Monday, January 26, 2015

SNF Speech Today: Reminisce and Expressive Language

Sometimes all you have is 23 min to see a patient. That patient is more than likely going to be in bed if you are working PRN at a SNF on the weekend. 
In this world of 95% productivity standards, every minute counts. It would take 10 minutes to go back to the therapy room and find some notebook with random expressive language drills in it. 
So you are in a room where a patient is in bed, don't know the patient because you are only PRN, and don't have any therapy materials with you. 

Well, look around. You are surrounded by therapy materials. See that picture on the wall of the young couple smiling and clinging to one another? The one where he is in a uniform and she barely looks 16? Chances are one of those people are laying in that bed! Pull it off the wall and ask "Well who is this handsome man? Or who is this striking young lady?" First thing you will get is a smile. Second thing you will get is a "me!"
Ask about the dress she's wearing, Or the hat and shoes. More than likely they made the dress and the hat was a graduation present. 
Grab the Bible on his/her night stand. This weekend when I opened it, there was one verse written on the back cover. As I read aloud how Jesus told Thomas to touch his hands and his side, it was apparent in my patient's eyes how important this particular passage was to her. We talked about faith and believing in Christ.
I then opened up the photo album which her family had so graciously labeled every picture with names and dates. This was great for memory and naming. Her single word utterances expanded to two and three and four word sentences. We talked about the houses in the photos and the cars. We talked about the dresses that the little girls were wearing. 
Before I knew it, my 23 minutes was up and I had to get on to my next patient. I went in not knowing this lady and left seeing her as a beautiful 20 year old, clinging to her husband who was home for a few weeks from the war, caring for her children and grandchildren, working in her flower beds, sewing dresses for her daughters, wearing a fancy new hat on Easter, playing at the beach with her grandchildren, loving her dogs and cats, and spending time in God's word.
I encourage you to think outside the box. Everything we did was related to this patient's goal of increasing orientation and memory. Her goal of responding to WH questions and yes/no questions was also addressed with a few spontaneous utterances. Think about the quality of the conversational exchanges and be sure and document that you used personal items in the patient's room to influence and encourage language. Mention alertness and attention to personal belongings. Medicare needs to know these are individuals, that our professional skills were required to bring the language out of the patient in a unique way that others could not. 
I would love to hear how you used personal items to aid in communication in comments:   .....

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