Speech Therapists: What They Do and How They Use Assistive Technology

Speech-Language Pathologists (SLP), sometimes called speech therapists, play a key role in developing and maintaining an individual’s communication, cognition and independence. To understand the role of speech therapy, its use of assistive technology (AT), mobile devices, and future trends AbleData’s subject matter expert, Stephanie Mensh, interviewed Joan Green, M.A. CCC-SLP, a nationally-recognized clinician, expert and author on using AT for speech-language needs and founder of Innovative Speech Therapy.

Stephanie: What is a Speech-Language Pathologist (SLP), or Speech Therapist?

Joan:  SLPs are the professionals who help to assess, diagnose, prevent and treat speech, language, communication, cognitive and swallowing disorders in children and adults. SLPs also work with people who want to learn how to communicate more effectively, for example, in how they give presentations for work, or to modify their accent and how they articulate words.   

Stephanie: Describe the services SLPs provide.

Joan: SLPs provide a wide-range of services depending on the individual’s needs and the setting in which they work. They may provide individual evaluations, individual and group therapy using skilled treatment techniques, help in using augmentative and alternative communication (AAC) systems and guidance for teachers and other education and rehabilitation professionals. Most people think of SLPs as working in the schools to help children learn to say their “R”s and “S”s. Our scope of practice is actually much larger. We help people with literacy, attention, organizational and memory challenges, too. Some therapists work in early intervention settings and help infants learn to swallow. Others work in acute care settings and help stroke survivors.

Stephanie: Describe your specialty in innovative treatment and technology solutions. Who do you treat and how is this different from other specialties?

Joan: I specialize in helping individuals of all ages who have communication, cognitive, literacy and learning challenges to maximize progress and enhance their overall quality of life, with a special focus on the use of technology. I empower families to learn about available resources so that they can become strong advocates. I also provide consultations and training to SLPs, special educators, SLP students, teachers, caregivers, administrators and other professionals in state-of-the-art treatment techniques with technology and other unique resources.   

My practice grew from the frustration that many of my patients’ health insurance benefits ran out too soon, particularly those recovering from stroke and traumatic brain injury (TBI). I found ways to use affordable, cutting-edge technology to speed their progress and improve outcomes. I started with computer software, then added applications for tablets and smartphones as they became more affordable, and more families were using them. And, while the evidence of technology’s effectiveness in treatment has grown in recent years, it has been a little slow to catch on.

Stephanie: Describe your approach to using AT for speech-language-cognitive treatment and supports. 

Joan: I consider the individual’s treatment goals and support needs, then determine what tools or features would be most useful in improving skills or providing practice drills.

If the individual has difficulty reading, I may consider text-to-speech or changing how text is displayed. If they cannot write, I look at dictation and word prediction, and other software tools to help with organizing, spelling and grammar. If the individual has difficulty speaking, I have various sources of pictures and symbols to facilitate communication.

With “executive function” or cognitive issues, for example, if the individual has difficulty with distractions, I look for tools that have a simple format, are not visually “cluttered,” maybe with larger fonts and remove the advertisements. For organization, time management and memory issues, I consider which calendars and reminders might work best, or easy ways to find documents and search for specific content. Also, there are products that record as a person writes and will sync what they are hearing with what was written at the time. This is very helpful for students when taking notes or for adults at work who have writing, attention or memory challenges.

Stephanie: Describe the assistive technologies that you most commonly use.

Joan: I generally start with the technologies that are already being used in the individual’s environment and try to enable features that they may not realize exist. Most new computers, smart phones and tablets have many accessibility features that include changing the text display, calendars with reminders, dictation capability and the ability to read text aloud.

I often recommend Google Chrome, which offers many add-ons that are especially helpful for individuals who have reading, writing, attention, organization and time management issues – and particularly for school-aged children, since many schools use Google for Education. 

If a family is trying to find technology to help individuals with complex communication needs, I generally suggest that they consider an iPad, given the extensive current ios app market available. But, individuals who have significant physical limitations may do better with dedicated communication devices for visual gaze and access to environmental controls.

Stephanie:  Describe the assistive technologies that you recommend for homework and ongoing support.

