, but I can tell you that it is based on applied behavior analysis (ABA) and you should be officially trained by Pyramid Educational Consultants.  In a nutshell, there are three phases to PECS.  For the most part, my students are on Phase I, which is strictly exchanging a picture card for a desired item.  With a communication partner, the student removes a picture card and initiates a communicative act with another person in order to receive something.  As the person progresses through the phases, he begins to build short sentences like, "I want ______."   I guess what I'd really suggest is that you go and get officially trained by Pyramid Educational Consultants (the only official PECS company).

Now, let's get to my activity.  PECS is all about repetition--lots and lots of repetition.  As long as the activity is motivating to the student, you can use recipes as functional activities.  In terms of speech and language, recipes are great for working on functional vocabulary, following directions, following safety rules, and best of all--enjoying a snack with classmates!

A few years ago, my mom (a retired fourth grade teacher) introduced me to "Gifts in a Jar".  She would create these really nice, inexpensive gifts for others at Christmas by using old canning jars and dry ingredients for various recipes.  After examining them, I realized that this would be a great PECS activity.  Basically, all you need to do is have picture cards for each ingredient and then, of course, all of the materials and ingredients needed for the recipe.  You can download the free Gifts in a Jar book here or visit their website for more information.  If you want to see lots of other ideas, check out Pinterest.  There's always a bunch of stuff like this on there.  I typically do cookies, but you can find ideas for bread, soup, and even golf tees for golfers.
Here's how it works.  Have an adult (or two) work the food preparation table with all of the ingredients (e.g. flour, sugar, chocolate chips, and etc.).    Each person takes a jar and a picture card to the table to request each ingredient.  The best way, I've found, is to have each student take turns requesting only one ingredient until that layer is completely done by the group.  Then move onto the next ingredient.  And the next.  And so on.  After we put the lid on, we finish off the jar with decorative cloth filled with polyester fill (you can buy it at a craft store).  Then we tie on the recipe card with twine.  That's it!

Gluten Free M&M Cookies from
Off the Wheaten Path Blog
Here are a couple of ideas that I've learned along the way to add to the activity:
  • Use wide mouth jars to make the pouring easier.  Many times, I get the jars (quart size) donated to me by fellow educators.  Other times, I search Craigslist for free (or cheap) jars.
  • For secondary activities, have the student cut the fabric into 9 inch circles.  You can pre-make a cardboard circle to trace on the fabric.  Additionally, you can have the students cut recipe/ ingredient tags out and paste the directions on the tags.
  • I've either had the students make these for gifts for their parents or we've sold them at our Holiday School Party (or Santa Store) for $5 each.  We use the proceeds to donate to a local charity like Special Olympics.
  • Always make sure you follow proper sanitation rules when handling food.  Be cautious when allowing students to carry glass jars too.  I had one student who like to see things break.  We learned this the hard way--twice.
  • Read the free Gifts-in-a-Jar Book for more detailed information on each recipe.