For the Record

A friend of mine recently raised a good question: What is the standard for record- keeping  when it comes to treatments? I know we officially learnt this at some point in time. I think my personal style of note taking and record keeping has definitely evolved with experience in various settings. I do know that this was something I really struggled with at varsity in our clinic practicals. It may not seem like it to those who know me but I have a slightly perfectionistic nature in that I hate getting something wrong, and if I do something I make sure I do it right the first time. This fear of being wrong really tripped me up when it came to writing notes in hospital folders. I found myself pouring over what others had written and how they had written it, then I’d rehearse what I was going to write. It was a process of editing and re-editing it until I felt vaguely confident in what I was going to say.  This fear became problematic because I didn’t have a lot of time to write, and when I eventually made myself do it, I had forgotten half of what I wanted to record. The SOAP (Subjective, Objective, Assessment and Plan) notes format helped a lot but we were never really taught this formally.  So here is a link on how to do the SOAP note thing properly.

In my clinical setting now (working in private practice) I tend to use a blank note page for each client. Each client has their own folder which is safely locked away in a cabinet in the office. Reports and accounts are password protected on my computer.  The structure of my progress notes changes according to each patient and I use my own shorthand when recording progress. I have looked around and there are many places which provide useful templates to use when one wants to keep track of progress. Speakingofspeech.com has a whole list of various data forms that you can find here. There are also several apps (Android and Apple) that can be used for note taking (this topic calls for its own separate post!) In South Africa we don’t need to submit IEP (individualised education programme) goals for each and every child but it is important to keep record of measurable aims and outcomes. These forms give a nice structure for doing so.

Official guidelines on record keeping in private practice are hard to come by, but what I have found in terms of legislature (and what I have gleaned from more experienced practitioners than myself) is the following:

• Keep record of everything!
• Keep your records for 5 years (and then a little bit longer just in case)
• Keep it confidential (unless you have written permission from the patient to share it)
• Another professional may have the info if they have a direct interest in the case
• If you email anything you should make it uneditable (PDF it) and password protect it. To do this click on Save As from the File tab in word, change the file type to a PDF and then click on the options tab. Check the box that says Encrypt the document with a password. voila! Make sure the person you are sending it to knows the password. 

If you have any other information on this topic that you think is important or new information I’m not aware of please share it here!

Hands on! Using Sign Language with Babies and Toddlers

Think of movies like “look who’s talking” and “daddy day care” where little tykes are given the ability to communicate as adults. It makes for great entertainment, and while it gives babies and toddlers way too much credit, it also makes one think about what baby would say if he could communicate.  Well he can communicate a lot sooner than you think! The technique of using sign language with babies has shown that they do have something to say before their little mouths are ready to work for them.

I use signs in my therapy with language delayed toddlers often and it has remarkable results. Using signs does not only give them a means to communicate but also helps to facilitate language development. I learned a lot about using signs in therapy from Monita of Tiny Handz. She is a dedicated mom who found that this really worked with her own son. Since then hundreds have benefited from her practical approach to incorporating signs into everyday tasks. It’s not just parents and therapists who are using this but teachers too, as we have implemented the Tiny Handz programme at Bel Porto school.  

Another point to consider is that it’s not only useful with the language delayed population, but normally developing children can be given a language boost when they are exposed to it too. This helps to alleviate the frustration of both mom and baby. Many people brush off the idea as they feel that learning sign language is too time consuming and mentally demanding. Taking the time to invest in this skill now is a way to possibly prevent spending time on speech therapy later. Parents also raise concern that their child will choose to sign above speaking;  however children who can talk do talk. Although it doesn’t come naturally, it is not as tough as it seems and with practice it becomes subconscious.

How then would you go about learning signs? Here are a few steps:

1.       First you would decide on your aim for implementing signs with your baby/toddler. This could be because you want to strengthen the bond with your child, you want to alleviate their (and your) frustration around communicating or you want to give that that little head start on communication.


2.       Then decide on which system of sign language you are going to implement. There are many systems that have been developed. I personally suggest going with a system based on South African sign language (like Tiny Handz); but I would also recommend that you look at other signing systems as there may be some signs from one that you like more than the other. It is completely up to you which signs you choose, as long as you are consistent in using them.



