Category Archives: Occupational therapy

Talking Mats and OT- a winning combination

learning_and_thinking

We are grateful to Rachel Woolcomb OT,  for sharing this Talking mats story.

Within my occupational therapy practice I have found Talking Mats to be an excellent thinking tool to help my clients establish their priorities for therapy.

I was asked to work with a teenage girl who had sustained a brain injury resulting in a mild cognitive impairment which was impacting on her participation and ability to learn at school.

She had undergone formal cognitive testing with a clinical psychologist, however had shown poor levels of engagement with the assessment process (which had taken over two hours). She was reported as having erratic focus and inconsistent answers to questioning. The results were therefore deemed to be inconclusive and no recommendations made.                                                                  I knew that Talking Mats would provide me with similar information to that which the psychologist was trying to gain, but in a way that would be engaging and client focused. I also felt that the concept of the Talking Mat, which enables the thinker to express their own views rather than a “right or wrong” answer, would help to improve participation.

I selected the learning and thinking topic cards from the communication set within the Health and Wellbeing pack. These cards cover areas that I would normally look at within any cognitive assessment and are functionally relevant.   Together we selected the visual scale, choosing the question “how well are you managing?”

She explained that organising herself, writing, listening, reading, problem solving and planning were all going well. She talked about how she sometimes had difficulties concentrating and paying attention due to getting distracted in the classroom. She also felt she was struggling more than before with calculating and that this was affecting her scores in Math tests. She explained that remembering and making decisions were “not going well’ and she was particularly worried about the fact she had forgotten some of the teaching she had received prior to her brain injury.   I was also able to conclude from the way she understood the concept of the mat, as well as her ability to engage and attend for the whole session, that she could concentrate, learn new skills and had the ability to weigh up information to help her make decisions.

Together we used the information gained from the Talking Mat to set goals for therapy which were focused around having a range of strategies to help her concentrate in class, remember new information, and make decisions.making_decisions (1)

Two months later, once having completed a therapy programme, we used the Talking Mat again to explore her current thinking about the topic area. She explained that making decisions was something she no longer had difficulty with as her confidence had grown. She felt that there had been some improvement with her ability to remember information and we discussed the strategies she now used to help her concentrate in class, which included ways to minimise any distractions.

In summary, the Talking Mat enabled her to think about how her brain injury had affected her ability to remember, make decisions and learn. This provided valuable information from which a therapy programme could be created. The Talking Mat also provided a visual representation of her perception of the issues before and after therapy, showing clearly her progress. This was well received by her parents, teachers and the other professionals involved in her care.

Once again I have been amazed by the power of the Talking Mat to produce a breadth of information in a relative short space of time and I will be advocating its use within cognitive assessment and rehabilitation across all ages.

 

 

 

 

Helping parents see their child’s point of view

Secondary

Talking Mats is a useful tool to help parents see their child’s point of view.

The stage for each parent when their child also has an opinion about what is best for them can come as a surprise and is sometimes challenging.  For parents of children with disabilities it can be even more so. This story is an example of how Talking Mats helped parents hear their own child’s voice amongst the background noise of the voices from health, education social and voluntary services.

David was in his final year of primary school.  He attended a small village school and was transitioning to a large mainstream secondary.  He has mobility problems due to cerebral palsy and uses a wheelchair.  He can walk very short distances with effort using a walker and in his primary school used this method to move around the classroom and go to the hall for lunch and PE. This was a functional way to meet 2 of his targets : changing position and walking practise.  His parents wanted this to continue when he transitioned to secondary school, although the health professionals involved felt it was going to be too difficult given the greater  distances in the new building.  An electric wheelchair was proposed for this new context.  David’s parents were finding this next step challenging.

One of the professionals involved wanted to find out what David felt was important in his new school and used Talking Mats as a way of supporting him to think about various factors.  The top scale used was ‘important/ not sure/ not important’.

David’s mat clearly showed that what was important to him in his new school was being with his friends.  When his parents saw his mat they realised that this would be impossible if he was to move from class to class using his walker and it helped them make the transition to seeing him in an electric wheelchair. It also helped them see things from David’s point of view. They were more than happy to fit walking practise into a different part of his busy day because they had heard what was important to him.

Talking Mats allows different voices to be seen and heard.The name has been changed to protect identity.

Work with adults ? Top 10 Talking Mats blogs

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What are the top 10 blogs for using Talking Mats with adults? Over the years we have posted lots of blogs on different aspects of our framework . If you are working with adults with communication disability these blogs maybe particularly helpful

  1. Where is the best place to start using the Talking Mats health and well-being resource? 
  2. A blog from Denmark which highlights the effectiveness of using Talking Mats with people with dementia
  3. Goal setting with a woman with Multiple sclerosis  
  4. Using the  app with someone with aphasia 
  5. The development of a resource to help people with learning disability raise concerns 
  6. How can Talking Mats support Capacity to make decisions
  7.  Involving  people in their decisions about eating and drinking 
  8. Thoughts on using Talking Mats with people with dementia to explore mealtimes 
  9. Using Talking Mats with someone with a learning disability and dementia
  10. Use  in a rehab setting in South Africa 

If you want to explore our  resource and training more  please visit our shop

Goal setting: getting to the root of the problem for someone with MS

lesley MS

Thanks to an OT colleague for this powerful story of how Talking Mats helped a woman with Multiple Sclerosis with goal setting by getting to the root of the problems she was having.