Joan: There has been an increasing demand for independent practice products, particularly for individuals recovering from stroke and TBI, and for certain school-aged children with literacy challenges, given the limits on coverage for speech therapy under health insurance and in schools. I look for functions that can provide relatively easy access for independent work, track the individual’s progress and allow customization to meet the individual’s goals. I often try Tactus Therapy, Constant Therapy, morespeech.com, and Lumosity – which uses neuroscience-based brain training games.

For individuals who have more complex challenges, like individuals with Alzheimer’s disease, I have had some success in providing enjoyable, engaging, stimulating activities by loading an iPad with photos of the person’s family and pets, favorite music using the Pandora app and puzzle-makers that use your own photos. Also, the iPad’s built-in video camera and FaceTime improve an individual’s ability to have face-to-face communication with family and friends, and to see video of events that they cannot attend in person. And, there are apps that provide icons for activities of daily living, so individuals who cannot talk can point to their basic needs.

For children and the school setting, I often recommend the Maryland Assistive Technology Network (MATN), a service of the Johns Hopkins University, Center for Technology in Education. Among other resources, they offer free webinars and workshops and a person-centered toolkit, “mATchup,” to help educators and families find high-quality and affordable assistive technologies and apps.

I also recommend sources that review AT and AAC products, provide additional information, and practical advice, including: Praactical AAC and Joy Zabala’s SETT framework. SETT is an acronym for “Student, Environment, Tasks and Tools,” representing a person-focused approach, similar to my own way of thinking, where you focus on meeting the user’s needs in a particular environment. 

Stephanie:  You’ve tested many devices, software, and apps in your practice. What advice do you give to other SLPs in evaluating and using AT?

Joan: I suggest that SLPs start small and gradually expand their toolbox. Collaborate with others in similar circumstances. Take advantage of social media and connect on Twitter, Facebook and list serves.

I have heard concerns that tech can make learning harder for kids, possibly making them more distracted, depending on the tools they use, not able to think for themselves and limiting recall. In my experience, the overreliance or abuse of technology is a real concern and the use of AT needs to be carefully implemented and monitored. Students can use tech to do better in school, whether they have learning challenges or are gifted. It comes down to identifying and supporting the needs of the user while not abusing the use of the tools. This applies to adults, as well. 

Individuals and families are continuing to demand more from my profession to take advantage of technology in their treatment and supports. My advice is to think about the specific functions, tasks or activities that the individual needs help with, then search the features of the AT for a match to their specific needs. Look for products that are easy to use independently. The SLP can set up the software or app, and train the family or others involved in the person’s life to help.

Listen and be creative in helping the individual succeed in their goals. AT can and should make life better, not add to frustrations. Safety needs to remain a primary concern and rules and responsibilities relating to technology use is part of this equation.

Also, SLPs should give feedback to the AT developers, directly, when possible, and/or through the online discussion groups sponsored by some of the sources I have mentioned. For example, there was a therapy product that I liked to use, but was a little frustrating, because you could not return to a previous page. When I described the benefits to the developers, they added a “go back” arrow.

Stephanie: Where do you see the future trends for communication, cognitive, and learning AT?

Joan: We are seeing more affordable, feature-filled devices, with universal designs that are easier to adapt to support individuals with special needs. The “cloud” will also provide more affordable go-anywhere solutions, as software and apps are provided and updated over the Internet, rather than on a specific device. Collaborations are becoming more important and easier, too, between the AT developers, therapists, teachers, individual users and their families. Also, it is becoming easier to find resources through web searches and YouTube video demonstrations. Professional support is also becoming easier to access as online educational tools and telemedicine becomes more prevalent.

Stephanie:  What have you found to be the most challenging and most rewarding as an SLP?

Joan: I enjoy helping to improve people’s lives through AT. Sometimes, I am frustrated with the “system’s” resistance to change. Medicare and health insurance have restrictions, school budgets are tight, and teachers already work extremely hard. Even so, I am grateful for the days when I am able to connect with individuals whose lives are changed for the better from what I offer. Most families, educators and rehabilitation professionals are eager to learn more but don’t know where to begin or become easily overwhelmed with all that is available. I have devoted my professional career to keeping up with cutting-edge resources, and it’s my pleasure to stay connected with individuals who want to continue learning.

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