tag:blogger.com,1999:blog-76842875580657502422024-03-17T21:02:58.939-06:00Pathologically SpeakingA Speech-Language Pathology blog by 2 SLPs: one medical and one educationally-based.Bobhttp://www.blogger.com/profile/01018453723060771140noreply@blogger.comBlogger83125tag:blogger.com,1999:blog-7684287558065750242.post-80327184774496248362017-09-19T15:39:00.000-06:002017-09-19T15:39:22.052-06:00What SLPs Need to Know When Working with Individuals with Spinal Cord Injuries part 1I don't think I've talked about this much on the blog, but I work in an inpatient rehabilitation center, and <b>I'm the SLP on the Spinal Cord Team</b>. We divide our patients into 3 main teams-- Stroke Team, Brain Injury Team, and Spinal Cord Injury Team. We get plenty of overflow from eachothers' caseloads, but mainly I see patients with high level spinal cord injuries. I see a lot patients who have tracheostomies and mechanical ventilators. A lot of AAC for these folks. Lots of swallowing assessment and therapy. Some cognitive therapy. It's an interesting little niche and sometimes my new student interns get thrown into this complex world with very little backgroud and instruction in it during grad school.<br />
<br />
My awesome student Sarah Janis did a little "Into to Spinal Cord Injury" booklet for future students. I think I'll divide it into 2 or 3 posts. Here's the first section which covers the basics of the spinal cord and spinal cord injuries. Thanks for letting me share it, Sarah!<br />
<br />
<b>Spinal Cord and Spinal Cord Injury Student</b><br />
<b>Information Packet</b><br />
<b>By: Sarah Janis</b><br />
<br />
<br />
General Spinal Cord Information<br />
The spinal cord, which is part of the central nervous system (CNS), transmits sensory and motor signals between the brain and peripheral nervous system (PNS). Upper motor neurons travel from the brain through the spinal cord in tracts before synapsing with lower motor neurons at the level of the spinal nerve roots; the lower motor neurons then carry the signal to skeletal muscles.<br />
<br />
The spinal cord is protected by the spinal column. The spinal column is comprised of 30 vertebrae separated by fibrous, fluid-filled sacs called discs, which act as shock absorbers, and connected with systems of ligaments. The thirty vertebrae are divided into five sections: cervical (7 vertebrae),<br />
thoracic (12 vertebrae), lumbar (5 vertebrae), sacral (5 fused vertebrae), and coccyx (1 vertebra).<br />
<br />
There are 31 pairs of lower motor neurons, or peripheral nerves, that originate in the spinal cord; these receive their names from the vertebrae through which they pass through. The 8 cervical nerves control the neck, arms, and hands; the 12 thoracic nerves control the trunk and upper abdominal muscles; the 5 lumbar nerves control the lower abdominal muscles and upper parts the legs; the 5 sacral nerves control the lower legs, bowel, bladder, and sexual function; the coccygeal nerve provides sensation to the bottom of the spinal column (see Figure 1).<br />
<br />
Figure 1<br />
3<br />
Each peripheral nerve innervates a specific area of skin, known as a dermatome (see Figure 2). When a nerve is damaged, an individual loses sensation from that dermatome. Thus, testing the presence or absence of sensation in certain dermatomes can indicate the exact level of spinal cord damage.<br />
<br />
Spinal Cord Injury (SCI)<br />
Damage to the spinal cord, from injury or disease, impairs sensory and/or motor function at and below the level of damage. Thus, damage to a higher level of the spinal cord (i.e., a cervical injury vs. a thoracic or sacral injury) results in a greater loss of neural function. Depending on the injury,<br />
individuals may experience a full or a partial loss of movement and/or sensation. Spinal cord injury often, but not always, results from trauma to the vertebral column as broken or displaced bone compresses, bruises, and/or tears the spinal cord. Damage can also occur as the result of loss of blood flow to the spinal cord. When spinal cord nerve cells are damaged, they can no longer carry messages between the brain and the rest of the body. Common causes of spinal cord injury include motor vehicle accidents (MVA), falls, sporting accidents, or gunshot wounds.<br />
<br />
SCI Classification: Classification Categories/Levels<br />
Spinal cord injuries are often classified by vertebral level, neurological level,<br />
and severity. Vertebral level indicates which vertebra or vertebrae were<br />
damaged. For example, an injury that causes the C5 vertebra to slip relative<br />
to C4 may be called a C4/C5 injury because it compresses the C4 and C5<br />
Figure 2<br />
4<br />
spinal cord. It is important to note, however, that the vertebral level does<br />
not necessarily indicate which level of the spinal cord was damaged.<br />
Classification according to neurological level indicates which level of the<br />
spinal cord experienced neurological loss. This can be identified according to<br />
(a) the first spinal cord segmental that shows sensory or motor loss<br />
(commonly used by neurologists) or (b) the lowest level that shows normal<br />
sensory and motor function (commonly used by physiatrists). For example,<br />
using the lowest functional level classification, an individual with a C-5 injury<br />
would have impaired function below the 5th cervical spinal cord segment.<br />
Severity indicates how much sensory and motor function remain within the<br />
damaged segments.<br />
Tetraplegia (formerly and still occasionally called quadriplegia) generally<br />
describes a C1 to T1 injury that results in a loss of function in the head, neck,<br />
shoulders, arms, and/or upper chest as well as the lower body. Paraplegia<br />
generally describes a T2 to S5 injury that results in the loss of function in the<br />
lower body, including the chest, stomach, hips, legs, and feet.<br />
As an indication of severity, spinal cord injuries are classified as complete or<br />
incomplete. A complete injury classification indicates that the individual has<br />
no motor or sensory function in the S4-S5 (anal) area. Individuals with<br />
complete injuries may, however, have some preserved motor or sensory<br />
function between the injury level and S5; this is called the zone of partial<br />
preservation (ZPP). An incomplete injury classification indicates at least<br />
partial movement or sensation in the S4-S5 area; however, the amount of<br />
functional movement/sensation remaining varies greatly according to the<br />
extent and location of nerve damage. Note that the terms “complete” and<br />
“incomplete” only refer to the functioning of the spinal cord, not extent of<br />
physical damage to the cord.<br />
The American Spinal Cord Injury Association (ASIA) developed a uniform<br />
classification system, the ASIA Impairment Scale (AIS), which places SCIs into<br />
one of five categories. Individuals are classified as follows:<br />
5<br />
Table 1<br />
A Complete – no sensory or motor function preserved in the sacral segments S4-5 B Sensory Incomplete – sensory but not motor function is preserved below the neurological level* and includes the sacral segments S4-5 (light touch or pin prick at S4-5 or deep anal pressure) AND no motor function is preserved more than three levels below the motor level** on either side of the body<br />
C Motor Incomplete – motor function is preserved at the most caudal sacral segments for voluntary anal contraction (VAC) OR the patient meets the criteria or sensory incomplete status (sensory function preserved at the most caudal sacral segments (S4-S5) by LT, PP or DAP), and has some sparing of motor function more than three levels below the ipsilateral motor level on either side of<br />
the body. (This includes key or non-key muscle functions to determine motor incomplete status.) For AIS C – less than half of key muscle functions below the neurological level of impairment have a muscle grade ≥ 3***.<br />
D Motor Incomplete – motor incomplete status as defined above, with at least half<br />
(half or more) of key muscle functions below the single NLI having a muscle grade<br />
≥ 3.<br />
E Normal – If sensation and motor function as tested with the ISNCSCI are graded<br />
as normal in all segments, and the patient had prior deficits, then the AIS grade is<br />
E. Someone without an initial SCI does not receive an AIS grade.<br />
*Neurological level indicates which level of the spinal cord was damaged<br />
**Motor level is defined as the level at which the key muscle innervated by the segment has at least 3/5<br />
of its normal strength. Sensory level is defined as the lowest spinal cord level that still has normal<br />
pinprick and touch sensation.<br />
***see ASIA examination protocol on pg. 6 for muscle grade scoring<br />
<br />
SCI Classification: Physical Examination<br />
Classification on the AIS is determined by a physical examination, which occurs between 72 hours and 7 days post injury. The purpose of the physical exam is to evaluate the extent of remaining motor and sensory function. Motor function is tested by instructing the individual to move certain key<br />
muscles. Each key muscle is awarded a score from 0 to 5 with 0 indicating total paralysis and 5 indicating active movement against full resistance; these scores are especially important in determining sensory level and motor level and in differentiating AIS C and AIS D injuries.<br />
<br />
Additionally, certain non-key muscles may be tested to differentiate AIS B and AIS C injuries. Sensory function is tested by administering different types of sensations (pinprick, touch, position of joints) to key sensory points. Sensory points are given a score between 0 and 2, with 0 indicating absent sensation and 2 indicating normal sensation.<br />
6<br />
In addition to the AIS physical examination, individuals may also undergo imaging procedures, such as x-ray or MRI, for visualization of the location and extent of damage. The following pages contain the ASIA examination for SCI classification.<br />
<br />
<br />
<br />Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com0tag:blogger.com,1999:blog-7684287558065750242.post-25568942380155504612016-03-03T10:57:00.001-07:002016-03-03T10:57:25.565-07:00Dysphagia Evaluation and Treatment Info for MyositisHere's another awesome project by my student Ani Haas! <br />
<br />
If you have a patient with Myositis, this info is a great guide for dysphagia therapy with these patients. Are exercises appropriate? What is the prognosis? What compensatory strategies tend to be helpful? Other considerations. Let us know in the comments if you found this helpful! <br />
<br />
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<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><u><span style="font-family: "Times New Roman",serif;">Myositis</span></u></i></b></div>
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<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Times New Roman",serif;">Background:</span></u></b></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">Myositis
is a general term meaning inflammation of the muscles. Inflammatory myopathies
are the largest group of potentially treatable myopathies in children and
adults.<span style="mso-spacerun: yes;"> </span>The disorders are best
classified on the basis of distinct clincopathologic features.<span style="mso-spacerun: yes;"> </span>To date, there are four subtypes: <span style="mso-font-kerning: .5pt;">dermatomyositis, polymyositis, necrotizing
autoimmune myositis, and inclusion-body myositis. Correct subtype
identification and the distinction of these conditions from other diseases that
have similar characteristics are fundamental in differing prognosis and
differing responses to therapy.</span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Times New Roman",serif; mso-font-kerning: .5pt;">Symptoms:</span></u></b></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif; mso-font-kerning: .5pt;">People with inflammatory myopathies have increasing difficulty with tasks
that require the use of proximal muscles. An example of this is getting up from
a chair, climbing stairs, or lifting objects.<span style="mso-spacerun: yes;">
</span>People may feel tired after standing or walking, have muscle pain or
soreness that lasts for weeks, and may have trouble holding their head up. With
certain subtypes, some patients may experience difficulty swallowing, cardiac
arrhythmia, ventricular dysfunction, or fever.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Times New Roman",serif; mso-font-kerning: .5pt;">Specific
Clinical Features: </span></u></b></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; mso-font-kerning: .5pt;">Dermatomyositis:
</span></b><span style="font-family: "Times New Roman",serif; mso-font-kerning: .5pt;">Affects both children and adults. Early symptoms include skin
manifestations, a blue-purple rash with edema accompanying or proceeding muscle
weakness. Muscle strength may not be affected and the dermatomyositis may be
limited to the skin.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; mso-font-kerning: .5pt;">Polymyositis:
</span></b><span style="font-family: "Times New Roman",serif; mso-font-kerning: .5pt;">This subtype is rare, often mis-diagnosed, and will stand-alone.<span style="mso-spacerun: yes;"> </span>Proper diagnosis is based on exclusion and is
often diagnosed as sub acute proximal myopathy in adults who do not have a
rash, family history of neuromuscular disease, exposure to mytoxic drugs like
statins, penicillamine, or any facial or extraocular muscle involvement. </span></div>
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<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; mso-font-kerning: .5pt;">Necrotizing
Autoimmune Myositis: </span></b><span style="font-family: "Times New Roman",serif; mso-font-kerning: .5pt;">This subtype makes up almost 20% of all myopathies.<span style="mso-spacerun: yes;"> </span>It can occur at any age but is typically seen
in adults.<span style="mso-spacerun: yes;"> </span>It can occur alone or
following a viral infection.<span style="mso-spacerun: yes;"> </span>It causes
severe weakness and very high creatine kinase levels in the blood. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">Inclusion-Body Myositis: </span></b><span style="font-family: "Times New Roman",serif;">Inclusion-Body Myositis (IBM) is
the most common and disabling inflammatory myopathy among people 50 years of
age or older. <span style="mso-spacerun: yes;"> </span>It is thought to be an
insidious disease that develops over a period of years.<span style="mso-spacerun: yes;"> </span>It often simulates a late-life muscular
dystrophy or slowly progressive motor-neuron disease. Early clinical features
of IBM include involvement of distal muscles, especially foot extensors and
finger flexors, atrophy of the forearms and quadriceps muscles. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">Causes:</span></b></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">Myositis
can be caused by anything that leads to inflammation of the muscles. Common
causes include; inflammatory conditions, viral infections, drugs, injury, or </span><a href="http://www.webmd.com/a-to-z-guides/rhabdomyolysis-symptoms-causes-treatments"><span style="color: windowtext; font-family: "Times New Roman",serif; mso-bidi-font-weight: bold; text-decoration: none; text-underline: none;">Rhabdomyolysis</span></a><span style="font-family: "Times New Roman",serif; mso-bidi-font-weight: bold;"> (a </span><span style="color: #1a1a1a; font-family: "Times New Roman",serif;">breakdown of muscle
tissue that releases a damaging protein into the blood).</span><u><span style="font-family: "Times New Roman",serif;"></span></u></div>
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<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">Diagnosis of Myositis:</span></b></div>
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<a href="http://www.webmd.com/heart/anatomy-picture-of-blood"><b><span style="color: windowtext; font-family: "Times New Roman",serif; text-decoration: none; text-underline: none;">Blood</span></b></a><b><span style="font-family: "Times New Roman",serif;">
tests:</span></b><span style="font-family: "Times New Roman",serif;"> Testing for
elevated levels of muscle enzymes, like </span><a href="http://www.webmd.com/heart-disease/cardiac-enzyme-studies"><span style="color: windowtext; font-family: "Times New Roman",serif; text-decoration: none; text-underline: none;">creatine kinase</span></a><span style="font-family: "Times New Roman",serif;">, which will be present in patients with active disease.
</span></div>
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<a href="http://www.webmd.com/a-to-z-guides/magnetic-resonance-imaging-mri"><b><span style="color: windowtext; font-family: "Times New Roman",serif; text-decoration: none; text-underline: none;">MRI</span></b></a><b><span style="font-family: "Times New Roman",serif;">:</span></b><span style="font-family: "Times New Roman",serif;"> A MRI is helpful for diagnosis
when muscle edema is present, identifying which particular muscles are affected
by atrophy. </span></div>
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<b><span style="font-family: "Times New Roman",serif;">EMG</span></b><span style="font-family: "Times New Roman",serif; mso-bidi-font-style: italic;">:</span><span style="font-family: "Times New Roman",serif;"> By inserting needle electrodes
into muscles, a doctor can test the response of muscles to electrical nerve
signals. EMG can identify muscles that are weak or damaged by myositis. EMG can
also be used to rule out neurogenic conditions and assess disease activity. </span></div>
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<b><span style="font-family: "Times New Roman",serif;">Muscle </span></b><a href="http://www.webmd.com/cancer/what-is-a-biopsy"><b><span style="color: windowtext; font-family: "Times New Roman",serif; text-decoration: none; text-underline: none;">biopsy</span></b></a><span style="font-family: "Times New Roman",serif;">:
This is the most accurate test for diagnosing myositis. A doctor identifies a
weak muscle, makes a small incision, and removes a small sample of muscle
tissue for testing. Muscle biopsy leads to a final diagnosis in most people
with myositis.</span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">Treatment Options:</span></b></div>
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<span style="font-family: "Times New Roman",serif;">Currently,
there are differing treatment options for specific subtypes:</span></div>
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<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">Treatment of dermatomyositis,
polymyositis, and necrotizing autoimmune myositis:</span></b></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "Times New Roman",serif;"><span style="mso-spacerun: yes;"> </span>Once daily doses of oral prednisone, a
corticosteroid, is the first-line drug in combating the above inflammatory
myopathies. Corticosteroids slow the body's immune system and stop the
inflammatory attack on muscle, skin and other body systems. These medicines
control the inflammation, ease pain, and increase muscle strength.</span></div>
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<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "Times New Roman",serif; mso-bidi-font-weight: bold;">Immunosuppressant: Commonly used is methotrexate</span><span style="font-family: "Times New Roman",serif;"> and <span style="mso-bidi-font-weight: bold;">azathioprine</span> is often used in combination with prednisone. They
may help the patient to taper off prednisone more quickly and avoid<span style="color: #333333;"> some of the unwanted effects. </span></span></div>
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<br /></div>
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<span style="font-family: "Times New Roman",serif; mso-bidi-font-weight: bold;">Intravenous immune globulin (IVIG):</span><span style="font-family: "Times New Roman",serif;">
<span style="mso-bidi-font-weight: bold;">IVIG</span> is a blood product derived
from human plasma. IVIG is used to boost the body's immune system response,
IVIG is usually reserved for cases resistant to other treatments.</span></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">Treatment of Inclusion-Body
Myositis (IBM):</span></b></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">Due to the
slow and progressive course of IBM, the degenerative effects are already
advanced by the time the patient seeks medical help. Musculature of the pharynx
is at risk for inflammatory myopathic changes, which can cause dysphagia. <span style="mso-spacerun: yes;"> </span>Treatment options used to treat other myositis
diagnosis have been ineffective in treating IBM; there is no clear treatment
option for IBM. Treatment is aimed at delaying the progression of the disease. </span></div>
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<br /></div>
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<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">Dysphagia in Myositis:</span></b></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">Due to
ineffective drug treatment options for IBM, dysphagia is more common in IBM than
any other inflammatory myopathy. Dysphagia in patients with IBM contributes to
aspiration pneumonia associated respiratory failure, which is the most common
cause of death in people with IBM. </span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">Clinical Features of Dysphagia in
IBM:</span></b></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">Patients
may experience feeling of: </span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">1. Food
sticking in throat </span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">2.
Coughing during meals </span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">3. Nasal
reflux </span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">4.
Difficulty with dry foods, solids, and thin liquids most frequently. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">Clinical
oral exam on patients with IBM typically show normal lingual range of motion,
strength, and coordination.<span style="mso-spacerun: yes;"> </span>Some
patients may exhibit reduced laryngeal elevation</span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">Videofluroscopic
abnormalities in patients with IBM included: <span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">1. Residual
pharyngeal pooling <span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">2. Reduced
pharyngeal constrictor contraction </span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">3.
Impaired laryngeal elevation</span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">4. Cricopharyngeal
(CP) dysfunction noted by poor relaxation and narrowing of upper esophagus </span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">5. Tongue
base weakness</span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">6. Reduced
laryngeal elevation.</span></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">7.
Zenker’s Diverticulum </span></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">Phases of Swallowing Effected:</span></b></div>
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<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Times New Roman",serif;">Oral Phase: </span></u></b><span style="font-family: "Times New Roman",serif;">The oral phase of the swallow may
be marked by slow bolus delivery due to slowed limb movements. Patients may
also exhibit slowed mastication. Patients are at risk for malnutrition because
feeding is difficult and lengthy and patients may lose motivation to finish
meals. </span></div>
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<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Times New Roman",serif;">Pharyngeal Phase: </span></u></b><span style="font-family: "Times New Roman",serif;">The pharyngeal phase of swallowing
is potentially the most affected by IBM. This is because this phase in
swallowing relies on skeletal muscles that may be affected by myopathic
changes. The upper esophageal sphincter (UES), which allows food to pass into
the esophagus may be unable to relax, causing dysphagia.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">Swallowing Rehabilitation:</span></b></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">Patients
should receive clinical dysphagia evaluations along with videofluoroscopy.<span style="mso-spacerun: yes;"> </span>Swallowing rehabilitation can include: diet
modifications, feeding strategies, compensatory techniques, and exercises. A
combination of oral and enteral feeding may be necessary for some patients.
Extreme cases may require exclusive enteral nutrition. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">Feeding Strategies:</span></b></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">Feeding
strategies include: </span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo1; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Chewing
food well</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo1; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Double
swallow</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo1; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Small
bites</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo1; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Alternating
solids and liquids</span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l1 level1 lfo1; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Upright
position during feeding</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">Compensatory Techniques:</span></b></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">Compensatory
techniques include:</span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Chin
tuck</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Head
turn, trial both sides </span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Effortful
swallow</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Mendelsohn
maneuver</span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo2; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Supraglottic
swallow</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">Swallow Exercises:</span></b></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">Swallow
exercise should be based off of swallow dysfunction noted during videofluoroscopy.