3.       Determine the vocabulary you will be using. Look for a list of baby’s first words for some guidance. Here is one that I recommend from teachmetotalk.com. For your own ease of learning I recommend that you pick 5 easy words to start with. These could be ‘eat’; ‘drink’; ‘more’; ‘mommy’; ‘daddy’.  Other words that you would target could then be vocabulary that your child shows an interest in. If you have pets, then you would do ‘dog’ and ‘cat’. If your child spends his day at Granny’s then ‘granny’ would be good. If he loves eating bananas then you will teach him the sign for banana. Make the vocabulary that you choose relevant to you and your family as this will make them more functional and easier to remember.

4.        Learn the signs that go along with the words you have chosen. You can find videos on YouTube that target specific signs. There are also signing charts available on many of the websites (see links). It is also a good idea to let those close to you and your little one know what the signs are and why you are doing them. Use them as you are talking to each other to establish the habit of signing as you speak.

5.       When you are talking to baby make sure they can see your mouth and the object. If you are teaching an action sign like “more”, then make sure that once you use the sign the action happens. Make it as practical as you can by incorporating the signs into daily activities as well as games. Children learn best through play and when something is fun or funny they will be more likely to imitate that.

6.        If your child is beginning to imitate the sign then you need to repeat it back to them with the word. Repetition is essential to language learning. Babysignlanguage.com talks about the different stages your baby goes through when learning signs and how to encourage your baby through each stage.  Have a look at those for more specific information.



I prefer the American sign for "more".
Click on the picture for another interesting article

For more information check out my Pintrest board on this topic!

Here are some more interesting links:

1.How do you start with signs?

2. 9 Things you should know...

3. Mommy Speech Therapy on Sign Language with Toddlers

If you would like to attend a class on learning sign language in Cape Town leave a reply or check the Tiny Handz programme to see where and when classes are happening

Happy Holidays

If you are like me (and most women in general) then you too peruse the malls for any bargain you can find. One of my favourite elements of retail shopping is looking for new therapy material. There are three toy shops in my area that I frequent, and I have started to consider myself a bit of a collector now. There are also specific brands of toys that I am beginning to prefer.  That’s not what I want to talk about today though. Today I want to bring up those awesome little discoveries that one finds unexpectedly. Actually, I now expect to find these awesome discoveries twice a year, namely at Christmas and Easter time at Woolworths. Their holiday items are becoming more arbitrary but I do find them rather exciting. The most exciting part for therapists and parents is that if you hang on a week or two after said holiday these items are reduced to anything from 25-75%.

A few years ago I found the loveliest farm-animal finger puppets that came with a small Easter egg inside; the year before that it was full sized Winnie-the-Pooh puppets over a giant Easter egg. This year it is little plastic robots and plastic ice-cream cones that open with an explosion of jelly beans. Now what does a robot or ice-cream cone, have to do with Easter you ask? Well if you come up with the answer please let me know too! I’m not complaining though because I am finding some very exciting uses for these in therapy and the jelly beans disappeared amongst our therapy staff very quickly.

I have loved hiding targets for vocabulary and articulation in these little toys and the children I see have loved it too. The element of surprise has been a real help in keeping the attention of otherwise inattentive little kiddos.

The basis of articulation therapy is really to get as many drills of the target sound in the desired word position as many times as you possibly can. Articulation therapy is quite a process and for more detailed information please click here and here. I use pictures to target specific sounds and I often use Black Sheep Press or the lovely articulation sheets from Mommy SpeechTherapy. I then cut them apart and lay each one face down on the table. I have been quite predictable in that I have used the ice-cream cones for the girls (they are in pretty pink and purple colours) and the robots for the boys. I have then either the robot or the ice cream cones out on the table too. The child takes one picture at a time and then says the target word (so we can learn what the pictures are) and then hides the picture in the toy. Once all the words are hidden I then hide the robots/ice cream cones around the therapy room. The child then gets to run around finding them (Like an Easter egg hunt, just to make them relevant). When they find one they have to open it and use their best sound to say the word (voila! spontaneous production!).  

I’m going to enjoy these little gems until the next holiday season comes around.

For more information on what articulation disorders are check this out.

For more resources for articulation therapy ideas go here.

