MORE Memory Therapy Task Ideas

 Memory troubles are just the worst!

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 here and here in the past.  This post just has more!  These are ideas gathered from several SLPs and students.  Comment and let us know what you do for memory!

(The cat realizes she left something in the oven.)

• Functional Strategies
• Associations
• Chunking
• Calendars
• Visual Memory/Mental Imagery
• Use of Alarms
• Writing things down in a planner or notebook
• Daily log
• Daily checklist
• Mnemonics
• Visual reminders
• Post-its
• Written instructions to-self
• Rehearsal
• Tasks
• 3 Facts
• Prospective memory: ask them to initiate telling them to you at a specified time.
• Have them make up a memory strategy to remember each
• Word list retention
• The Simon Game app (there are several variations/apps like this)
• Recalling 4 categories as they go through a 4x4 categorization matrix
• The “Help for Memory” book is great
• 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
• 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.)
• Hide 3-4 objects around the room (good for non-verbal patients)
• Have them remember a hand shake combo (also good for non-verbal patients)
• Apps with “concentration” game
• Practice strategies for remembering faces or photo cards
• Practice strategies for memorizing state abbreviations
• Chunking word lists (Help for Memory p. 52)
• Using visualization to remember information (Help for Memory p. 101)
• Taking notes from material presented out loud (Help for Memory p. 103)
• Associate visual objects (The Source for Memory Exercises p. 81, 83)
• Mental Manipulation - read patient 3 words, have pt. say them back in alphabetical/chronological/reverse order (ie. “October, April, February” → “February, April, October”)
• Visual Memory: Have the patient use a chunking strategy to recall 12 pictures (The Source for Memory Exercises p. 152, 153)
• Identifying “key” information: Read sentence to patient, have patient identify key words to simplify encoding. (Help for Memory p. 21)
• 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.)
• Cog-log worksheet (more difficult than it's famous sister worksheet- the O-log)
• WALC 10 workbook is great.
• Practice using day planner or electronic day planner (calendar app)
• 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!
• Mental math with no writing things down
• 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
   Book: "Memory Rehabilitation: Integrating Theory and Practice" by Barbara Wilson.
  "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

Hope you got some new fodder for your sessions tomorrow.  :)   

Don't forget to comment- 

I need some fresh ideas!  

What do you use for working on memory deficits?

-Kristin

Speech Therapy Task Ideas for Treating Attention

Attention skills and avoiding distractions can be tough to target.

What do you do to target attention skills?

Even the Phantom struggles with attention span issues...

For my next few blog posts, I will be sharing portions of a student SLP project by Janelle Barrett.

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 separate post.  For this post, here are all the treatment task ideas for working on attention...  Functional, structured, high-level, low-level. These are ideas for sustained attention or focus, unless otherwise specified.  Please please please, comment and add some of your own!  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.

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:

• Focused Attention - the ability to respond discretely to specific visual, auditory, and tactile tasks.
• Sustained Attention - ability to maintain cognitive dedication to a specific, continuous, or repetitive task.  requires vigilance and working memory.
• Divided Attention - ability to respond or attend to multiple stimuli at once.  E.g., watching a small child while cooking a stir fry. Multitasking. 
• 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. 
• 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. 

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.

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.  

Tasks for targeting Attention skills:

• Compensatory strategy training:  
•  use of a timer to give breaks and goal time for maintaining attention to a given task
• turning off other sounds and distractions 
• Using finger to follow along when reading
• Reading aloud
• Changing the pace of reading
• Making a list of disctractions or things that have helped you
• Making a schedule of tasks to do do 
• Educate the family so they or visitors are not distracting
• Try performing a task with music on and then with music off to assess the effectiveness
• 
  