Typical exercises implemented include:</span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l2 level1 lfo3; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Masako
(tongue hold)</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo3; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Mendelsohn
maneuver</span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo3; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Falsetto</span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l2 level1 lfo3; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Supraglottic
exercises</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">Interventional Measures:</span></b></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">Swallow
rehabilitation including the above mentioned strategies might not be sufficient
in treating some patients with IBM.<span style="mso-spacerun: yes;"> </span>Interventional
measures include: </span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l3 level1 lfo4; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Cricopharyngeal
myotomy </span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l3 level1 lfo4; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Pharyngoesophageal
dilation </span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l3 level1 lfo4; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Botulinum
injections</span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l3 level1 lfo4; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif;">Percutaneous
endoscopic gastrostomy</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">Of these
interventional measures, cricopharyngeal myotomy is the most well documented
surgical technique for alleviating cricopharyngeal spasm or uncoordinated
pharyngeal contraction.<span style="mso-spacerun: yes;"> </span>The best results
are when a long myotomy (6 cm or greater) is created.<span style="mso-spacerun: yes;"> </span>This is because it incorporates the
cricopharyngeus that extends into the constrictor above and the esophageal
musculature below, which is aimed at improving pressure generation and
cricopharyngeal opening. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman",serif;">Dysphagia
is a progressive condition in patients with IBM.<span style="mso-spacerun: yes;"> </span>It often leads to death from aspiration
pneumonia. Immunosuppressive therapy has shown not to be beneficial when
treating patients with IBM. Treatment of CP dysfunction seems to provide some
symptomatic benefit.<span style="mso-spacerun: yes;"> </span>Unfortunately, due
to the progressive nature of the disease, pharyngeal function seems to worsen
and enteral feeding may become the patient’s only option. Until then, feeding
strategies, compensatory techniques, swallow exercises, and interventional
measures can help in treating dysphagia in patients with IBM. <span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">References</span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: #262626; font-family: "Times New Roman",serif; mso-bidi-font-weight: bold;">Dalakas, M. C., Sonies, B., Dambrosia, J., Sekul,
E., Cupler, E., & Sivakumar, K. (1997). Treatment of inclusion-body
myositis with IVIg: A double-blind, placebo-controlled study. Neurology, 48(3),
712-716.</span><span style="font-family: "Times New Roman",serif;"></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: #262626; font-family: "Times New Roman",serif; mso-bidi-font-weight: bold;">Dalakas, M. C. (2015). Inflammatory Muscle Disease.
Inflammatory Muscle Disease, 372(18).</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: #262626; font-family: "Times New Roman",serif; mso-bidi-font-weight: bold;">Houser, S. M., Calabrese, L. H., & Strome, M. (1998).
Dysphagia in patients with inclusion body myositis. Laryngoscope The
Laryngoscope, 108(7), 1001-1005.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: #262626; font-family: "Times New Roman",serif; mso-bidi-font-weight: bold;">Oh, T. H., Brumfield, K. A., Hoskin, T. L.,
Kasperbauer, J. L., & Basford, J. R. (2008). Dysphagia in Inclusion Body
Myositis: Clinical Features, Management, and Clinical Outcome. American Journal
of Physical Medicine & Rehabilitation, 87(11), 883-889. Retrieved February
14, 2016.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: #262626; font-family: "Times New Roman",serif; mso-bidi-font-weight: bold;">Pars, K., Garde, N., Skripuletz, T., Pul, R.,
Dengler, R., & Stangel, M. (2013). Subcutaneous immunoglobulin treatment of
inclusion-body myositis stabilizes dysphagia. Muscle & Nerve Muscle Nerve,
48(5), 838-839.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: #262626; font-family: "Times New Roman",serif; mso-bidi-font-weight: bold;">TMA - The Myositis Association. (n.d.). Retrieved
February 28, 2016, from </span><a href="http://www.myositis.org/"><span style="font-family: "Times New Roman",serif; mso-bidi-font-weight: bold;">http://www.myositis.org/</span></a><span style="color: #262626; font-family: "Times New Roman",serif; mso-bidi-font-weight: bold;"></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: #262626; font-family: "Times New Roman",serif; mso-bidi-font-weight: bold;">Wintzen, A. R., Ambots, G. T., De Bakker, H.,
Hulshof, J. H., & Padberg, G. W. (1988). Dysphagia in inclusion body
myositis: Clinical Features, Management, and Clinical Outcome. Journal of
Neurology, 51, 1542-1545.</span><span style="font-family: "Times New Roman",serif;"></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com2tag:blogger.com,1999:blog-7684287558065750242.post-79316976553016672372015-07-06T11:00:00.000-06:002015-07-07T15:46:30.633-06:00Speech Therapy Treatment for Myasthenia Gravis<div class="separator" style="clear: both; text-align: center;">
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<br /></div>
<span style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt;">My student Julie Frost did a project where she researched<b> info and treatment considerations for Myasthenia Gravis patients.</b> I think she did an excellent job! There are really specific dysphagia guidelines that helped us withe a patient we had on Rehab who was having severe swallow issues, and severe fatigue. </span></span><br />
<br />
<span style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt;">I think a lot of times these patients are <b>not treated appropriately. </b> We really should be <b>timing their treatment and meals with their medication dosages,</b> and providing <b>fewer or shorter sessions</b> including co-treats if necessary so that we don't over-fatigue them and hinder their progress instead of helping. And we also need to be careful <b>not to eat up their outpatient benefits</b> of they are not ready yet, are still in a myasthenic crisis. </span></span><br />
<br />
<span style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt;">Let me know in the comments if you find this helpful or have anything to add. </span></span><br />
<br />
<span style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt;">Good job Julie! </span></span><span style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt;">Thanks for letting me share this on the blog!</span></span><br />
<span style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt;"></span></span><br />
<span style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt;"></span></span><br />
<span style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt;"><br /></span></span>
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt;">~Kristin </span></b></div>
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<br /></div>
<div align="center" class="MsoNormalCxSpMiddle" style="line-height: normal; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt;">Background, Causes, and Symptoms</span></b></div>
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<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">MG -
grave muscle weakness</span></div>
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<br /></div>
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<span style="font-family: "Times New Roman",serif;"><span style="mso-tab-count: 1;"> </span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Myasthenia gravis
(MG) is a chronic autoimmune neuromuscular disease characterized by varying
degrees of weakness of the skeletal (voluntary) muscles of the body without any
other signs of neurological deficit. MG may affect any voluntary muscle,
including those used to speak, breathe, and swallow, as well as limb, trunk,
and eye muscles. </span></div>
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<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Muscle weakness usually occurs
during periods of activity and improves after periods of rest. <span style="background: white;">This waxing-and-waning weakness of muscles, worsening
with use and improving with rest, is a hallmark of this particular disease.
There typically are periods when you may notice more symptoms (exacerbation),
interspersed with periods when symptoms decrease or disappear (remission). </span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"><span style="mso-tab-count: 1;"> </span>Aside
from generalized muscle weakness, common symptoms include double vision,
dysphagia (oral, pharyngeal, and possibly esophageal), dysarthria, trouble with
balance, and shortness of breath. A myasthenic crisis occurs when weakness
affects the muscles that control breathing, creating a medical emergency.
Deterioration can be abrupt and may require the patient to be put on a respirator.
This can be triggered by infection, fever, medication side-effects, and
emotional stress. </span></div>
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<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"><span style="mso-tab-count: 1;"> </span>The
general cause of MG is a disruption to the communication between nerves and
muscles at the point of the neuromuscular junction. The specific
neurotransmitter involved is <span style="background: white;">acetylcholine<span class="apple-converted-space">. </span></span>Though the exact cause of MG is
unknown, it is thought to be related to a thymus gland abnormality, which is a
gland located under the breastbone that is important in developing the immune
system in early life. MG can occur at any age, but is most common in women
under the age of 40 and men over the age of 60. MG is not contagious or fatal,
and does not affect life expectancy. It tends to progress slowly and treatment
is often highly successful. MG typically reaches maximum severity within the
first 5 years after onset, with males having more rapid symptom progression.
Most patients with MG improve to live healthy lives with close to normal
activity levels.</span></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt;">General Treatment: Medical</span></b></div>
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<br /></div>
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<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Factors that determine medical intervention
include severity of weakness, which muscles are affected, patient's age, and
co-morbid medical conditions. Medical interventions are as follows:</span></div>
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<br /></div>
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<li class="MsoNormalCxSpMiddle" style="line-height: normal; mso-add-space: auto; mso-list: l3 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Anticholinesterates: drugs
that increase muscle strength and contraction; symptom relief can occur
in as little as 15-30 minutes, and last as long as 3 to 4 hours; can be
administered 3 to 4 times per day, depending on dose size (mg); side
effects can actually cause additional weakness and symptoms similar to
those of MG.</span></li>
<li class="MsoNormalCxSpMiddle" style="line-height: normal; mso-add-space: auto; mso-list: l3 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Azathioprine: long-term
immunosuppressive treatment (around 3-12 month activation period) that
gradually improves muscle strength and decreases severity of symptoms. </span></li>
<li class="MsoNormalCxSpLast" style="line-height: normal; mso-add-space: auto; mso-list: l3 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Corticosteroid Therapy: improves
muscle strength, but also may cause transient deterioration upon initiation
of treatment </span></li>
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<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">High-dose
intravenous immune globulin (IVIG): Can be effective to temporarily modify the
immune system and provide the body with normal antibodies from donated blood.</span></div>
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<li class="MsoNormalCxSpFirst" style="line-height: normal; mso-add-space: auto; mso-list: l3 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Thymectomy </span></li>
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<li class="MsoNormalCxSpMiddle" style="line-height: normal; mso-add-space: auto; mso-list: l3 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Surgical removal of the thymus
gland. This procedure takes years to have an effect and is used for
long-term control of MG, possibly resulting in complete remission. </span></li>
<li class="MsoNormalCxSpMiddle" style="line-height: normal; mso-add-space: auto; mso-list: l3 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Effective for symptom relief
in patients under 60 years of age who have a tumor or abnormality of the
thymus gland. </span></li>
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<li class="MsoNormalCxSpMiddle" style="line-height: normal; mso-add-space: auto; mso-list: l3 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Plasma exchange therapy
typically involving 3 to 5 exchanges of 1 or 1.5 volumes (based on
patient's height and weight) per week until the patient shows
satisfactory improvement. Usually combined with immunosuppressive
treatment. </span></li>
<li class="MsoNormalCxSpMiddle" style="line-height: normal; mso-add-space: auto; mso-list: l3 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Helps to remove antibodies
from the body.</span></li>
</ul>
<li class="MsoNormalCxSpMiddle" style="line-height: normal; mso-add-space: auto; mso-list: l3 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">C-PAP or Bi-PAP</span></li>
<ul type="circle">
<li class="MsoNormalCxSpMiddle" style="line-height: normal; mso-add-space: auto; mso-list: l3 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Used with patients whose
respiratory muscles are too weak to properly function on their own.</span></li>
<li class="MsoNormalCxSpMiddle" style="line-height: normal; mso-add-space: auto; mso-list: l3 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">May be used throughout the day
or during sleep as needed, as well as during a myasthenic crisis.</span></li>
</ul>
</ul>
<div align="center" class="MsoNormalCxSpMiddle" style="line-height: normal; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 14.0pt;">Treatment: Speech-Language Pathology</span></b></div>
<div align="center" class="MsoNormalCxSpMiddle" style="line-height: normal; text-align: center;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman",serif; font-size: 13.0pt;">Voice and Speech</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman",serif;">:</span></i></b></div>
<div align="center" class="MsoNormalCxSpMiddle" style="line-height: normal; text-align: center;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<span style="font-family: "Times New Roman",serif;"><span style="mso-tab-count: 1;"> </span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Voice problems correlated
with myasthenia gravis include vocal fatigue, difficulty controlling pitch, and
a monotone voice. The voice problem can stem from poor breath support, or from
weakness causing disordered vocal fold movement. Speech disturbances include hypernasality
(caused by weak palatal muscles) and dysarthria (particularly slurred speech,
caused by articulatory imprecision). Dysarthria is more frequently seen in
younger patients diagnosed with MG, whereas dysphonia is more often seen in
elderly men with MG. Typically, the symptoms appear and/or worsen with
continuing or extended speech. </span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"><span style="mso-tab-count: 1;"> </span>The
treatment of speech and voice disorders in MG should occur on an individualized
basis, and should take into consideration the underlying cause and severity of
the problem. Speech and voice treatment should occur in conjunction with
medical treatment, with the SLP planning treatment during peak medication times.
The focus of speech and voice treatment in individuals with MG should be in providing
compensatory strategies and environmental modifications to help increase
intelligibility. Additionally, the patient should be educated on vocal hygiene,
with specific emphasis on vocal rest. </span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"><span style="mso-tab-count: 1;"> </span>A
high- or low-tech augmentative and alternative communication (AAC) device may
be useful for patients to communicate their wants and needs while resting their
voice. Low-tech devices are particularly recommended during myasthenic crises
when it is expected that the patient will be weaned off the ventilator in under
2 weeks. During periods of exacerbation or crisis, patients should be taught to
communicate using function or content words, thereby decreasing the overall
length of their message and resulting fatigue. Treatment may include strengthening
exercises, but this is not indicated during a myasthenic crisis or exacerbation
(see below for more information). Improvement and prognosis of voice and speech
is often related to the treatment of overall MG disease.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman",serif; font-size: 13.0pt;">Swallowing</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman",serif;">:</span></i></b></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<span style="font-family: "Times New Roman",serif;"><span style="mso-tab-count: 1;"> </span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">The impact of MG
on swallowing may occur gradually or suddenly. Swallowing muscles may become
fatigued during a meal in as little as 1-20 minutes. <span style="background: white;">A FEES examination is recommended for assessment because it can be used
over an extended period of time to assess laryngeal fatigue and potential
progression of aspiration throughout a meal. This will help ensure that the
patient's fatigue does not overwhelm their swallowing safety, and will allow
for appropriate recommendations to be made. The SLP should always be sure to
take into account the timing of the patient's medication cycle when
interpreting assessment results. The SLP should carefully schedule the
examination to be at peak performance time (to see the patient's optimal
swallow), or at a less peak time (to observe a more realistic situation).<span style="mso-spacerun: yes;"> </span></span>Dysphagia symptoms in individuals with
myasthenia gravis include the following: <span style="background: white;"></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<br /></div>
<div class="MsoNormalCxSpLast" style="line-height: normal;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Oral</span></i></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; mso-list: l1 level1 lfo5; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">anterior
spillage</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l1 level1 lfo5; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">prolonged
and incomplete mastication</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l1 level1 lfo5; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">trouble
forming cohesive bolus</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l1 level1 lfo5; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">oral
residue</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; mso-list: l1 level1 lfo5; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">decreased
posterior lingual bolus propulsion</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; mso-list: l1 level1 lfo5; text-indent: -.25in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Pharyngeal</span></i><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; mso-list: l0 level1 lfo4; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">delayed
onset of laryngeal elevation and epiglottic inversion</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l0 level1 lfo4; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;">vallecular residue due to decreased tongue base to pharyngeal
wall approximation and decreased pharyngeal contraction (with resulting
multiple swallows)</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l0 level1 lfo4; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;">decreased overall pharyngeal peak pressure</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l0 level1 lfo4; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;">delayed pharyngeal response, possibly causing aspiration
before and during the swallow</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l0 level1 lfo4; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;">decreased VF closure, aryepiglottic closure/tightening,
aryteniod-epiglottic approximation, epiglottic retroversion</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; mso-list: l0 level1 lfo4; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">note:
prognosis tends to be poorer in individuals with pharyngeal phase dysphagia</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; mso-list: l0 level1 lfo4; text-indent: -.25in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Esophageal</span></i></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; mso-list: l2 level1 lfo3; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">t</span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;">he muscles which provide traction
force to open the PES may not produce sufficient force to pull the PES open </span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l2 level1 lfo3; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;">decreased hyoid elevation and excursion, resulting in
decreased PES opening</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; mso-list: l2 level1 lfo3; text-indent: -.25in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;">prolongation in mean duration of the peristaltic wave in the
upper esophagus </span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"><span style="mso-tab-count: 1;"> </span>Treatment
for dysphagia should be individualized and based on the underlying cause and
severity of the swallowing problem. It should be noted that there is a moderate
risk of silent aspiration in this population, and decreased pulmonary function
can lead to a myasthenic crisis. Signs and symptoms of aspiration (coughing, throat
clearing) should be minimized at all costs to reduce the risk of fatigue in the
respiratory muscles. If these signs and symptoms are present during treatment, allow the patient time to rest and recover muscle function before proceeding. </span></div>
<div class="MsoNormal" style="line-height: normal;">
<br /></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"><span style="background: white;"></span></span></div>
<i style="mso-bidi-font-style: normal;"><span style="background: white;">Exercise</span></i><br />
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;">exercise
is generally not recommended due to patient fatigability and energy expenditure,
particularly d</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">uring
a myasthenic crisis or exacerbation. However, an active strengthening program
may be implemented during periods of stability or remission, considering that
medical treatments are stable and well-managed. </span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">consistent
exercise will elevate the patient's baseline functional capacity, and thereby
decrease the effect of future MG exacerbations and likelihood of aspiration.<span style="background: white;"></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;">low
intensity exercise (60% of max or less) is most beneficial to maintain and even
regain some muscle strength and function. </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;"> </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;"> Recommended
exercises:</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Masako: improve bilateral pharyngeal
contraction </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Mendelsohn: improve laryngeal
elevation</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Precautions:</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;">always closely monitor for immediate during- or post-exercise
fatigue, as evidenced by decreased swallowing or speaking function. If fatigue causes
functional impairment, reduce the exercise intensity.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">do not prescribe or practice
exercises around meal times. </span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">try to complete exercises at peak
medication time, near 1.5 to 2 hours post-dosage of anticholinesterase. </span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">collaborate
and communicate with the patient's other therapists to make sure that he or she
is not overwhelmed by the sum of all of the individual areas of therapeutic
