Tag Archives: Resources

Talking Mats in Practice

Following on from my last blog introducing my journey with Talking Mats (TMs), I have described below two examples of my use of TMs in practice. I specialise in working with people who have had sudden onset brain disorders, such as strokes, brain injuries and other progressive brain disorders, such as Parkinson’s disease and dementia. I work in a rehabilitation hospital where we provide a service to the elderly and to a neurological rehabilitation unit.

Talking Mats has been an invaluable picture communication tool to facilitate communication with people who present with cognitive (thinking, memory) and/or communication (talking) skills as described in the examples below:

The first example of TMs shows how it can be used to get to know someone and find out what their hobbies and interests are.

This is Bob’s Talking Mat:
Topic: Indoors activities – likes and dislikes
Bob (*name changed) had a large stroke that affected the left side of his brain. This affected his thinking and talking skills. It also affected his walking and he was using a wheelchair in hospital. Bob found it difficult to engage in conversation. The Physiotherapist and I thought that TMs may be a way to help Bob tell us about himself. We also wanted to see how he responded to using TMs to see if this would help him to think about some goals.

We started with symbols that Bob would find easiest to understand, so we explored Bob’s hobbies. The topic we picked was ‘indoor hobbies’ – this was placed at the bottom of the mat. We asked Bob how he felt about different indoor hobbies encouraging Bob to place the pictures on the mat. Using a visual scale of like/so-so/dislike at the top of the mat, Bob told us he liked music, TV, snacks, and card games. He disliked reading, arts and crafts. He felt ‘so-so’ about pets, computers, chatting, cleaning, cooking, photographs, and relaxing. Using the information in his ‘All about me’ book filled out by his family and talking to Bob more about his likes, in particular music and TV, I was able to incorporate his music choices in our music group. Bob became very vocal in the music group, happily singing away to his favourite band! Bob enjoyed TMs and it was used successfully to help Bob set his goals. The picture symbols also helped Bob’s thinking, understanding and talking. The visual framework of his hobbies allowed him time to think, process and respond.

This is Ruby’s Talking Mat:
Topic: Management of domestic life
 Ruby (*name changed), a 92 year old, was admitted to hospital with dementia following a fall resulting in a fractured hip. She lived on her own with some help from carers. As a result of her dementia, her thinking and memory were affected. The dementia also caused her to muddle her words and she would talk about her pet ‘penguin’ meaning her ‘parrot’.

The hospital team were worried that Ruby may not manage at home on discharge from hospital and that she may not fully understand the risks if she chose to go home. The Occupational Therapist and I used TMs with Ruby to look at how she felt about managing her self-care and domestic life at home. Ruby was engaged in TMs, but it became apparent that her insight and awareness was impaired. For example, Ruby forgot she had carers to visit her and that her meals were prepared for her by the carers. The hospital team were also concerned about Ruby during the night as she needed help in the hospital to get to the toilet and she would not be able to do this without help at home.

The Social Worker and I worked together with Ruby using TMs to look at her capacity to make an informed choice about her discharge destination. According to the Mental Capacity Act, “individuals must be given help to make a decision themselves. This might include, for example, providing the person with information in a format that is easier for them to understand”.

We carried out TMs as shown in the picture above. The topic, ‘domestic life’, was placed at the bottom of the mat. The top scale at the top of the mat, ‘easy’ was placed in the left hand corner; ‘so-so’ in the middle and ‘difficult’ in the top right hand corner. Ruby felt that cooking, paying her bills, cleaning, shopping, laundry and money were difficult. She felt unsure about being able to make a snack and there was nothing she found easy. When we asked her if she wanted to add anything else to her mat, she said that she was worried about ‘somebody ringing the bell’; ‘falling over’; night-time – ‘being alone’.

The Social Worker and I carried out a ‘sub-mat’ to explore with Ruby other options regarding discharge from hospital. It was felt, given the level of her care needs in hospital, that a nursing home might be the safest option.

Sub-mat exploring discharge destination options including nursing home:
Topic: Nursing home positives and negatives
 The topic placed at the bottom of the mat was ‘nursing home’. The symbol options on the previous mat that Ruby felt were ‘difficult’ were used for the sub-mat. The top scale for this mat was ‘like’, in the top left hand corner, ‘so-so’ placed in the top middle and ‘dislike’ in the top right hand corner of the mat.

Ruby put the ‘eating’ symbol under ‘like’ as it meant to her that her meals would be provided and that she would be eating with others at mealtimes if she chose to. She liked that her laundry would be done for her, and she liked the fact that she would not have to worry about the shopping, cleaning and cooking, as this would all be taken care of by the nursing home. We discussed the concerns that she had about people ringing the bell at home and that she would not be alone at night time.

