Speech Ninja

iPad Tut 002 - Using Gestures

2013-09-19T10:00:00.000+10:00

One the best features of the iPad (and in fact a lot apple devices) is how easy it is to use from the beginning. Anyone, from the technophiles, children through to Orangutans can get use to simply navigating around the iPad.

Aside from the simple and obvious controls Apple has built into the iPad, there are also some hidden features and shortcuts that are great for power users. In this episode will demonstrate how to use multitasking gestures and shortcuts to be able to quickly navigate around your iPad.

Enable Multitasking Gestures
The first step to being able to use most of the time-saving gestures is to enable Multitasking Gestures in Settings (under general). Some examples of multitasking gestures will also be provided here.

Below is a list of the gestures and shortcuts (with brief instructions), that will be covered.

Pinch to Home Screen: Use 4 fingers and pinch inwards when using an app to return to the homescreen.

Access to Multitasking Bar: Access your multitasking bar by dragging upwards on your docked taskbar.

Thumb Typing: When the keyboard is displayed, click on the keyboard icon in the bottom right-hand corner and select split. Go to top of a page/list: Simply click in the time/power bar at the top of the iPad to automatically scroll to the top of a page.

Shake to undo: Simply shaking your Apple Device will cause it to undo the last thing you typed.

Gesture Assistance: Can be useful if you’re disabled (e.g. patients), not getting the hang of a certain gesture or just plain lazy. It allows you to easily access common gestures (e.g. pinch to zoom), device properties (e.g. rotate device, change volume, take a screenshot) and custom gestures as well.

To turn gesture assistance on go to; Settings -> General -> Accessibility -> Assistive Touch.
Once gesture assistance is turned on a white circle will appear on your iPad which will allow you to access these features. Importantly, gesture assistance can be a life-saver for those with a faulty home button.

Custom Gestures: Custom gestures are about taking your iPad once step further. Here you can create multitouch gestures that will only require one finger to use upon completion. For example you could create the four-finger home screen pinch as a custom gesture, so that it only requires the use of one finger.

Custom Gestures are accessed under the Assistive Touch menu.

In the next episode we will take a look at how you can find, delete and manage apps.

This post first appeared on Lifeinthefastlane.com.

Oral Motor Exam: Quick Checklist

2013-09-10T10:02:00.002+10:00

The oral motor exam assesses the muscles, reflexes and movements required for speech and swallowing. Generally, speed, strength, coordination and range of movement (ROM) are observed in addition to cranial nerve function.

Here's what an oral motor exam can look like with a child...

I have made this quick checklist for students and new speech pathologists to make sure all areas of the face and oral cavity have been examined. Structures and functions are noted as 'within normal limits' (WNL) or commented on in terms of deficit. Obviously a lot more can be added to this list and the activities may vary between clinicians.

Oral Motor Checklist PDF

Ninja Star Tip; Always perform an oral motor exam before your clinical swallow exam. You need the information from this exam to determine the presence of Dysphagia etc. Also, you might need to clear/clean the patients mouth of any mucous, old food or secretions.

References

Alva, R. (2010). Using Clinical Practice Guidelines for Evaluations in Early Intervention. ASHA Convention.
Photo: Lipsticks by SpooSpa via Flickr

Speech Ninja’s Choice: Apps for Aphasia

2013-08-26T14:11:00.000+10:00

This week: 5 iPad apps for people with Aphasia.

Apps featuring the gold ninja star are

recommended and used by patients I have seen

on my university practicals.

The Cat in the Hat LITE

FREE

style='width:200px;' Currently 3.5/5 Stars.

Click here for more info...

Great for improving reading skills.

Record your own voice to hear the story.

Record sentence by sentence to practice reading out loud.

Read each word by touching the word you want to hear.

iTunes | Android (Paid) | Website

Abby Write and Play
FREE

style='width:200px;' Currently 3.5/5 Stars.

Click here for more info...

Good for improving your writing skills.

Copy and write whole words.