• Focused attention: listening for a certain sound. 
• Connect the dots 
• Build an object based on written/picture instructions (could also target sequencing) 
• Word search 
• Sudoku (also could target Info processing and reasoning) 
• List of words (find or list all words that start with __ ) 
•  unscrambling words, sentences
• putting words (or the words form a sentence) in alphabetical (or sequential) order (e.g., smallest to largest, earliest in the year to latest)
• Calculating money amounts in ascending or descending order (e.g., 3 nickels, 2 dimes; 5 quarters, 4 pennies 2 nickels).
• Word creation - provide a long word for patient to hold in memory and make smaller words out of a big word
• App: Jumbline 2
• Timer: attend for ___ minutes without a break
• Reading comprehension/auditory comprehension task
• Visual attention/neglect: 
• letter/digit/symbol cross-out task, aka: cancellation worksheet
• reading words, sentences, then paragraphs, and articles
• Visual attention strategies: highlighting the side of the page, numbering the lines, following along with a finger, finding the edge of the page.  
• 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.) 
• Myers and Mackisack suggest 2 techniques:
• 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. 
• 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. 
• Following multi-step directions 
• Following complex written directions (e.g., "Place a line under each word that begins with a vowel.")
• APT (Attention Process Training)
• “Find the differences” picture/apps
• “Find the hidden objects” Apps
• I Spy Book
• Where's Waldo book or app
• Brain baseline app (also has alternating attention)
• Doodle Find app
• Little Things app
• Short video with quiz questions after (like practicing for listening in school) 
• Divided Attention: 
• Could really do ANY of the attention tasks listed in this post but do them simultaneously
•  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
• Sort a deck of cards while listening to spelled words (and then stating the word)
• rearrange the letters of scrambled words for increased difficulty

• Completing a number pattern (verbally)
• Math story problem
• Decoding worksheets
• Finding differences; easy to hard levels- attention to details
• IPad app: Differences
• Providing navigational directions to another person (Focus on Function p. 156)
• Describe 5+ features/parts/characteristics of a given object
• iPad app: Museum search (high complexity level)
• iPad app: Doodle pro (timed, min-complexity)
• iMazing, iPad app (mazes of increasing complexity)
•  Listing (find all words that start with __ )

• Selective Attention:
• turning on the radio while giving instructions to the patient and during task
• open the therapy office door
• treat them in a busy area
• open the window
• talk with someone else or make a phone call while they complete a pen and paper task
• tap the table with a pen or move your foot within their sight, turn pages of a book, or type on a computer. 
• 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. 
• Ask client to listen for only one of two voices on a recording and ask questions about what the voice said. 
• listen for key words in a paragraph (or sentence)
• Alternating Attention: 
• On paper randomly put the letters A-J and numbers 1-10 have pt alternate between number and letters in ascending order
• 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
• “Think It Through” tile game (we ordered this through Discovery Toys)
• Task switch with cards: odd/even & high/low (also on the iPad)
• Stroop tasks (both interactive- computer and on paper) color task, directionality, number task, objects task
• Motor--Card sorting tasks (There are various.  We actually have a book of these tasks!)
• Motor--Sort coins, small objects, photo cards colored rubber bands or paper clips, inventory pages, coupons, magazines by month, folders or papers. 
• Respond to yes/no questions or simple WH- questions, open ended questions, opinion questions, state the advantages/disadvantages of a situation.  
• Use phone or navigate the internet, send an email.
• Solve math problems
• Unscramble words, generate items in a given category, put a target word into a sentence
• Fruit Ninja, Dr. Ben (iPad)
• 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.)
• 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). 
• 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).
• 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. 

So, whaddya think?  Did you find any good ones?

Now be sure to comment and help us add to the list!!  What do you use to target attention skills in your patients?

-Kristin

Look 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? 

Get to the online version of the article via ASHA's website here.

See our post about short-term memory therapy ideas here. 

 Thanks for reading!  

 Kristin 

My news!!!

Ahem... Hey guys, I have something personal to announce...

I'm pregnant!!!

15.5 weeks along, and feeling much better than I was. This was me at 12 weeks...just starting to show:

And no, I didn't make my bed (yet) that day.  :)

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.

 12 week sonogram.

-Kristin

Radiation Safety and Guidelines During MBS / VFSS for SLPs and Patients

Hi friends,

I have had some awesome student interns lately.  Each of them completes a student project 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.

