Communicating with Technology

Sometimes people with disabilities have problems communicating even their basic needs and wants.  This is frustrating for them and those around them.
 
Communicating is a complex task, which, at its most basic level, is about understanding and being understood. There are many components to the process of communication, like understanding and using:
 

• Non-verbal communication e.g body language, facial expression, signs, writing, pictures and drawings
• Verbal communication
  

            -  making speech sounds
            -  words and sentences (Ianguage)

• Social rules e.g turn taking, listening and staying on topic

 
If someone has a problem with any of these areas then it can make communication difficult. A speech Language therapist is skilled in identifying where the break down in communication occurs and finding solutions to these problems.
 
The use of technology can help some people struggling to communicate however not everyone. Others may benefit more from low-tech solutions.  Independence can be enhanced with the use of technology too. For those who technology would help Speech Language Therapists can help with:
 

• identifying what sort of communication method would best assist the person communicate e.g. switch, iPad and software.

• giving advice and support to those around the young person on the use of communication devices or switches to interact and communicate.

 

• referring to Talk Link for assessment.

 

• training support people to use a communication device as part of the person’s daily routines.

 

• supporting the client to use their communication device so they become an independent communicator e.g. when ordering food and drink

 

• developing a low tech option should the technology fail.

​

• Use of switches to: 

 

• communicate e.g. greet people

 

• assist with independence e.g. to operate a CD, turn on a blender. 

 
 
Therapy Professionals Speech Language Therapists are experienced working with people of all ages and many kinds of disabilities. Whether you are older having had a stroke or you’re a child with an intellectual and physical disability we can help.

 If you need help with a communication problem our friendly Speech Language Therapists
can help,  just contact us.
 
                                              
Phone   3775280
         Email     admin@tpl.nz

Teaching Crossing the Road Skills
For most adults, crossing the road is automatic behaviour, we do it without thinking and we don’t consider how complex a skill crossing the road is. Nor do we consider how our life might be curtailed if we couldn’t successfully negotiate our way around roads.
 
Some of the skills required for crossing the road include:
 

• determining when it is safe to cross. This requires the ability to observe your environment.
• identifying moving cars, as different from stationary vehicles
• identifying signals at crossings that let you know it is safe to cross.

​In some cases even more advanced problem solving is required.  For example, if the traffic light signals say it is safe to cross and a motorist continues through the intersection, we need to be able to identify the car is not stopping and decide to wait for it to pass before crossing.
 
Traffic-related mishaps account for a large number of deaths and injuries amongst our society’s children and youth. For youngsters with special needs, the risks can increase dramatically due to:

,Acquiring these skills is important for our independence and quality of life.  For those of us with special needs, who struggle to learn road skills easily, this can be a big barrier to independence.  
 
Parents, educators and support workers need to work much harder to teach young people with special needs about street and traffic safety and employ strategies to help compensate for the challenges they may face. The first step is to break the skill down into its separate skills and teach each of these skills step by step.
​
If you are struggling to teach a young adult to cross the road and would like some help our friendly Occupational Therapists at Therapy Professionals Ltd can help.  

Enable Equipment Service
 (Ministry of Health Funded Equipment Management Scheme)
 
If you’re in need of equipment to assist you to function in life, you may be eligible for Enable equipment.  The equipment is on loan from the Ministry of Health free of charge, however the assessment and application may cost you, so please discuss with a therapist.
 
Therapy Professionals Ltd’s Physio and Occupational Therapists are accredited assessors for Enable equipment in the following areas:
 
1.  Personal Care & Household Management  
​
     a)   Personal equipment to enable you to carry out personal care activities in their home, at work
           or place of study, such as:
             -  eating and drinking
             -  personal hygiene (washing and toileting)
             -  getting dressed
             -  transferring from the bed or chair
             -  getting in or out of the home 

      b)    Household Management equipment to enable you to carry out essential 
              household tasks to return to, or remain safely your home, such as the preparation of food
              and drinks, if you live alone or by yourself for much of the day.