exercise.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"><span style="background: white;"></span></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-left: 0in; mso-add-space: auto;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Diet considerations:</span></i></div>
<div class="MsoNormalCxSpFirst" style="line-height: normal; margin-left: .5in; mso-add-space: auto; mso-list: l4 level2 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">patient strategies can include:</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Alternate liquid/(semi)solid swallows to wash thicker
material down. </span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Consider diet with softer textures, less chewing required. </span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Multiple swallows per bite to clear residue (use with
caution because series of repetitive swallows may be too fatiguing). </span></div>
<div class="MsoNormalCxSpLast" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Eat several small meals throughout the day, rather than 3
large meals. </span></div>
<div class="bodyCxSpFirst" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="color: windowtext; font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: windowtext; font-family: "Times New Roman",serif; font-size: 12.0pt;">Eat
calorie-rich foods as much as possible to ensure adequate nutrition.</span></div>
<div class="bodyCxSpMiddle" style="margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="color: windowtext; font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: windowtext; font-family: "Times New Roman",serif; font-size: 12.0pt;">Crushing
or halving pills to reduce swallow effort and risk of aspiration.</span></div>
<div class="bodyCxSpMiddle" style="margin-left: .5in; mso-add-space: auto; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="color: windowtext; font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: windowtext; font-family: "Times New Roman",serif; font-size: 12.0pt;">warm
liquids, like coffee, tea or soup, can relax swallowing muscles and further
exacerbate swallowing difficulties. Ice chips can be a great alternative. </span></div>
<div class="bodyCxSpMiddle" style="margin-left: .5in; mso-add-space: auto; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="color: windowtext; font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: windowtext; font-family: "Times New Roman",serif; font-size: 12.0pt;">very
hot, spicy, and dry foods may trigger MG symptoms. </span></div>
<div class="bodyCxSpMiddle" style="margin-left: .5in; mso-add-space: auto; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="color: windowtext; font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: windowtext; font-family: "Times New Roman",serif; font-size: 12.0pt;">introduce
potassium-rich foods if a deficiency is the source of muscle weakness. </span></div>
<div class="bodyCxSpMiddle" style="margin-left: .5in; mso-add-space: auto; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="color: windowtext; font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: windowtext; font-family: "Times New Roman",serif; font-size: 12.0pt;">consider
patient quality of life when making diet recommendations. Limiting diet in
patients who already find eating to be a chore may lead to more negative
reactions toward food. </span></div>
<div class="bodyCxSpLast" style="margin-left: .5in; mso-add-space: auto; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="color: windowtext; font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: windowtext; font-family: "Times New Roman",serif; font-size: 12.0pt;">if
the patient has moderate to severe dysphagia, an NG or PEG tube may be
indicated as primary or secondary means of nutrition and hydration. </span></div>
<div class="bodyCxSpLast" style="margin-left: .5in; mso-add-space: auto; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: 0in; mso-add-space: auto;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Positioning</span></i></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"> </span></i><span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">a properly-fitted
removable cervical collar can help support the patient's neck and reduce muscle
fatigue.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">sitting fully
upright will reduce the risk of nasal regurgitation.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">when considering
compensatory swallowing maneuvers, always try strategies that require less
effort <i style="mso-bidi-font-style: normal;">first</i> before those that
require more effort (e.g., chin tuck before supraglottic swallow). </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">effective
minimal-effort strategies</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;">head turn: decreases pharyngeal pooling </span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">by narrowing pharyngeal area to compensate for lack of
muscle constriction.</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 2.0in; mso-add-space: auto; mso-list: l4 level4 lfo2; tab-stops: list 2.0in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">have the patient turn to the weak side
(if unilateral weakness) to divert the bolus to contralateral stronger side .</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">head
tilt: toward stronger side (if unilateral weakness) to compensate for oral
and/or pharyngeal weakness.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">chin
tuck: compensate for reduced bolus control with aspiration before or during the
swallow.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 0in; mso-add-space: auto;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Timing</span></i></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"> </span></i><span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">be sure that the
patient has adequate rest time before meals or PO trials, and avoid
conversation during these times. </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">time the patient's
meals around their medication cycles (especially those that are intended to
improve muscle function). </span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">due to the fact
that muscle weakness usually occurs during periods of activity and improves
after periods of rest, the patient should have a rest break between each
therapy session.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;">patients
benefit from shorter treatment sessions with frequent rest breaks.</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 0in; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 0in; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 0in; mso-add-space: auto;">
<i style="mso-bidi-font-style: normal;"><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt; mso-bidi-font-weight: bold;">Neuromuscular Electrical Stimulation (NMES)</span></i></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 0in; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;">aim
to strengthen muscles without causing fatigue. </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;">since
not all motor end plates are affected to the same degree in MG, some motor
units (ones that are less affected) may have greater capacity for improvement than
others. </span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="background: white; font-family: "Times New Roman",serif; font-size: 12.0pt;">limited
research base for NMES in this population. The following are recommended guidelines:</span></div>
<div style="margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="background: white;">Initiate a conservative exercise program at moderate
exercise intensities while closely monitoring for fatigue and functional
decline.</span></div>
<div style="margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="background: white;">Add electrotherapy to facilitate the process if no
progress is made but only if no functional declines were observed.</span></div>
<div style="margin-left: 1.5in; mso-add-space: auto; mso-list: l4 level3 lfo2; tab-stops: list 1.5in; text-indent: -.25in;">
<span style="font-family: Wingdings; font-size: 10.0pt; mso-bidi-font-family: Wingdings; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="background: white;">If still no progress is made and/or functional
declines are observed, stop electrotherapy.</span></div>
<div style="margin-left: .5in; mso-add-space: auto; mso-list: l4 level2 lfo2; tab-stops: list .5in; text-indent: -.25in;">
<span style="font-family: "Courier New"; font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="background: white;">functional
decline with NMES will be noticeable during or immediately after the very first
session. If this is observed, NMES should not be considered as a therapeutic
option for that patient.</span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: 0in; mso-add-space: auto;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"><span style="mso-tab-count: 1;"> </span>Dysphagia may persist when other
clinical symptoms have improved. It is important for patients to have their
swallowing function re-assessed every 3 months, even <span style="background: white;">when in a long-term remission period. This helps to manage potential
aspiration before it adversely affects pulmonary function and creates a
possible exacerbation of MG symptoms. The patient should be extensively
educated on signs and symptoms of aspiration and beginning signs of pneumonia,
in order to ensure on-going self-monitoring skills. The SLP should also make it
a focus to reduce the patient's stress and anxiety as much as possible during
his or her stay in the hospital, due to the impact of i</span>ncreased stress
and emotionality on a myasthenic crisis. This can be achieved through
education, collaboration, and building rapport.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="background: white; line-height: normal;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="background: white; line-height: normal;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="background: white; line-height: normal;">
<br /></div>
<div align="center" class="MsoListParagraphCxSpLast" style="background: white; line-height: normal; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif; font-size: 13.0pt;">References</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman",serif;">:</span></b><span style="font-family: "Times New Roman",serif;"></span></div>
<div class="MsoNormal" style="line-height: normal;">
<span style="font-family: "Times New Roman",serif;"><span style="mso-tab-count: 1;"> </span>Duhon, K. & Tompkins, S. <i style="mso-bidi-font-style: normal;">Myasthenia Gravis<span class="apple-converted-space">: </span>Treatment of Swallowing Disorders</i><span class="apple-converted-space"> </span>(Retrieved from </span><span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";">http://www.ucs.louisiana.edu/~ncr3025/roussel/codi531/MG2.htm)</span></div>
<div class="MsoListParagraphCxSpFirst" style="background: white; line-height: normal; margin-left: 0in; mso-add-space: auto; text-indent: .5in;">
<span style="font-family: "Times New Roman",serif;">Grob, D., Arsura, E. L., Brunner, N. G., & Namba,
T. (1987). <i style="mso-bidi-font-style: normal;">The course of myasthenia
gravis and therapies affecting outcome.</i><span class="apple-converted-space"> </span>Ann
N Y Acad Sci.<span class="apple-converted-space"> </span>505:472–499. doi:
10.1111/j.1749-6632.1987.tb51317.x.<span class="apple-converted-space"> </span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="background: white; line-height: normal; margin-left: 0in; mso-add-space: auto; text-indent: .5in;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="background: white; line-height: normal; margin-left: 0in; mso-add-space: auto; text-indent: .5in;">
<span class="apple-converted-space"><span style="font-family: "Times New Roman",serif;">Howard,
J. F. Jr., <i style="mso-bidi-font-style: normal;">Ed.</i> (2008). <i style="mso-bidi-font-style: normal;">Myasthenia Gravis: A manual for the health
care provider. </i>Myasthenia Gravis Foundation of America. (Retrieved from: http://www.myasthenia.org/LinkClick.aspx?fileticket=S472fPAE1ow%3D&tabid=69)</span></span></div>
<div class="MsoListParagraphCxSpLast" style="background: white; line-height: normal; margin-left: 0in; mso-add-space: auto; text-indent: .5in;">
<br /></div>
<div class="MsoNormalCxSpFirst" style="line-height: normal; text-indent: .5in;">
<span style="background: white; font-family: "Times New Roman",serif;">Juan, H.-C., Tou,
I., Lo, S.-C., & Wu, I.-H. (2010). <i style="mso-bidi-font-style: normal;">Efficacy
of postural techniques assessed by videofluoroscopy for myasthenia gravis with
dysphagia as the presenting symptom: a case report</i>.<span class="apple-converted-space"> </span><span style="mso-bidi-font-style: italic;">Journal
of<i> </i>Medical Case Reports</span>,<span class="apple-converted-space"> </span><span style="mso-bidi-font-style: italic;">4</span>, 370. doi:10.1186/1752-1947-4-370
(Retrieved from </span><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009659/" target="_blank"><span style="background: white; color: windowtext; font-family: "Times New Roman",serif;">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009659/</span></a><span style="background: white; font-family: "Times New Roman",serif;"> )</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal; text-indent: .5in;">
<span style="font-family: "Times New Roman",serif; mso-fareast-font-family: "Times New Roman";">Myasthenia
Gravis Foundation of America, Inc. (www.myasthenia.org)</span><span style="font-family: "Times New Roman",serif;"></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<span style="font-family: "Times New Roman",serif;"><span style="mso-tab-count: 1;"> </span>Patient
Education Institute, Inc. (2012). <i style="mso-bidi-font-style: normal;">Myasthenia
Gravis</i>. National Library of Medicine. (Retrieved from http://www.nlm.nih.gov/medlineplus/tutorials/myastheniagravis/nr239106.pdf)</span></div>
<div class="MsoNormalCxSpLast" style="line-height: normal;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="background: white; line-height: normal; margin-left: 0in; mso-add-space: auto; text-indent: .5in;">
<span style="font-family: "Times New Roman",serif;">Schwartz, D.C., Waclawik, A.J., Ringwala, S.N., & Robbins,
J. (2005). <i style="mso-bidi-font-style: normal;">Clinical utility of
videofluorography with concomitant Tensilon administration in the diagnosis of
bulbar myasthenia gravis</i>.<span class="apple-converted-space"> </span>Dig
Dis Sci.;50:858–861. doi: 10.1007/s10620-005-2653-2.<span class="apple-converted-space"> </span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="background: white; line-height: normal; margin-left: 0in; mso-add-space: auto; text-indent: .5in;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-left: 0in; mso-add-space: auto; text-indent: .5in;">
<span style="font-family: "Times New Roman",serif;">Vital
Stim Therapy System (2009). <i style="mso-bidi-font-style: normal;">Guidance</i> <i style="mso-bidi-font-style: normal;">from the literature: Myasthenia Gravis</i> (Retrieved
from </span><a href="http://www.vitalstim.com/uploadedFiles/Health_Professionals/Certified_Provider_Resources/Disease_Specific_Information/MG_111309.pdf" target="_blank"><span style="background: white; color: windowtext; font-family: "Times New Roman",serif;">http://www.vitalstim.com/uploadedFiles/Health_Professionals/Certified_Provider_Resources/Disease_Specific_Information/MG_111309.pdf</span></a><span style="font-family: "Times New Roman",serif;">)<span style="background: white;"></span></span></div>
Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com6tag:blogger.com,1999:blog-7684287558065750242.post-29780612235296177172015-06-13T15:00:00.000-06:002015-07-06T11:31:58.525-06:00You are a Social Detective Beginner App ReviewI am always on the look out for some decent social skill materials to use when working with students. So, when I was asked to review the <a href="http://socialskillbuilder.com/" target="_blank">"You Are a Social Detective Beginner App"</a> by the same people who make the Think Social! curriculum (which I love and use all the time) I had to give it a try.<div>
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<a href="http://socialskillbuilder.com/" target="_blank"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_gD3FmEzEsXGfuQLz2pDIjYBN3x6MGUTuKhV3b3By37EqvVfyryzRqfq7_uFJapexzbSgC3gkQeuCkXkW2MkqvwpIZO4XvmGCLDSbXVbUUva9bDWAAH9RhPK7lp3pwmgNM21OgqEL-nuZ/s320/IMG_0621.png" width="320" /></a></div>
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Of course, I agreed to do this review at the beginning of the IEP season. I'm afraid I am way late in making my review. However, its now summer, and even though I'm at a year round school, I have more time on my hands than I did back in May.<br /><div>
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<div>
So, I have been fairly disenfranchised by speech therapy apps as of late. I feel like there is a lot of apps thrown together real quick to make a quick buck. The last few app purchases I've made I've been disappointed with. To be honest, at first I thought that was what I was getting into when I started to look at this app. However, I was pleasantly surprised.</div>
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The app was meant to go with the You are a Social Detective Book by Michelle Garcia Winner and Pamela Crooke. It emphasizes the use of social "smarts" at home, in school and everywhere else. If you are already familiar with the Think Social curriculum then you'll already be very familiar with the concepts that this app teaches.</div>
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This app has quizzes to test your students social skill "smarts". I especially like the videos of real kids. There has been a lot of research done on using video modeling to teach social skills to students on the Autism Spectrum. I been to several training's where they have emphasized this. Students with Autism and Asperger's respond well to watching social skill videos. The short little videos during the quizzes are fantastic. </div>
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Now, I tried to use this during therapy with some kids with social skill goals on their IEPs. One problem is that you can't access all the sections unless you have unlocked it with a your "Avatar". It doesn't lend itself well to group therapy in my opinion. It would be great if you were working one-on-one with a student or as supplement practice for home. This is something that parents can do with their kids at home to further generalize the information from the "You Are a Social Detective" book. </div>
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<div>
However, the app costs $24.99, which might be a difficult sale for parents. For therapists, it would be well worth the price at least for the video quizzes. </div>
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These guys have also created the Social Skill Builder app which I haven't had a chance to look at yet, but would love to hear from any of you if you like it or not. </div>
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So, how are you using technology for social skills? Have you found something helpful in assisting students or at least augmenting your lessons?</div>
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Bobhttp://www.blogger.com/profile/01018453723060771140noreply@blogger.com1tag:blogger.com,1999:blog-7684287558065750242.post-4819635690570008252015-06-12T14:52:00.002-06:002017-09-19T15:40:11.735-06:00Review of new product- the ForbrainI got the opportunity to try a product from Europe called Forbrain.<br />
<br />
First of all the company has been so great to work with and so dedicated to their product. They were also patient with me as I took an ETERNITY to write this review! <br />
The Fobrain offers auditory feedback via bone conduction! They call it an "enhanced audio vocal loop." It's supposed to increase your sound encoding skills. They say it can improve your comprehension of the info you read aloud, it can help your attention to the task, your encoding it into memory, and your improved speech and voice as you listen to yourself, among other things. Basically, while you're speaking, you can hear what you're saying more loudly and intensely as it comes back to you. The "speaker" part of the device rests in front of your ears right on your bones and the sound is vibrated through to your ears. The company suggested I try it out with patients working on voice, motor speech, and cognition.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigkRPOAUl9f9kyZwLdEf4FefoPXCmWeuDv8VKpoTyRAY3UXs3yldNGUkvIIdmeoOCVkwwuMQuX7We4SXf7BBOY-QoJKesUIr5mPeb3yzKZZjanhsIXkjE-QR7LAz5xJ260maQncl1zK2ET/s1600/forbrain1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigkRPOAUl9f9kyZwLdEf4FefoPXCmWeuDv8VKpoTyRAY3UXs3yldNGUkvIIdmeoOCVkwwuMQuX7We4SXf7BBOY-QoJKesUIr5mPeb3yzKZZjanhsIXkjE-QR7LAz5xJ260maQncl1zK2ET/s320/forbrain1.jpg" width="320"></a></div>
<br />
<br />
I tried the device on myself first, and did some reading out loud. I could definitely hear my speech coming back to me loud and clear, and I could feel the vibrations in my bones. I immediately thought this would be great for those patients with voice issues or dysarthria who are less aware of their speech problems, or who have a hard time hearing the subtle things we are asking them to listen for. Even artic problems could benefit I'm guessing.<br />
<br />
Of course, after wearing it myself and doing some reading, it's very hard for me to judged accurately whether or not it improved my attention and memory, etc. There are some clinical trials going on in Europe right now to test those things. It will be interesting to see the results. If the company can still stand to work with me after me being so slow and annoying, I'll keep you posted. :)<br />
<br />
I then tried the device with several of my patients, since it is obviously not harmful, and since any additional potential help to my dysarthria and voice therapy skills is welcome. My patients have all commented that the device is comfortable, seems to be helping. I did notice with two particularly quiet and dysarthiric patients, their speech did seem to improve mildly after placement of the device. I think I will hang onto it and continue to use it with patients who need a little something more than traditional tx, or who are not responding to my cues well. I tried it with a couple of patients working on memory and attention, and again, they said the device seemed helpful in staying on task and remembering what they were reading. Again, I don't see why this couldn't be used by me experimentally to help give patients a "boost."<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrIdbRiR4zrpxZ8EK9-gZQbpkG1d4dqd1bIrCq8_uVdBqxCH6wLuLUAPZ1bp-cX0XCDdzhCSpBkf3_v5h0tnC1aJErLChPR4rKqOWzQ5Ez7G9AcG6kMLZiaFDmBVudALflEDi9koBxymni/s1600/for3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="264" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrIdbRiR4zrpxZ8EK9-gZQbpkG1d4dqd1bIrCq8_uVdBqxCH6wLuLUAPZ1bp-cX0XCDdzhCSpBkf3_v5h0tnC1aJErLChPR4rKqOWzQ5Ez7G9AcG6kMLZiaFDmBVudALflEDi9koBxymni/s320/for3.jpg" width="320"></a></div>
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Several of my colleagues are considering using the device experimentally, and we even considered doing a simple research project and presenting a poster at ASHA. This could be a future research project!<br />
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In conclusion, I think the deice has some great potential. I love to try to things, and will continue to use it with dysarthria and voice patients who need more help with listening, perceptual skills, changing subtle thinks in their speech, resonance, voice, etc. And I'll be watching for the results of these trials in Europe. If you are interested in the device, you can leave a comment below and I'll ask my contact person if they would like to contact you for beta testing, reviewing, research, or purchasing. I don't know if they are currently available for purchase in the US. <br />
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Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com1tag:blogger.com,1999:blog-7684287558065750242.post-80565777526329658022014-10-23T09:20:00.000-06:002017-09-19T15:40:44.178-06:00Orientation and calendar taskOhhh my goodness, I have not blogged in an eternity!! Sorry. I had a baby and life got too crazy. She is an adorable baby!!! I'll post pictures. In the mean time, here's a little orientation task I just created since working on orientation can feel kinda...repetitive and boring. :)<br />
<br />
<u><b>Orientation and calendaring exercise for Inpatient Rehab </b></u><br />
<ul>
<li>Number each day in this month </li>
<li>Place a small post-it on today’s square.</li>
<li>Write the word “today” on the post-it.<span style="mso-spacerun: yes;"> </span></li>
<li>Are there any holidays (or family birthdays) this month-
fill them out.</li>
<li>What events or appointments are coming this week?<span style="mso-spacerun: yes;"> </span>Point to them or fill them in.</li>
<li>Which is the first day of the week this month?</li>
<li>Count how many days from today to the end of the month. </li>
<li>How many Sundays are there in this month?</li>
<li>On which day of the week does the 14<sup>th</sup> fall?</li>
<li>Which day did you arrive in Rehab?</li>
<li>How many days have you been here?</li>
<li>Which day will you be leaving?</li>