Image source: http://lc19.blogspot.com/2010/06/meet-readi-cat-worse-than-drinking.html

The story:
We have had several issues lately regarding confusion about how much radiation is too much, how many frames per second is safe, 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.  How can we convince the techs that this is not that much more, and is safe for them and the patients (and is it??)?  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.  I thought she did a fantastic job!  Some of the guidelines are specific to our hospital , so you would have to research your own hospital's guidelines.  Some of the questions Amelia investigated included:

• An MBS/VFSS exam is equivalent to how many hours in the sun?
• How much protection does the lead provide?
• Where do SLP's need to stand in order to avoid radiation scatter during MBS/VFSS?
• What is the pattern of the radiation scatter during the MBS/VFSS?
• How much more radiation is the patient receiving when the frames/second are increased?  
• What are the guidelines from pregnant patients and SLPs/therapists/techs?
• Should we wear lead or radiation-resistant gloves and goggles during MBS/VFSS procedures? 
• What are the radiation dose limits for SLP's and patients?

She interviewed the hospital's radiation physicist, the Radiology PA, looked up hospital and State guidelines and scoured ASHA and research articles.

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.  :)
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Radiation MBS/VFSS Safety Information:

What Is Radiation?

• Energy in the form of particles and waves
• Ionizing: X-rays and gamma rays
• Some x-rays enter body and interact partially, completely, or not at all
• Denser tissue absorbs more radiation than less dense tissue

Local Radiation Regulations (Utah):

• www.radiationcontrol.utah.gov
• Utah law mirrors the federal laws

Radiation Dosage info:

• Radiation is all around us
• Inverse square law (radiation received and distance from source)
• Received through naturally occurring radionuclides (soil, food, water) and through radon indoors
• 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. 
• No “zero dose” of radiation exists!

                                                                                                                       (ASHA, 2004)

• Naturally occurring: 300millirems/year
• 300mr added from medical and man-made sources (mostly in latter years of life)    

Radiation Safety Education:

• Education on radiation safety is not standard in graduate programs for speech pathology
• SLP’s responsibility to be aware of guidelines, etc. to reduce radiation exposure to self and patient  

ASHA Guidelines on Radiation;

• Guidelines for Speech-Language Pathologists Performing VFSS:
• 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” (ASHA, 2003). Furthermore, individuals should consult state licensure laws regarding speech-language pathologists (SLPs) utilizing the VFSS in their particular state.

Average VFSS/MBS Radiation Exposure:,

• Average: 1 millisievert
• Exposed to 50 millisieverts in first 17 years of life
• Low dose and low risk procedure
• Little radiation exposure and dose = no risk when compared to medical benefit
• Reducing exposure

1) Time that fluoroscopy is on
2) Distance from the source and patient
3) Shielding

Fluoroscopy time during a study:

• Should not exceed 5 minutes (if possible)
• Less time spent in fluoro = less radiation exposure

C Arm:

• The arm is the source of radiation to patient 

Scatter:

• Radiation emitted from the patient (not the direct beam)
• Radiation hits the patient’s tissue, interacts and then changes direction
• Decreased by a factor of 1,000 for every 1 meter in distance

                                                      (P. Jenkins, personal communication, August 13, 2013

• Distance from the beam
• Distance of 6 feet or more from patient:
• Exposure due to scatter and leakage radiation from x-ray tube is so small that wearing apron does not add much protection

                                                                                        (X-ray Radiation Protection Manual, 2010

• SLP can move to the side of the image intensifier, behind radiologist

Fluroscopy Collimation:

• The radiation beam can be collimated to reduce scatter and enhance the contrast of the image
• If radiologist or tech does not collimate, request it                                                                                                        (Kelchner, 2004)
• Collimators can help change the shape (round, square) and size (large, small) of the beam                           
  

Panning:

• A/P view of espohageal phase of swallow
• Increases amount of radiation given off
• Should be kept to minimum
• No need for clinician to be close to patient
• Stay back or step behind the secondary barrier                                                                                      (Kelchner, 2004)
• More radiation required to go through thicker abdominal tissue vs. pharynx, more scatter produced                                                                       (Hayes et al, 2009)

FDA: Radiation Risks:

• Radiation burns and/or radiation-induced cancer
• Probability = very small
•  Radiation risk is usually far less than other risks not associated with radiation, such as anesthesia or sedation, or risks from the treatment itself.
• Fluoroscopy should always be performed with the lowest acceptable exposure for the shortest time necessary

UofU Hospital Guidelines:

• Part of Utah Administration Code R313-15-201
• Occupational dose limit for adults: 5 rem/year (5,000 millirem)
• Non-occupational dose limit (members of the public and non-radiation workers): 0.1 rem/year
• Pregnant worker dose limit: 0.5 rem/9 months