2.   Walking & Standing 

    a)  Walking equipment to support you with walking and transferring.    

    b)  Standing equipment to support you to maintain a good functional position
         and body alignment in standing.  

3.  Basic housing modification equipment to ensure your safety at home such as: 
     -  handrails,
     -  wedge threshold ramps
     -  lever taps or 
     -  internal door widening. 

4.  Complex Housing Modifications are where the alterations to the structure of the property are
      made. 

5.  Wheeled Mobility and Postural Management Level 1 and credential lying advice and
​     recommendations related to wheeled mobility, seating and postural management. 

The Process: 
 
It takes between two hours and several months depending on the complexity and expense of the equipment. 
 
   -  an Enable accredited therapist assesses your need for equipment and if you’re eligible. 
   -  Therapist completes the Enable service request electronically if funding is ‘available’.  While
      funding may be available, Enable has final discretion on eligibility for equipment. 
   -  Equipment is trialed or issued to you. 
   -  The therapist will follow up on the use and appropriateness of the equipment. 

Keeping Records of Equipment 

Most equipment comes with an ASSET NUMBER. You or the residential providers are responsible for keeping records of asset numbers and maintenance of the equipment. 

The asset number stickers can fade and come off especially on soft fabrics, eg slings. We recommend you develop a system to record asset numbers permanently. (eg: taking a photo of the piece of equipment and asset number.  Keep it somewhere safe or in your client’s file). 

Repairs and Maintenance: 

Contact one of the subcontractors listed below: 
 
    More Mobility/ Mobytech Ltd
            113 Blenheim Road, Christchurch 8041
            
            Phone:            (03) 348 3460 Option 3 or 027 516 2340                    
            Email:             repairs@mobytech.co.nz                                                                                                                                                                                                                                                                            
                                    christchurch@moremobility.co.nz
            Website:         http://www.moremobility.co.nz 
 
 
    Personal Mobility Systems (Wheelchair Services (SI) Ltd)  (not generally a mobile service) 
            29 Shakespeare Road, Christchurch 8240 
 
           Phone:        (03) 366 8815 or 0275 383 584, Free: 0508 662 454 
           Email:           admin@mobilitysystems.co.nz
           Website         www.mobilitysystems.co.nz
 
    Rehab Enterprises, mobile workshop.
         Contact Owen Henwood on phone: 027 230 5974 or email: owenhenwood@live.com 
 
Alteration or Modification of Equipment

If you wish to have equipment altered or modified this is not a repair or maintenance. Call the therapist. 
 
 
Equipment no longer needed for clients:

Ring Enable and ask for it to be picked up                  Phone: 0800 171 995 
 
OR 
 
Residential providers - If another client would benefit from the equipment, call the therapist, they will assess and if suitable re-issue the equipment. 

​Eating and Drinking Problems related to Dementia
 
A number of eating and drinking issues may occur for those with dementia including under or over eating and swallowing problems. Swallowing difficulties (dysphagia) related to dementia and Alzheimer’s have increased with longer life expectancy.  The prevalence among those individuals with intellectual disability is also increasing, however at a younger age as they prematurely age.
 
 
Swallowing difficulties:
 
How do you know someone has an eating and drinking difficulty?

They will have some or all of the following signs while or after eating and drinking:

• coughing and choking
• food or fluid spilling from the mouth. 
• food/fluid being gulped down too quickly.
• food/fluid coming out of the nose.
• refusal to eat
• long time taken to eat and drink or refusal of favourite foods
• wet or gurgly voice 
• food staying in the mouth after the swallow
• dribbling
• recurrent chest infections
• weight loss, dehydration or weight gain

Under-eating

As we age our appetite decreases.  For those with dementia this decrease in appetite can be more pronounced. In the early stages under-eating can be prompted by depression and later on due to forgetting to eat or even how to eat. Medications can affect appetite too.

Suggested support
 

• visit a dentist and make sure teeth and/or gums aren’t sore and dentures fit
• review medications
• prepare appetising food high in colour and smell
• offer finger foods, they may be more easily managed

• offer food little and often throughout the day may be more beneficial than three big meals
• exercise - this can help make people feel hungrier so therefore they will eat more

 Over-eating:
 
For some people with dementia an increase in weight can be an issue for a number of reasons.  They:

• forget they have eaten.