<li>How many days until you discharge?</li>
<li>How many days <u>(total)</u> will you have been in Rehab by
the time of your discharge?</li>
<li>What season(s) is/are this month? (summer, fall, winter,
spring)</li>
</ul>
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<b style="mso-bidi-font-weight: normal;"><u>For home</u></b></div>
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Each day:</div>
<ul>
<li>Ask a family member or caregiver to join you in doing your
orientation exercise.<span style="mso-spacerun: yes;"> </span></li>
<li>Try to say the date without looking at the calendar. </li>
<li>Move the “Today” post it forward one day. </li>
<li>Say the date now, looking at the calendar.<span style="mso-spacerun: yes;"> </span></li>
<li>Cross of the previous day (all days that have passed should
be crossed off).</li>
<li>Look at upcoming appointments/events.</li>
<li>Write any to-dos, appointments, events that you learn about
today.</li>
<li>Make any preparations you need to make for those events
(e.g., if there is a family birthday tomorrow, do you need to get a gift or
card?<span style="mso-spacerun: yes;"> </span>If there is a therapy appointment
this morning, do you need to shower, dress, etc.?)</li>
<li>Say the date without looking at the calendar. </li>
</ul>
Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com2tag:blogger.com,1999:blog-7684287558065750242.post-6792728086835869522013-11-27T16:45:00.001-07:002017-09-19T15:41:24.114-06:00Personal update!Hey all,<br />
<br />
Just for fun I thought I would let you know how things are going. I'm still pregnant- 23.5 weeks along. Get my first kick this week! Had a rough lower back injury a couple weeks ago. Oh, and I am only 2 days apart with my sister!<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4dIEK5SdrCcyRsXBvJIxge0uJM6r5XVAaqEerUhDCzHGcQRiaOZhUFohvp4yiWQV-8jweQylIFSr5O0_nA7PyrF19zS_cs9871TXGy61jvdQaMaocU4H9jXqgzBDpJZP7dFvhs4Ao2y_W/s1600/siss.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4dIEK5SdrCcyRsXBvJIxge0uJM6r5XVAaqEerUhDCzHGcQRiaOZhUFohvp4yiWQV-8jweQylIFSr5O0_nA7PyrF19zS_cs9871TXGy61jvdQaMaocU4H9jXqgzBDpJZP7dFvhs4Ao2y_W/s320/siss.jpg" height="293" width="320"></a></div>
<br />
That's her on the left, and me on the right a couple weeks ago. We are excited! I'm having a girl and she's having a boy.<br />
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Have a great Thanksgiving holiday! Hope you get some time off.<br />
<br />
<span style="font-family: 'Fontdiner Swanky'; font-size: large;"><b>~Kristin</b></span>Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com5tag:blogger.com,1999:blog-7684287558065750242.post-56794831736105423372013-11-21T12:43:00.000-07:002014-10-22T15:11:32.804-06:00Therapy task ideas for working on impulsivity and other pragmatic deficit areas<!--[if gte mso 9]><xml>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Dear fellow SLPs,</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><br />
To me, this is the <u>hardest</u> area to target. When a patient is
impulsive, they are often both unaware of it, and not receptive to education
and training in this area. </span></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Common patient reactions to pragmatic therapy:</span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbD21ndw2VV0qV8C3LcGf-RagNB9rJP5YH63NeXcy1QZpn1Xj_DbHYUeGWdyzfRb46yj80MwnCd2rSS8J2BGJynOPOskvntBYrqMIUb7wuajyZ9G9S4TuWkTSBDAq6bUsnOdxzi7Ks-O0C/s1600/disgust.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbD21ndw2VV0qV8C3LcGf-RagNB9rJP5YH63NeXcy1QZpn1Xj_DbHYUeGWdyzfRb46yj80MwnCd2rSS8J2BGJynOPOskvntBYrqMIUb7wuajyZ9G9S4TuWkTSBDAq6bUsnOdxzi7Ks-O0C/s320/disgust.gif" height="320" width="320" /></a></div>
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<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><br /></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Yes, it's easy to want to shy away from taking the bull by the horns and addressing these things, but...</span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOVCk-IPRwe1H23onaOQfV7uj1TuomqTaq_E01i2ID_6ilgd9XRJCaahTG1lt-3qq3jqW5VCotjyy7u0T6w-pcGKvoMEVlNacAXC0punwUJtR6trqRrfCos43M1TTgna-iXthXtMC999gr/s1600/syour+job.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOVCk-IPRwe1H23onaOQfV7uj1TuomqTaq_E01i2ID_6ilgd9XRJCaahTG1lt-3qq3jqW5VCotjyy7u0T6w-pcGKvoMEVlNacAXC0punwUJtR6trqRrfCos43M1TTgna-iXthXtMC999gr/s320/syour+job.gif" height="180" width="320" /></a></div>
<br />
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> I have a few commonly used phrases when talking to patients about these potentially sensitive areas. I often say something like this:</span></div>
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<span style="font-size: x-small;"><span style="font-family: "Arial","sans-serif";"> <i><span style="font-size: small;"> "One of the things I watch for closely during my evaluation are subtle social changes in patients' behavior which can be very common after [an injury like yours]. Many times these are things that can go unnoticed, or even ignored. I would like to be very frank with you when and if I ever notice these things in you- if you are open to my feedback."</span></i></span></span></div>
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<i><span style="font-size: small;"><br /></span></i></div>
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<i><span style="font-family: "Arial","sans-serif"; font-size: small;"> At this point the patient usually says they are very open to any feedback and frankness.</span></i></div>
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<i><span style="font-family: "Arial","sans-serif"; font-size: small;">I then say something along these lines:</span></i></div>
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<i><span style="font-size: small;"><br /></span></i></div>
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<i><span style="font-family: "Arial","sans-serif"; font-size: small;"> "Let's talk about the most common social and behavioral changes that go along with [this type of 'injury"] and some of the things I have noticed during our evaluation/interactions. And any time in therapy when I notice these things, I will very frankly point them out. I don't want to make you feel embarrassed- in fact you shouldn't! This is why we are here. And I always say, 'No one is going to be honest with you like you speech therapist is," at least with regard to these subtle social things. Actually, people will often feel uncomfortable bringing them up with you, so I would rather we discuss it all openly while you're here so you are aware and you can start using strategies and techniques to help you when you interact with others, go back to work, etc."</span></i></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">This tends to create more openness and at least provides a way for me to point out behaviors as they occur. </span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Can you add anything to this list below? Does
anyone else have any great materials for working on this area? Leave your
comments below- I would love to hear from you!</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><br />
Here are all the ideas I could think of today, plus a couple from my fellow
SLPs. What else can you add?</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
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<br /></div>
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<b><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Tasks
for <u>pragmatic/social skill areas</u> such as: </span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";"> </span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Self-Awareness,</span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";"> </span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Self-Monitoring,</span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";"> </span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Self-Regulation,</span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";"> </span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Impulse
Control,</span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 13.5pt; mso-fareast-font-family: "Times New Roman";"> </span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Disinhibition:</span></b></div>
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<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">·</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;">
</span></span><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Video the patient and have him
analyze his behavior/performance</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: Symbol; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">·</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;">
</span></span><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Have the patient list his
deficits/goals</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: Symbol; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">·</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;">
</span></span><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Have the patient predict how they
WILL perform on a given task, and then assess how they DID perform afterward
(scale of 1-10 or percentage). </span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: Symbol; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">·</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;">
</span></span><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Have the pt. take data for
themselves</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">·</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;">
</span></span><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Practice social role-plays</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: Symbol; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">·</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;">
</span></span><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Give scenarios of “wrong” behavior
and have them identify it and propose a solution</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">
</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: Symbol; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">·</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;">
</span></span><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Descriptions of self (“What
motivates me?”, “What do I imagine myself doing in a year from now?”, “What are
things I like to do?”)</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: Symbol; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">·</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;">
</span></span><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Social interaction role-plays including discussion of compensatory strategies and behaviors</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: Symbol; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">·</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;">
</span></span><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Role play job interview questions
(i.e., “What is your greatest strength?”) (There are good example is this workbook-- Focus on Function p. 299)</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: Symbol; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">·</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;">
</span></span><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Develop tactile cue system for
patients with tangential conversation to let them know they have been talking
too long/off topic</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: Symbol; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">·</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;">
</span></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Before starting any
task, ask the patient how they think they will perform. Discuss any
differences in expected vs. real performance</span></div>
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</div>
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</div>
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<span style="font-family: Symbol; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Apps: </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: Symbol; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">·</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;">
</span></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Moron Test (if you're
too impulsive, you'll mess up!)</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
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<span style="font-family: Symbol; font-size: 12.0pt; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">·</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;">
</span></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Doodle Pro </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div>
<br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;">What else, SLPs? Add your ideas in the comments below!</span></span>Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com0tag:blogger.com,1999:blog-7684287558065750242.post-65241621536202020042013-11-18T16:38:00.000-07:002013-11-20T09:04:11.161-07:00On the Flip SideSo, the other day I got a little nudge.<br />
<br />
Kristin got her cousin to send me a hint. Where's the educational SLP? Isn't he suppose to post things as well? His he permanently stuck writing progress reports and IEPs?<br />
<br />
Well, yes. He is.<br />
<br />
So, I am going to blame the same things I always blame... parenthood and netflix. What can you do?<br />
<br />
Anyway, I wanted to talk briefly about my experience on the flip side. What is it like to be a parent with a child who has special needs, at least from my perspective.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVdNBFP0tCPbeHIIN_JQgT4r-XXa_rgdM7TvRp1ECErT80d5_NscPbCtquVu9cQzzXEuqy3ktoHJNugXitTj6V8J6NPTX51VEBYykZM7kXp0ZQJ7OkHitrsa60ElKx0CJGoJqu7DV-0XxL/s1600/boblogan.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVdNBFP0tCPbeHIIN_JQgT4r-XXa_rgdM7TvRp1ECErT80d5_NscPbCtquVu9cQzzXEuqy3ktoHJNugXitTj6V8J6NPTX51VEBYykZM7kXp0ZQJ7OkHitrsa60ElKx0CJGoJqu7DV-0XxL/s1600/boblogan.jpg" /></a></div>
My son, Logan has always been a bit rambunctious and a little behind his sisters when it comes to many developmental milestones. Yet we didn't right away recognize that he might have special needs. Many people had told us that boys are more difficult than girls. We just assumed that they were very right. Once our little boy became mobile then he learned real quick how to get into just about everything. He also demonstrated many characteristics that were similar to students with ASD. At the time he was very echolalic, he wouldn't socialize with others, he couldn't handle any changes to his routine, and he got hyper-focused (obsessed) on particular items or topics.<br />
<br />
Sometimes parents get a blindside to their own children which was definitely the case for us. It wasn't till our child was old enough to go to the children's class at our church when we began to realize that our child wasn't like the other children his age. He was the only kid who couldn't sit still during class. We had the "problem child", the kid that people tend to question what the parents are doing. Were the parents doing any discipline in the home at all? Don't get me wrong, most of the people at my church were very nice about it, trying their best to help Logan participate in primary<br />
. Yet, we knew that something was wrong, or at least suspected.<br />
<br />
I called up my sister-in-law and point blank asked her, "Do you think my son has a disability?"<br />
<br />
She replied, "I would never say anything negative about your son. You know we all love him, but to be honest, none of my kids were ever that hard."<br />
<br />
I felt like I was kicked in the stomach. What did I do wrong? I was suppose to know how to fix children who had problems. I was suppose to be a better father. Did we not give him enough attention? Were we not consistent enough in our disciple? What did we do wrong? My wife took it equally hard. She felt that everybody hated our son. She felt that people thought we were bad parents when he was melting down in public over one thing or another. My wife also has Special Education background. So, she also felt the double guilt that I was feeling. Not only were we bad parents in our minds, we were also bad professionals.<br />
<br />
Its easy to tell parents that it isn't their fault that their child has special needs, but its difficult as parents to listen and believe that simple truth. That nagging feeling of "what if I just did this differently?" clings to our minds. It's difficult to shake off.<br />
<br />
We had Logan tested. The local elementary school's preschool team gave him a variety of assessments including developmental, cognitive, expressive and receptive language, social, etc. We had to wait even longer for special Autism testing.<br />
<br />
Several labels were thrown around willy nilly. I started to realize why first person speech was so important. We could tell who saw our son as a disability first and who saw him as a little boy first. It was a huge difference to us. Parents are a lot more perceptive than you might think. They can tell if you really care about their child or not. It makes a big difference to have people working who want the absolute best for your child, people who will look at their strengths as well as their weaknesses. I found also that I didn't care about the label; it seemed much more important to other people.<br />
<br />
This experience has completely changed how I see my profession and how I interact with students and with parents.<br />
<br />
There is much more I could write about this, but frankly I need to get back to my family.<br />
<br />Bobhttp://www.blogger.com/profile/01018453723060771140noreply@blogger.com7tag:blogger.com,1999:blog-7684287558065750242.post-1952420409548103392013-11-13T15:53:00.002-07:002013-11-13T15:53:17.803-07:00Convergent Thinking Speech Therapy Task Ideas<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqWvUgTWhILUkRt04GLTBpxPtZAJo3v7dAo1CJEDyBh6MnbatP0FcEjSR-47gDLsdj1QOQ7FRKVFcz-lUIoX0qOH64he6NVdNNgACZivcBJs9Jv69IeFDsz5W70DPJdknz3rBcI2TSPHz_/s1600/con2.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="302" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqWvUgTWhILUkRt04GLTBpxPtZAJo3v7dAo1CJEDyBh6MnbatP0FcEjSR-47gDLsdj1QOQ7FRKVFcz-lUIoX0qOH64he6NVdNNgACZivcBJs9Jv69IeFDsz5W70DPJdknz3rBcI2TSPHz_/s400/con2.jpeg" width="400" /></a></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;">Here's my next cognitive area in this series of posts adapted from my old student Janelle Barret's "student project." Convergent thinking tasks! </span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;">First of all, to better understand <u><b>Convergent Thinking (CT)</b></u>, read my previous post <b><a href="http://pathologicallyspeaking.blogspot.com/2013/11/speech-therapy-task-ideas-for-divergent.html" target="_blank"><u>HERE</u></a> </b>on the differences between CT and DT (Divergent Thinking). It can be a tricky topic to understand in some ways. </span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2o5ISeejiacyee0Xp_kVzgUDwhqlol4VrMnthvhlxB-um0HuWigMKI8q2wF9fxbhFnsCu7KgVdCHzIkYhuzEuXjFnZu5qqTiTsiogWf5BoXkCZDHgNcdLPqv8-MJI_1fLmwJxNe4NzqP7/s1600/divcon.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="393" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2o5ISeejiacyee0Xp_kVzgUDwhqlol4VrMnthvhlxB-um0HuWigMKI8q2wF9fxbhFnsCu7KgVdCHzIkYhuzEuXjFnZu5qqTiTsiogWf5BoXkCZDHgNcdLPqv8-MJI_1fLmwJxNe4NzqP7/s400/divcon.jpeg" width="400" /></a></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;">Still having trouble understanding the differences? Here are a couple of simple posts and quizzes I found on a blog about teaching children.</span><ul>
<li><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">http://imaginationsoup.net/2012/01/quiz-yourself-examples-of-divergent-and-convergent-thinking/</span></span></li>
<li><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">http://imaginationsoup.net/2012/01/chimera-vs-stickman-the-difference-between-convergent-and-divergent-thinking/</span></span></li>
<li><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">http://education-portal.com/academy/lesson/creativity-and-divergent-thinking.html#lesson</span></span></li>
<li><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">http://chriscorrigan.com/parkinglot/?p=1265</span></span></li>
<li><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">http://mrsaley.edu.glogster.com/divergent-and-convergent-thinking/</span></span></li>
<li><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: #6545ba;"><b>Linear thinking</b>, <b>or convergent thinking</b>, is about learning facts, follow instructions, and solving problems with one right answer.</span></span></span></li>
<li><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="color: #6545ba;"><b>Divergent thinking</b> is generating unique solutions and seeing various possibilities in response to questions and problems.</span></span></span></li>
<li><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">- See more at:
http://imaginationsoup.net/2012/01/quiz-yourself-examples-of-divergent-and-convergent-thinking/#sthash.rSdTZJ2c.dpuf</span></span></li>
<li><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">http://bouncingideas.wordpress.com/2011/09/02/when-to-let-go/</span></span></li>
<li><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">http://www.bing.com/images/search?q=divergent+thinking&FORM=HDRSC2&id=C11770466133B1ACFA59DA365BE002DAF3F7E1F1&selectedIndex=126#view=detail&id=C11770466133B1ACFA59DA365BE002DAF3F7E1F1&selectedIndex=0</span></span></li>
<li><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">http://www.thinkingdimensionsglobal.com/problem-solving-through-divergent-and-convergent-thinking/</span></span></li>
<li><span style="font-size: x-small;"><span style="font-family: Arial,Helvetica,sans-serif;">A Test of DT: Break Point and Beyond</span></span></li>
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<span style="font-family: Arial,Helvetica,sans-serif;">And without further ado:</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<u><span style="font-family: Arial,Helvetica,sans-serif;"><b><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Convergent Thinking Therapy Task Ideas:</span></b></span></u></div>
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to a problem</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Given 4-5 examples, have
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<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Name similarities between 2
items (this is an interesting cross between CT and DT!)</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: Arial,Helvetica,sans-serif;">Elimination tasks (which of these is not like the other?). WALC 2 has some good ones.</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: Arial,Helvetica,sans-serif;">List several foods with one ingredient in common- have the patient name the common ingredient (e.g., eggs, sugar, meat, etc.)</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: Arial,Helvetica,sans-serif;">Games and Apps:</span></li>
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<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: Arial,Helvetica,sans-serif;">Riddles</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: Arial,Helvetica,sans-serif;">Crossword puzzle apps</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: Arial,Helvetica,sans-serif;">Analogies for Kids app </span></li>
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<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: Arial,Helvetica,sans-serif;">Giving clues for figuring out the described object</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: Arial,Helvetica,sans-serif;">Taking several pieces of information and then making the best educated decision</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: Arial,Helvetica,sans-serif;">Following Directions tasks of all kinds (verbal, written, etc.). Yes- this is convergent thinking too!</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: Arial,Helvetica,sans-serif;">Category and first letter grids (animal that beings with "O") </span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: Arial,Helvetica,sans-serif;">Crossword puzzles</span></li>
</ul>
<div style="text-align: center;">
<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">What do you do to target convergent thinking? </span></span></div>
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<span style="font-size: large;"><span style="font-family: Arial,Helvetica,sans-serif;">Leave us a comment below! </span></span></div>
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Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com3tag:blogger.com,1999:blog-7684287558065750242.post-82294948939336671122013-11-07T18:06:00.003-07:002017-09-19T15:43:00.003-06:00Speech Therapy Task Ideas for Divergent ThinkingHere's my next cognitive area in this series of posts adapted from my old student Janelle Barret's project.
This blog post was an exercise in divergent thinking! Ha ha ha. It took me a lot of work, so I hope you enjoy!<br />
<br />
Not all of these tasks are as strictly divergent thinking as others, but for lack of a more specific category (or post) I am going to lump them in together. Don't forget to comment and add your own ideas!