I am an OT working in a community rehabilitation team in Scotland.  I have been seeing a woman (who I will call Jill) with MS.  Jill has been experiencing increasing problems associated with her MS and finding it difficult to cope.  During my first visit, Jill found it difficult to tell me about the problems she had been experiencing, and almost impossible to consider how we could translate these problems into tangible goals that we could work on.   She was closed to any suggestions I made about potential rehabilitation goals.  In her mind, the problems she had were there to stay, nothing could be done about them and she would just have to struggle on.  We didn’t seem to be getting anywhere just talking about it.  Jill was getting a bit exasperated and I was finding it difficult to keep a structure to our conversation and steer it towards agreeing on a goal that we could work towards.  I felt there was a real risk of her disengaging from the service because we could not agree on a way forward.

Then I decided to use Talking Mats to see if that would help.  I knew that using Talking Mats could help people with cognitive problems as well as those with communication difficulties.  I wondered if doing a general Talking Mat using the Health and Well-being TOPIC symbols would help me identify what Jill thought her main problem areas were.  Then I planned to do a sub-mat to look at her priority areas in more detail.  My aim was to try and identify one or two rehabilitation goals (reflecting Jill’s priorities) that we could work towards.  I really felt that there was potential to make a positive impact on Jill’s quality of life if I could get her to engage and agree on a goal to work towards.

Using Talking Mats proved to be a great success.  Jill very quickly got the concept of it.  It seemed to be much easier for her to pick up a symbol card, consider it, and then place it on the Mat.  Using the Mat appeared to reduce the ‘cognitive load’ of the conversation and gave her structure to work within which she found much easier.  Jill was able to identify what her main problem areas/ priorities were: – Mobility and Learning/ Thinking (see picture of her Mat above).  Jill was pleased that she had got her message across and actually seemed to enjoy the process of using Talking Mats.

Now we have got a starting point.  In my next session I’m hoping to complete sub-Mats with Jill in the Topics of Mobility and Learning/Thinking.  This will allow us to explore these areas in more detail.  Using Talking Mats was a real breakthrough in Jill’s rehabilitation.

To read another blog about using Talking Mats with someone with Multiple Sclerosis click here

 

 

AAC, group work and Occupational Therapists

AAC  for all

We’re delighted that Andrea Powell, an Occupational therapist in Edinburgh has written a Blog for us about her experiences of being involved in group work with people who use AAC.

As a student occupational therapist, I worked part time as a support worker with an amazing lady Jennifer, (Jennifer is a pseudonym) Jennifer just happened to use an iPad to communicate. At this time I was about to commence my final year studies and was required to research and write a dissertation on a subject of interest. The lightning bolt of inspiration came when I, with Jennifer attended a weekly AAC user support group which was run and organised by a group of SLT’s.

The group was a wonderful resource that truly benefited the people who used it. I witnessed how much Jennifer valued spending time chatting with friends who also used an AAC device and who understood the unwritten rules of engagement. Such as patience while I set up my speech, don’t look at my screen while decide what I want to say etc. Her confidence in using different types of conversation grew while attending the group. It encouraged her to add to her already wide and variety vocabulary. As her support worker I also valued the opportunity to gain access to training on how to use her AAC and how I could provide better support to her.

I began reading around AAC and how people integrate of devices into their lives.  I was however shocked to find that the wonderful group Jennifer attended was a rare occurrence for many users. The more I read, the more I realised that many users struggled to continue using an AAC device due to lack of support, access to trained professionals and most did not have wonderful resources like user support groups.

As an OT I was interested to explore the role in which I would play within AAC provision and found that as an OT I would be mainly providing support and advice on positioning, accessing devices and ergonomic type support.

However I felt that as an OT we have many more skills that didn’t appear to be to be getting utilised, within in my dissertation proposal I postulated that OT’s could expand their role within AAC to i) collaborating on assessments for AAC; ii) training on devices once they have been issued to users; and, iii) running and facilitating groups for AAC users and communications partners in the community.

OT’s are highly trained specialists skilled at understanding what is achievable and realistic for an individual. Occupational therapists assess individuals holistically in order to establish realistic and manageable goals which can be graded and adapted to suit the individual. Through the utilisation of appropriate grading of an occupation, a user can experience success and therefore less failure and frustration, ensuring the challenge is set at the appropriate level for the individual concerned (Park 2009).

Running and facilitating groups as a therapeutic tool is something that occupational therapists have been doing since the earliest days of the profession and groups are now utilised in many areas of practice (Howe and Schwartzberg 2001). By continuing this tradition, occupational therapists are well placed to take the lead in running and facilitating groups for AAC users, integrating social and community activities into the groups, for example, meeting in local shops to provide real life experience of interactions and, importantly, promoting the use of AAC to the general public. There are similar projects being attempted in Motherwell to increase the awareness of Dementia and make local businesses “Dementia friendly” (Shafii and Crockett 2013). Providing groups for AAC users not only enables them to learn how to use their devices, but also provides a support network of other users and communication partners.

I feel that if the skills of an OT were utilised in more than ergonomics then more positive outcomes could be seen for the user of AAC. I believe that if there were more OT’s taking on additional roles within AAC provision it could help reduce the pressure for SLT’s and the waiting lists to see SLT’s. It would also enable more users to be assessed to use AAC.