We gave Ruby a copy of her TM so that she could think about what we had discussed together. A few days later, Ruby called over the SLT and Social Worker on separate occasions when sitting in the ward dining room and said she was keen to ‘get going and look at nursing homes’. I felt that the visual framework of TMs had helped support her thinking, memory and understanding. It gave Ruby ‘thinking space’ to add her concerns of ‘someone ringing the bell’, and ‘being alone’ at night. The mats showed Ruby’s problem solving, such as her difficulties at home versus the benefits of a nursing home. The Social Worker and I felt that Ruby had capacity to make an informed decision regarding where she wanted to be discharged to from hospital. I am pleased to say that Ruby was very happily ensconced in a nursing home chosen by herself and her family.

Leila Paxton

For more information about this blog and foundation training (TMs beginners) please contact me via:
Email: leilapaxton@hotmail.com
Twitter: @leilapaxton

 

 

 

My Journey with Talking Mats

Talking Mats (TMs) I hear you say, is that a mat that talks?! And so begins my story of Talking Mats. Talking mats is an evidence-based pictorial tool developed by Dr Joan Murphy in 1989. Since its creation, it is used in the UK and worldwide.

What does Talking Mats do? It gives individuals with thinking and talking difficulties a voice. This means that it gives those with difficulties expressing themselves a medium to communicate: for example, to express thoughts, make choices, have a chat. Research has shown its effectiveness with individuals who have sustained a stroke, dementia or MND as well as adults and children with learning difficulties. It is also used with individuals who stutter and asylum seekers where English is a second language.

How do you use it? Firstly, I suggest to anyone new to Talking Mats that they enrol on the day’s Foundation Training to understand the theory of Talking Mats whilst gaining the practical experience on the training. A topic is selected from a core of topics and the individual is asked how they feel about aspects of this topic, placing the picture on the mat where they feel this applies to them. There is a top scale with a range of headings depending on the question asked. For example, see the picture below – the topic is ‘hobbies’ and the top scale is ‘like – so so- dislike’:

Talking mats can be used to explore a variety of elements including the individual’s insight and awareness, their goals, exploring their views, management of activities of daily living, facilitating capacity, and facilitating conversation. The complexity arises in the use of Talking Mats and the skill in asking the relevant questions. Initial mats, can often, lead to a ‘sub-mat’. More to follow on this with case examples in my blog next month!

I initially did my foundation training in London, run by Talking Mats, in 2013. Since that initial day’s training I have not stopped using Talking Mats! In November 2015, I travelled to Talking Mats HQ to train as an accredited trainer in Stirling, Scotland. The 2-day course was inspiring and reflective. Joan, Lois and Rhona brought out the best in us and gave us constructive feedback to continue our learning. Their hospitality and the beauty of Scotland left me feeling inspired and confident to deliver their foundation training. The course participants were teachers, SLTs, OTs and a social worker. In sharing each other’s videos, we exchanged views and ideas. I came away with ideas of using TMs as an outcome tool; and to explore using TMs in our groups – I had not considered this before. It encouraged course participants to reflect on their own communication skills in their videos carrying out Talking Mats, as well as how to teach the core principles of Talking Mats to others. I am now qualified to teach Talking Mats at foundation level (beginners). So far, I have run one course in the NHS and one independently. I have enjoyed teaching Talking Mats and incorporating my own experiences of using Talking Mats. The reflective process is also transformative for the participants who have attended my foundation courses. The use of video and reflective feedback enables changes in SLT practise. Feedback from participants included their use of TMs: using TMs symbols they were able to reflect on what went well and what didn’t. The ideas and the variety of videos shared by the group participants was just as inspiring for me as a facilitator, as it was for them. Ideas such as using TMs with carers to compare their views with their relatives and using a child’s TMs picture on the front of their SLT report or school report, for example.

I highly recommend the accredited training for those that have completed their foundation Talking Mats training and have experience of using Talking Mats in practice.

 

Leila Paxton

For more information about Talking Mats, please visit: www.talkingmats.com
For more information about this blog and foundation training (TMs beginners) please contact me via:
Email: leilapaxton@hotmail.com
Twitter: @leilapaxton

 

Helping people with aphasia have better conversations

Screen Shot 2014-06-11 at 16.13.11

Aphasia is the name given to a condition where speaking, understanding, reading and writing are damaged. If you experience aphasia, it can be devastating. Speaking is a bit like blinking – it is something you take for granted until that bit of grit lands in your eye, then you realise just how much you rely on it. In the UK around 152,000 people have a stroke each year, and one third of them will be left with aphasia.