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1Y74hsrZXcvpmadCAuN5lMJWdcHKebNiyUT3wY1b99QGHrHrMaeJYAU-94BdW88qZtzVITmFM55nYB1Izxh2Wf9YwP5bsB1EvkLPMnJULJrP_JrIjc-rvJa-lKdk5mdX8Zk0amOtQO8Xn/s1600/divcon2.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="292" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1Y74hsrZXcvpmadCAuN5lMJWdcHKebNiyUT3wY1b99QGHrHrMaeJYAU-94BdW88qZtzVITmFM55nYB1Izxh2Wf9YwP5bsB1EvkLPMnJULJrP_JrIjc-rvJa-lKdk5mdX8Zk0amOtQO8Xn/s400/divcon2.jpeg" width="400" /></a></div>
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<div style="text-align: center;">
<span style="font-size: large;"><b>What exactly is Divergent Thinking or DT </b></span></div>
<div style="text-align: center;">
<span style="font-size: large;"><b>(aka: lateral thinking)? </b></span></div>
<div style="text-align: center;">
<span style="font-size: large;"><b>How is it different from Convergent Thinking </b></span></div>
<div style="text-align: center;">
<span style="font-size: large;"><b>(aka: linear thinking)??</b></span></div>
<br />
With many questions and problem-solving scenarios in life, <span style="font-size: small;">we <u>start</u> with DT</span> to create ideas, options, possible solutions, more questions, more ways of LOOKING at or interpreting the problem or question...<br />
Then we use <u>Convergent</u> Thinking to make the actual choices and decisions. DT is not the same as <u>Creative</u> Thinking, but is required for creative thinking! (<u>Convergent</u> thinking typically involves situations in which there is ONE right answer or one right way of doing things. Learning facts, and following directions also fall under the umbrella of convergent thinking.)<br />
Do you have a hard time remembering which is which? With divergent thinking you take a question and DIVERGE into many thoughts and possibilities. Or a good memory association is that you have to <u><b>"dive in"</b></u> and think of various possibilities. <br />
<div id="stcpDiv" style="left: -1988px; position: absolute; top: -1999px;">
<div style="padding-left: 30px;">
<span style="color: #6545ba;"><b>Linear thinking</b>, <b>or convergent thinking</b>, is about learning facts, follow instructions, and solving problems with one right answer.</span></div>
<div style="padding-left: 30px;">
<span style="color: #6545ba;"><b>Divergent thinking</b> is generating unique solutions and seeing various possibilities in response to questions and problems.</span></div>
- See more at:
http://imaginationsoup.net/2012/01/quiz-yourself-examples-of-divergent-and-convergent-thinking/#sthash.rSdTZJ2c.dpuf</div>
<br />
<div id="stcpDiv" style="left: -1988px; position: absolute; top: -1999px;">
<div style="padding-left: 30px;">
<span style="color: #6545ba;"><b>Linear thinking</b>, <b>or convergent thinking</b>, is about learning facts, follow instructions, and solving problems with one right answer.</span></div>
<div style="padding-left: 30px;">
<span style="color: #6545ba;"><b>Divergent thinking</b> is generating unique solutions and seeing various possibilities in response to questions and problems.</span></div>
- See more at:
http://imaginationsoup.net/2012/01/quiz-yourself-examples-of-divergent-and-convergent-thinking/#sthash.rSdTZJ2c.dpuf</div>
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<b><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Divergent Thinking </span></b><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><b>Task Ideas:</b><br style="mso-special-character: line-break;" />
<br style="mso-special-character: line-break;" />
</span></div>
<ul type="disc">
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">List of 4-5 words: which does not belong? (i.e., dog,
cat, bowl, bird, fish)</span><span style="font-family: "symbol"; font-size: 12.0pt;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"> </span></span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="font-family: "symbol"; font-size: 12.0pt;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Catch phrase: describe a
word without saying it</span><span style="font-family: "symbol"; font-size: 12.0pt;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"> </span></span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="font-family: "symbol"; font-size: 12.0pt;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Multiple definitions of
a word, WALC</span><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;"> </span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Apps and Games:</span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Tetris</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Jumbline 2 (very addictive!) :) </span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Boggle </span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Goo</span></li>
</ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Multiple/non-traditional
uses of an object</span><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;"> </span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">I encourage extreme creativity here - a paperclip can be twisted into different shapes and each of those shapes can do various things. A paperclip could also be enormous and become an artistic sculpture in the park, or a heavy anchor for a ship)</span></li>
</ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Sorting task</span><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;"> </span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Name several words in a given category, or do Brainstorming tasks</span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">WALC 2</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;"> Can get really abstract and creative for patients who need more difficulty tasks (my hubby, Matt came up with all of the following! Nice job, Babe.)</span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Ways to wake someone up in the morning)</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Name a cooking ingredient and name all the dishes that can be made with it</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Name a body part or muscle and name all the uses you can think of</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Name a significant number and have them name all the ways that make that number significant (e.g., 3. Three's a crowd, three's company, a trilogy, Goldilocks and the 3 bears, the 3 little pigs, 3 strikes and your out...etc.) (10 ones make $10 10 tens make $100, based 10 numbering system, 10 fing4rs, then toes, count down from 10 when a rocket is launching, etc.) 42: 4/2 = 2 Jackie Robinson's number, both even numbers)</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Name a color and have the patient tell you as many things of that color as they can think of.</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Give the patient a word and ask them to think of all the songs with that word in it (e.g., love, baby, tonight, stars, heart, sleep, can't). </span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Etc! </span></li>
</ul>
</ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Categorize a list of
words into sub-groups </span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Take a list of things that are all related to each other in different ways. Have the patient organize that list in as many types of organizational ways they can thing of</span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">E.g., take a list of flowers and have them organize it by: color, look of the petals, alphabetically, number of letters, vowels, etc, etc, </span></li>
</ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Mind mapping</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Journaling</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">List-making</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Take a word</span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Give the definition</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Homonym</span></li>
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<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Examples </span></li>
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<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Break down a word or idea</span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">What is it for?</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">How valuable is it/</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">How is it used?</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">When is it used?</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Who would use it?</span></li>
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<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Etc. </span></li>
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<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Breaking down a task</span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Simple </span></li>
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<ul><ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Planning a trip</span></li>
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<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Planning a meal</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Plannning a party </span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">How to catch a fish</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Make a paper airplane</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Do your makeup</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Tie a tie or tie your shoes</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;"> More Complex </span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">How to write an essay (and I'll have them actually write one, especially if they areplanning to return to school)</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">How to make a Powerpoint (if they are familiar witht his. Again, If they do this for work, I will have them actually prepare one)</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;"><span style="color: black; font-family: "arial" , "sans-serif"; font-size: 11.5pt;">For that matter (Lawyer- prepare a case or argument, etc.) </span></li>
</ul>
</ul>
</ul>
<span style="font-size: large;">Comment below- what do you do to target DT with your patients?</span>Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com3tag:blogger.com,1999:blog-7684287558065750242.post-12049043696325311502013-10-31T16:15:00.000-06:002017-09-19T15:44:57.816-06:00Strategies and tasks for people with Dementia or AlzheimersThis is my next installment in the series of cognitive therapy task ideas taken in part from a student project by Janelle Barrett). Have you read my ideas for Orientation therapy tasks <a href="http://pathologicallyspeaking.blogspot.com/2013/10/therapy-task-ideas-for-orientation.html" target="_blank">HERE</a>, Left Attention and Left Neglect <a href="http://pathologicallyspeaking.blogspot.com/2013/10/tasks-ideas-for-visual-attention-left.html" target="_blank">HERE</a>, Memory <a href="http://pathologicallyspeaking.blogspot.com/2013/10/therapy-task-ideas-for-orientation.html" target="_blank">HERE</a>, and Attention <a href="http://pathologicallyspeaking.blogspot.com/search?updated-max=2013-10-21T11:56:00-06:00&max-results=7" target="_blank">HERE</a>.<br />
<br />
Without further ado, I give you all the dementia treatment ideas I could think of today:<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
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<b><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;"></span></b></div>
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<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Make a personalized memory book</span></li>
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<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Include information about the patient themselves, what they like, their age, etc.</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Include photos of the family, the home, etc.</span></li>
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<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Example: </span></li>
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<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Page 1: My page</span></li>
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<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Consider including name, address, birthday... </span></li>
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<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Page 4-7?: My kids</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Page 8: My grandkids</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Page 9: My dogs</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Page 10: My house</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Page 11-14: My history</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Page 15: My hobbies</span></li>
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<span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;"> *I should add here that one of my old students- <u>Melissa Kirby</u> from a few years ago, made me an AWESOME example memory book to show to patients and families and to help them create their own. It's been really nice to have an example to show them isntead of just explaining it. It usually helps them spark other ideas. I try to have them start working on it right away and get it done early so we can use it in therapy before the patient discharges. </span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;"> </span><br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFGDoiqZVCiLcacX3hZuxdNOs-nPZX8Us3eqGE9-wmhy2stZfSsoDvaGonBLS-XsSjn3Blm0sm-I1_t-6TEgOqbYPtEjSrMIw4TbqJM2W_Q8KZM85-h1B6a4ZTvQq7BQGpOFwWBmOTJkuz/s1600/dementia2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="278" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFGDoiqZVCiLcacX3hZuxdNOs-nPZX8Us3eqGE9-wmhy2stZfSsoDvaGonBLS-XsSjn3Blm0sm-I1_t-6TEgOqbYPtEjSrMIw4TbqJM2W_Q8KZM85-h1B6a4ZTvQq7BQGpOFwWBmOTJkuz/s400/dementia2.jpg" width="400" /></a></span></div>
<span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">
</span>
<br />
<ul type="disc">
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Reminiscence therapy</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: arial, sans-serif;"><span style="font-size: 15.3333px;">Spaced Retreival</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;">Have patient write out steps
for specific tasks (ie. taking medications)--place around patient’s room</li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Place labels around the room
where certain objects should be kept (ie toothbrush, keys, shoes, etc.).</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Family training for use of
strategies</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Creating a daily schedule - teaching family how to assist patient with it daily. </span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Create a daily log notebook or a journal. Have patient and family contribute daily.</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Research shows that in patients with dementia, the brain is still capable of new learning, so cognitive tasks and cognitive stimulation continue to be beneficial.</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Place orientation information around the room</span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">A (large-print) calendar </span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Photos of family and even staff if appropriate </span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">A note on the mirror (or in a location that will be most helpful) to help with confusion in the morning, for example.</span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">This depends on the patient's needs, but could include something about who they are, where they are, where to find the information they need, etc. </span></li>
</ul>
</ul>
</ul>
<span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Other helpful tips:</span><br />
<ul>
<li><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Familiar music can be comforting</span></li>
<li><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Staying active and going for walks is good too!</span></li>
<li><span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;">Keeping a calm positive therapy atmosphere</span></li>
</ul>
<br />
<span style="font-family: "arial" , "sans-serif"; font-size: 11.5pt;"> So what do you do for patients with dementia? Many of you may have MUCH more experience with this population than I do! </span><br />
<ul type="disc">
</ul>
Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com1tag:blogger.com,1999:blog-7684287558065750242.post-32861164896704221372013-10-29T10:24:00.000-06:002017-09-19T15:45:32.364-06:00Tasks Ideas for Visual attention, Left Neglect/Inattention<!--[if gte mso 9]><xml>
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</xml><![endif]--><span style="font-family: inherit;">Portions of Janelle Barrett's student project continued...</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">Visual Inattention or Visual Neglect are such a bizarre phenomenon. I remember when I was a beginner clinician and saw my first patient with left neglect. It was hard to wrap my head around the fact that it's not a VISUAL problem. The patient absolutely could not see things on the left, only because they were "not looking." Totally blew my mind as I watched the patient struggle to find my eyes, bang into the wall on the left, and eat only the food on the right side of his plate. The patient was just as baffled as I was (I mean, I had learned about this in school, but seeing it in real life was so wacky!) Of course, <u>left</u> neglect is most common, but despite those non-believers, I HAVE seen true right-sided inattention or neglect as well!</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">People seem to make relatively quick progress in this area if they work really hard on it. </span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">There has been some argument about whether or not the word "neglect" is truly correct, versus inattention, etc. Call it what you want- but how do you attack it. Here are some ideas from a few SLPs and SLP students. The high- and low-level are all mixed together. What about your ideas? Leave me a comment!</span><br />
<span style="font-family: inherit;"><br /></span>
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<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
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<span style="font-family: inherit;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivNX5GZkkaW9w0IT92YlvLhRN7hPzbzvlGdG-gV1XYDCTUllXIJeO5PWtUM-2C5xfCpiIdhIuNUqhpPP5CITWMgKZ20Qm2nBw7jn1d14nWfH7Sydx0yoJRfS9LXdUfgwFtyGMOUUr0KJWs/s1600/L+neg.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="270" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivNX5GZkkaW9w0IT92YlvLhRN7hPzbzvlGdG-gV1XYDCTUllXIJeO5PWtUM-2C5xfCpiIdhIuNUqhpPP5CITWMgKZ20Qm2nBw7jn1d14nWfH7Sydx0yoJRfS9LXdUfgwFtyGMOUUr0KJWs/s400/L+neg.jpg" width="400" /></a></span></div>
<div style="text-align: center;">
<span style="font-family: inherit;"><span style="font-size: xx-small;">Image courtesy of: cognitiveneuro.wordpress.com</span></span></div>
<div style="text-align: center;">
<span style="font-family: inherit;"><br /></span></div>
</div>
<ul type="disc">
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Of course I always sit to the patient's neglected side, and try to ask them to look at me all throughout the session. </span></span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">I also ask staff and family to always sit to the neglected side</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">I have their TV put on the left, or shift the bed around if needed so that they are looking to the left</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">A couple of my patients have loved looking out their window or out into the hallway, so I have had the bed switched around so those things are on the left. </span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">I will literally hold the patient's head to the left in severe cases (where they cannot sustain a left sided turn of the head and they instantly "sprinkler" back to the right or non-nelgected side). </span></span></li>
</ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">I put all therapy tasks on the neglected side (if the patient can do it) </span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Cancellation and cross out tasks </span></span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">For really severe cases this can be as simple as having two pictures on a page and having the patient find the one on the left</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Letter cancellation tasks (large or small print, full or part-page)</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Symbol cancellation can be even tougher.</span></span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">I think it's important to make sure the patient goes line by line, left to right. No jumping around. That will not help them with reading in the future. </span></span></li>
</ul>
</ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Reading tasks</span></span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Newspapers, magazine articles, large print if needed</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Can use colored line on side of neglect or inattention if needed</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Can use colored index
card to follow lines of writing</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">I usually have them follow along with their finger</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Can also number the lines if needed </span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">My co-worker has patient follow along as she reads </span></span></li>
</ul>
<li><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Writing tasks</span></span></li>
<li><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Keyboarding/typing tasks</span></span></li>
<li><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Web navigation</span></span></li>
<ul>
<li><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Google searches</span></span></li>
<li><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Email</span></span></li>
<li><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Reading and typing </span></span></li>
</ul>
<li><span style="font-family: inherit;">Apps: </span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Dr. Ben</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Doodle Pro</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Little Things</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Reading and typing tasks on iPad </span></span></li>
</ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Games: </span></span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Memory or concentration </span></span></li>
</ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Cooking tasks: keep necessary
items on side of neglect</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Visual search tasks </span></span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Find all the similar symbols</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Where's Waldo</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">I Spy </span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Fruit Ninja</span></span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">"Oops, you missed that bomb. It must have been on the left side!" </span></span></li>
</ul>
</ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Going for a walk or an outing </span></span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">I'll have them look for things on the neglected side</span></span></li>
<ul>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Post-its or pictures on the wall</span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Hidden clues </span></span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Ask about details in the pictures on the wall, etc. </span></span></li>
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<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: inherit;"><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Sometimes we place obstacles on the neglected side</span><span style="font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";"> </span></span><span style="font-family: inherit;"><br /></span></li>
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<ul><span style="font-family: inherit;">
</span>
<li><span style="font-family: inherit;">Having the patient read and follow a map</span></li>
<li><span style="font-family: inherit;">We have really liked some of the tasks and worksheets in the book Focus on Function (among many other great cog books) and have used everything from check writing, to maps, to filling out forms, to reading a TV guide from this book. </span></li>
<li><span style="font-family: inherit;">Hide things in the drawers of the room (on the left side of the drawer (e.g., Where's your chap-stick?).</span></li>
<li><span style="font-family: inherit;">Some of the Lumosity games are great (we have a staff log-in we can all use which has worked well. </span></li>
<li><span style="font-family: inherit;">Tic-tac-toe</span></li>
<li><span style="font-family: inherit;">Mazes</span></li>
<li><span style="font-family: inherit;">There is a task we like that is hard to describe- it has a poem at the top, and then the poem below with many similar and extraneous words throughout. We have the patient circle the correct words as they read along. In the end you have the poem in order once again.</span></li>
<li><span style="font-family: inherit;">Kitchen tasks </span></li>
<ul>
<li><span style="font-family: inherit;">Have the patient find the ingredients or utensils they will need</span></li>
<li><span style="font-family: inherit;">Have them search for safety problems (my OT co-worker sets up an awesome room full of hazards, including cords ready to trip someone, running water, a burner left on, a knife placed precariously, etc.) </span></li>
</ul>
</ul>
<span style="font-family: inherit;"> Happy Left-Scanning!</span><br />
<span style="font-family: inherit;"><br /></span>
<span style="font-family: inherit;">Kristin</span>Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com2tag:blogger.com,1999:blog-7684287558065750242.post-29282610523680762212013-10-24T16:34:00.000-06:002013-10-24T16:34:08.872-06:00Therapy Task Ideas for Orientation<!--[if gte mso 9]><xml>
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</xml><![endif]--><span style="font-family: "Arial","sans-serif";">This post is a
continuation of the series of cognitive therapy ideas taken from a
student project by Janelle Barrett (who is not a student anymore!). These are ideas gathered from several SLPs and students. <span style="font-size: large;">Comment and let us know what you do for orientation!</span></span><br />
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<br />
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; vertical-align: baseline;">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhK6nmSDqfstsVUu2wKffkEa-Tpucbv4u_EdkS5wjp2cufLy9P1hqkk7mQLgJ4f0JDFCxVgkO19QW_gRxkD9PNbk1KVT-eplweGBFCkpVFDos9xe2PCy-gq3LuDZ9tpaP3IJb23CaSTI2Pn/s1600/clock.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhK6nmSDqfstsVUu2wKffkEa-Tpucbv4u_EdkS5wjp2cufLy9P1hqkk7mQLgJ4f0JDFCxVgkO19QW_gRxkD9PNbk1KVT-eplweGBFCkpVFDos9xe2PCy-gq3LuDZ9tpaP3IJb23CaSTI2Pn/s320/clock.jpg" width="296" /></a></div>