For the love of Pirates

preschoolers.about.com

So this weeks post was a little later in coming out as I have had my fair share of busy-ness but it is a topic that has been on my mind as long as this blog has. Please feel free to comment and add your own ideas!



preschoolers.about.com

I must say that growing up I was a very girly-girl and although I was intrigued by all things “Under the sea” I only ever gave thought to pirates after the appearance of the oh-so-swaggering Captain Jack Sparrow. The Pirates of the Caribbean series seemed to spark a renewed interest in this age-old theme. Until then pirates had a bit of a bad rap and in some cases still do (deservedly- thanks Somalia!). Their value in a therapy session, though, is incalculable. To the 4-8 year old population this topic holds a mystical sense of adventure that I take full advantage of. I’m not alone in this. There are many resources and blogs out there that are also capitalising on this franchise. One of my favourite bloggers, Brea, from ‘Let’s talk SLP’ has come up with a whole pirate package. This is full of fun and useful therapy material that focuses on articulation and language skills. I have acquired some of these and have frustrated my poor husband by spending my evenings cutting, laminating and re-cutting these gorgeous pictures. My favourite one is the pirate barrier game. It is a great way to elicit language and to introduce the rest of the series.  

In my own toy cupboard I have a treasured game: “Pop-up Pirate-Treasure Island”. This is one in a series of Pop-up Pirate games by TOMY®. I am still trying to get hold of the original Pop-up Pirate here in SA but it seems impossible. A former colleague had this version and the kids went mad over it! I had one little boy in particular who was so enthralled by this game that his mom and I both went on a treasure hunt looking for it for him. I eventually found a very cheap Chinese knock-off that did the trick.

 

Now there is actually value in my ramblings. The original Pop-up pirate was not only useful for keeping attention and making therapy fun but I would often use it in auditory processing tasks.  The game includes swords in 4 different colours; the point of the game is to put the swords into a barrel, when you hit the right spot the pirate pops out. It does well in creating suspense and lots of giggles. I would place the swords on my minimal pairs picture when targeting auditory discrimination. The child would be required to pick the sword from the picture he heard. I would also use them in auditory sequencing tasks. For example I would lay out one sword of each colour and then give an instruction like: “take the red one first and then the yellow one” or “take the blue one, then the green one and then the red one”. It was then simple to work out what level we would be working on for auditory memory and sequencing.  These tasks would not form the whole therapy session but form a productive part in the positive reinforcement section of my session.

The Pop-Up Pirate- Treasure Island game is fairly new in my repertoire so I have not yet had the fun of figuring out all its hidden secrets. It can definitely be used for more advanced auditory sequencing tasks as it contains 6 different coloured keys. This week I also had the opportunity to use it with a little articulation guy. He has particular difficulty with the /k/ and /g/ sound as he fronts these to /t/ and /d/ respectively. His attention is very poor so he finds it hard (and boring) to do traditional drills. This game gave us the perfect platform to do lots of repetitions of the target words /key/; /gold/; /coin/; /back/ and /lucky/ as he has had lots of practice with both /k/ and /g/ in all word positions already. I could’ve taken it even further by hiding his other target words under the barrels where the keys get hidden. In fact that is exactly what I’m going to do in our next session. The exciting bit about this game is that you never know when the sneaky pirate is going to pop out of the treasure chest and demand his gold back. I foresee myself using this game for many different language targets (prepositions are easy to elicit with this) and sentence expansion.  I have seen that TOMY® have also come up with a Captain Jack Sparrow Pop-Up Pirate. That may be another acquisition I’ll have to make!

Until next week then! Oh and if you want some more ideas for auditory processing tasks then look at these links:
1. https://pinterest.com/schoolsparks/auditory-processing-activities-for-kids/
2. http://www.speakingofspeech.com/Auditory_Processing.html
3. http://sensoryplanet.com/blog.php?user=BodyLogique&blogentry_id=492

5 Things that I need in my life as a Speechy...

1.       MY DIARY:

(Picture from Lady Grey Collections on Facebook)

       Every year I go on the ultimate diary hunt. I get so excited around Christmas time when the stores start stocking their shelves with the prospect of new beginnings. Yes, a new beginning. A clean slate. Something to fill up with… appointments. But it is so much more. I can spend hours in a book shop pouring over paper-back, leather-bound, A4, A5, colourful or plain, picture-filled or serious. This year what I desperately wanted was an A4 leather-bound zip folder diary but in the end chose “A Diary for a Lady” by Elise Grey. This is a sweet A5 sized hard-cover with beautiful pictures and warm inspiration. It fits in my handbag and is happy to get stuffed full of all those random scraps of paper I tend to collect as I go along. It inspires creativity and organization and is very pretty to look at. My other favourite diary in the past has been a Joyce Meyer diary (I was also trying to get my hands on a leather back version of this).  I have a terrible habit of hording my old diaries “just in case”! With excitement and a hope to be organised I can hardly wait for the next New Diary season to begin!

