Wednesday, March 11, 2015

How I Use Apps in Skilled Nursing for Cognitive Therapy

Five years ago I would have said you were crazy to pull out a computer with my geriatric population. Today I say, KEEP IT CHARGED!

I started using my iPad during speech therapy over the last couple of years to initially increase my productivity in an ever increasing competitive PRN SNF job where you are either 90% productive or you don't get called back! Not only did I begin carrying the laptop with me all the time so that I could be documenting as the patient ate, played BINGO, got dressed, and other seemingly odd activities, but I also carried my iPad JUST IN CASE I got to the patient's room and they were in bed. If you live in my world, you know every minute counts. You cannot wait even 10 minutes for a patient to get up and come to the therapy room. Sometimes patients REFUSE to get up. (That's their right!)

What then? Open up the iPad!

It was much easier making multiple trips, carting around binders, cards and games back and forth from the therapy room to patient rooms.

One of the first things I used the iPad for was simple naming, word finding and expanding language from photos. I took Google images of familiar ADL items and saved them into my photo album. I would just swipe them have the patients name them, give a definition, tell their function, tell what goes with them, etc.

The patients, at that time, were just AMAZED at this little device that had "such clear pictures" and that "held so much information!" (Adorable, I know.) This was probably early 2012. 

I then had a patient who was in for therapy short term but who suffered dementia and was WAY out of her element. She missed her precious little apartment that she lived in with a full time caregiver. All around her apartment were family antiques to keep her grounded, familiar items that made her happy because she remembered them and she could talk about them competently to any visitor. 

Unfortunately we could not move everything (especially her unbelievable craft room) to our tiny two per person room living quarters at the LTC facility. I asked her caregiver to take pictures and send them to me of everything she was proud of in her apartment. She faithfully did so and we got them uploaded onto the iPad. The patient was now able to see her beloved belongings and tell other residents and staff about her treasures. Her communication had intent and she was better adapting to her current living situation.

Since the patient was so successful and her communication improved so much with these pictures to talk about, I began saving pictures of things as patients would say "we used to have..."

I came up with pictures of butter churners, rotary dial telephones, the milk man, radios, record players, etc. These pictures would create so much conversation. Even patients who couldn't communicate well would study them fiercely and answer questions in short phrases/comments about them, ALWAYS with a smile or a laugh. The pictures were easy to access and I could carry HUNDREDS with me all the time. ...again, they were fascinated!

As my children began using apps to entertain them, I realized they were also performing some simple and more complex cognitive tasks! I think the first app I tried with a patient was a puzzle app that my daughter LOVED. We tried the free version first but loved it so much we soon downloaded the full version once my patients started using it. 

Still to this day, I use this app EVERY TIME I work at the SNF.

I had always used jigsaw puzzles for visual problem solving and attention to task. Then I ran into a few patients who would immediately let me know, "I HATE puzzles!" I didn't want to overtly inform them that they probably HATE them because they are too hard for them to attend to and figure out, so I just snuck this little "game" in front of them and provided them with verbal and visual cueing as necessary to accomplish it. I like this app because the finished puzzle creates a picture. The one below makes a picture of cherries. It is fun to let them examine it before completing it and "predicting" what the picture will be. Sometimes they are spot on...other times not so much!

Once they mastered six or seven "puzzles" in a row, we would move on to another more functional task...usually NOT jigsaw puzzles!

You can click my affiliate link here to download this app:


I have also co-treated with PT and OT while patients are standing in a standing frame, at a rolling bedside table raised to standing height, or while they are lying on a mat table and the PT needs them distracted while they have to range their newly replaced knee or hip. 

I have taken the iPad in isolation rooms where patients have little to NO interaction or fun simply by placing it in a gallon sized zip lock bag.

The second app I began using and STILL use DAILY when I work PRN at the SNF is a memory app. What I LOVE about this app is that you start with only two cards. ANYONE can touch the two cards and get a match. Advance the skill level each time a game is completed by pushing "next" and adding more cards to the game. Sometimes the patients really get into this game and LOVE the challenge. 

Sometimes it is really hard and frustrating, so we just go back a level, decreasing the amount of cards in the game. This app has ads running at the top of it but they can typically be ignored once the patient gets the hang of it. If they keep touching the flashing ad at the top of the page, just tape a strip of paper over it and voila! It's gone.

You can click my affiliate link here to download this app:

Since these two apps are my absolute favorite apps, I will pause here for now.

I would like to know any FREE apps that you use in #snfspeech. Can you please comment below with your favorite FREE apps? I would like to try them out and want others to give it a try in their therapy sessions as soon as possible!

To see more activities appropriate for Speech Therapy in 
Skilled Nursing Facilities click on each of these posts:


2 comments:

Emily Stephens said...

I've recently used MemoryBlock to target short-term memory and impulsivity :)

Darla said...

I will look into that Emily!