Speech Therapy

Speech Therapy - Objectives

• Speech therapy exercises will focus on:– Handwriting rehabilitation programs. – Expression rehabilitation.– Breathing exercises.

• Therapist need to define exercises program adjusted to patient requirements.

• Default exercises programs required

• Exercise program = sequence of exercises

• Evaluated by system (if possible) or therapist

• Results stored to be consulted whenever

• Results compared with through time for analyzing patient evolution.

• Motivation introduced during exercises and before/after session

Speech Therapy – Scenario 1

Association working one therapist individually with one patient: 45 minutes sessions. Therapist will supervise work. Suitable interface System recovering handwriting info. System motivating patient System evaluating patient responses. Data stored and consulted whenever Session repeated with planed periodicity.

Speech Therapy – Scenario 2

Patient’s home: Therapy alone. System will motivate patient during execution. System will not evaluate patient responses. System will not store handwriting information. No special device needed.

Speech Therapy – Handwriting Exercises

• Handwriting exercises: Patient handwriting models using a template :– Grid with straights.– Grid with curves.– Grid with straights and curves.– Basic stroke of straights and curves over a line:

All of these exercises could be done in three modalitiesFollowing a template.

Repeating a template with reference lines

Repeating a template without reference lines.

Speech Therapy – Handwriting Exercises

• Handwriting exercises: Patient handwriting models using a template :– Grapheme:

• All grapheme (print letter) basic stroke repetition with reference lines.• Grapheme (print letter) uppercase and lowercase repetition.• All grapheme (print letter) basic stroke repetition cursive letter with reference lines. • Uppercase and lowercase grapheme repetition in cursive letter without

reference lines– Words or phrases copy.– Dictation.

Speech Therapy – Handwriting Evaluation

• Particular exercise evaluated from 0 to 10

• Exercise program evaluated from 0 to 10 (media).

• Evaluating handwriting:– Each person has got his/her own personal letter– There is not an objective method to define a sample as altered. – Subjective analysis and experience to decide if a writing sample is altered. – Best method compare writing sample before Parkinson with new samples.– Very useful to store samples along time and compare them.– Patient able to see his own old handwriting sample: Very useful feedback.

Speech Therapy – Handwriting Evaluation

HANDWRITTING

Parameters Characteristics

Width Normal

Smaller

Bigger

Writing Basic Line

Sticky

No Sticky

Speed Normal

Slower

Faster

Letters omission

Yes

No

Letters substitution

Yes

No

Stroke tremor Yes

No

HANDWRITTING

Letter inclination

Yes

No

Stroke direction changes

Yes

No

Writing fluid Yes

No

Vertical and horizontal

strokes parallelism

Yes

No

Agglutination Yes

No

Rounded letters angle

Yes

No

• Parameters to take into account evaluating handwriting comparing two samples of the same phrase written at different times:

Speech Therapy – Other Exercises

• Face expression rehabilitation exercises:– Patient face expression against face expression model at the same time: compare both, working to match them.

• Breathing exercises– Motivation techniques to improve patient concentration along the exercise. – Counting seconds that a patient must be blowing. – Digital Spiro-meter could be used to measure the

volume of air inspired and expired.

Speech Therapy – Therapist's Recommendations

• Motivation techniques much appreciated to increase patient interest.

• Handwriting program:

– Store handwriting information to compare samples along time.– “Thickeners” to improve support diameter obtaining more wide strokes.– Parkinson patient’s movement difficulties: support area for writing bigger– Parkinson patient needs to use wrist and forearm and must do more pressure

•Using a screen to write on, it would have to be reduced to an area where only the pencil could press, not the wrist or the arm

– Screen width must not change normal patient movement– Introduce screen into the table in order to have a plane surface to write– Screen big? => Nonslip in order to avoid wrist displacement– Digital pen = not necessary to alter patient writs movement.

• Face expression exercises: Video models & Store video patient’s face

• Digital Spiro-meter could be used in breathing exercises.

Speech Therapy – Technologies

Graphics Tablets:• Development difficulty: medium• Price: medium (50 - 500€)

Interactive Whiteboard:• Development difficulty: medium• Price: high (400 - 4700€)

Touch screens & Tablet PCs:• Development difficulty: low• Price: medium (200€)

Speech Therapy – Technologies

Digital Pen & Digital Paper:• Development difficulty: medium• Price: low (50 -100€)

Parkinson diagnosis through calligraphy software• Development difficulty: unknown• Price: unknown

• Scenarios:– Association working one therapist individually with one patient–Patient's home

• Exercises:– Handwriting exercises– Handwriting exercises automatic evaluation– Face expression rehabilitation exercises– Breathing exercises

• Technologies:– Video models & Self-image capture– Digital Spiro meter– Graphics tablets– Interactive Whiteboard– Touch screens & tablets PC– Digital Pen & Digital Paper– Parkinson diagnosis through calligraphy software

Speech Therapy – Proposals