Best used with a stylus.

iTunes | Website

Popplet LITE
FREE

style='width:200px;' Currently 3.5/5 Stars.

Click here for more info...

Use to help tell a story, as a prompt to

remember names or as an organiser.

Add your own pictures and text.

Older adults might need help to get started.

iTunes | Website

Language Therapy LITE
FREE

style='width:200px;' Currently 3.5/5 Stars.

Click here for more info...

Great for naming practice.

Add your own pictures,

target words and cues.

Has word and sentence level naming.

Recommend getting help to set up prompts and pictures initially.

iTunes | Website

Sentence Builder Teen
$5.99
Click here for more info...

Practice correct

sentence constructions.

Gives feedback for right and

wrong sentences.

Has both simple and complex sentence

constructions for practice.

iTunes | Website

iPad Tut 001 - Basic iPad Controls & The Hard Reset

2013-08-22T10:00:00.000+10:00

In this first episode we cover how to get started with using your iPad. Covering the basic controls, and getting you out of trouble with the hard reset.

iPad Controls
Understanding some basic iPad controls, is useful for getting the most out of our iPad. Some controls that we will cover today are;

Adjusting Brightness
Changing Volume
Muting
Rotation lock
Playing/Pausing, selecting next/previous songs or videos
Adjusting the side button function

Hard Reset
Though not common sometimes your iPad or apple mobile device can lock up. What do you if this happens?

The easiest way of getting your device to work again is by doing something called a hard reset. To reset an iPad or iPhone simply press and hold the power and home buttons. This will cause the device to turn off and reset usually to a working state, much like restarting a computer.

In the next episode we will take a look at using & creating Gestures to quickly navigate around the iPad.

Swallowing a Sword: Intro to Oropharyngeal Anatomy

2013-08-20T12:38:00.000+10:00

Before I start explaining how Sword Swallowers actually swallow, here’s a little disclaimer…

Don’t try this at home!

Sword swallowing is dangerous. It can cause oesophageal perforation, gastrointestinal bleeding and much more. So don’t try this unless you have been trained and supervised by professionals.

Structures of of the Oral Cavity & Pharynx
Before we try to visualise where a sword might fit in a person’s anatomy, let’s orient ourselves to the structures of the oral cavity and pharynx.

In the oral cavity we find; the tongue, teeth, uvula, and the hard and soft palates.

The pharynx sits inferior to the nasal cavity and posterior to the oral cavity. It is the passageway from the mouth and nose to the oesophagus. The pharynx is divided into 3 regions;

Nasopharynx
Oropharynx
Laryngopharynx

Both the Nasopharynx and Laryngopharynx regions are considered airways while the Oropharynx has shared involvement in respiration and digestion. Since we are interested in the structures for swallowing we will look at the structures of the Oropharynx;

Epiglottis
Cricopharyngeal Sphincter/Upper oesophageal sphincter

Note, both the Nasopharynx and Laryngopharynx have important structures involved in protecting the airway during a swallow. These structures will be looked at in a future post about swallowing liquids and solids.

Swallowing a Sword
Now, here is the part where we find out where the sword actually goes.

Sword swallowers are trained to relax the Cricopharyngeal sphincter (i.e. the sphincter at the entrance to the oesophagus) so the sword can pass through the mouth, pharynx and oesophagus with no contact. In a normal swallow the Cricopharyngeal spincter does not open on its own rather, it is pulled open with the superior and anterior movement of the larynx while the bolus widens the sphincter on passing.

The positioning of the head must be correct to line up the mouth with the Cricopharyngeal sphincter and stomach. If it is not lined up correctly it is likely that the sword will pierce the sphincter or pharyngeal walls.

Also, sword swallowers must train to overcome the gag reflex. This is achieved by causing repetitive gags, desensitising the reflex. Damage to the oesophagus, pharynx and oral cavity is usually caused during this training by the stomach acid that is brought up during the gag desensitisation.

Finally, sword swallowers must relax the upper gastrointestinal tract from squeezing against the sword as it passes.