Living well with long-term aphasia has been linked to an ability to maintain close friendships and relationships as well as a sense of control and independence over one’s life (Brown, Davidson, Worrall, & Howe, 2013; Cruice, Worrall, & Hickson, 2006). The ability to have a conversation is central to this. Just think about how many conversations you have with different people every day. Whether it’s having a good gossip with neighbours, chatting to our children about their day at school or speaking with friends and colleagues, we need to be able to speak and understand to have those conversations. Aphasia can make conversation almost impossible, devastating the quality of people’s lives, and the lives of those nearest and dearest to them.

For this reason I applied to the Stroke Association to do a PhD to further explore how we, as speech and language therapists, help people with aphasia develop skills and strategies to have more enjoyable conversations.

Left aligned logoPrior to my PhD I was part of a UCL based research group that developed the ‘Better Conversations with Aphasia’ (BCA) therapy (Beeke et al., 2013). BCA helps people with aphasia and a regular conversation partner of their choice learn about how conversations work in general, and then explore how their conversations are working. The aim being for them to then make informed decisions about how they may (or may not) want to change the ways they currently accommodate aphasia within their conversations. Watching videos of their own conversations, and the conversations of others is key to this approach. However, some clinical settings access and permission to use video with clients is not always easy. For this reason, I am keen to find out how speech and language therapists working clinically work on communication strategies with people with aphasia and their partners. My end goal is to then compare ‘typical’ clinical practices to the BCA approach, to better understand how different therapy techniques might change peoples’ communication strategy use.

If you would like to find out more, or you have aphasia and are interested in taking part in my PhD project, please visit my blog http://www.firleb.wordpress.com. You can also follow me on twitter @firleb.

There is also a free, aphasia friendly, e-learning tool for people with aphasia, their family and speech and language therapists, which can be accessed via this link: https://extendstore.ucl.ac.uk/product?catalog=UCLXBCA

All you need to do is register and then you can access it.

Firle Beckley

PhD Student University College London/Stroke Association Junior Research Fellow

Beeke, S., Sirman, N., Beckley, F., Maxim, J., Edwards, S., Swinburn, K., & Best, W. (2013). Better Conversations with Aphasia: an e-learning resource. UCLeXtend.

Brown, K., Davidson, B., Worrall, L. E., & Howe, T. (2013). “Making a good time”: the role of friendship in living successfully with aphasia. International Journal of Speech-Language Pathology, 15(2), 165–75. doi:10.3109/17549507.2012.692814

Cruice, M., Worrall, L., & Hickson, L. (2006). Perspectives of Quality of Life by People with Aphasia and Their family: Suggestions for Successful Living. Topics in Stroke Rehabilitation, 13(1), 14–24. Retrieved from http://thomasland.metapress.com/index/4jw57vg8g6x31qvj.pdf

 

Reflections on what supports change and personal growth (2/2)

march14Continuing with our two-part blog post on the different strategies people employ to support change, this month’s entry reflects the voice of some of our clients who have generously shared their ideas below:

Dom: “When I am planning anything I am always trying to save myself energy and to plan anything I need to be energetic for. The first person I always go to is Marc. He is my best starting point. Then I go to Gary and then my parents. Marc is impartial, independent, and my friend. He wants to help out – he is my housemate and nearest carer. Gary (my paid carer), by contrast, is efficient and organised! All the things Marc isn’t. Asking Gary is like asking my Dad for something, but without the judgmental nature of my Dad! Plus I pay Gary and so I can expect the job to be complete and not forget stuff. My parents are like my safety net – the last line of defense.”

Here Dom identifies the importance of the initial planning process when contemplating change, as well as considering the personal demands the change involves – including the emotional and physical energy engaging in something new can take. He highlights the value of knowing who he can turn to for what when looking for support as different people bring a unique set of qualities and skills and are, therefore, more naturally suited to helping in some situations more than others. Finally, Dom signals that family are not always the first port of call and that being willing to pay for help can usefully bring consistency and reliability.

Tony: “With something I want to do that I am motivated about I rely on myself mainly. But with things I know I should do like going to the gym I need others to help motivate me. To get to the gym, Jane (my wife) keeps on at me and gives me a push! Knowing that it’s going to do me some good and make me feel better when I have done it also helps to get me there!”

Tony emphasises the importance of personal meaning and engagement when trying out something new. He also reflects on the significance of recruiting support from others for desirable but less intrinsically motivating activities. Finally, drawing on past experience to identify a sense of future achievement is highlighted as a helpful means of self-motivation.

Cara: “It’s useful for me to set goals for myself, both short- and long-term when trying to make a change. Having something tangible to work towards keeps me focused and moving forward. Encouragement from other people – family, friends, or people inside therapy – gives me the strength to push myself and try new things. I’m very inspired by other people who stammer and their stories. When I see someone living their life in a way that I thought was impossible, it motivates me to change.”