• eat too much - as they are not aware of feeling full
• have cravings for lollies or chocolate
• are bored
• have reduced their exercise
• are on medications that affect appetite and weight gain

Suggested support:

• limit access to sweets or disguise unhealthy snacks behind plain wrappers.
• substitute healthy alternatives.
• nutritious snacks or finger food throughout the day with smaller main meals
• plan activities to decrease boredom.
• review medications.

Safety:

• cooking for themselves - watching for burnt pots, under or uncooked food
• meals on wheels or other options may be a safer option

 
The role of the team and when to refer:

• GP – review of medications
• Dentist – ensure teeth and gums are healthy/dentures fit
• Speech-Language Therapist – assessing for swallowing problems, modified diet and fluid and textures prescription
• Dietitian – supplement and dietary advice
• Occupational Therapist – eating and drinking utensils
• Physiotherapist - exercise

If you need help with someone with a swallowing problem, just contact us at Therapy Professionals Ltd, our friendly Speech Language Therapist can help.
 
                                    Phone:                       03 377 5280
                                    Email:                         admin@tpl.nz
                                    Website:                    therapyprofessionals.co.nz           

THE LUNCH BOX DILEMMA
 
Making school lunches can be a great source of stress for many parents, myself included. We can fall into the trap of giving our children exactly the same lunch day after day and wonder why they stop eating them! Or we go for the convenient packs of chips, dairy foods and muesli bars, which often children love, however they are not a healthy option. 
 
When you’re tired and busy it’s hard to take the time and have the imagination to produce good healthy lunches for your children.  A few years ago one of our Dietitians, a parent of two young boys, put together these guidelines to help we parents who are struggling to put lunch boxes together.

How to put together a tasty and nutritious lunch box.
 
Choose from these foods to get the balance right.
 
1)    Wholegrain bread, wraps, pita bread, roti, rolls, rice, noodles (not 2 minute noodles), pasta, 
        rice wafers etc. 
           
        COMBINE WITH
 
2)   Chicken, shaved ham, lean meat, fish/tuna, eggs, cheese, peas/beans/lentils, hummus, nut
       butters and hard boiled eggs and nuts etc 

        ADD
 
3)   Whole or cut-up fruit, berries, grapes, pottle of stewed/tinned fruit, salad, vege sticks, cherry
       tomatoes etc.      

       Fruit and vegetables provide essential vitamins and fibre for good health and digestion
 
4)    Include healthy fats for taste and brainpower such as avocado, salmon or oily white fish
       (tinned is fine) and nuts. 

       OPTIONAL EXTRAS

5)   Dried fruit, popcorn, pikelet, small homemade muffin, or plain biscuits, bite-sized cereal
       eg Weetbix Bites/Miniwheats, small can creamed rice, nuts (if allowed), crackers, corn thins,  
       low sugar yoghurts or natural yoghurt with frozen berries.  

       Makes lunch boxes appealing and provide energy
 
 6)  Fluid – Water is the best choice; the good thing is it’s free from any drinking fountain and tap at
       school.  


If you need more help putting lunch boxes together for you children, especially if you have a child with a health condition or disability, our friendly Dietitians can help, just contact us at Therapy Professionals 
 
                                            Phone: 03 3775280          Email: admin@tpl.nz
 
 
Written by Helen Gunn, Mother of two and Dietitian for Therapy Professionals Ltd Ph. (03) 377 5280

Why do some people need thickened fluids?

If a person has a swallowing problem (dysphagia), they may benefit from drinking thickened fluids.  Thick fluids move more slowly down the throat, giving more time to swallow, and make it less likely to ‘go down the wrong way’ into the lungs.
 
Thickened fluids are prescribed by Speech Language Therapists and can be purchased pre-thickened, or can be thickened at home with thickening powder.
 
Thickened liquids come in four thicknesses: slightly, mildly, moderately and extremely thick.  