This relaxation of the sphincter can cause permanent misshaping of the sphincter muscle and a permanent open position increasing the risk of reflux. The reflux can cause damage to linings of the tract and teeth etc. And of course, perforation of any of the linings from mouth to stomach can occur from the sword.

Ninja Random Fact
Sword-swallowers have done a great deal for modern medicine and endoscopic techniques. In 1868 Dr. Adolf Kussmaul of Freiburg, Germany performed the first esophagoscopy on a sword-swallower using a rigid 47 cm tube, mirrors, and a gasoline lamp.

Finally to wrap things up check out this Discovery Channel Episode featuring Dan Meyers, to take an inside look on Sword Swallowing.

References

Witcombe, B., and D. Meyer. “Sword Swallowing and Its Side Effects.” BMJ 333, no. 7582 (December 23, 2006): 1285–1287. doi:10.1136/bmj.39027.676690.55.

Photos

Sword Swallowing by Ruben Bos
Oral Cavity adapted by Aaron Sparshott
(Originals: Patrick J. Lynch & Drcamachoent)
Longitudinal view of pharynx adapted by Aaron Sparshott
(Original: Grays Anatomy)

The DRS.ABCD path to First Aid

2013-08-05T23:55:00.000+10:00

First Aid or Basic Life Support, is the most fundamental level of care a health professional, or any individual can give to someone who is acutely unwell. It is important because timely action can often delay or minimize further detrimental consequences to the patient, before help arrives.

In Australia (as per the Australian Resuscitation Council), we use the DRSABCD approach in carrying out our Basic Life Support.

D anger
R esponse
S end for Help
A irway
B reathing
C irculation
D efbrillator

The presentation below, summarises the DRSABCD approach, with some helpful tips. It also includes further sections on some common injuries and how best to manage them acutely.

Need to scrub up on your CPR Skills?
Ian Miller, a nurse from Canberra, Australia, has come up with a way to use two milk bottle's to refresh that CPR experience. It's quick, it's easy and it should be largely free. So watch the video and remember humming the Bee Gees classic, Stayin’ Alive sets the pace at which to compress.

References

Photo: First Aid Box by Syromaniac via flickr
Australian Resuscitation Council
ARC: Basic Life Support Flow Chart

How to tell if someone is unconcious

2013-08-05T20:34:00.000+10:00

At it's most simple level unconsciousness is the state of not being conscious. This can be considered to be a state in which an individual does not respond to people or environmental stimuli. Unconscious states include things like coma, through to more temporary unconscious states like faints.

So why should you care?
As healthcare professional's (or students) we tend to be firstly, in environments where we encounter individuals with varying levels of consciousness, secondly as healthcare professionals people look to us to do something about it. I also believe conscious state is an obvious, yet poorly understood vital sign, and it's important to have an idea of how to assess it. In light of this I also feel that it's appropriate that all health professionals have at least a rudimentary understanding of assessing consciousness.

Assessing Consciousness
Before we start assessing consciousness, it's important to note that loss of consciousness (e.g. unconsciousness) is different to altered state of consciousness. An altered state of consciousness implies that the individual still has some level of conscious awareness (i.e. responds to stimuli). Examples of altered state of consciousness include delirium and normal sleep. Anyway that's enough semantics for me. If you have any questions about the above, don't hesitate to ask in the comments section below.

In the following sections I shall show some of the ways of assessing loss of consciousness.

AVPU
AVPU stands for Alert, Voice, Pain, Unresponsive and is one the simplest systems by which someone can judge a person's level of consciousness.

Alert

Awake, though not always oriented.
You can assess orientation by asking questions like what is your name, where are you and what day is it?

Voice

Responds to verbal stimulus.
Can be in the form of voice (e.g. grunting), eyes or motor (e.g. moves a limb or hand)

Pain

Responds to pain.
Ways to elicit pain include; sternal rub, squeezing the trapezius muscle or fingers, poking with a pin.