                                                                                     (X-ray Radiation Protection Manual, 2010)

• 1 rem = 1,000 millirems (10 millisieverts)

ALARA: As Low as Reasonably Achievable:

• Risk-benefit approach
• Considers amount of exposure + need for exposure
• If a pt’s radiation exposure is below the limit, should they receive radiation?
• Depends on the need/benefit of the exposure                                                                                (X-ray Radiation Protection Manual, 2010)

                                -Professional risk and benefit weighed differently than patient risk and benefit
                                -No radiation dose limit for patients (MD decides)                                    
                                       (P. Jenkins, personal communication, August 13, 2013)

                                                                                               

Dosimeter badges:

• Utah Division of Radiation Control regulations   
• 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
• Worn on collar (or waist or finger, if issued)
• Best legal proof for radiation exposure at work
• Make sure that all radiation exposure is recorded (esp. unanticipated exposure!)
• Good for radiation protection program
• Fee for lost, damaged or “late” badges
• Individual dosimetry report can be requested at any time

                                                                                             (X-ray Radiation Protection Manual, 2010)

Wearing Lead:

• Leads are checked at least once/year
• Not truly lead, but rubber material with some copper and lead interspersed
• 1/2mm of lead-like material = min protection
• 1 lead apron will block 95% of primary beam
• 1 lead apron will block 99% of scatter
• Different organs respond to radiation differently
• Limits:

Head and torso: 5,000mr/year

Eyes: 15,000mr/year

Extremities: 50,000mr/year

Reducing Radiation Exposure

• Know rationale for conducting a study (or repeating one)
• Investigating the appropriateness of referrals ensures that fluoroscopy time is necessary
• Rotating SLPs who do VFSS
• Use FEES when possible if multiple studies will be needed

                                                                                                                     (Kelchner, 2004)

Pregnancy and Radiation Exposure

• National Council on Radiation Protection-no. 116 requirements:
• Dose shall not exceed 5mSv to the fetus during 9 months (0.5 mSv per month)

                                                                                          (X-ray Radiation Protection Manual, 2010)

• 1 millisievert = 0.1 rem
• Limited involvement with close sources of radiation, to the extent practical
• Work in protected areas or wear protective clothing when radiation present
• Wear additional pregnancy dosimeter at waist level (worn under apron)
• Monthly update with DRP

                                                                                           (X-ray Radiation Protection Manual, 2010)

• No justification to wear 2 lead aprons
• If concerned, get thicker lead apron, but this is not really necessary
• Can’t refuse to do radiation-related activities if under radiation limit

                                                                        (P. Jenkins, personal communication, August 13, 2013)

References:

American Speech and Hearing Association. http://www.ASHA.org

“Fluoroscopy Radiation and Safety Training Manual” (n.d.). https://www.case.edu/ehs/Training/RadSafety/fluoro.htm

Hayes et al. (2009). Radiation safety for the speech-language pathologist. Dysphagia, 24: 274-279.

Health Physics Society (2013). Answer to question #10592 submitted to “ask the experts.” https://hps.org/publicinformation/ate/q10592.html

Kelchner, L.N. (2004). Radiation safety during the videofluoroscopic swallow study: The adult exam. Swallowing and Swallowing Disorders, 24-28.

“Radiation Emitting Products” (n.d.) http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm115354.htm

X-Ray Radiation Protection for Diagnostic X-ray use at the University of Utah Hospitals and Clinics (2010).

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That's it folks.

Kristin

(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.  :) )

Guest Post: Humor, the Secret to Early Interventions

We'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.

Humor is the Secret to Successful Early Childhood Interventions

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.

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 Head, Shoulders, Knees and…Peanut Butter What Makes Young Children Laugh, by Paul E. McGhee.

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.

Consider the following example: 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.

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 Speech Pathology.

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.

By Stephanie Small and edited by Laura Morrison, the Content Manager of GradSchools.com. For tips and information on continuing education in Speech Language Pathology, please visit www.GradSchools.com .

Review of Sanapsis app for People with Aphasia and Cognitive Deficits

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.

Sanapsis App

My favorites:
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.

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!

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. 

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?") 

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.)

Kristin