Normal/Thin (Level 0)

• -  Flows fast like water and can be drunk through a straw with ease.


• Slightly thick (Level 1)

​- slightly thicker than water, similar consistency to flavoured milk,  Ensure or
  Fortisip

• - Can flow through a straw

​Mildly thick (Level 2)​
-  Pouring cream consistency
-  It runs freely off a spoon, leaving a small coating
-  Similar consistency to honey or nectar
-  Can drink from a cup and through a wide straw 

Moderately thick (level 3)
-  Smooth yoghurt consistency
-  Drips slowly in dollops through the prongs of a fork
-  Can drink from a cup however easier if spooned into the mouth
​-  Difficult to drink through a wide straw

Extremely thick (level 4)
- Similar consistency to 'instant pudding or dairy food'
- Holds its shape on the spoon and falls off in a single spoonful when tilted
- Liquid does not dollop or drip continuously through prongs of a fork.
​  Cannot drink from a cup or straw, needs to be spooned into the mouth.

It is safest to measure the thickness using the flow test.  The flow test measures how thick a liquid is by how much goes through a 10 ml syringe in 10 seconds. A speech language therapist with experience in thickened fluids needs to explain how to do the test.

Can fluids be thickened at home?
 
When in a hospital or residential care facility, thickened drinks will be provided.  If you are at home, you will need to purchase pre-thickened drinks or use thickening powder to thicken drinks yourself.
 
Pre-thickened drinks 
 
Pre thickened drinks come in a variety of flavours and in the three levels of thickness: mildly, moderately and extremely thick.
 
Thickening powders
 
Each product is different and the instructions on the tin should be followed however the resulting thickness is the important thing and the flow test is the best way of knowing the thickness.

Naturally thick fluids
 
There are a number of naturally thick fluids such as:

• Pureed fruit with yoghurt
• Fruit nectar (eg apricot, mango, feijoa)
• Thick shakes with greek yoghurt or ice-cream
• Fruit smoothies
• Frozen yoghurt (frozen fluids get thinner as they melt)

 
The flow test needs to be applied to naturally thick fluids to ensure they’re the right level of consistency before drinking. 

How much fluid should we drink in a day?
 
Adults need to drink an average of 6 to 8 cups (1.5- 2 litres) of fluid a day to prevent dehydration. In hot weather we need more fluids.  A dietitian can advise on how much is required.
 
What kinds of fluids need to be thickened?
 
All fluids may need to be thickened depending on the consistency level required including pureed fruits and vegetables, nutritional supplements.

What about ice cream?

Melt slightly, mix in thickener and re-freeze.

What about jelly?

Mix in thickener and refrigerate.
​

Can you thicken fizzy drinks?
 
Yes. First stir the fizzy drink to release the bubbles or “de-carbonate”. Ensure the glass isn’t too full, then slowly add the thickener. There may be some frothing so keep a cloth handy!
 
Can tea and coffee still be made the same way?
 
Yes.  When making tea, coffee or hot chocolate, ensure you add the milk before thickening the drink; otherwise milk added later will water down the thickened drink.
 
What about thin soups?
 
You thicken soups in the same way you thicken drinks. Follow the instructions on the tin and adjust to the right level of thickness if needed with additional fluid or thickening powder.
 
Can thickened fluids be frozen?
 
Not all thickeners can be frozen, however drinks made with Easy Thick Advanced Powder can be frozen, as it remains stable when thawed.

If you want more information or help with a swallowing problem, Therapy
Professionals Ltd’s friendly Speech Language Therapists can help.
 
  Just contact us:

Phone:          03 3775280            Email:      admin@tpl.nz

​Hand and Finger Skills

We use our hands and fingers constantly during the day and rarely consider the complexity of tasks they do, and how life would be, without their ability to manipulate objects. 
 

