Life lately

 

I have not blogged since January.  I felt really emotionally drained after the death of one of my clients – see here.  Then I just got so unbelievably busy and feel like I’m only just coming up for air.  My clients are starting to think about their summer holidays and I can see a slight lift in the pressure coming up.

I’ve been getting really stuck into some very complex clients, but achieving some really satisfying results.  I have two clients who are just above a minimally conscious state who are both making pleasing strides with their communication – one with a Tobii I-15  and one via training of a head nod/shake.  I will be back to update properly soon!

 

 

Week in review 

  
I haven’t done a week in review post for a while. 

Highs:

  • Client with severe prosody changes asking me if I want a cup of tea with a normal voice
  • Driving in -5c through Oxfordshire countryside to see a client and the icy branches looked like Narnia
  • An MDT meeting where all professionals were on the same page & being re-energised with a very challenging case
  • Eating breakfast and lunch every day, even though most were eaten in the car
  • Low level client smiling at one of my terrible sketches

  
Lows: 

  • Staying up until midnight to finish a report on Monday night- not a good way to start the week & I should know better by now!
  • Lots of little traffic queues adding up to a big accumulation of lateness and added stress by the end of each day
  • Drowning in emails and not through them yet!

What have been your highs and lows this week? 

This week I lost a client…

  
This week one of my long term clients died from a progressive neuro disease. Working in private community neuro- rehab, my clients don’t often die- most do not have progressive diseases. However, as with the last death a few years ago, I feel so raw. It’s a different grief compared to a family member /close friend dying, but I’m still overwhelmed by the intensity of my feeling. I’m seeing him everywhere, everything is reminding me of him, I keep shedding tears at unexpected times. 

This client taught me so much. A tough case for a number of reasons which has kept me on my toes for two years. A huge amount of background work with a big multi disciplinary team which has taken a lot of my time. My first proper experience of reminiscence therapy as a communication therapy tool (and what a powerful tool it is). I also read this book twice in its entirety whilst treating this client. 

The best part of working with this client was our 1:1 sessions in the middle part of his disease progression when he was still able to communicate well enough to talk about the past. Despite being a jargon aphasic he was a powerful communicator. He was a specialist in a particular type of engineering and had the most amazing life. We built up a strong relationship bonding over his past- this relationship stood me in good stead when he deteriorated further and needed help in the unfamiliar environment of a hospital and required input for his swallow. 

This quote fits my client so well. As his disease progressed the very essence of him was still there right to the end and I love & respect him for that. 

Do not go gentle into that good night,

Old age should burn and rave at close of day;

Rage, rage against the dying of the light.

Dylan Thomas, Do Not Go Gentle Into That Good Night

The Inspiration Series 1: My Dad 

My interview series looks at other neuro speech and language therapists. This new series explores people outside of the profession who inspire my working life.

On my dad’s 70th birthday it’s fitting that he is the first person to feature. He was my earliest role model of someone who is not afraid of hard work  and his work ethos sticks with me very strongly today.

My dad when I growing up:

I am the 3rd of 6 children (4 girls and 2 boys). Despite my dad being a very traditional person on paper, in reality he treated the girls no different from the boys. I used to beg him every weekend for ‘wood and nails’ and he would bring out all his scrap pieces of wood and his tool-kit and let me and my sister make whatever we wanted. He taught us to mow the lawn, do DIY jobs, take stuff to the tidy tip etc. I had not heard of the concept of ‘blue jobs’ and ‘pink jobs’ until I was older and I was horrified!  However my two girls  have strong ideas of girl and boy jobs, even at their young age. Thanks to my dad, my husband and I try and instil in them the fact they can do anything they put their mind to- they don’t need a prince to come along and rescue them. We know there is a huge problem of a lack of women in science, particularly areas such as engineering.  (As an aside – I love the book Rosie Revere Engineer as an inspirational book for girls).  If more dads did what my dad did, then the science gender gap might have closed a bit more!