2.       TEA!!!

(from South African Artist Thea Burger)

       My tea break is sacred! As with any other South African. In fact when I was doing my clinical practical I realized that you do not mess with a tea-break in Africa. This has been reinforced as I have worked in various settings around South Africa and seen this theory in play: You do not disturb a nurse’s tea break! And there is no being flexible people! The building will be on fire and falling in around the nurses tea room and they will not be moved until their 20 minutes (or an hour in African time) is over. I remember trying to get a nurse to sign a document for me on her tea-break. This took a lot of convincing (it’s like sacrilegious to the tea-time god). Anyway… I have come to appreciate the need for a ten minute sit-down-do-nothing-think-nothing-and-just-breathe break. This is essential, especially when your day is made up of running between 3 different sites and seeing all-sorts. Most of the time my “tea break” happens in my car, when I can put on a good song, compose my nerves and build up battery power to make it through the next session. On a good day I am able to sit at my desk and brew a special something (at the moment it is Woolworths Vanilla Chai Tea! Yummo!) and browse Twitter or Facebook for an all too brief 20 minutes. Whatever form this break takes it is very important to be able to recollect oneself and rest!

3.       MY SAMSUNG GALAXY TABLET:

(Picture from here)

       Ah, technology. I haven’t quite graduated to an Apple iPad yet but this is something, ok? Actually in South Africa, a Samsung is the wiser choice right now. Access to Apple products is getting better but it is limited and expensive. Part of my rationale for getting the tablet was that if there were apps that I found useful, that it would be easier to recommend the android versions for the majority of patients I see. I do have a few higher income patients that do own an iPad and then I rely on app reviews and opinions of others in order to recommend appropriate apps. (Great app reviews for speech therapists here). I have found that this little gadget has opened my world significantly. I am able to access emails quicker, social media is life-saver and if I need to look something up then there is a quick and portable way to do this. Not to mention the screen-capture function (being able to take a screen shot of a picture or idea and save it for later has proven invaluable). This also allows me to collate information all in one place. Last year I attended a course at the University of Cape Town for Clinical Educators. All our course work was emailed through to us and I saved a lot of money on (not) printing and a lot of time on (not) filing. Plus I didn’t have to lug around a massive bag full of paperwork!

4.       FRIENDS:

       Speechie friends are essential to my development as a professional. Whether it’s meeting up with colleagues or girls I graduated with or using social media to connect with other therapists around the world. Bouncing ideas around, listening to new ideas, confirming a suspected diagnosis or just crying about THAT patient is a blessing I don't take for granted. As speech therapists, I find that we are mostly very keen for new insights and when we get together it is endemic to only talk SLP. When I get together with the girls I studied with you can literally see the glaze clouding over our non-speechie partners eyes. Every now and then one of our husbands will chirp in with a “That sounds like aphasia.” and a smug grin that says "I've cracked your code!" Bless. They try. Then there is social media. It has been so exciting to get to know(of) all the #slpeeps out there. I have learnt new things, found new ways of doing old things and seen that I am not alone in my obsessions.

5.      A SENSE OF HUMOR:

          Yes I am being super cheesy about this last one. I have always and will always believe that laughter is the best medicine. This idea has been supported in various places and here is a link to an article discussing the benefits of humor in aphasia therapy.  I enjoy my patients so very much and feel like I have a unique relationship with each and every one. We joke. We laugh. But at the end of the day they come to trust me and invite me into their lives to improve their quality of life. It is also good to have a laugh at the end of the day at one’s self. To find the funny moments and reflect. To be completely honest I do think that the funny moments we experience in day-to-day therapy sessions would make a good book! But then again we’d probably be the only ones to find it exciting.

My Introduction...

Hi there and welcome to my very first blog post! I thought I would start off by introducing this blog and the purpose for it. I am a speech therapist in Cape Town, South Africa. I qualified from the University of Cape Town in 2007 and have since worked in rural settings and in private practice. I currently run a practice in the Southern Suburbs called Peninsula Speech Therapists. We are a general practice and see a wide range of speech and language disorders. We also consult at hospitals, schools, and do home visits around the area.

With this blog I hope to be a fellow contributor to the growing library of internet resources available to therapists and patients. I consider this an open forum and would love to hear your comments and questions and I hope to be helpful in my responses.

 

This is a short one but I plan to follow up with something nice and meaty pretty soon!