​In fact hand and finger skills or fine motor skills are very important for doing every day tasks such as:

• drawing
• handwriting
• cutting with scissors
• eating with a fork, knife, and spoon
• dressing skills such as using buttons, zippers, and snaps
• manipulating small objects for crafts and games
• tying shoelaces 

Children who experience difficulties with hand and finger skills, may:

• use both hands for skills that should only take one hand, 
• change or transfer objects to the other hand for repositioning, 
• hold an object against their body during activities.

 
 
A child’s fine motor (hand and finger) skill development impacts on every area of a child’s life.  For some children, a skill that is slow to develop can be a source of frustration and cause them to avoid practising important tasks such as writing, dressing, and participating in sports.
 
Children struggling with hand and finger skills may have problems with:

• weak hands
• controlling posture
• co-ordination between hands
• using information from their senses
• eye hand co-ordination

​Development of hand skills occurs throughout childhood in an orderly and predictable way like building with blocks.  Hand skills require a combination of other skills to be developed before they can be mastered.  If a skill is not gained this will affect acquiring other skills.  It’s important for a child’s learning and independence to have good hand and finger skills. 
 
An Occupational Therapist can help by assessing and suggesting a fun range of activities for school and home to develop a child’s fine motor (hand and finger) skills.

If you know a child who is experiencing any of these problems, our friendly occupational therapist can help; just contact us at Therapy Professionals.
 
                        Phone:           (03) 377 5280           
                        Email:            admin@tpl.nz
                        Website:        http://www.therapyprofessionals.co.nz

High Temperatures  and Dehydration

A long spell of hot summer weather can take its toll on most of us, as it saps away the moisture from our bodies.  For those of us who are ageing or disabled hot weather could be deadly, especially if we are relying on others to give us drinks.
 
In such weather we need to drink more water than the usual recommendation of 6-8 standard glasses a day. 
 
Why is dehydration a problem?  Our bodies are 60% water and it is used in: 
 

• digestion
• circulation
• saliva
• transporting nutrients and wastes to and from our cells 
• maintaining our body temperature (sweat helps to cool us down)

 
Our bodies are continuously losing moisture though:
 

• urinating
• our bowels
• breathing
• sweating

 
We may lose fluids for other reasons such as:
 

• an underlying medical problem such as heart failure, kidney disease or electrolyte imbalance
• diarrhoea
• vomiting
• large blood loss
• high fever

 
Dehydration can occur quickly in hot or humid temperature as our body sweats more to try and cool our bodies down.
 
Here are some early signs of dehydration: 
 

• tired and grumpy 
• struggling to concentrate 
• experiencing a dry mouth 
• headachy
• unusually constipated 
• unusually hungry 
• dry skin
• cramp in the arms or legs
• urinating less than normal
• dizziness

If any of these signs are present in you or anyone you’re looking after, the first simple solution is to drink more fluids.  If this isn’t making things better seek medical help.'

How do you know whether you, or those you are caring for, are dehydrated?   
 
You or they may feel thirsty or hungry, however the best sign is urinating less frequently, with very dark urine. 
 
Remember dehydration is life threatening, so if you have any of the signs mentioned, ensure you drink more water than you would normally do. 
 
 
If you need more advice on how to keep hydrated just contact us at Therapy Professionals our friendly dietitians can help. 
 
 
            Phone                        (03) 3775280, 
            Email:                         admin@tpl.nz
            Website:                    http://www.therapyprofessionals.co.nz
 
 

Stroke
 
A stroke is a sudden interruption of the blood supply to the brain.  Every stroke is different and the effects depend on the area of the brain which is injured.
 
A stroke on the left side of the brain will affect the right side of the body and vice-versa.  Each side specialises in different functions and one or more of those functions may be mildly or severely affected.

This is a simple guide, more information and help on speech and communication is available from the local hospital speech language therapist and the Stroke Foundation.
  

Advice on how to survive a stroke - from the
Hornby Stoke Group Participants – May 2012
 
A stroke doesn’t need to be a life sentence. 

If you need help following a stroke,
our friendly physio, speech language, music and 
occupational  therapists and dietitians can help.  
 