My dad on my school work:

My dad didn’t expect academic excellence but he did expect that we performed to our potential. He was particularly hot on our handwriting being the best it could be, and taking the time to do our work properly so homework wasn’t a ‘sloppy job’. Recently he handed me a folder full of my reports and certificate he had kept throughout my school life. In the folder was a copy of a letter he had sent to my year 9 form tutor. He had asked my form tutor to make sure all my teachers were pushing me as he felt I had become lax in recent weeks. I’m sure I was mortified at the time but my dads attention to detail and need to do things properly has always stayed with me.

If it’s worth doing, it’s worth doing properly

 

My dad on working life and managing other people:

The advice that has stayed with me the most is

‘don’t be a jobs-worth’.

My dad taught me to embrace any work that I did as an opportunity.  As a student I did many jobs I did not enjoy very much (retail, cold-calling, car sales, dental nursing to name a few!).  I have tried to live by his advice to not say ‘that’s not my job’, but rather ‘let me see what I can do’.  He is right, it has opened many more doors and opportunities for me.

The other piece of advice that has always stayed with me relates to management of others:

‘Praise in public, chastise in private’.

Very important!

My dad as a support:

My dad has always been there to help me (and my siblings).  He will be the first to say ‘What can I do to help you?’ or  ‘Let’s look at this together’.

Once when I was going through a tough time with a very young baby (6 months old) a three year old, husband away and no sleep I phoned my parents for a bit of a moan. I was having to drive a 3 hour round trip twice a week to see a client and that was a particular killer. I was needing so much coffee to keep my eyes open on the road. My parents called me back a few hours later and offered my dad to be my chauffeur for a few days! I didn’t take them up on it but the genuine offer made all the difference to me and I was able to get back on track.

My dad and his interest in me and my siblings:   

My dad is so interested in the six of us and what we all do (wide and varying careers and interests).  He is so supportive of every new venture we do and shares it among the family in his monthly family letter or via whatapp voice messages I often wake up to in the morning (he is an early riser!).  One day I noticed a hit on every page of this blog, and sure enough it was my dad having a good read as he fed back to me later that day (thankfully not correcting my spelling and grammar although I know I do sometimes make mistakes!).

(My dad and me 6 years ago)

So, to my dad, on his 70th birthday, I want to say thank you for the work ethos you have inspired in me.  It will pass on through the generations! I love you very much xxxx

Christmas Wish List for a Neuro Speech and Language Therapist / Pathologist

 I’ve been seeing lots of Christmas gift guides / wish lists on the lifestyle blogs I follow, and I thought it would be fun to dream up the perfect stocking for a Neuro SLT!

  1.  Pilot Frixion Erasable Black Pen currently £5.48 – I love the fact this is erasable.  I know that it should not be used for clinical notes, but for all of my crazy scribbles and planning, it would be great to have an erasable pen!
  2. Library scented candle £28.00. I work from home and often write reports with scented candles.  This candle sounds perfect for creating the type of studious ambience needed for serious thought!
  3. i-Tunes gift card  – I’m always buying myself new apps (largely from Tactus, Aptus and Therapy Box, so vouchers for the app store would be perfect!
  4. Powersheets $50 As I mentioned I work from privately and from home and although I have access to good peer supervision, it can be hard to get motivated on my own goals for development over a year.  I imported these from America last year and they are brilliant! They helped me focus my personal and career goals and break them down into manageable steps.   They look good too, and I really enjoyed filling them in each month.  I think I need to invest again for next year.
  5. CELF-5  £450 (INC vat) I’ve been so excited that this assessment is now standardised to 21 years and 11 months.  It will perfectly capture a lot of my client group who are young adult brain injury and need a really through assessment with an age equivalent score.
  6. Grey’s Anatomy box set £69.99 My favourite series by far! Love the one brief appearance and few brief references to speech and language pathologists – wish there were more!
  7. Water infusion bottle My friend and voice specialist Tor reminds us of how well we need to look after our voices for the job we do I do not drink enough water, but have been trying harder. I’ve got this bottle, and stuffed with lemon slices and mint leaves I’ve been drinking a lot more water and feeling a lot better for it!
  8. Engraved Littman stethoscope £58.73 (inc VAT), £4.74 for engraving up to 15 letters / symbols.  This is my stethoscope of choice for swallowing assessments and I love the fact it can be personalised with an engraving!