Here Cara foregrounds the value of structure and a clear idea of what she is working towards from the outset, which she achieves by breaking bigger aspirations down into smaller, more manageable steps. She identifies recruiting the support and encouragement of others as a valuable means of promoting a more experimental attitude to change and fostering greater risk-taking. Cara also cites the importance of meeting others with similar experiences for inspiration and the re-definition of what is possible.

Walter: “My current approach to ‘new growth’ is to be tough with myself in taking on new challenges in which my stammer is likely be “an issue’ – especially at work (e.g. chairing meetings, talking in senior meetings) – having decided that I am happy to present myself as someone with a speech problem. It would otherwise be all to easy to spend the rest of my life internally using my speech as an excuse for not doing things, while externally trying to present myself as fluent – that if anything would cramp new growth. The other important new developmental thing I have taken on is to be proud to talk about my stammer and how I handle it – it is, after all, an extremely tough course on which to find oneself, much like SAS selection in psychological terms, and, as a person who stammers, I am proud of how I am surviving it and keen to project my pride in that survival.”

Walter signposts the importance of courage and being willing to challenge himself to take risks and step outside of his comfort zone. He highlights the value of working hierarchically as a means of doing this. Walter also advocates being more honest and genuine with people rather than attempting to hide any communication difficulties from them. Being aware of the short- and long-term costs of not making the change is also cited as self-motivating. Finally, Walter highlights the value of developing a kinder and more compassionate understanding of the day-to-day challenges of living with a communication disability, reframing openness and a willingness to share his personal experience of stammering as an act of pride and personal achievement.

I thank everyone who has contributed to this two-part blog post for their time, self-scrutiny and insight, and hope that their diverse examples inspire you to consider the ways in which you support your own change process – and to even contemplate trying out something new.

Sam

Who or what helps us make the changes we strive for? (1/2)

blog

As we step into 2014, we may have exciting new projects ahead. The weather is starting to change, there may be a spring in our step and our goals for the year may seem more possible. New growth feels achievable! So how do we each go about attempting to make the changes we are striving for? Do we launch into the new adventure with planning and preparation? Do we consider who or what we might need to set up the new experiment and how we might sustain the changes? This month we hear from three colleagues who share their experiences of embarking on a change. Next month we hear the voice of our clients. What emerges from these stories is the unique and different ways people approach change, using a combination of personal knowledge & resources and the process of reaching out to others for help to start out on a new path.

Sarah reflects on how she set up a change to her life recently. Sarah starts with turning to others: ‘Doing it with another person e.g. spouse, who wants to make the same change for the same reason; doing it together can make all the difference. Having others around me who have made this change or a similar one and seeing the benefits it has brought them can be inspiring. Also, being confident and assured that those who may be supporting me in change are well equipped, be it in terms of qualifications, emotionally, intellectually etc.’ And then looking to her own resources: ‘I have found taking smaller regular steps is more likely to result in lasting and actual change. Seeing benefits (albeit small) can spur me on and be very motivating. Being flexible and open to adjusting my expectations or goals in light of new information can keep the momentum of change and stop me from going backwards. I often think of the wheel of change we sometimes use in therapy and how easy it is to slip backwards if new habits aren’t maintained!’

Nic knows what works for her: ‘My projects usually start as an idea while I’m cooking tea for my 3 kids. In between peeling, stirring and then usually overcooking, I brainstorm ideas on the pile of scrap paper I keep in the kitchen for this very purpose. The next step is to talk to my trusted, enthusiastic, inspiring, always encouraging colleagues and my service manager who generally tell me to ‘go for it’. I must then set myself a strict deadline to ensure the idea is not squeezed out by the pressure for face to face clinical contacts.’

Mark: ‘In my experience support for ‘new growth’ comes from clinical supervision, sharing of ideas and projects with supportive and motivated colleagues, good team dynamics, and a supportive line manager. I found the opportunity to talk through the situation in relation to a big job change recently really helpful, especially my feelings related to it. It felt invaluable to do this with someone unconnected to the situation in any way (in private clinical supervision), as their distance and impartiality, not to mention enormous skill in listening and hearing the real issues, really helped me to see what was happening and to tease out why I was feeling such mixed emotions.’

New growth depends on many factors, including reaching out to a variety of people (both those within and outside a situation), being flexible enough to adjust expectations, setting useful deadlines and knowing what works for you as an individual. We invite you to email us with your stories of change and growth. What helped or hindered you to move in the direction you wanted? What lessons have you learned that you are carrying forward into your next innovation?

Thanks to everyone for their contributions so far!

Cathy