Sunday, July 26, 2015

More Than Just Apps: Creative and Skilled Therapy Using the iPad

In my previous post, I showed some examples of and linked to some of my favorite apps to use in the SNF and LTC for your speech therapy sessions.


Today I would like to show you another way I have used the iPad when working with patients.
If you are working in the SNF setting, you know how competitive it can be to be productive and efficient. Quite often there will be that patient who for whatever reason will need to be seen by more than one discipline at the same time. Instead of getting frustrated or having unbillable, unskillable minutes in your day, work together to achieve what is most beneficial to the patient.




In the event that a co-treatment is necessary, we MUST keep in mind that both disciplines need to be performing separate and skilled treatments. ASHA clearly outlines what are skilled and what are unskilled services under Medicare guidelines. 

Here are two examples of how Speech-language pathologists use their expert knowledge and clinical decision-making to perform skilled services: 
  • Develop and deliver treatment activities that follow a hierarchy of complexity to achieve the target skills for a functional goal.
  • Based on expert observation, modify activities during treatment sessions to maintain patient motivation and facilitate success by:
  • Increase or decrease complexity of treatment task.
  • Increase or decrease amount or type of cuing needed.
  • Increase or decrease criteria for successful performance (accuracy, number of repetitions, response latency, etc.).
  • Introduce new tasks to evaluate patient’s ability to generalize skill.
Keeping those points in mind, let's look at a common activity that you will see in the therapy room any given hour. The OT was using the Omnicycle as a ROM and strengthening task. The patient had used the Omnicycle many sessions prior so she was familiar with it. This patient had difficulty with divided attention during ADLs posing a safety risk as she was becoming more independent in her room and planning on returning home.

We had already worked on attention sitting at the table in a crowded and noisy therapy room by completing peg patterns of increasing complexity, working on large print word find puzzles, simple jigsaw puzzles, etc. This patient really enjoyed using the iPad so apps were introduced early on for problem solving and attention skills.



It was time for me use my professional judgement and knowledge to advance along a hierarchy of complexity to achieve the short term goal which was to divide attention between a cognitive and motor/mobility task while demonstrating adequate safety, problem solving and reasoning skills across a 10 minute period with less than 10% visual and verbal cueing.

On this day, I introduced a new task to evaluate this patient's ability to generalize the skills she had mastered at the table on over across the room on the Omnicycle where she was actively performing another task.



Using the iPad and an app by Super Duper, Inc. called Let's Name Things, the patient was able to ...with heavy cueing for memory and attention... name four or five items in each category. By remaining close to the patient and providing constant support, I was able to decrease the complexity of the task by giving her clues when she was stuck, like describing a word in the category by feature/function. She then became more engaged as her success level and confidence increased.

As you become more flexible with your treatments and your idea of what therapy should look like, you will see that your patients become more engaged, motivated, and willing to participate with new and interesting activities.

I look forward to hearing how you use your iPad in unique ways throughout your day! Please feel free to share comments below...

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