Unconscious/Unresponsive

Glasgow Coma Scale
The Glasgow Coma Scale or GCS is one of the most common ways of assessing level of consciousness in a healthcare setting.

It is scored out of 15, with 15 being totally awake and alert and 3 being unresponsive.

There are three components which make up the GCS score.

Motor (M - 6 points)
Verbal (V - 5 points)
Eye (E - 4 points)

GCS is important not only as measure of consciousness, but also because below a score of 9, patients are unable to properly protect their airway. However, just because a patient's GCS is above 8, does not necessarily mean that their airway is protected.

Below is how each individual component is scored, plus a nice overview diagram by Sketchy Medicine.

Best motor response

Obeying commands 6
Localising pain 5
Withdrawing to pain 4
Flexing to pain 3
Extending to pain 2
None 1

Best verbal response

Oriented 5
Confused 4
Inappropriate words 3
Incomprehensible sounds 2
None 1

Eye opening

Spontaneous 4
To speech 3
To pain 2
None 1

The important thing to remember is that the lowest score possible is 3.

Even a rock has a score of 3.

What about Young Children?

To deal with the fact that children aren't just little adults, an adapted form of the Glasgow Coma Scale was also developed.

Motor

Infant moves spontaneously or purposefully 6
Infant withdraws from touch 5
Infant withdraws from pain 4
Abnormal flexion to pain for an infant (decorticate response) 3
Extension to pain
(decerebrate response) 2
No motor response 1

Verbal

Smiles, orientated to sounds, follows objects, interacts as usual 5
Cries but consolable, inappropriate interactions 4
Inconsistently inconsolable,
moaning 3
Inconsolable, agitated 2
No verbal response to pain 1

Eye opening

Spontaneous 4
To speech 3
To pain 2
None 1

Ninja Star Tip - Assessing Response

The COWS Method is a quick and easy way to assess response, drawn from basic life support principles.
C an you hear me?
O pen your eyes?
W hat's your name?
S queeze my hand?

An additional 'S' can include Squeezing the individual's trapezius muscle or performing a Sternal Rub.

The Final Word
So we have covered two of the most common systems for assessing the consciousness of a patient; AVPU and the Glasgow Coma Scale. The simple system AVPU, stands for Alert, Voice, Pain, Unresponsive and is useful for a quick assessment. The Glasgow Coma Scale has several more components (Motor, Eyes, Verbal) and also has a modified scale for children.

Finally, whilst it is a good idea to assess the patient's level of consciousness if you can, don't spend too much time on it if they are acutely unwell. Instead consider commencing Basic Life Support.

References

McNarry, A F, and D R Goldhill. “Simple Bedside Assessment of Level of Consciousness: Comparison of Two Simple Assessment Scales with the Glasgow Coma Scale.” Anaesthesia 59, no. 1 (January 2004): 34–37.

Images

Koala by TimeElf
Glasgow Coma Scale by SketchyMedicine
Rock: Original by Kate Ter Haar. Adapted by Aaron Sparshott

iPad Tutorials for Health Professionals

2013-08-05T17:43:00.000+10:00

The iPad has well and truly established itself as a one of the best tablets on the market. And it's use in the healthcare industry has only continued to grow, largely thanks to it's intuitive interface.

In this series of tutorials, we aim to help you get the most out of your iPad, at home and in the workplace (where-ever that may be). In each episode will focus on one of;

practical tips/tricks
accessory sneak peeks
apps reviews
clinician experiences with the iPad in healthcare settings
and much more

The first couple of tutorials are from the Pimp my iPad series hosted on IVLine.info, which have also been featured on Lifeinthefastlane.com. Though pitched at Doctors and Medical Students, they provide useful information to any health professional wishing to understand their iPad and the Apple World a bit better.

iPad Tuts 001 - Basic iPad Controls & The Hard Reset
iPad Tuts 002 - Using Gestures
iPad Tuts 003 - Apps Galore: How to find & use apps
iPad Tuts 004 - Folders & Sharing