With the deteriorating state of medical reimbursement, patients need to be empowered with the ability to help themselves in the rehabilitation process. A unique approach to speech therapy utilizes advances in technology to improve the lives of people with stroke, head injury, and the initial stages of Alzheimer's disease. 
 
People with neurological impairments can maximize their communication and cognition skills by learning strategies that use the tools of technology and stimulating daily routines. 
 
Group therapy, computer intervention and community resources are cost-efficient and productive ways to help individuals regain lost skills. The high-tech world is constantly changing. It is imperative that we strive to link these individuals and their families with new technology and teach them in a way they can understand and use it. 
 
With the changing reimbursement situation with Medicare, HMO's and private insurance, there is a dire need for patients with stroke to be given an opportunity to continue to receive guidance on the best way to improve their communication and cognition after discharge from individual therapy. Many people who were told their communication could not get any better have benefited from the adult communication therapy groups and structured home visits using computers offered by Innovative Speech Therapy, in Potomac, M.D.
 
For many families it is difficult to attend therapy outside of the home. Providing speech therapy in the home environment helps to ensure maximum carryover of new skills and strategies. Functional tasks should relate to items in the home, such as the mail, newspapers, calendars, phones, televisions and cookbooks. 
 
The frequency and length of the sessions is flexible and changes with the client's needs. We may establish an intensive home practice program and spend the time helping the person adjust to life with communication and cognitive deficits. Sometimes we supplement outpatient therapy and travel to a person's home to focus solely on computers and community re-entry. 
 
If a person is more than six months post onset of stroke, we may recommend a combination of group and individual home based therapies. Over time we may decrease sessions to twice a month, once a month and then every three or six months. 
 
Whenever possible, we encourage individuals to use special computer technology in their rehabilitation efforts in addition to traditional therapy. An introduction to email and the Internet is provided, and specialized software is reviewed. Particular attention is given to accommodating people with communication deficits in using this technology to their greatest potential. When individuals are empowered with the ability to communicate with the Internet, communication barriers are lifted are feelings of isolation are minimized. 
 
Many people benefit the most from speech therapy at home on their own computers. We teach clients how to make necessary adaptations and establish an individualized practice plan. 
 
A computer discussion group for adults meets to discuss ways to make e-mail easier, show useful Internet sites related to stroke and rehabilitation, review specialized software to improve speech and language, and provide a forum for discussion and support related to home computer use. 
 
Small, hands-on computer classes are forming to provide training with specific software programs that we have found to be the most effective and affordable ways to work at home to improve communication. 
 
We look at the "big picture" of our clients and try to help them explore ways to maximize their quality of life. Emphasis is placed on helping people with stroke, head injury, and increasing memory and cognitive deficits and their families to resume as many social, leisure, volunteer and work-related activities as possible. Clinicians travel to a work site or selected community activities to assist with issues related to communication or cognition. Extensive information about local and national resources is provided. 
 
Many patients feel isolated and have not met others with aphasia or cognitive limitations. Speech therapy groups enable people to learn from each other and provide psychosocial support. We teach strategies to improve reading, writing talking and listening. Sessions are thematically based and address everyday situations. 
 
We work with a person's therapist and/ or doctor to set up an individualized, self-paced action plan. To prepare an action plan, we review reports from therapists and doctors and call and speak with supportive professionals and family members. The client's interests, talents and abilities are reviewed; and related factors such as transportation and family support are considered. 
 
The action plan outlines suggested activities at home and in the community and details how to incorporate them into a daily routine. We provide information on how to continue to improve communication and cognition. An individual's strengths, deficits and learning styles are analyzed prior to making these recommendations. Suggested items may include workbooks, communications aides, videotapes and computer software. 
 
Joan Green is founder of Innovative Speech Therapy. For more information, contact Innovative Speech Therapy, 9812 Falls Rd, #114-290, Potomac, MD 20854; 301-602-2899; 301-610-9234; email: Jgreenslp@aol.com
 
Featured in Advance for Speech-Language Pathologists & Audiologists 
July 10, 2000