<br /></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">O-Log worksheet. Do this before showing them their calendar and memory aides. (This is a standardized little task with 10 questions. They are worth up to 3 points per question for a total of 30 points. </span><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Practice "calendaring"</span></li>
<ul>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Have the pt. fill out a blank calendar (numbering the days, labeling the month)</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Have the pt. cross out days that have past</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Write all holidays and important upcoming family events and birthdays</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Write all significant hospital-related days (surgeries, accidents, date of admission to Rehab, discharge date, last day of therapies, etc.)</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Have the patient answer questions (e.g., "According to your calendar, how long have you been here in the hospital? In Rehab? How much longer will you be here? How long until the next holiday? How long will your total Rehab stay be?") </span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Jot down up-coming appointments or to-do's (e.g., Write a birthday note to Julie before Friday.)</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">I like to use a small post-it sticky on "today's date" if the patient is struggling each day to find it. Each morning we practice moving the sticky and crossing off the previous day. </span></li>
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<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Discuss different
ways to find orientation info (environmental cues, calendars,
newspapers, etc.)</span></li>
<ul>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Have the patient go on a walk and find ways to answer orientation questions (Where are we? Where could you go to find the answer?) </span></li>
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<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Have a daily log book</span></li>
<ul>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Have them write down what the patient did each session, who was there, any other significant events, visitors, the patient's thoughts and feelings.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Have the patient review past entries each day to remind them of what's going on and who has been around. </span></li>
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<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Practice day planner use, including to-dos, etc. </span></li>
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<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Or for tech-savvy patients and teens, we work on electronic planners, calendar apps, etc.</span></li>
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<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">I'll put an enormous poster-sized calendar or orientation poster at bedside if needed. Sometimes I'll have the patient put it together with me as part of therapy.</span></li>
</ul>
<span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><span style="font-size: large;">What other comments do you have? Leave me some fresh ideas in your comments!</span></span><br />
<ul type="disc">
</ul>
Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com0tag:blogger.com,1999:blog-7684287558065750242.post-68395244720718388972013-10-21T11:56:00.001-06:002013-10-21T13:14:10.076-06:00MORE Memory Therapy Task Ideas<div style="text-align: center;">
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<span style="font-family: "Arial","sans-serif";"> Memory troubles are just the worst!</span></div>
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<span style="font-family: "Arial","sans-serif";"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_Zzzzwt4PRN0-VJnO0ANu6-br347CGf8eqXHp__fndv0SaXVuttmxPC2ac__XGYV-gCdaMftgaMNXIEhf_cYKnWINgsnLPwlFhco3bW7hzIPgsS25gvqNgDWhbTgl-1Qi_rObhH8igVGf/s1600/crying.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_Zzzzwt4PRN0-VJnO0ANu6-br347CGf8eqXHp__fndv0SaXVuttmxPC2ac__XGYV-gCdaMftgaMNXIEhf_cYKnWINgsnLPwlFhco3bW7hzIPgsS25gvqNgDWhbTgl-1Qi_rObhH8igVGf/s1600/crying.gif" /></a></span></div>
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<span style="font-family: "Arial","sans-serif";">This post is a continuation of the series of cognitive therapy ideas taken from a student project by Janelle Barrett (who is not a student anymore!). I know I have posted about memory task ideas <a href="http://pathologicallyspeaking.blogspot.com/2013/07/more-short-term-memory-therapy-ideas.html" target="_blank"><span style="font-size: x-large;">here</span></a> and <a href="http://pathologicallyspeaking.blogspot.com/2013/05/email-slp-q.html" target="_blank"><span style="font-size: x-large;">here</span></a> in the past. This post just has more! These are ideas gathered from several SLPs and students. <span style="font-size: large;">Comment and let us know what you do for memory!</span></span><br />
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<span style="font-size: x-small;">(The cat realizes she left something in the oven.)</span></div>
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<ul type="circle">
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Associations</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Chunking</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Calendars</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Visual Memory/Mental Imagery</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Use of Alarms</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Writing things down in a
planner or notebook</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Daily log</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Daily checklist</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Mnemonics</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Visual reminders</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Post-its</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Written instructions to-self</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Rehearsal</span></li>
</ul>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Tasks</span></li>
<ul type="circle">
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">3 Facts </span></li>
<ul type="square">
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level3 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Prospective memory: ask them
to initiate telling them to you at a specified time.</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level3 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.5in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Have them make up a memory
strategy to remember each</span></li>
</ul>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Word list retention</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">The Simon Game app (there are several variations/apps like this)</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Recalling 4 categories as they
go through a 4x4 categorization matrix</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">The “Help for Memory” book is
great</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Study a picture 1-2 minutes,
then recall all they can. THEN think of a strategy to remember them
better and practice again or change pictures</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Flick Flag app (First we study the flags under the instructions. I have them come up with a good association strategy for remembering each flag- the more creative the better. Great for learning to make memory tricks and associations.)</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Hide 3-4 objects around the room (good for non-verbal patients)</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Have them remember a hand shake combo (also good for non-verbal patients)</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Apps with
“concentration” game</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Practice strategies for
remembering faces or photo cards</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Practice strategies for
memorizing state abbreviations </span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Chunking word lists (Help for
Memory p. 52)</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Using visualization to remember information (Help for Memory p. 101)</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Taking notes from material
presented out loud (Help for Memory p. 103)</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Associate visual objects (The
Source for Memory Exercises p. 81, 83)</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Mental Manipulation - read
patient 3 words, have pt. say them back in
alphabetical/chronological/reverse order (ie. “October, April, February”
→ “February, April, October”)</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Visual Memory: Have the patient use a
chunking strategy to recall 12 pictures (The Source for Memory Exercises
p. 152, 153)</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Identifying “key” information:
Read sentence to patient, have patient identify key words to simplify
encoding. (Help for Memory p. 21)</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Repeat list of 3-6 words, then
ask pt. to identify which items have certain attributes (e.g., which are
animals, which are the softest, etc.)</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Cog-log worksheet (more difficult than it's famous sister worksheet- the O-log)</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">WALC 10 workbook is great.</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Practice using day planner or electronic day planner (calendar app)</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Alternating card task: I show them one word or picture card (e.g., fork) and then another (e.g., ball) and have them say the previous card (fork). We continue until they get lost. I have found that ~11 is typical for my non-impaired co-workers. Some people can go an even longer time!</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";">Mental math with no writing things down</span></li>
<li class="MsoNormal" style="color: black; line-height: normal; mso-list: l0 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in; vertical-align: baseline;"><div id="stcpDiv" style="left: -1988px; position: absolute; top: -1999px;">
Memory
Rehabilitation: Integrating Theory and Practice" by Barbara Wilson -
See more at:
http://pathologicallyspeaking.blogspot.com/2013/05/email-slp-q.html#sthash.0EaYqvrC.dpuf</div>
<span style="font-family: "Arial","sans-serif"; font-size: 11.5pt; mso-fareast-font-family: "Times New Roman";"> Book: "Memory Rehabilitation: Integrating Theory and Practice" by Barbara Wilson.</span><div id="stcpDiv" style="left: -1988px; position: absolute; top: -1999px;">
"Memory
Rehabilitation: Integrating Theory and Practice" by Barbara Wilson -
See more at:
http://pathologicallyspeaking.blogspot.com/2013/05/email-slp-q.html#sthash.Ec7dO5e9.dpuf</div>
</li>
</ul>
</ul>
<div style="text-align: center;">
<span style="font-family: "Arial","sans-serif";">Hope you got some new fodder for your sessions tomorrow. :) <span style="font-size: x-large;"> </span></span></div>
<div style="text-align: center;">
<span style="font-family: "Arial","sans-serif";"><span style="font-size: x-large;">Don't forget to comment- </span></span></div>
<div style="text-align: center;">
<span style="font-family: "Arial","sans-serif";"><span style="font-size: x-large;">I need some fresh ideas! </span> </span></div>
<div style="text-align: center;">
<span style="font-family: "Arial","sans-serif";">What do you use for working on memory deficits?</span></div>
<br />
-Kristin<br />
<ul type="disc">
</ul>
Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com0tag:blogger.com,1999:blog-7684287558065750242.post-58822178987188602392013-10-16T16:50:00.001-06:002015-08-20T15:35:07.968-06:00Speech Therapy Task Ideas for Treating Attention<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsfUkg61QpyOrglEtXjlWSDlA1XgMfb6tvC8wpjyBCXHtBzLVe5s9Rd7CD9tMHO0t9clPUXGxVMXRd3qcsrb0zZkqIRcVjTYKA3KUa1UcG9ROedcdaJPlY2aCJfb8sqoiZ5QU5jF3zvlnG/s1600/attention5.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="164" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsfUkg61QpyOrglEtXjlWSDlA1XgMfb6tvC8wpjyBCXHtBzLVe5s9Rd7CD9tMHO0t9clPUXGxVMXRd3qcsrb0zZkqIRcVjTYKA3KUa1UcG9ROedcdaJPlY2aCJfb8sqoiZ5QU5jF3zvlnG/s320/attention5.gif" width="320" /></a></div>
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<span style="font-size: x-small;">Attention skills and avoiding distractions can be tough to target.</span></div>
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5wMlSJiSihGUljDd3t2hrFsWBmYTEbuK8b3hzwJhx1noRYZsNkTQVCgJaiEKmEq2pDxnvA3Lej7zwJuK_jGrL_t0wQMPHKPzjGaIMJ0D1Rkweg5OPQDD2NxDCMuCbxg-DW6zWZJhJvsp8/s1600/attention.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5wMlSJiSihGUljDd3t2hrFsWBmYTEbuK8b3hzwJhx1noRYZsNkTQVCgJaiEKmEq2pDxnvA3Lej7zwJuK_jGrL_t0wQMPHKPzjGaIMJ0D1Rkweg5OPQDD2NxDCMuCbxg-DW6zWZJhJvsp8/s1600/attention.jpg" /></a></div>
<br />
<span style="font-size: large;">What do you do to target<span style="font-size: x-large;"> <b><u>attention</u></b> <span style="font-size: large;">skills</span>? </span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDt-KQT1zGhBFqeMaC4QxzPJNTLjt54VbN3Dw9wBXd2Ur8IsiyivYKXZwZhEC47fJbOjyneoeEek6wpbdf6dWD1FU8GGBGiKmGXEbug_Ews29ri3KG1CCoc4XVqvu7oPGqbH8cxpybZQoA/s1600/attention4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDt-KQT1zGhBFqeMaC4QxzPJNTLjt54VbN3Dw9wBXd2Ur8IsiyivYKXZwZhEC47fJbOjyneoeEek6wpbdf6dWD1FU8GGBGiKmGXEbug_Ews29ri3KG1CCoc4XVqvu7oPGqbH8cxpybZQoA/s1600/attention4.jpg" /></a></div>
<div style="text-align: center;">
<span style="font-size: x-small;">Even the Phantom struggles with attention span issues...</span></div>
<br />
For my next few blog posts, I will be sharing portions of a <span style="font-size: large;">student SLP project by Janelle Barrett.</span><br />
<br />
Janelle was my student about a year ago. For Janelle's project, she created a shared document and asked several of her student colleagues and my colleagues and others to contribute all their task ideas for a given area. I'm going to divide each area into a <span style="font-size: large;">separate</span> post. <span style="font-size: large;">For this post, here are all the treatment task ideas for working on attention... Functional, structured, high-level, low-level. </span>These are ideas for sustained attention or focus, unless otherwise specified. <u><b>Please please please, comment and add some of your own! </b></u> We would love some more great ideas. Janelle asked all of her student cohorts, and my colleagues, and many others to contribute to a shared spreadsheet, so these are ideas from several different SLPs. Great, huh? Who can get enough task ideas in their repertoire? Not me.<br />
<br />
By the way, what is attention? The most basic cognitive skill- which is a prerequisite for the other skill areas in many ways. It's the fundamental skills required for new learning and successful cognition. Attention is generally divided into 5 types:<br />
<ul>
<li>Focused Attention - the ability to respond discretely to specific visual, auditory, and tactile tasks.</li>
<li>Sustained Attention - ability to maintain cognitive dedication to a specific, continuous, or repetitive task. requires vigilance and working memory. </li>
<li>Divided Attention - ability to respond or attend to multiple stimuli at once. E.g., watching a small child while cooking a stir fry. Multitasking. </li>
<li>Selective Attention - the ability to select and maintain cognitive focus in the presence of internal or external stimuli or distractions. It's the ability to tune-out those distractions. </li>
<li>Alternating Attention - involves the mental flexibility for moving between tasks with different cognitive requirements. Shifting attention. E.g., having a conversation while occasionally checking your email for an important incoming message. </li>
</ul>
Evidence Based Practice suggests that some tasks can not be generalized, and actual real life tasks must be practiced in order to be effective. AND that compensatory strategies are the most effective use of therapy time.<br />
<br />
Most of these tasks below are for addressing sustained and focused attention, and then I'll try to label them if it's for a different type of attention. <br />
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<br />
<h3>
<span style="font-family: 'Fontdiner Swanky'; font-size: large;"><b><u>Tasks for targeting Attention skills:</u></b></span></h3>
<br />
<ul>
<li><b><u>Compensatory strategy training: </u></b> </li>
<ul>
<li> use of a timer to give breaks and goal time for maintaining attention to a given task</li>
<li>turning off other sounds and distractions </li>
<li>Using finger to follow along when reading</li>
<li>Reading aloud</li>
<li>Changing the pace of reading </li>
<li>Making a list of disctractions or things that have helped you</li>
<li>Making a schedule of tasks to do do </li>
<li>Educate the family so they or visitors are not distracting</li>
<li>Try performing a task with music on and then with music off to assess the effectiveness</li>
<li><br /></li>
</ul>
<li>Focused attention: listening for a certain sound. </li>
<li>Connect the dots </li>
<li>Build an object based on written/picture instructions (could also target sequencing) </li>
<li>Word search </li>
<li>Sudoku (also could target Info processing and reasoning) </li>
<li>List of words (find or list all words that start with __ ) </li>
<li> unscrambling words, sentences</li>
<li>putting words (or the words form a sentence) in alphabetical (or sequential) order (e.g., smallest to largest, earliest in the year to latest)</li>
<li>Calculating money amounts in ascending or descending order (e.g., 3 nickels, 2 dimes; 5 quarters, 4 pennies 2 nickels).</li>
<li>Word creation - provide a long word for patient to hold in memory and make smaller words out of a big word</li>
<ul>
<li>App: Jumbline 2</li>
</ul>
<li>Timer: attend for ___ minutes without a break </li>
<li>Reading comprehension/auditory comprehension task </li>
<li><u><b>Visual attention/neglect:</b></u> </li>
<ul>
<li>letter/digit/symbol cross-out task, aka: cancellation worksheet</li>
</ul>
<ul>
<li>reading words, sentences, then paragraphs, and articles</li>
<li>Visual attention strategies: highlighting the side of the page, numbering the lines, following along with a finger, finding the edge of the page. </li>
<ul>
<li>however note that research suggests that internal strategy training is the most effective treatment (patient internalizes the need to look left, as opposed to external cues). (Myers, 1994.) </li>
<ul>
<li>Myers and Mackisack suggest 2 techniques:</li>
<ul>
<li>Edgeness - requires a rectangular work space with a raised border. The patient traces the border with their finger. SLP places colored cubes at various areas within the work space adn instructs the patient to locate adn remove the total number of cubes with the instructions, "Look until you have found them all." Increase the difficulty by placing most of the blocks on the left. Or placing 2 colors of blocks and asking for only one. Encourage patient to begin tracing boundaries of other work surfaces such as keyboards, books, etc. </li>
<li>Bookness - Patient describes a closed book which is placed at midline. Patient opens the book, traces the perimeter, and again describes what they see. Begin with matching tasks (a word on the left or right) and ask the patient to trace the book between every stimulus item. Over time, increase the number of stimuli, and add foils. </li>
</ul>
</ul>
</ul>
</ul>
<li>Following multi-step directions </li>
<li>Following complex written directions (e.g., "Place a line under each word that begins with a vowel.")</li>
<li>APT (Attention Process Training) </li>
<li>“Find the differences” picture/apps </li>
<li>“Find the hidden objects” Apps</li>
<li>I Spy Book</li>
<li>Where's Waldo book or app </li>
<li>Brain baseline app (also has alternating attention) </li>
<li>Doodle Find app </li>
<li>Little Things app </li>
<li>Short video with quiz questions after (like practicing for listening in school) </li>
<li><u><b>Divided Attention:</b></u> </li>
<ul>
<li>Could really do ANY of the attention tasks listed in this post but do them simultaneously</li>
<li> Attend to multiple stimuli-- provide a page-length story with instructions to circle all capital letters, cross out commas, and to put a check over the prepositional phrases</li>
<li>Sort a deck of cards while listening to spelled words (and then stating the word)</li>
<ul>
<li>rearrange the letters of scrambled words for increased difficulty</li>
</ul>
</ul>
</ul>
<ul>
<li>Completing a number pattern (verbally) </li>
<li>Math story problem </li>
<li>Decoding worksheets </li>
<li>Finding differences; easy to hard levels- attention to details</li>
<li>IPad app: Differences </li>
<li>Providing navigational directions to another person (Focus on Function p. 156) </li>
<li>Describe 5+ features/parts/characteristics of a given object </li>
<li>iPad app: Museum search (high complexity level) </li>
<li>iPad app: Doodle pro (timed, min-complexity) </li>
<li>iMazing, iPad app (mazes of increasing complexity) </li>
<li> Listing (find all words that start with __ ) </li>
</ul>
<ul>
<li><u><b>Selective Attention:</b></u></li>
<ul>
<li>turning on the radio while giving instructions to the patient and during task</li>
<li>open the therapy office door</li>
<li>treat them in a busy area</li>
<li>open the window</li>
<li>talk with someone else or make a phone call while they complete a pen and paper task</li>
<li>tap the table with a pen or move your foot within their sight, turn pages of a book, or type on a computer. </li>
<li>Assess which distractions have the more significant impact on performance by timing or checking accuracy on a comparable task with different distractions happening on each trial. </li>
<li>Ask client to listen for only one of two voices on a recording and ask questions about what the voice said. </li>
<li>listen for key words in a paragraph (or sentence) </li>
</ul>
<li><u><b>Alternating Attention:</b></u> </li>
<ul>
<li>On paper randomly put the letters A-J and numbers 1-10
have pt alternate between number and letters in ascending order </li>
</ul>
<ul>
<li>Alternation patterns could also include months, counting BACKWARD,
alphabet BACKWARD (or part of it), colors of the rainbow (if they know
them in order), days of the week, random WORDS in alphabetical order,
planets (if they know them), playing cards in a standard deck, states
(if they know the song), do re mi..., holidays, OR pick any category and
have them alternate with something in a different category : e.g., any
fruit and then a month in order </li>
<li>“Think It Through” tile game (we ordered this through Discovery Toys) </li>
<li>Task switch with cards: odd/even & high/low (also on the iPad) </li>
<li>Stroop tasks (both interactive- computer and on paper) color task, directionality, number task, objects task </li>
<li>Motor--Card sorting tasks (There are various. We actually have a book of these tasks!)</li>
<li>Motor--Sort coins, small objects, photo cards colored rubber bands or paper clips, inventory pages, coupons, magazines by month, folders or papers. </li>
<li>Respond to yes/no questions or simple WH- questions, open ended questions, opinion questions, state the advantages/disadvantages of a situation. </li>
<li>Use phone or navigate the internet, send an email.</li>
<li>Solve math problems</li>
<li>Unscramble words, generate items in a given category, put a target word into a sentence</li>
<li>Fruit Ninja, Dr. Ben (iPad) </li>
<li>Blink Card naming or sorting tasks (I love these cards! Example of a high-level task: "Flip over the cards one by one, and with each flip, say the color of the objects, then on the next flip, the number of objects, then the shape of the objects. Continue in that order- color, number, shape.)</li>
<li>Typing what's on a paper or typing the answers to questions on a page (patient has to alternate between the paper, their thoughts, the keyboard, the screen, the mouse). </li>
<li>Name and company sorting - using business cards or business info on index cards-- instruct patient to sort alphabetically by names or company names on the left. When you say switch, they sort by the names on the right. (Could also do it with street numbers or zip codes).</li>
<li>verbal interruptions while reading -- instruct the patient to read an article and prepare to discuss. Provide paper and pen and randomly interrupt with instructions to write and to recall later (e.g., your wife wants you to call her after therapy. Bring your book back to the library by 8pm). Then discuss the article to assess reading comprehension and review the written instructions to ensure accurate processing and recording of information. </li>
</ul>
</ul>
<br />
<ul><ul>
</ul>
</ul>
So, whaddya think? Did you find any good ones? <br />
<br />
<b><span style="font-size: large;">Now be sure to comment and help us add to the list!! What do you use to target attention skills in your patients?</span></b><br />
<br />
<span style="font-family: 'Fontdiner Swanky'; font-size: small;">-Kristin</span>
Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com3tag:blogger.com,1999:blog-7684287558065750242.post-20143476629221671782013-10-11T11:10:00.000-06:002017-09-20T14:13:54.666-06:00Look who got mentioned in the ASHA Leader!My colleague called me this weekend to ask me, "Are you feeling famous?" I didn't even know about it until then. ASHA took an excerpt from our blog (the post about ideas for working on short-term memory and working memory). Did you see the article? <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKz_A1eFTpOmm5rl8ML5iRyCi_zwA8mU8Z4WCFMcGRVMiZ383ikXrj-0UrXGpL3XZQWQRNmAj7DiukDslGj7ZlmS-rqZF_8r4AJe-r-VIB3dCiTDenJOsSoINsI7v3oLARjNwJYVzpqIrG/s1600/leader.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKz_A1eFTpOmm5rl8ML5iRyCi_zwA8mU8Z4WCFMcGRVMiZ383ikXrj-0UrXGpL3XZQWQRNmAj7DiukDslGj7ZlmS-rqZF_8r4AJe-r-VIB3dCiTDenJOsSoINsI7v3oLARjNwJYVzpqIrG/s400/leader.jpg" /></a></div>
<div style="text-align: center;">
Get to the online version<span style="font-size: small;"><span style="font-family: "script one";"> of the article via ASHA's website</span></span> <span style="font-size: x-large;"><a href="http://www.asha.org/Publications/leader/2013/131001/Blogjam--October-2013.htm?utm_source=asha&utm_medium=enewsletter&utm_campaign=leaderlive100713" target="_blank">here</a>. </span></div>
<div style="text-align: center;">
See our post about <i>short-term memory therapy ideas</i> <span style="font-size: x-large;"><a href="http://pathologicallyspeaking.blogspot.com/2013/07/more-short-term-memory-therapy-ideas.html">here</a>. </span><br />
<br />
<div style="text-align: left;">
<span style="font-size: x-large;"><span style="font-size: small;"> Thanks for reading! </span></span></div>
<div style="text-align: left;">
<span style="font-size: x-large;"><span style="font-size: small;"> Kristin </span> </span></div>
</div>
Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com2tag:blogger.com,1999:blog-7684287558065750242.post-55330479484640535132013-10-10T12:19:00.001-06:002017-09-20T14:14:26.568-06:00My news!!!<div style="text-align: center;">
<span style="font-family: "fontdiner swanky"; font-size: large;">Ahem... Hey guys, I have something personal to announce...</span>
</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsk6IhYnbDR0Wb1k0dQunHZzv0lP2J18XiexVId256rls-Yhnb1q_BymFgJBTYcCaU8aG6ecJuQY4m1Z803xlxfGcRTNlLv1EOGhwekpbHjVvcS30DjqfQfF9_-YE-9wFoCGEUAQaTi1AB/s1600/preggo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsk6IhYnbDR0Wb1k0dQunHZzv0lP2J18XiexVId256rls-Yhnb1q_BymFgJBTYcCaU8aG6ecJuQY4m1Z803xlxfGcRTNlLv1EOGhwekpbHjVvcS30DjqfQfF9_-YE-9wFoCGEUAQaTi1AB/s320/preggo.jpg" width="320" /></a></div>
<br />
<div style="text-align: center;">
<span style="font-family: "fontdiner swanky"; font-size: x-large;">I'm pregnant!!!</span></div>
<div style="text-align: center;">
15.5 weeks along, and feeling much better than I was. This was me at 12 weeks...just starting to show:
</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEagoO7J5R1X6x-DdpEZfUbHK59OUa3r_aLyB7eHvVXOmtiUJ7Jwi5NBVSPTm5IxxRjY9nTqAmzU3Ttpr-i36mT5cEMH5qWvlIrHb8yq5om6q7Vuf0Eyxeudyw4bhlVzSktIcM_KEeM6No/s1600/showing.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEagoO7J5R1X6x-DdpEZfUbHK59OUa3r_aLyB7eHvVXOmtiUJ7Jwi5NBVSPTm5IxxRjY9nTqAmzU3Ttpr-i36mT5cEMH5qWvlIrHb8yq5om6q7Vuf0Eyxeudyw4bhlVzSktIcM_KEeM6No/s320/showing.jpg" width="320" /></a></div>
<div style="text-align: center;">
And no, I didn't make my bed (yet) that day. :)</div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: center;">
I was pretty sick for the first trimester, but am feeling MUCH better now. I'm really excited! I'll keep you posted on the little guy or gal.</div>
<div style="text-align: center;">
<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaiBbR18ixugeudB-28N0Wwj-Z_T_fy6jE0HFskLnMHqDzYszUV0E2lr4cwYuhhG1aXIQECAgYq62S7BWTtDnBb_Jb9sXJrwvWbiudrcsQBbi6cOGtMOvY2MbKH-YuaggqwS-gqTJcCVeY/s1600/baby.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaiBbR18ixugeudB-28N0Wwj-Z_T_fy6jE0HFskLnMHqDzYszUV0E2lr4cwYuhhG1aXIQECAgYq62S7BWTtDnBb_Jb9sXJrwvWbiudrcsQBbi6cOGtMOvY2MbKH-YuaggqwS-gqTJcCVeY/s1600/baby.jpg" /></a></div>
<div style="text-align: center;">
12 week sonogram.</div>
<br />
-Kristin Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com3tag:blogger.com,1999:blog-7684287558065750242.post-48374168666865738452013-09-30T11:27:00.002-06:002017-09-20T14:15:07.657-06:00Radiation Safety and Guidelines During MBS / VFSS for SLPs and PatientsHi friends,<br />
<br />
I have had some awesome student interns lately. Each of them completes a <b><span style="font-size: large;">student project</span></b> of some kind. some of them are so awesome, I have decided to ask the students' permission and post some of them on the blog. Here is the first of many-- a project by Amelia Bergmann.<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgb0XElyqa7w-r9jTyXFsiJsJlmMctaPUpa5FBYaU24YzD32WD-eEi6FKmrL0SWa4NCJ2AXW8BnpirAa7c-cYyyzLeLk3sj811mFR-O8q-APgn72m26K0EA2BPkJl7YELTv4DtWm9kiAsKM/s1600/readi_cat.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgb0XElyqa7w-r9jTyXFsiJsJlmMctaPUpa5FBYaU24YzD32WD-eEi6FKmrL0SWa4NCJ2AXW8BnpirAa7c-cYyyzLeLk3sj811mFR-O8q-APgn72m26K0EA2BPkJl7YELTv4DtWm9kiAsKM/s320/readi_cat.jpg" width="176" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Image source: http://lc19.blogspot.com/2010/06/meet-readi-cat-worse-than-drinking.html</td></tr>
</tbody></table>
<br />
<span style="font-size: large;">The story:</span><br />
We have had several issues lately regarding confusion about <b>how much radiation is too much</b>, <b>how many frames per second is safe</b>, etc. Some of the techs in radiology are hesitant to film the studies at 25 frames per second or more, but we feel we can not make adequate measures and judgment calls with anything less. The alternative with our machines is 12.5 frames/second! Just terrible. Jeri Logemann said anything less than 30 is abysmal. <b>How can we convince the techs that this is not that much more, and is safe for them and the patients (and is it??)?</b> We didn't really understand ourselves some of the ins and outs of radiation/fluoroscopy safety. I put this issue on my to do list and my student project list in case anyone was interested, and Amelia took me up on it. She completed this Powerpoint presentation about Fluoroscopy. <b> I thought she did a fantastic job!</b> Some of the guidelines are specific to our hospital , so you would have to research your own hospital's guidelines. <b>Some of the questions Amelia investigated included:</b><br />
<ul>
<li><span style="font-size: large;">An MBS/VFSS exam is equivalent to how many hours in the sun? </span></li>
<span style="font-size: large;">
</span>
<li><span style="font-size: large;">How much protection does the lead provide?</span></li>
<span style="font-size: large;">
</span>
<li><span style="font-size: large;">Where do SLP's need to stand in order to avoid radiation scatter during MBS/VFSS?</span></li>
<span style="font-size: large;">
</span>
<li><span style="font-size: large;">What is the pattern of the radiation scatter during the MBS/VFSS?</span></li>
<span style="font-size: large;">
</span>
<li><span style="font-size: large;">How much more radiation is the patient receiving when the frames/second are increased? </span></li>
<span style="font-size: large;">
</span>
<li><span style="font-size: large;">What are the guidelines from pregnant patients and SLPs/therapists/techs?</span></li>
<span style="font-size: large;">
</span>
<li><span style="font-size: large;">Should we wear lead or radiation-resistant gloves and goggles during MBS/VFSS procedures? </span></li>
<span style="font-size: large;">
</span>
<li><span style="font-size: large;">What are the radiation dose limits for SLP's and patients?</span></li>
</ul>
She interviewed the hospital's radiation physicist, the Radiology PA, looked up hospital and State guidelines and scoured ASHA and research articles.<br />
<br />
So check it out! I have pasted the slides here below. Amelia and I hope it helps other SLPs with their questions about the mysteries of fluoroscopy. :)<br />
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<br />
<div class="MsoNoSpacing">
<h4>
<span style="font-family: "fontdiner swanky"; font-size: x-large;">Radiation MBS/VFSS Safety Information:</span></h4>
</div>
<ul>
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><b><u>What Is Radiation?</u></b></span></h5>
<li><span style="font-weight: normal;"><span style="font-size: small;">Energy in the form of particles and waves</span></span></li>
<span style="font-weight: normal;">
</span>
<li><span style="font-weight: normal;"><span style="font-size: small;">Ionizing: X-rays and gamma rays </span></span></li>
<span style="font-weight: normal;">
</span>
<li><span style="font-weight: normal;"><span style="font-size: small;">Some x-rays enter body and interact partially,
completely, or not at all</span></span></li>
<span style="font-weight: normal;">
</span>
<li><span style="font-weight: normal;"><span style="font-size: small;">Denser tissue absorbs more radiation than less dense tissue</span></span></li>
</ul>
<div class="MsoNoSpacing">
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><b><u>Local Radiation Regulations (Utah):</u></b></span></h5>
</div>
<ul>
<li><span style="font-size: small;"><a href="http://www.radiationcontrol.utah.gov/">www.radiationcontrol.utah.gov</a></span></li>
<li><span style="font-size: small;">Utah law mirrors the federal laws</span></li>
</ul>
<div class="MsoNoSpacing">
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><u><b>Radiation Dosage info:</b></u></span></h5>
</div>
<ul>
<li><span style="font-size: small;">Radiation is all around us</span></li>
<span style="font-size: small;">
</span>
<li><span style="font-size: small;">Inverse square law (radiation received and distance from
source)</span></li>
<span style="font-size: small;">
</span>
<li><span style="font-size: small;">R</span>eceived through naturally occurring radionuclides (soil,
food, water) and through radon indoors</li>
<li>The type of radiation emitted during fluoroscopy is not the same type of "rays" as the rays of the sun- so telling a patient that an MBS is like __ hours in the sun is not accurate. They are not comparable. </li>
<li>No “zero dose” of radiation exists!</li>
</ul>
<div class="MsoNoSpacing">
<span style="mso-tab-count: 7;"> </span><span style="mso-spacerun: yes;"> </span>(ASHA, 2004)</div>
<ul>
<li>Naturally occurring: 300millirems/year </li>
<li>300mr added from medical and man-made sources (mostly in
latter years of life)<span style="mso-spacerun: yes;"> </span></li>
</ul>
<div class="MsoNoSpacing">
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><u><b>Radiation Safety Education:</b></u></span></h5>
</div>
<ul>
<li>Education on radiation safety is not standard in graduate
programs for speech pathology</li>
<li>SLP’s responsibility to be aware of guidelines, etc. to
reduce radiation exposure to self and patient <span style="mso-spacerun: yes;"> </span></li>
</ul>
<div class="MsoNoSpacing">
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><u><b>ASHA Guidelines on Radiation;</b></u></span></h5>
</div>
<ul>
<li>Guidelines for Speech-Language Pathologists Performing
VFSS:</li>
<li>Principle of Ethics II Rule B: “Individuals shall engage
in only those aspects of the profession that are within their competence,
considering their level of education, training, and experience” (<a href="http://www.asha.org/policy/GL2004-00050/">ASHA, 2003</a>). Furthermore,
individuals should consult state licensure laws regarding speech-language
pathologists (SLPs) utilizing the VFSS in their particular state.</li>
</ul>
<div class="MsoNoSpacing">
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><u><b>Average VFSS/MBS Radiation Exposure:</b></u></span>,</h5>
</div>
<ul>
<li>Average: 1 millisievert </li>
<li>Exposed to 50 millisieverts in first 17 years of life</li>
<li>Low dose and low risk procedure </li>
<li>Little radiation exposure and dose = no risk when
compared to medical benefit </li>
<li>Reducing exposure</li>
</ul>
1) Time that fluoroscopy is on<br />
2) Distance from the source and patient<br />
3) Shielding <br />
<div class="MsoNoSpacing">
</div>
<div class="MsoNoSpacing">
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><u><b>Fluoroscopy time during a study:</b></u></span></h5>
</div>
<ul>
<li>Should not exceed 5 minutes (if possible)</li>
<li>Less time spent in fluoro = less radiation exposure</li>
</ul>
<div class="MsoNoSpacing">
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><u><b>C Arm:</b></u></span></h5>
</div>
<div class="MsoNoSpacing">
<ul>
<li>The arm is the source of radiation to patient </li>
</ul>
</div>
<div class="MsoNoSpacing">
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><u><b>Scatter:</b></u></span></h5>
<h5>
</h5>
</div>
<ul>
<li>Radiation emitted from the patient (not the direct beam)</li>
<li>Radiation hits the patient’s tissue, interacts and then
changes direction </li>
<li>Decreased by a factor of 1,000 for every 1 meter in
distance<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfwrVIri6VVeLIslmwA4zTKOaWQSMFFZtUZ2jbiB_ef6L_ZhNyWO4upA2WbDnPF4oCDqRF8WUSvI2KoD11Qrrg8hL0X1nceu7b4QtZckDI-yiw5ckL2-hkIaaUcXoeJJx0z8WsjcDZKNzZ/s1600/mbs2.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="269" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfwrVIri6VVeLIslmwA4zTKOaWQSMFFZtUZ2jbiB_ef6L_ZhNyWO4upA2WbDnPF4oCDqRF8WUSvI2KoD11Qrrg8hL0X1nceu7b4QtZckDI-yiw5ckL2-hkIaaUcXoeJJx0z8WsjcDZKNzZ/s320/mbs2.png" width="320" /></a></li>
</ul>
<div class="MsoNoSpacing">
<span style="mso-tab-count: 6;"> </span>(P.
Jenkins, personal communication, August 13, 2013</div>
<div class="MsoNoSpacing">
<br /></div>
<ul>
<li>Distance from the beam</li>
<li>Distance of 6 feet or more from patient:</li>
<li>Exposure due to scatter and leakage radiation from x-ray
tube is so small that wearing apron does not add much protection </li>
</ul>
<div class="MsoNoSpacing">
<span style="mso-tab-count: 6;"> </span>(X-ray
Radiation Protection Manual, 2010</div>
<div class="MsoNoSpacing">
<span style="mso-no-proof: yes;"></span></div>
<div class="MsoNoSpacing">
<ul>
<li>SLP can move to the side of the image intensifier, behind
radiologist</li>
</ul>
</div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><b><u>Fluroscopy Collimation:</u></b></span></h5>
<h5>
</h5>
</div>
<ul>
<li>The radiation beam can be collimated to reduce scatter
and enhance the contrast of the image</li>
<li>If radiologist or tech does not collimate, request it <span style="mso-tab-count: 7;"> </span>(Kelchner,
2004)</li>
<li>Collimators can help change the shape (round, square) and
size (large, small) of the beam <span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqKW7YjH-0HL13eeS3guYg6R3jvMwC6rUsA5kATTZPQ1I8903lLFEryjAAlx40khN5_DNJNQxe4km079YPz8Q2bk1Eism30OZOmeALuAhBp_GMHhO6wQ3zG9bqp-_b9qiTrU4J7i9Eoz9J/s1600/mbs4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqKW7YjH-0HL13eeS3guYg6R3jvMwC6rUsA5kATTZPQ1I8903lLFEryjAAlx40khN5_DNJNQxe4km079YPz8Q2bk1Eism30OZOmeALuAhBp_GMHhO6wQ3zG9bqp-_b9qiTrU4J7i9Eoz9J/s1600/mbs4.jpg" /></a></div>
</span></li>
</ul>
<div class="MsoNoSpacing">
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><b><u>Panning:</u></b></span></h5>
</div>
<ul>
<li>A/P view of espohageal phase of swallow</li>
<li>Increases amount of radiation given off</li>
<li>Should be kept to minimum </li>
<li>No need for clinician to be close to patient</li>
<li>Stay back or step behind the secondary barrier<span style="mso-tab-count: 8;"> </span>(Kelchner,
2004) </li>
<li>More radiation required to go through thicker abdominal
tissue vs. pharynx, more scatter produced <span style="mso-tab-count: 3;"> </span><span style="mso-tab-count: 2;"> </span>(Hayes et al,
2009)</li>
</ul>
<div class="MsoNoSpacing">
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><b><u>FDA: Radiation Risks:</u></b></span></h5>
</div>
<ul>
<li>Radiation burns and/or radiation-induced cancer </li>
<li>Probability = very small </li>
<li> Radiation risk is usually far less than other risks
not associated with radiation, such as anesthesia or sedation, or risks from
the treatment itself. </li>
<li>Fluoroscopy should always be performed with the lowest
acceptable exposure for the shortest time necessary</li>
</ul>
<div class="MsoNoSpacing">
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><b><u>UofU Hospital Guidelines:</u></b></span></h5>
</div>
<ul>
<li>Part of Utah Administration Code R313-15-201</li>
<li>Occupational dose limit for adults: 5 rem/year (5,000
millirem)</li>
<li>Non-occupational dose limit (members of the public and
non-radiation workers): 0.1 rem/year</li>
<li>Pregnant worker dose limit: 0.5 rem/9 months</li>
</ul>
<div class="MsoNoSpacing">
<span style="mso-tab-count: 6;"> </span>(X-ray
Radiation Protection Manual, 2010)<br />
<ul>
<li>1 rem = 1,000 millirems (10 millisieverts)</li>
</ul>
</div>
<div class="MsoNoSpacing">
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><b><u>ALARA: As Low as Reasonably Achievable:</u></b></span></h5>
</div>
<ul>
<li>Risk-benefit approach</li>
<li>Considers amount of exposure + need for exposure </li>
<li>If a pt’s radiation exposure is below the limit, should
they receive radiation?</li>
<li>Depends on the need/benefit of the exposure<span style="mso-tab-count: 7;"> </span>(X-ray
Radiation Protection Manual, 2010)</li>
</ul>
<span style="mso-tab-count: 2;"> </span>-Professional
risk and benefit weighed differently than <span style="mso-tab-count: 1;"></span>patient
risk and benefit<br />
<span style="mso-tab-count: 2;"> </span>-No
radiation dose limit for patients (MD decides)<span style="mso-spacerun: yes;"> </span><br />
<span style="mso-spacerun: yes;"> </span>(P. Jenkins, personal communication,
August 13, 2013)<br />
<div class="MsoNoSpacing">
<span style="mso-tab-count: 6;"> </span></div>
<div class="MsoNoSpacing">
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><b><u>Dosimeter badges:</u></b></span></h5>
</div>
<ul>
<li>Utah Division of Radiation Control regulations <span style="mso-tab-count: 1;"> </span></li>
<li>Requires only those who have a reasonable chance of
exceeding 10% of the annual occupational exposure limit (5000 millirem) or
those who operate a fluoroscopic x-ray unit</li>
<li>Worn on collar (or waist or finger, if issued)</li>
<li>Best legal proof for radiation exposure at work</li>
<li>Make sure that all radiation exposure is recorded (esp.
unanticipated exposure!)</li>
<li>Good for radiation protection program</li>
<li>Fee for lost, damaged or “late” badges </li>
<li>Individual dosimetry report can be requested at any time</li>
</ul>
<div class="MsoNoSpacing">
<span style="mso-tab-count: 6;"> </span><span style="mso-spacerun: yes;"></span>(X-ray Radiation Protection Manual,
2010)</div>
<div class="MsoNoSpacing">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7KwevM8K6RG7AnTSBo5JlkBGXnBv4XD4sY2swrWGCapXBQZnKeOZRUsLg-mtOZsylbgdPncS_H8UIsJTLicku42EhAhy0z0PoM7t5agsMOZgPtQoCus0vnXP1bnoo-u-Qakl56visfjz8/s1600/mbs5.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7KwevM8K6RG7AnTSBo5JlkBGXnBv4XD4sY2swrWGCapXBQZnKeOZRUsLg-mtOZsylbgdPncS_H8UIsJTLicku42EhAhy0z0PoM7t5agsMOZgPtQoCus0vnXP1bnoo-u-Qakl56visfjz8/s1600/mbs5.png" /></a><span style="mso-no-proof: yes;"></span></div>
<div class="MsoNoSpacing">
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><b><u>Wearing Lead:</u></b></span></h5>
</div>
<ul>
<li>Leads are checked at least once/year</li>
<li>Not truly lead, but rubber material with some copper and
lead interspersed </li>
<li>1/2mm of lead-like material = min protection </li>
<li>1 lead apron will block 95% of primary beam</li>
<li>1 lead apron will block 99% of scatter</li>
<li>Different organs respond to radiation differently</li>
<li>Limits: </li>
</ul>
<div class="MsoNoSpacing">
Head and torso: 5,000mr/year</div>
<div class="MsoNoSpacing">
Eyes: 15,000mr/year</div>
<div class="MsoNoSpacing">
Extremities: 50,000mr/year</div>
<div class="MsoNoSpacing">
<br />
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><u><b>Reducing Radiation Exposure</b></u></span></h5>
</div>
<ul>
<li>Know rationale for conducting a study (or repeating one)</li>
<li>Investigating the appropriateness of referrals ensures
that fluoroscopy time is necessary</li>
<li>Rotating SLPs who do VFSS</li>
<li>Use FEES when possible if multiple studies will be needed</li>
</ul>
<div class="MsoNoSpacing">
<a href="http://www.blogger.com/blogger.g?blogID=7684287558065750242" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="http://www.blogger.com/blogger.g?blogID=7684287558065750242" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="http://www.blogger.com/blogger.g?blogID=7684287558065750242" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="http://www.blogger.com/blogger.g?blogID=7684287558065750242" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="http://www.blogger.com/blogger.g?blogID=7684287558065750242" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="http://www.blogger.com/blogger.g?blogID=7684287558065750242" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="http://www.blogger.com/blogger.g?blogID=7684287558065750242" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="http://www.blogger.com/blogger.g?blogID=7684287558065750242" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="http://www.blogger.com/blogger.g?blogID=7684287558065750242" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="http://www.blogger.com/blogger.g?blogID=7684287558065750242" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="http://www.blogger.com/blogger.g?blogID=7684287558065750242" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><span style="mso-tab-count: 7;"> </span><span style="mso-spacerun: yes;"> </span>(Kelchner, 2004)</div>
<div class="MsoNoSpacing">
<h5>
<span style="font-family: "fontdiner swanky"; font-size: large;"><b><u>Pregnancy and Radiation Exposure</u></b></span></h5>
</div>
<ul>
<li>National Council on Radiation Protection-no. 116
requirements:</li>
<li>Dose shall not exceed 5mSv to the fetus during 9 months
(0.5 mSv per month) </li>
</ul>
<div class="MsoNoSpacing">
<span style="mso-tab-count: 6;"> </span><span style="mso-spacerun: yes;"> </span>(X-ray Radiation Protection Manual, 2010)</div>
<ul>
<li>1 millisievert = 0.1 rem </li>
<li>Limited involvement with close sources of radiation, to
the extent practical</li>
<li>Work in protected areas or wear protective clothing when
radiation present</li>
<li>Wear additional pregnancy dosimeter at waist level (worn
under apron)</li>
<li>Monthly update with DRP</li>
</ul>
<div class="MsoNoSpacing">
<span style="mso-tab-count: 7;"> </span>(X-ray
Radiation Protection Manual, 2010)</div>
<ul>
<li>No justification to wear 2 lead aprons</li>
<li>If concerned, get thicker lead apron, but this is not really necessary</li>
<li>Can’t refuse to do radiation-related activities if under
radiation limit </li>
</ul>
<div class="MsoNoSpacing">
<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 6;"> </span>(P.
Jenkins, personal communication, August 13, 2013)</div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<h6>
<span style="font-family: "fontdiner swanky"; font-size: large;"><u><b>References:</b></u></span></h6>
</div>
<div class="MsoNoSpacing">
American Speech and Hearing Association.
http://www.ASHA.org </div>
<div class="MsoNoSpacing">
“Fluoroscopy Radiation and Safety Training Manual”
(n.d.). https://www.case.edu/ehs/Training/RadSafety/fluoro.htm </div>
<div class="MsoNoSpacing">
Hayes et al. (2009). Radiation safety for the
speech-language pathologist. Dysphagia, 24: 274-279. </div>
<div class="MsoNoSpacing">
Health Physics Society (2013). Answer to question #10592
submitted to “ask the experts.” https://hps.org/publicinformation/ate/q10592.html
</div>
<div class="MsoNoSpacing">
Kelchner, L.N. (2004). Radiation safety during the
videofluoroscopic swallow study: The adult exam. Swallowing and Swallowing
Disorders, 24-28.</div>
<div class="MsoNoSpacing">
“Radiation Emitting Products” (n.d.)
http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm115354.htm
</div>
<div class="MsoNoSpacing">
X-Ray Radiation Protection for Diagnostic X-ray use at
the University of Utah Hospitals and Clinics (2010). </div>
<br />
-------------------------------------------------------------------------------------------------------------------------<br />
<br />
That's it folks.<br />
<br />
Kristin<br />
<br />
<span style="font-size: xx-small;">(Note: I was having some serious trouble with formatting and inserting pictures into this post. I am aware of some of the inconsistencies in the formatting. I don't seem to be able to fix it. Need to take an HTML course I suppose. :) ) </span>Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com3tag:blogger.com,1999:blog-7684287558065750242.post-11388419066617056922013-09-19T08:43:00.002-06:002013-10-03T13:20:52.063-06:00Guest Post: Humor, the Secret to Early InterventionsWe've had several people request to write guests posts for our blog. We promise that we only agree when we feel that it adds a meaningful contribution. I liked this particular post because I work with a lot of children on the Autism Spectrum and many of them have a difficult time with humor. So, this one goes out to my fellow educational SLPs. Enjoy.<br />
<br />
<b>Humor is the Secret to Successful Early Childhood Interventions</b><br />
<br />
Humor is known to improve the quality of an individual’s life, it helps people manage stress, develop healthy social and communication habits, enhance creativity, and develop reading and language skills. The sound of a child’s laughter may be taken for granted as a naturally developing aspect of a child’s personality. However, a more sophisticated assessment of the development of humor in children requires an understanding of how the development of a child’s sense of humor is directly related to the development of the child’s cognitive, social, and linguistic abilities. When humor is viewed from this perspective, it becomes an overwhelmingly important aspect of the educational and development process. Humor may even be used as an intervention tool for children experiencing developmental challenges. <br />
<br />
In order to use humor as an intervention tool practitioners must first understand that situations, actions or words found humorous by children often occur when there is a violation of a social, behavioral, or linguistic norm. Therefore, a child’s ability to find something humorous relies on their ability to recognize these norms and understand actions or behaviors that would violate them. The chart below summarizes the stages of humor development in children, and provides examples of violations of recognized norms a child might find humorous. This data is described in the article <u>Head, Shoulders, Knees and…Peanut Butter What Makes Young Children Laugh</u>, by Paul E. McGhee.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkRX0YU1H22NE3M99r6diO2j8u6PWNoRbwRthlsVK4VSNd2XVHgq74jmDLS0fw7ItV7258EJrBegbcyvbvwIAggppoAYgkCcC2y5gI22ZKPoVV7TZhra4DscBIqgrYBs3xw2k0V5ye3P0m/s1600/humor+chart.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="270" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkRX0YU1H22NE3M99r6diO2j8u6PWNoRbwRthlsVK4VSNd2XVHgq74jmDLS0fw7ItV7258EJrBegbcyvbvwIAggppoAYgkCcC2y5gI22ZKPoVV7TZhra4DscBIqgrYBs3xw2k0V5ye3P0m/s400/humor+chart.jpg" width="400" /></a></div>
<br />
Using humor in an intervention has many benefits; it is useful in generating interest in the lesson, it may help explain complex concepts, and it may help develop a strong relationship between the child and the practitioner. In addition to these benefits, using humor in intervention techniques may serve to enhance the child’s social skills by improving the child’s confidence in their ability to tell jokes and be funny, and helping them to understand the jokes and play of their peers. <br />
<br />
<b>Consider the following example:</b> If a pre-school aged student is having difficulty recognizing or naming an object such as a pencil playing a game that uses the pencil in every way except for its intended use will explain why this play is funny and help the child to recognize the pencil’s intended purpose. To enhance language development rhyming games would help to improve the child’s memory of the pencils name and enhance the child’s understanding of the humorous nature of playing with different sounds. <br />
<br />
Using humor to treat developmental disorders in children has many mental health and social benefits. If you’re interested in helping children through their developmental stages of life, there are many career paths that allow you to help these kids such as <u>Speech Pathology</u>.<br />
<br />
The challenge of this treatment is in determining what level of development the child is at and appealing to that humor to make the therapeutic process fun and effective while enhancing social skills. Approaching the treatment of a child’s developmental disorders in a way to nurtures their humor helps develop necessary cognitive and language abilities and helps them to get along and play better with their peers.<br />
<br />
By Stephanie Small and edited by <a href="https://plus.google.com/u/0/105753525104891798074?rel=author">Laura Morrison</a>, the Content Manager of
GradSchools.com. For tips and information on continuing education in Speech Language Pathology,
please visit <a href="http://www.gradschools.com/search-programs/speech-pathology">
www.GradSchools.com </a>.