This is obviously a bit tongue in cheek – I’m going to be quite happy with chocolate and nice bubble bath! But what would be on your dream SLT themed Christmas wish list?

App review – Predicatable from Therapy Box

I first came across Predictable a few years ago. A client’s mother reported that he had it on his iPad but didn’t find it useful. It was briefly shown to me and without me being able to play around with it, it looked complex and I’m ashamed to say I dismissed it since then. Especially given its one of the more expensive speech therapy apps (119.99 pounds from the apple store, 130.80 pounds on android, with mouse emulator access) I felt it was not worth the purchase.

Recently I’ve had quite a few cases with aphasia/apraxia. Their skill set is such that they could manage a simple high tech AAC aid- they have some spoken expression, can write a few letters of a word, recognise symbols/pictures & their comprehension is ok at a single word level. I needed something that bridges the gap between something like alpha topics (which is an brilliant & innovative way to replicate what we’ve encouraged for years with pen & paper) and Proloque2Go (fully symbol based communication grid). Therapy box were looking for therapists to try out Predictable over the summer & I was very happy to look at it properly this time and see if I could make it work for some of my clients.

And it’s brilliant! It is so easy to use. I find my six year old the perfect tester of apps for my clients. She can recognise symbols, have a good stab at spelling and is developing her vocabulary. (As an aside, at university I just lived for the acquired disorders lectures and disliked child language acquisition. Now I find it so fascinating to see how my daughters lay down their language skills and I find it’s helped me approach aphasia in a more enlightened way). So, here she is showing you around the app (all self taught):


As you can see, you can flip easily between symbol based communication or typing on a keyboard with predictive text. The symbol based communication is fully editable for your client. You can add your own phrases and organise the symbol home page in the best way for your client.  It’s extremely easy to edit.  I found it was perfect for the aphasia/apraxia clients I had in mind.  They took to the format really well with little teaching required, and two are now in the process of purchasing iPads with the plan to download the app to use themselves.  I feel very relieved to have had the chance to explore this app properly and realised what a genius and user friendly tool it is. I feel it justifies the price tag.

App review- Verb Trainer by Aptus Therapy


One of my ‘go-to’ therapy techniques is sentence therapy. I like to use pictures that illustrate a Subject, Verb and Object sentence and ‘build’ the sentence with visuals and words and then practice saying it.

I find it helps fluent aphasia because it focuses on key words and gives clients a meaningful framework. It helps non-fluent aphasia because it puts some simple grammar into a sentence. It helps aphasic-apraxia mixed because it’s a mixture of word finding and a predictable framework.

As iPad apps are being developed I’m eagerly looking for one that will do this in a more high tech way:

  
Although Lorraine’s app doesn’t do quite the above, I was excited to trial this new app from Aptus Therapy. I’ve been using it pretty much in most sessions with clients since I downloaded it a few weeks ago. I love versatile apps and this is one of them. To my joy it’s a collection of high quality SVO pictures as well as being a app specific to training verbs. I think some of my clients are a little fed up of my low-tech sentence therapy pack! When my clients are ready to move on from a very supported sentence expression approach these pictures are perfect to use as a stimuli.

You can use the app in two different modes – training or test. The training mode allows an errorless learning approach – it repeats the verb three times for the client to repeat (and can also be backed up with a written cue). This mode is perfect for practice between therapy sessions.  Test mode shows you the pictures without the spoken or written verb cue.

   
 The apps costs £4.49 (download here) and is a happy member of my app toolbox now.

Prior to Verb Trainer I used two other Aptus therapy apps. Conversation Paceboard and Speech Pacesetter.  Recently I’ve been using them a lot with a client with PD and remembered how fantastic they are- look out for a blog post coming soon on these apps!

Disclaimer: Lorraine from Aptus Therapy gifted me the Verb Trainer app in return for an honest review. All thoughts are my own. The Conversation Paceboard and Speech Pacesetter apps are apps I purchased myself a while ago and have been using for a long time.