Just contact us at Therapy Professionals Ltd
 
Phone:   03 377 5280       Email:      admin@tpl.nz       Website:  therapyprofessionals.co.nz

Speech Language Therapy

A Speech Language Therapist is trained in the area of swallowing and in the development of communication speech, and language.  The reason they are trained in both these areas is many of the same muscles, nerves and body parts are used in both communication and swallowing. 

Communication is a complex activity that involves us understanding and being understood and includes:

• non-verbal communication

            -  facial expression
            -  gestures/sign language
            -  body language
            -  symbols (writing, drawing picture)
            -  technology

• verbal communication - speech
• language or understanding words and sentences
• social rules 

           -  considering others people’s views
           -  recognising non verbal clues
           -  taking turns, eye contact, personal space
           -  staying on topic
           -  adapting communication for different situations and audiences.

Swallowing or dysphagia is a common consequence of many health conditions, head and neck surgery and ageing, affecting over 20% of over 50 year olds.  
​
Signs of swallowing problems may include:
 ​

• coughing while eating or drinking
• choking while eating and drinking
• repeated chest infections 
• taking longer to eat or drink
• reduced appetite
• unplanned weight loss
• problems eating/drinking in public
• food sticking in your throat
• difficulty chewing tough foods
• dribbling
• food/fluid coming out of your nose
• spilling food from mouth while eating
• wet or gurgly sounding voice after eating or drinking
• problems with drinking enough fluid

What does a Speech Language Therapist do?
 
Communication
 
Speech Language Therapists give practical solutions to improve your communication, such as:

• ways to use and/or enhance your current communication skills
• exercise to help all areas of speech, language and voice
• use of gestures, signs, symbols and/or technology

 
With you, and those supporting you, they will:

• tailor a plan for you and help you put it into action
• review plan if required
• recommend equipment and its funding

Swallowing (Dysphagia)
 
Speech Language Therapists will give practical solutions to improve your eating and drinking, such as:

• swallowing exercises
• the best position to eat and drink
• advice on special cutlery or cups to make eating and drinking easier 
• advice on food and fluids and how to make them so they are safe to swallow
• advice on the ways to feed when eating and drinking is no longer safe

With you, and those supporting you, they will: 

• tailor a plan for you and help you put it into action
• review plan if required
• recommend equipment and its funding

Who does a Speech Language Therapist work with?
 
Adults and children with a variety of communication and or swallowing difficulties.
 
Conditions that may require help from a Speech Language Therapist include:
 
Developmental
 

• Learning (Intellectual) Disability
• Developmental Delay
• Chromosomal Disorders eg  Down Syndrome
• Dyspraxia
• Autism
• Cerebral Palsy
• Reading and writing difficulties

Health and wellbeing
 

• Deafness/hearing impairment
• Ageing           
• Oral cancer
• Stuttering/fluency

 
Neurological
 

• Stroke (CVA)
• Parkinson’s
• Multiple Sclerosis (MS)
• Dementia
• Motor Neurone Disease
• Huntington’s
• Muscular Dystrophy
• Brain/head injuries
• Specific language impairment
• Stuttering
• Abnormalities of head or neck

How does a Speech Language Therapist work?
 
The way in a Speech Language Therapist works is determined by the individual needs of the client and may include one or a combination of the following approaches.
 
Consultation and Monitoring
 
Consultation is an effective way of working with a person to improve their communication wherever they live, work play or learn. Therapists work together with the Significant Others, who are in the best position to carry out ideas on a day- to-day basis.
 
The Speech Language Therapist can provide support and regular review.
 
Direct/Hands On Intervention
 
The therapist carries out a programme on a regular basis, in a one-to-one or group setting.
 
Transdisciplinary Team Approach
 
People we work with may require support from a range of therapists including occupational therapists, physiotherapists, dietitian, and music therapists. At Therapy Professionals Ltd we work within a transdisciplinary team and are able to provide support one another’s programmes when appropriate.
 
If you think you or someone you know needs a speech language therapist Therapy Professionals Ltd’s friendly Speech Language Therapist can help, just contact us:
 
                        Phone:   (03) 377 5280        Fax:    (03) 377 5281           Email:  admin@tpl.nz