Bobhttp://www.blogger.com/profile/01018453723060771140noreply@blogger.com0tag:blogger.com,1999:blog-7684287558065750242.post-80137754396212581512013-08-08T15:25:00.000-06:002013-10-03T13:18:17.431-06:00Review of Sanapsis app for People with Aphasia and Cognitive Deficits<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKvMIC6IK1PkFwNsHzXc8WUYZJ7CMojuxn5Ce-6fTGa6IHwF6J8xz0mUn8zBYwpos006PDi6kBHQjfWTnSl1iL71yeZBxCsuctN8kjlcoTqcXSvXeqiTQ7zWlzsKLsjfRHn3KUU2qRqPUX/s1600/sanapsis2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKvMIC6IK1PkFwNsHzXc8WUYZJ7CMojuxn5Ce-6fTGa6IHwF6J8xz0mUn8zBYwpos006PDi6kBHQjfWTnSl1iL71yeZBxCsuctN8kjlcoTqcXSvXeqiTQ7zWlzsKLsjfRHn3KUU2qRqPUX/s1600/sanapsis2.jpg" /></a></div>
<br />
<br />
I was recently given the opportunity to try out the Sanapsis app. The app has picture naming cards, verb photo cards, cards to prompt questions and descriptions, sentence-building/unscrambling tasks, etc. I want to tell you some of the exercises I think will be helpful to use with my aphasic patients.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8CZsnFh29bbDqBB-BSMSb8aU6CCOmEZHffcvQJ_fyYpFd6BKBrDn7cAceo2uw_QZzcsIWwLtRZQ1aG3O_SGk9kXf7REqevaDYcQ-x5Q3-oZ8aEoT0-NFaWl21C9e57-KcMJI6jHVBw4vM/s1600/sanapsis1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8CZsnFh29bbDqBB-BSMSb8aU6CCOmEZHffcvQJ_fyYpFd6BKBrDn7cAceo2uw_QZzcsIWwLtRZQ1aG3O_SGk9kXf7REqevaDYcQ-x5Q3-oZ8aEoT0-NFaWl21C9e57-KcMJI6jHVBw4vM/s1600/sanapsis1.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Sanapsis App</td></tr>
</tbody></table>
<div style="text-align: center;">
<br /></div>
<br />
My favorites:<br />
Giving Instructions-- This is a unique task I haven't found in many other language apps. It gives prompts such as, "Give instructions on how to give a dog a bath." I get tired of picture and object description tasks for sentence and conversation elicitation. This is new, and having it on a tablet device or smart phone seems to spice things up a bit in therapy as well.<br />
<br />
Retell a Story-- I thought this was great, because every story contains humor in the punchline, and would allow for me to assess humor, abstract language skills, inferencing abilities in patients with higher-level cognitive deficits. I will definitely be using this with some of my R CVA patients who need practice understanding subtleties. Not to mention, it's a great memory exercise!<br />
<br />
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<br />
Organize a sentence-- This one (pictured above) requires the patient to put the sentence back in the correct order. Some would be pretty tough for my aphasic patients, but could work really well for some of the cognitively-impaired patients who need to work on sequencing, or cognitive organization. <br />
<br />
It was obvious that some of the naming and description pictures and word choices were more European/UK, but it could make for interesting responses from the patients and provide an opportunity for them to take initiative (e.g., "I don't really know what that is! Is it some sort of tool?") <br />
<br />
The app is about to come out with a new update including edits and many more pictures (they tell me it will have over 200 more words, and over 5000 more pictures). They were also really great about wanting my feedback and suggestions. Check it out at the app store! (Not yet available at the Google Play Store.)<br />
<br />
KristinKristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com0tag:blogger.com,1999:blog-7684287558065750242.post-77247670134451423292013-07-31T11:28:00.004-06:002013-07-31T11:28:38.275-06:00Guest Post: Communication Disorders and Social Security Disability BenefitsHello everybody!<br />
<br />
Occasionally we get requests from people who want to write guest posts. So, we are willing to post them if the content is good and it fits the spirit of the blog.<br />
<br />
I recently was contacted by Molly Clarke who wrote a guest post that would be greatly helpful to parents who are looking into applying for Social Security. I hope this information is helpful, if you have any questions for Molly you can contact her at <a href="mailto:mac@ssdhelp.org">mac@ssdhelp.org</a> or you can go visit her blog: <a href="http://www.disability-benefits-help.org/blog">Social Security Disability Help</a>.<br />
<br />
~bob<br />
<br />
<b>Childhood Communication Disorders and Disability Benefits</b><br />
<br />
Human communication is a vital component of daily life. Being able to communicate both verbally and non-verbally allows us to inform others of our wants and needs, it allows us to share our thoughts and ideas, and it allows us to enjoy basic human companionship. Unfortunately, for a significant number of children, communication disorders make it difficult—even impossible—to speak.<br />
<br />
Communication disorders can cause issues that impact the affected child as well as his or her parents. While some communication disorders can be corrected with therapy, others are more permanent and require lifelong treatment. Therapy, assistive devices, and specialty care can cause a significant financial burden. <br />
<br />
If your child has been diagnosed with a communication disorder, he or she may be eligible for financial assistance in the form of Social Security Disability (SSD) benefits. Although the SSD application process is known for being lengthy and overly complicated, benefits often provide a necessary lifeline for parents of children with communication disorders. Continue reading to find out if your family is eligible for assistance.<br />
<br />
<b>Childhood Disability</b><br />
<br />
To qualify for any sort of financial assistance through the Social Security Administration (SSA), children must first meet the SSA’s definition of childhood disability. Taken from the SSA’s website, this definition is as follows,<br />
<br />
A child under age 18 is disabled if he or she:<br />
<br />
<ul>
<li>Is not working at a job that is considered to be substantial work; and</li>
<li>Has a physical or mental condition (or a combination of conditions) which results in “marked and severe functional limitations.” This means that the condition(s) very seriously limits his or her activities; and</li>
<li>The condition(s) has lasted, or is expected to last, at least 1 year or is expected to result in death.</li>
</ul>
<br />
<br />
<b>Medical Eligibility Requirements</b><br />
<br />
In addition to meeting the SSA’s definition of childhood disability, your child will have to meet very specific medical regulations in order to qualify for SSD benefits. These regulations can be found in the SSA’s blue book. The blue book is an official manual of potentially disabling conditions and the medical criteria that qualifies each condition.<br />
<br />
The SSA recognizes the following disorders as disabilities (Although some of these disorders are not traditionally considered to be communication disorders, many are characterized by issues with speech and communication):<br />
<br />
<ul>
<li>Autism (112.10)</li>
<li>Personality disorders (112.08)</li>
<li>Psychotic disorders (112.03)</li>
<li>Organic mental disorders (112.02)</li>
<li>Mood disorders (112.04)</li>
<li>Hearing Impairment (102.10 or 102.11)</li>
</ul>
<br />
<br />
Children with communication disorders most commonly meet blue book listing 111.09- Communication Impairment Associated with a Documented Neurological Disorder. This listing requires that your child demonstrate the following symptoms:<br />
<br />
<ul>
<li>A documented speech deficit which negatively impacts the content and clarity of his or her speech; or</li>
<li>A documented comprehension deficit that has resulted in ineffective verbal communication based on his or her age; or</li>
<li>A documented hearing impairment.</li>
</ul>
<br />
<br />
It is important to note that if your child does not meet a specific listing he or she may still be able to qualify for SSD benefits if you can prove, using medical documentation, that he or she is not able to perform daily activities due to his or her communication disorder. To access all blue book listings, visit the SSA’s website, here: <a href="http://www.ssa.gov/disability/professionals/bluebook/ChildhoodListings.htm">http://www.ssa.gov/disability/professionals/bluebook/ChildhoodListings.htm</a><br />
<br />
<b>Disability Benefit Programs</b><br />
<br />
Although the SSA offers SSD benefits through two separate programs, children typically only qualify for SSI benefits. SSI stands for Supplemental Security Income and offers benefits to elderly or disabled individuals who earn very little income. Eligibility for SSI is based on an applicant’s income and financial resources. Because children do not earn income, they will undergo something called parental deeming. Essentially, parental deeming is the process of allocating a parent or guardian’s income and resources to the child.<br />
<br />
Learn what types of income are counted toward parental deeming, here: <a href="http://www.socialsecurity.gov/ssi/spotlights/spot-deeming.htm">http://www.socialsecurity.gov/ssi/spotlights/spot-deeming.htm</a><br />
<br />
<b>Start the Application Process</b><br />
<br />
Because, the application process can take months to complete, you should prepare and apply for SSI as soon as possible—this way, you will receive a decision sooner. Prior to submitting your application, be sure to have copies of all relevant medical records to support your child’s claim. Without medical proof, the SSA will not approve your child’s claim. In addition to medical documentation, you should also be prepared to submit proof of income and citizenship.<br />
<br />
Once you are thoroughly prepared, you can begin the process. This process will include two different forms— the “Application for SSI” and the “Child Disability Report”. Your child will also have to attend an in-person interview. Although the SSA has made it possible to complete the child disability report online, many parents prefer to fill out both documents at the time of their interview. Schedule your interview by calling the SSA’s main number: 1-800-772-1213.<br />
<br />
After completing and submitting your child’s application, it may be months before you receive a decision and you should be prepared for the possibility of being denied. If your child’s claim is denied, this decision is not final. You can file an appeal within 60 days of receiving your notice of denial.<br />
<br />
While this process is not simple, it is often necessary. Parents whose children qualify for SSI find that they can better provide for their children’s special needs with the assistance of Supplemental Security Income.<br />
<br />
For more information about SSI, visit <a href="http://www.disability-benefits-help.org/blog">Social Security Disability Help</a> or contact Molly Clarke at <a href="mailto:mac@ssdhelp.org">mac@ssdhelp.org</a>.Bobhttp://www.blogger.com/profile/01018453723060771140noreply@blogger.com0tag:blogger.com,1999:blog-7684287558065750242.post-52164681480960040342013-07-16T15:58:00.001-06:002017-09-20T22:36:57.894-06:00SLP jokes on tumblr - this made me laugh SO hard!Can I be honest? I don't really understand what tumblr is. Or should I say what A tumblr is? Not sure of the correct use of the word. I am starting to learn today, thanks to my lovely graduate student intern. :) She showed me this: http://whatshouldwecallslp.tumblr.com/<br />
<br />
It's a series of tumblrs (?) about being in SLP grad school. And many of them apply to SLPs who are working! What do you think? (There are pages and pages of these. I could watch them for weeks.)<br />
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Example #1:<br />
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My face when I go to do an assessment on a patient with aphasia and the family assures me they can talk just fine. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoAfG-XVVe5oBgobl_zHP1bm-SBiEJ8wiGzWclWpnXA1iENbM8QsJe8xfzaPoq1BUgPln0aOSEFQCIP87J7STG3Yprwx73a5n1SvAbYUI9fNuscwDjPy6KWD8UrOy2Y-sFHcdEL1anXxOT/s1600/tumblr_inline_mlu404LdFL1qz4rgp.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoAfG-XVVe5oBgobl_zHP1bm-SBiEJ8wiGzWclWpnXA1iENbM8QsJe8xfzaPoq1BUgPln0aOSEFQCIP87J7STG3Yprwx73a5n1SvAbYUI9fNuscwDjPy6KWD8UrOy2Y-sFHcdEL1anXxOT/s1600/tumblr_inline_mlu404LdFL1qz4rgp.gif" /></a></div>
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"I'll just double check anyways."</div>
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#2:</div>
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When a child is misbehaving in therapy, but the parents are watching, so you just have to be like:</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWcC5NoQpLtMi8sKqwcVvoD-Ba_MeExqdt7wnNnI2O2cbyaAhih1308A7S21QEurQXSgvpUOpOFDwRNAITMV93v_LeHAwxJNmANEro9geZonGEkhlif4mC81u53OOPpY13_ZH3j2kHAFhC/s1600/tumblr_inline_mo8eumsNfu1qz4rgp.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWcC5NoQpLtMi8sKqwcVvoD-Ba_MeExqdt7wnNnI2O2cbyaAhih1308A7S21QEurQXSgvpUOpOFDwRNAITMV93v_LeHAwxJNmANEro9geZonGEkhlif4mC81u53OOPpY13_ZH3j2kHAFhC/s320/tumblr_inline_mo8eumsNfu1qz4rgp.gif" width="320" /></a></div>
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Also, can you please explain to me about Tumblr or at least tell me how to use the word syntactically correctly? I'm a Speech-Language Pathologist for Pete's sake!<br />
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Love,<br />
Kristin<br />
<br />
PS: By the way, I also learned today that there are different tumblrs like this for almost any subject. Could this be a great therapy task? My brother sent me this one about Accountants. I don't get all their jokes, but I had some good laughs. Google this: #howshouldweaccountforme?Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com4tag:blogger.com,1999:blog-7684287558065750242.post-54894616309694799242013-07-10T17:08:00.001-06:002013-10-17T12:10:30.517-06:00More Short-Term Memory Therapy IdeasThanks for your comments and requests. Sounds like a couple of you would like another post about memory task ideas.<br />
<br />
Memory is one of my favorite things to work on with patients. I love teaching compensatory strategies. Maybe it's because I need them so badly for myself?
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<span style="font-size: xx-small;">Image courtesy of: http://mainepi.org/ALZ/Cafes.html </span></div>
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I usually start out each session with a quick memory quiz (What did you have for breakfast? What was you first therapy session this morning? Who is your nurse? What was for dinner last night? What time did your wife leave/arrive?) We also use the O-log and the Cog-Log protocols around here quite a bit.<br />
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Here are a couple of books I use a lot:<br />
<ul>
<li>WALC 10</li>
<li>HELP for Memory</li>
<li>The Source for Memory Exercises </li>
<li>One of my blog commentators recommended: <span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">"Memory
Rehabilitation: Integrating Theory and Practice" by Barbara Wilson</span></li>
</ul>
<br />
<span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Apps I like for short-term memory:</span><br />
<ul>
<li><span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Calendar App</span></li>
<li><span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Flick Flag (I have the patient come up with a memory "trick" (association, elaboration, visualization, etc.) for each flag as we study them, then we play the game to see what they can remember. It's great for learning how to come up with effective "tricks."</span></li>
<li><span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Simon (remember this memory game from the 80's?? Love it.</span></li>
<li><span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Brain Baseline has a couple of tasks for memory (and a lot of great tasks for improving processing speed!) </span></li>
</ul>
<br />
<span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Much of the therapy focuses on compensatory strategy training. </span><br />
<span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">We practice using the tools they will use in their home: calendars, calendar apps, day planner, notebook, post-its, alarms, association "tricks"/mnemonics, elaboration, chinking, rehearsal, visualization...</span><br />
<br />
<span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span>
<span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Other fun tasks:</span><br />
<ul>
<li><span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Index cards with faces on one side and names on the back. Again, we focus on associations to help remember the names (e.g., Nyla never likes to smile-a). I make sure they are effective (e.g., she looks like another Allison I know) vs ineffective (Tyler starts with T, tooth starts with T-- Tyler has big teeth! There are too many names that start with T.) I also like to try it the first time with no strategies so that they can see what a difference the strategies make.</span></li>
</ul>
<ul>
<li><span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Objects - I'll show a photo or drawing of several objects (or anything! A magazine picture with a bunch of foods...). I'll have them study it for 1-2 minutes and remember all they can. Then we'll list them out. Then I have them do it again with some strategies and associations (e.g., make up a story using the objects, or group them into meaningful categories). THEN, I'll do yes no questions to see what they can remember (e.g., Was there a hammer? Was there a beach ball? Was there a shoe?). </span></li>
</ul>
<ul>
<li><span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Sometimes I'll read a story/article/bit of information and have them answer questions afterward.</span></li>
</ul>
<ul>
<li><span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Prospective memory tasks: Prospective memory involves remembering to do something at a certain time or in a certain situation. Such as remembering to take a pill or feed your dog. I will give the patient tasks to remember at a certain time. This could be anything from remembering to hand my a paperclip every 5 minutes on the clock, to remembering to tell me the 3 facts I taught them about their favorite hobby (I pick facts they don't already know) at the beginning of our next therapy session. Etc., etc. There are a million ways to do this one. I could go on and on but you get the idea. They key here is that they try to initiate the task without my help. If needed, we add compensatory strategies or reminders.</span></li>
</ul>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh-9QH3UbBh_anceCUHsdisGKAc4bx5dD7ssdSwB4YK2e-B26VJNJn2ylHxOuKPM3zeKdMEMWX8FADe_fHcioT8oNf56IcdK8mHCyFYgKJ7UkZFJVe_JgZJ-HcoUbJ7bTWqci-RR4CUZ3b/s1600/erinscartioon.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="270" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh-9QH3UbBh_anceCUHsdisGKAc4bx5dD7ssdSwB4YK2e-B26VJNJn2ylHxOuKPM3zeKdMEMWX8FADe_fHcioT8oNf56IcdK8mHCyFYgKJ7UkZFJVe_JgZJ-HcoUbJ7bTWqci-RR4CUZ3b/s320/erinscartioon.jpg" width="320" /></a></div>
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<span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-size: xx-small;">Image courtesy of http://cognitivepsyc.tripod.com/id10.html</span></span><br />
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<span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-size: xx-small;"><span style="font-size: small;">Well, I could say more. But I would LOVE to hear your ideas! Do you have any to add? Post them, por favor, in the comments below.</span></span></span></div>
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<span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-size: xx-small;"><span style="font-size: small;">Until next time, </span></span></span></div>
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<span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><span style="font-size: xx-small;"><span style="font-size: small;">Kristin </span> </span></span></div>
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Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com7tag:blogger.com,1999:blog-7684287558065750242.post-90922841159777153672013-05-28T09:43:00.001-06:002013-10-21T11:55:45.519-06:00SLP Q&A's (from my email) Memory Therapy Task IdeasHi guys!<br />
<br />
I get a lot of email questions from young SLPs. I thought it might be fun to start posting their questions and my responses. Feel free to add your own comments!<br />
<br />
-Kristin<br />
<br />
Hi Kristin,<br />
<div>
<br /></div>
<div>
I just graduated with my Masters in
speech in May from the University of (withheld). I'm now working for a
hospital there where I was previously a student. I mainly see
inpatients, however my outpatient caseload is growing. Ive been seeing
one of my outpatients since I was a student and I was wondering if you
had any tips for functional working memory therapy tasks that might
spice up my therapy sessions. Thank you for your time! I am looking forward to any ideas/tips you may have!</div>
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<br /></div>
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Sincerely,</div>
<div>
Haley S.<br />
<br />
----------------------------------------<br />
Hi Haley,<br />
<br />
Do you mind if I post your question on the blog?<br />
Ummm, how about the following:<br />
<br />
1) I'll ask them to imagine a 4x4 matrix and I name 4 letters and 4 categories. (this is a high level task). <br />
I'll have them mentally fill in the chart. They have to remember the
letters and categories on their own. (E.g., for slot 1, they'd name an
animal that starts with B)<br />
<br />
2) I'll ask them to listen to 3-5 words, and then repeat them back in alphabetical order<br />
<br />
3) Same task as #2, but repeat them back in reverse order<br />
<br />
4) Mental math problems where they have to remember the problem's elements as they work it out.<br />
<br />
That's
just a quick list. I'm trying to be working memory-specific here. I
can think of a lot of other short term memory tasks I like (most of
which focus on some aspect of compensatory strategy retraining). Does
this help?<br />
<br />
Thanks for reading!<br />
<br />
Kristin<br />
<br />
***note: Haley did agree to let me post her question. :)<br />
Can you add some more memory task ideas? Also see my 2 other memory task posts! </div>
Kristinhttp://www.blogger.com/profile/12759525741172489782noreply@blogger.com8